Are new registered nursing graduates adequately prepared to be competent practitioners? a Victorian study

Abstract

Abstract Background: Each year, thousands of new nursing graduates join the health workforce in Australia. Evidence from the literature suggests that undergraduate nursing programs do not adequately prepare these graduates to be practice-ready and competent on graduation. Technological advances in healthcare, increased acuity of care, and increased numbers of hospital admissions due to an ageing population and higher prevalence of chronic disease means that the issue of nurse graduates’ competence continues to escalate. Despite the significance of this issue, the viewpoints of qualified nurses have rarely been examined. Their previously unexplored perspectives may identify points for intervention that have until now been overlooked. Aim: The overall aim of this study was to explore the perceptions of qualified nurses in relation to the practice readiness of registered nursing graduates in Victoria, Australia. Method: A two-phased, exploratory sequential mixed methods approach was utilised for this research study. Firstly, a qualitative descriptive design using semi-structured interviews to access information and perceptions from Graduate Nurse Program Coordinators (n=16) was employed. Interview transcripts were thematically analysed to reveal reoccurring themes and subthemes. In the second quantitative phase, a survey tool of 51 clinical skills and open-ended questions was used whereby qualified nurses (n=245) rated new nursing graduates’ abilities utilising a 5-point Likert scale. Data were analysed using descriptive statistics to provide frequencies, medians and interquartile ranges for each skill. Comparative analysis was used to identify differences according to the varying demographic and clinical characteristics of participants. Results: The three themes and subthemes that emerged from the thematic analysis in Phase One were: preparation readiness (clinical skills deficits, communication issues, transitioning as an Enrolled Nurse to a Registered Nurse), role adaptation (reality shock, work-life balancing, unrealistic assumptions), and nature of transition programs (composition of rotations, study days, supernumerary strategies). These themes provide in-depth insight into the deficits in skills and the challenges nursing graduates experience in the workplace. In Phase Two, participants rated new nursing graduates’ abilities for undertaking clinical skills as good or very good in 35.3% of skills, 33.3% were rated as adequate and 31.4% rated as being performed poorly or very poorly overall. Of concern, essential skills such as critical thinking and problem solving, working independently and physical assessment procedures were found to be poorly executed and affecting new RN graduates’ competence. Comparative analysis of the findings illustrate there were significant differences according to the age of the nurse, number of years registered, the tertiary educational setting in which they undertook their nursing education, their roles, and the clinical areas they worked in. There were no significant differences found according to whether the qualified nurse worked in the private or public health sector and only one according to the geographical location (Metropolitan or Regional/Rural). Conclusion: Findings from this research will support education providers and health care organisations to develop clinical education models that provide quality learning experiences for graduates to ensure they are clinically competent, with the ultimate aims of improving readiness to practice and the quality of patient care.