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" Despite the evidence supporting the benefits of Nurse Residency Programs, anecdotal evidence suggested that the curriculum does not provide a focus on the lack of confidence new graduate nurses have transitioning into practice, nor does it provide resources to enhance confidence development. This evidence-based change project included new graduate nurses who were enrolled in a transition to practice, Nurse Residency Program (NRP) cohort. The participants engaged in a quality improvement project that provided confidence building exercises and resources to increase inter-professional confidence as an addendum to their current NRP curriculum. A confidence building curriculum addendum project was implemented during months five and six of their twelve month program. The data to measure the outcomes of this evidence-based change project was collected using the Casey-Fink Graduate Nurse Experience Survey as a pretest/posttest. New graduate nurse residency participants (N=10) showed a limited overall improvement in their confidence/comfort level post intervention. One area of noted increase was having less difficulty organizing patient care needs (mean increase 24.14%). The survey results suggest numerous possibilities for improvement of new graduate nurses transitioning into practice-such as confidence building initiatives, to include seasoned nursing staff education on the importance of their role in the onboarding of new graduate nurses. Key words: Nurse; New graduate; Transition to Practice Program; Confidence; Inter-professional; Nurse Residency Program; Evidenced-based practice; Change project. " -- Abstract
"It is essential for new graduate nurses to possess professional confidence in order to practice and provide high quality care in the healthcare system today. Unfortunately, many new graduate nurses are entering the field without it. The purpose of this descriptive qualitative study was to explore how new graduate BSN nurses perceive their professional confidence and what contributes to it during their first year of practice in the hospital setting. Data collection involved one individual semi-structured recorded conference interview with each of the five participants through the Zoom application which was transcribed verbatim. Each transcript was analyzed using manual content analysis with a constant comparative technique. Five major themes as well as four facilitators and four inhibitors to the development of professional confidence emerged. The five themes related to new graduate nurses' perception of professional confidence included knowledge and experience, interprofessional collaboration, independence, ongoing learner, and critical thinking. The four facilitators were positive feedback, support systems, asking for help, and perseverance. The four inhibitors were self-doubt, not being confident, being unprepared, and fear. These findings have implications for both undergraduate nursing education programs and nursing practice in the hospital setting. Undergraduate nursing programs should evaluate implementing strategies that better prepare new graduate nurses for their transition into the professional role. Healthcare professionals involved in developing new graduate nurses in practice, specifically nurse managers and preceptors, should be aware that they are entering practice without professional confidence and should focus efforts on what they can do to help promote its development." -- From page v.
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
"Graduate nurses are not receiving adequate support to ensure a smooth transition into practice. New nurses that do not receive adequate support and socialization within their work environment may seek employment elsewhere. A pilot buddy program was implemented pairing graduate nurses with experienced professional nurses offering additional support upon entering practice. The buddy relationship supported positive role transition among new nurses improving their confidence levels in providing safe, quality patient care. A new graduate nurse's transition takes place over the first 12 months of practice and requires extensive support to minimize the level of transition shock experienced by graduate nurses. Implementing a buddy program is crucial for added peer support due to the loss of the preceptor/coach relationship post orientation and provides a platform for gradual progression as new nurses experience role transition." -- Abstract.
In acute care settings that hire new graduate nurses of different educational backgrounds, does having a new graduate transition or residency program versus a traditional preceptorship create better prepared nurses and increase the retention rate within the first year of nursing? Research shows the initiation of new graduate programs help transition the new graduates from a novice and new nurse to a competent and confident nurse by the end of their first year of nursing by addressing their specific needs and by offering support (Philips, Kenny, Esterman, and Smith, 2014). Memorial Hospital currently does not have a new graduate residency and could highly benefit from implementing a new graduate residency program. The programs entails a specific and structured orientation with a manager approved preceptor, monthly meetings with the group of new graduates and the clinical educator, and self-evaluations for the new graduates to see their transition and improve their confidence month to month. Similar such programs improve retention of new graduate nurses and improve the employee satisfaction (Squires, 2002). By improving the retention rate the organization can also save money that would be lost by training an employee and then having them quit soon thereafter. The estimated cost of the program for twenty five new graduates including their preceptors is around $111,600, and with the average cost of training a new graduate nurse being
This work offers discussion of topics and issues of great relevance for students of nursing who are preparing to enter the world of clinical practice as new registered nurses. Addresses topics critical to nursing professionalism such as becoming a competent, confident practitioner.
The aim of this qualitative, phenomenological study was to explore the lived experience of new graduate nurses who completed a Student Nurse Associate Program during the summer between junior and senior year of their baccalaureate nursing program. This pre-licensure program was designed to support transition to professional practice by fostering confidence and competence, thus reducing fear and anxiety. Purposive sampling with the use of the snowball technique yielded data saturation with a of sample of 12 nurses. Data were generated by asking the participants to respond to four research questions during individual interviews. The naturalistic inquiry of Lincoln and Guba and the data analysis method of Colaizzi were germane to the study. This study revealed eight themes which were significant for new graduates to facilitate a smooth transition to professional practice. These included: 1. Confidence: Growth during the program; 2. Delegation: A difficult challenge; 3. Communication: Learning how to interact with patients, families, and other healthcare professionals; 4. Competence: Perfecting basic skills; 5. Time Management: Developing organizational systems; 6. Work Environment: Learning practices, policies, and people; 7. Prioritization: Critical thinking in action; and 8. Collaboration: Becoming a team player. The participants reported improved abilities in all areas with the exception of delegation and prioritization; these two areas were not mastered to the same extent. This study has contributed to knowledge development regarding transition to practice although more work is needed with a larger and more diverse sample. Pre-licensure and post-licensure programs should be compared in terms of cost, efficacy, and outcomes.
The transition from student nurse to professional nurse is often difficult for the new graduate especially if transitioning into critical or progressive care areas of practice. It is imperative for new graduates to receive a clinical orientation that meets their educational and transitional needs. The orientation process should provide them with a strong foundation in critical or progressive care practices. Educators are challenged to provide educational opportunities while accommodating diverse learning needs and continuing to maintain competency that ensures the highest quality of patient care and improved patient care outcomes. New graduate nurses hired into the critical or progressive care areas were asked to participate in a study evaluating the effect of blended orientation approaches on their level of self-confidence and satisfaction with current orientation methods. Their level of self-confidence and satisfaction were evaluated and measured using a pretest and posttest questionnaire. New graduates entering critical or progressive care areas of practice were evaluated following nursing school (prior to hospital orientation) and following a two-month hospital orientation model. The results did not reveal any significant difference between pre and post orientation. The review of literature suggests that the use of a more blended learning approach to teaching and learning can be beneficial. Blended learning can include online learning, case studies, human simulation, clinical time with a preceptor, service-based classroom lectures, quizzes, games, videos, mock events, review of pertinent evidence-based articles, and demonstration with return demonstration (p. 10), and is a growing area in education requiring more evaluation and research.