Abstract
This longitudinal research study aimed to develop a pregraduation clinical training program for nursing students before graduation and evaluate its effect on students' self-perceived clinical competence, clinical stress, and intention to leave current job. A sample of 198 students returned the questionnaires before and after the program. They were followed up at 3, 6, and 12 months after graduation. Results showed that posttest clinical competence was significantly higher than pretest competence, positively related to clinical competence at 3 and 12 months, and negatively related to clinical stress at 3 months. The clinical competence at 3 months was positively related to clinical competence at 6 and 12 months, and clinical competence at 6 months was related to intention to leave at 12 months. Intention to leave at 6 months was positively related to intention to leave at 3 and 12 months. Clinical stress at 3 months was positively related to clinical stress at 6 and 12 months, but not related to intention to leave at any time points. The training program improved students' clinical competence. The stressful time that was correlated with new graduate nurses' intention to leave their job was between the sixth and twelfth months after employment.
Highlights
Nurse shortage has become a worldwide issue
While 30.9% of new graduate nurses agreed that the pregraduation clinical training program was helpful in reducing their clinical job stress, 48.7% agreed that the program was helpful to their clinical competence, and 67.0% expressed the necessity of continuing the program in the future
This study found that new graduate nurses who participated in the pregraduation clinical training program had significantly higher posttest clinical competence score compared to pretest, the strength of the conclusion drawn— that the program results in significant increase in clinical competence—is limited by the lack of a comparison group in this study
Summary
Nurse shortage has become a worldwide issue. Using the United States as an example, the shortage of hospital registered nurses will reach 340,000 nurses by the year 2020 [1]. Kramer [10] coined the phrase “reality shock” to describe the beginning work experience of new nurses. She defined reality shock as “the shock-like reaction that occurs when an individual who has been reared and educated in that subculture of nursing that is promulgated by schools of nursing suddenly discovers that nursing as practiced in the world of work is not the same—it does not operate on the same principles” (page 291) [10]. Phase two is the shock phase, which begins when the new nurses discover that the reality of the clinical work does not match their expectations based on what they were taught. Phase four is resolution which can be either positive or negative—the new graduate nurses either learn new ways to cope effectively with their new role or they reject the role and continue to experience symptoms of stress and burnout
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