In a Level II trauma center, experienced nurses are retiring from nursing positions, which is causing an unstable workforce. According to the literature, there are not enough experienced nurses to mentor the new nurses. Evidence suggests that experienced nurses are associated with improved patient outcomes and that experienced nurse mentors can improve the work environment for less experienced nurses. Focusing on Watson's theoretical framework of caring and Covell's theoretical framework of intellectual capital, this phenomenological study explored the lived experiences of a small group of nurses. Five nurses with 15 years of experience and who had served as mentors were selected for in-depth individual interviews. Open coding and thematic analysis were used to analyze the data, and 5 themes emerged: lengthening work shifts and related effects, increasing workload and responsibilities due to higher patient acuity, learning new technologies, mentoring with a decreased patient ratio, and surveying customers as the main focus of patient care. The results of this study guided the development of a proposal for a computer-based learning module on nurse mentoring. The module explains what mentoring is, the importance of mentoring, and proper ways to mentor. Implications for positive social change include retaining intellectual capital in an organization through mentoring positions for experienced nurses.

The hospital-based novice nurse is presented daily with complex patients with multiple coexisting morbidities, which demands increasing responsibility for evidence-based clinical decision-making to prevent adverse health outcomes and associated high health costs. Knowledge and confidence of novice nurses in a medical-surgical unit in the assessment and clinic management of the respiratory system was identified as a gap during onboarding of new nurses. The purpose of this doctoral staff education project was to determine whether a respiratory educational component added to a medical-surgical novice nurse's orientation would impact the respiratory confidence and knowledge of respiratory assessment and clinical management. Benner's nursing theory of novice to expert and Ericsson's theory of deliberate practice were the 2 theories for the project. To assess effectiveness, a 10-item survey was administered to nurses (N = 10) during the first week of orientation and repeated following the educational intervention. Analysis from SPSS 22.0 showed statistically significant improvement differences in confidence and knowledge on all items following the posttest (p < .05), except for confidence levels with nasal cannula/mask use (p = .151). The strongest item-correlation was between knowledge management of respiratory deterioration and knowledge of the disease effects on respiratory assessments. Basic respiratory education added to the orientation during onboarding has the potential to improve knowledge and confidence acquisition, clinical decision-making in the clinical assessment and clinical management of respiratory issues. Positive social change in the health of the community and this educational intervention will empower the novice nurses with an additional layer of respiratory education.

Indiana University-Purdue University Indianapolis (IUPUI) / The growing and aging population has created an increased demand for health care, resulting in a need for hundreds of thousands more nurses across the United States. As a result, additional nurse faculty are needed to teach the next generation of nurses. However, nurses who enter the faculty role in academia often come from various professional backgrounds with different educational preparation that may not equate to success with the tripartite faculty role of teaching, scholarship, and service. As a way to retain and develop novice faculty, mentoring relationships and programs are promoted as an intervention for career and psychosocial development within academia. Mentoring is an interpersonal process built on mutual trust and friendship to create a professional and personal bond. Mentoring relationships can help develop selfconfidence, productivity, and career satisfaction among nurse faculty members. Effective mentoring relationships can ease the transition into academia and provide a vital foundation for productive academic careers. However, the interpersonal process that is the hallmark of mentoring can differ between a mentor and protégé, leading to vast differences in quality and effectiveness. Although mentoring is widely recommended, little is known about the process of mentoring relationships in academia or how novice nurse faculty utilize mentoring to transition into academia. The purpose of this qualitative grounded theory study is to uncover a theoretical framework that describes how mentoring relationships, as experienced by novice nurse faculty, unfold. Charmaz's method of grounded theory was used to interview full-time novice nurse faculty (N = 21) with three years or less in the faculty role from nursing programs across the United States. The grounded theory theoretical framework, Creating Mentorship Pathways to Navigate Academia captures the process of mentoring as experienced by novice nurse faculty within academia. The theoretical framework contains five main phases as described by novice nurse faculty being assigned a formal mentor, not having mentoring needs met, seeking an informal mentor, connecting with mentor, and doing the work of mentoring. Participants created mentorship pathways through both formal and informal mentoring relationships to navigate academia by acquiring knowledge, meeting expectations, and functioning in the role as a faculty member.

Many newly graduated registered nurses (NGRNs) leave the nursing profession within the first 2 years of employment in a rural hospital located in the Southwestern region of Oklahoma. A strategy to address this problem was to introduce a mentorship process that would help support the NGRNs as they transition into independent practice in the clinical setting. The goal of this project was to develop a mentorship program for future implementation. The Partners In Nursing (PIN) program sponsored by the Robert Wood Johnson Foundation, and developed by the American Association of Colleges of Nursing and the American Nurses Association, was selected to support the NGRN transition from student nurse to practicing clinician with a goal to improve retention rates by 10 percent. Benner's novice to expert framework and the Psychological Empowerment model were used in the development of activities contained within the mentorship program modules. Barrett's theory of power helped to guide the development of resilience activities for the future participants. An evaluation plan was developed to monitor new nurse progress before and during the program using the Casey and Fink questionnaire to evaluate the needs and job performance of the participants. The target hospital National Database of Nursing Quality Indicators (NDNQI) was analyzed to help justify the project abe used in future evaluations. Facilitating mentorship will result in social change through increased autonomy of the new professionals, along with improved retention which positively impacts patient outcomes. Social change will bridge the gap in retention and the cost of replacing a NGRN. Dissemination of this project is planned to occur both within the facility and at the relevant national organizations supporting nurse educators.

The push to generate professional nurses has raised questions about the competency level of the novice nurses that are entering the workforce. Utilization of simulation laboratories is being viewed as an option for bridging the gap for the shortage of nurses, nurse educators, and clinical sites. The theory of goal attainment was used to guide this project, which aimed to develop and validate an ER simulation scenario that mimics a clinical setting as a tool for measuring nursing skills. An additional purpose, to be accomplished after graduation, will be to implement a pilot project to determine the impact of the validated simulation scenario within the nursing skills laboratories on the quality of care provided by novice nurses to patients. The validation of the ER simulation scenario was completed by having 10 local experts review the developed ER simulation scenario. The experts then completed a 5-question Likert-type scale survey. Descriptive analysis was used to evaluate the results of the survey and validate the simulation scenario tool. Results revealed that all experts strongly agreed that the ER scenario was visually appealing and had enough subject content. Most experts strongly agreed that it was easy to read and follow. Post-graduation and with the assistance of the education organization, the second part of this proposal will occur with a pilot study implementation. The significance of this project to the nursing practice is to utilize simulation as a bridge to real life practice settings. This project may contribute to the American Nurses Association Standards of best practice which works to improve patient safety as well as quality nursing care.

The importance of nurse residency programs is addressed in the literature; however, a review of residency program outcomes and effectiveness is needed. Guided by Roy's adaptation model and Deming's plan-do-check-act model, the purpose of this quality improvement project was to assess the current state of a longstanding critical care nurse residency program in meeting organizational goals and objectives and to recommend modifications to the program related to external factors, internal challenges, and educational deficits of nurses entering the program. A review of the evidence-based literature and feedback from focus groups of leadership stakeholders were used to develop recommendations for residency program improvement. Using qualitative analysis of the focus group data, three common themes emerged related to external factors: financial resources, patient acuity, and generational differences that influence nurse satisfaction with the residency program. Three additional themes emerged related to organizational barriers to satisfaction with the program: preceptor availability and development, limited training hours due to productivity standards, and leader time to support novice nurses. Reality shock when starting to practice in the high acuity critical care area was the most frequently reported educational deficit among new nurses. Recommendations for program improvement included obtaining feedback from residency program participants and preceptors, initiating preceptor development pathways, reinstituting a dedicated cost center for nurse residents' training, and using competency assessment tools to customize training plans for residency program participants. This project has the potential for social change by increasing job satisfaction and retention of new nurses and improving health outcomes in critical care patients.

A perceived discrepancy exists in understanding between nursing educators' and hospital nurse leaders' views on job performance expectations and the reality of current job performance that may contribute to the difficulty experienced by novice nurses during their transition period. Lack of clarity in expectations may lead novice nurses to change jobs or leave the nursing profession within the first year of practice. The purpose of this descriptive study, guided by Benner's novice to expert theory, was to determine whether a difference exists between hospital nurse leaders' beliefs and nursing educators' beliefs about the frequency and competency levels, including leadership for novice nurses transitioning into practice, critical care nursing performance, teaching and collaboration, ability to plan and evaluate, interpersonal relations and communications, and professional development. Survey data were collected from 52 nursing educators and 52 hospital nurse leaders using the Schwirian's 6-dimension scale of nursing performance and analyzed using MANOVA and independent t tests. No differences were identified between hospital nurse leaders' and nurse educators' beliefs on the frequency and competency level in all areas examined for novice nurses transitioning into practice. Hospital nurse leaders' and nurse educators' expectations for novice nurses aligned. Further research should focus on ways to strengthen novice nurses' knowledge, critical thinking, and skills so they are better prepared to enter the transition period. Outcomes from this study may be used to improve education and transition to practice for novice nurses, which can result in positive social change.

Bakgrund: Sjuksköterskeyrket är en egen profession och det finns ett högt förtroende i samhället för den legitimerade sjuksköterskans kompetens. Sjuksköterskans yrkesroll framställs som komplex och mångdimensionell. Transitionen från student till nyutexaminerad sjuksköterska beskrivs som en central händelse där första tiden inom professionen har stor betydelse för sjuksköterskans utveckling.  Syfte: Syftet var att belysa upplevelsen av att vara nyexaminerad sjuksköterska. Metod: Designen var allmän litteraturöversikt. Litteratursökningen genomfördes i databaserna CINAHL Complete, PubMed och PsycINFO. Elva vetenskapliga artiklar identifierades, kvalitetsgranskades och analyserades.  Resultat: Resultatet illustrerar upplevelsen av att vara nyutexaminerad sjuksköterska. Första tiden speglade känslor av kaos, överväldigande och ansvar. Den nyutexaminerade sjuksköterskan upplevde rädsla att göra fel, säga fel och verka okunnig. Handledning och stöd ansågs som viktiga incitament i transitionen liksom att bli accepterade av kollegor och erkänd för sin kunskap. Professionell yrkesstolthet och självförtroende utvecklades med tid och erfarenhet.  Diskussion: Resultatet diskuteras utifrån omvårdnadsforskaren Patricia Benners teori att gå från novis till expert samt tidigare forskning. Diskussionen belyser hur nyutexaminerade sjuksköterskor ur ett internationellt perspektiv, upplevde ett glapp mellan utbildning och yrkesroll, osäkerhet i förhållande till patientsäkerhet och omvårdnad samt att introduktion och handledning under den första tiden var av stor betydelse. / Background: The profession of nursing has its own dicipline and there is a high level of trust in society for the qualified nurse's skills. The vocational role is presented as complex and multidimensional. The transition from student to newly graduated nurse is described as a central event where the first period in the profession is of great importance for the nurse's development. Aim: The aim was to highlight the experience of beeing a newly graduated nurse.  Method: The design was a general literature review. The literature search was conducted in the databases CINAHL Complete, PubMed and PsycINFO. Eleven scientific articles were identified, quality-reviewed and analyzed. Results: The result illustrated the experience of being a newly graduated nurse. The first period reflected feelings of chaos, overwhelming and responsibility. The newly graduated nurse experienced fear in making mistakes, saying the wrong thing or to appear unskilled. Tutoring and support were considered as an important incentive in the transition, as well as being accepted by colleagues and recognized for their knowledge. Professional pride and self-confidence were developed with time and experience. Discussion: The result is discussed based on Patricia Benner's theory, from novice to expert and previous research. The discussion illustrates how newly graduated nurses from an international perspective, experienced a gap between education and vocational role. Furthermore, insecurity in relation to patient safety and caring, and finally how the introduction and preceptorship initially was of great importance for the nurses.

In a report on the nursing shortage, the American Association of Colleges of Nursing cited insufficient preceptors as one of the factors influencing the decreased intake of nursing students to registered nurse (RN) programs, thus compounding the shortage issue. The site selected for this project was a teaching hospital that annually facilitates hundreds of nursing students for clinical practice. Graduate nurses rotating through the hospital are assigned to work with RNs within their assigned units. The purpose of this doctoral project was to develop a preceptor training program for RNs in a teaching hospital. The practice-focused question examined whether RNs would identify perceived competence and understanding in the preceptor role as a result of preceptor training. Knowles'€™s adult learning theory and Benner'€™s theory of skills acquisition framed the project. Participants (N = 7) completed a 2-week didactic and clinical training in preceptorship. As a result of the educational intervention, the preceptor trainees reported an increase in knowledge, skills, and confidence in the preceptor role. Seven participants (100%) expressed that the training was interesting, relevant, beneficial to their work, and stimulated sharing. The implications of this project for positive change include the potential benefits to new and experienced graduate nurse preceptors by reducing feelings of inadequacy, stress, and burnout and enhancing job satisfaction. Additionally, graduate nurses who work with competent, confident preceptors experience less anxiety, improved job satisfaction and a smoother transition to the role of professional nurses prepared to deliver quality health care to patients. Improving preceptor-graduate nurse experiences may result in reduced turnover among nurses and improved customer experiences.

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