Clinical Practicum Research Articles

The experiences of newly qualified nurses in intensive care unit: a qualitative meta-synthesis.

Clinical rotation practicum provides NQNs with more opportunities to learn their professional knowledge and develop basic nursing skills. ICU is often used as one of the clinical practicum departments for NQNs. Nursing shortages have been particularly felt in ICU. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU. The experience of NQNs is highly stressful and challenging in these settings, which hinders their professional development and impacts patient care. The study aimed to systematically review and synthesis the findings of qualitative studies exploring experience of NQNs in ICU rotation, to provide a basis for enhancing the quality of clinical nursing. Nine databases were systematically searched for relevant publications from inception until February 2024. All qualitative studies in English and Chinese that explored the experience of NQNs in ICU rotation were collected. Two independent reviewers selected the studies and used The Joanna Briggs Institute Critical Appraisal Tool to evaluate the quality of the studies. Meta-synthesis was performed to integrate the results. A total of 13 studies revealed five descriptive themes and 14 sub-themes: ICU readiness, physical and psychological stress, positive self-perception, developing relationships, and ICU reflections. Standardized training in ICU, the working ability of NQNs is exercised and their professional quality is improved. However, it is also adversely affected by various stressors. The appropriate guidance and monitoring should be given by hospital managers, so as to promote the development of NQNs and enhance the quality of clinical nursing. https://www.crd.york.ac.uk/PROSPERO/, CRD42023475257.

Infographics: A Novel Approach to Improve Faculty-Preceptor Communication.

Communication between preceptors and faculty and the time to teach have been identified as common barriers for preceptors working with nurse practitioner (NP) students. Despite traditional preceptor orientation strategies in school of nursing NP primary care programs, preceptors continued to express uncertainty and lack of clarity regarding the expectations of the precepted experience. Data to support this innovation were obtained through preceptor-faculty interactions through surveys, site visits, and focus groups examining the preceptor's experience with precepting. Infographics were developed for each of the three clinical practicum courses in the NP primary care track, which address expectations for these precepted experiences. Preceptors reported being more likely to review infographics, kept them accessible/available during the semester, and experienced clarity on the expectations for the experience. Preceptors and students expressed a more thorough understanding of the expectations for the NP student's practicums with the implementation of the infographics. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Resilience of nursing students: A concept analysis study

ObjectivesThis study aimed to identify attributes of resilience among nursing students. DesignThe concept analysis method was used. Data sourcesLiterature reviews from the past 10 years were searched in Science Direct, Cumulative Index to Nursing and Allied Health Literature, PubMed, and the Wiley online library. The literature search database and review period were determined after verification of validity by five experts (nursing professors). The inclusion criteria for the literature review were that the paper must be written in English, and the abstract or title of the paper should have included attributes of nursing students' resilience. Exclusion criteria were papers written in languages other than English, papers that did not include the attributes of resilience of nursing students, and duplicate papers. Seventeen studies were included in the analysis. ResultsResilience among nursing students comprised three attributes and 28 sub-attributes. The three attributes were individual, educational, and situational. Individual attributes included personal competency characteristics (e.g., self-confidence and self-efficacy) and consisted of 15 sub-attributes. Educational attributes included characteristics related to academic and clinical practicum (e.g., coping with academic work pressure) and consisted of seven sub-attributes. Situational attributes comprised characteristics that changed according to circumstances (e.g., coping with increased levels of patient acuity during the crisis), such as the COVID-19 pandemic and social support from significant others, and consisted of six sub-attributes. ConclusionsThis study identified resilience attributes reflecting the characteristics of nursing students and recent situational changes. Consequently, tools to assess resilience should be developed based on study findings and utilized in various studies aimed at enhancing the resilience of nursing students.

Psychometric evaluation of the Chinese version of the Nursing Student Contributions to Clinical Settings scale and analysis of factors influencing nurses' perceptions of nursing students' contributions: a cross-sectional study

BackgroundMost medical organizations accept many nursing students each year who gain clinical practice skills under the supervision of clinical nurses. However, there are no assessment tools to measure the contributions nursing students make to the clinical setting during clinical practicum. This study aimed to translate the 'Nursing Student Contributions to Clinical Settings' scale into Chinese and test its reliability and validity from the perspective of Chinese clinical nurses. And to explore whether nurses' personal and professional characteristics are related to nurses' perception of nursing students' contributions to the clinical settings.MethodsThe original scale was translated into Chinese following the Brislin translation model. A convenience sample of 935 clinical nurses was selected from January to March 2024 for the survey. The content validity of the scale was assessed by expert consultation and content validity index. Exploratory factor analysis and confirmatory factor analysis were performed to assess the construct validity of the scale. The reliability of the scale was measured using internal consistency, split-half reliability, and test–retest reliability. The measurement quality of the scales was assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments. One-way analysis of variance was used to identify variables related to students’ contributions.ResultsThe content validity index of the scale was 0.983. Exploratory factor analysis supported a one-factor structure, and the cumulative variance contribution was 71.177%. Confirmatory factor analysis showed that the model fit indicators were all within the acceptable range. The McDonald's Omega coefficient and Cronbach's alpha coefficient for the scale were 0.983. Nurses perceive that nursing students' contribution to the clinical settings is influenced by nurses' personal characteristics, professional characteristics, and the hospital environment.ConclusionThe Chinese version of the Nursing Student Contributions to Clinical Settings scale has good reliability and validity and can effectively and reliably measure the contributions of Chinese nursing students to clinical settings.

Artificial intelligence (AI) applications in healthcare and considerations for nursing education

Aim/objectiveTo review the current AI applications in healthcare and explore the implications for nurse educators in innovative integration of this technology in nursing education and training programs. BackgroundThere are a variety of Artificial Intelligence (AI) applications currently supporting patient care in many healthcare settings. A nursing workforce that leverages healthcare technology to enhance efficiency and accuracy of patient health outcomes is necessary. Nurse educators must understand the various uses of AI applications in healthcare to equip themselves to effectively prepare students to use the applications. DesignQualitative synthesis and analysis of existing literature. MethodsGenerative AI (ChatGPT) was used to support the development of a list of the current AI applications in healthcare. Each application was evaluated for relevance and accuracy. A literature review to define and understand the use of each application in clinical practice was completed. The search terms “AI” and “Health Education” were used to review the literature for evidence on educational programs used for training learners. ResultsTen current applications of AI in healthcare were identified and explored. There is little evidence that outlines how to integrate AI education into educational training for nurses. ConclusionA comprehensive multimodal educational approach that uses innovative learning strategies has potential to support the integration of AI concepts into nursing curriculum. The use of simulation and clinical practicum experiences to support experiential learning and to offer opportunities for practical application and training. Considerations for ethical use and appropriate critical evaluation of AI applications are necessary.

High-Fidelity Environment Effect on Early Postpartum Haemorrhage Management

Objective: In order to compare outcomes of a simulation of early postpartum haemorrhage management through a medium-fidelity mannequin in a high-fidelity environment before clinical practicums with those after clinical practicums in nursing students. Methods: This quasi-experimental study was performed on second-year nursing students (n=61). After the simulation, the students were asked to perform postpartum haemorrhage control in clinical practicums. Data were collected with the State-Trait Anxiety Inventory, Student Satisfaction and Self-Confidence in Learning Scale, Educational Practices Questionnaire, and Student Self-Evaluation Form. Results: The mean satisfaction, self-confidence, and Educational Practices Questionnaire scores after the simulation were high. The mean scores for feeling competent in involution, haemorrhage control, fundus massage, perineal care, andestablishing appropriate communication with patients and their relatives were 19.18±5.70 after the simulation and 23.83±5,03 after the clinical practicums. Conclusion: The medium-fidelity simulation in a high-fidelity environment of early postpartum haemorrhage management enhanced the students’ learning satisfaction and self-confidence. This helped them to feel more competent in the clinical practicums.

Insights into an innovative point of care ultrasound curriculum for Ontario primary maternity care providers

Point of care ultrasound (POCUS) has increasingly been used by midwives worldwide. In 2018, the scope of midwifery care in Ontario was expanded to include POCUS to allow practitioners to provide more comprehensive care. In response to the scope expansion, a new continuing POCUS education course was created in collaboration with faculty and clinicians from obstetrics, midwifery, and medical radiation sciences. The continuing education sonography course focused on fostering the knowledge, skills and judgment Ontario midwives required to safely perform these new POCUS skills. The course included online modules, a two-day hands-on bootcamp workshop, and a clinical practicum under the supervision of a sonographer to confirm competency across the three trimesters of pregnancy. The first cohort of 17 learners completed the course in Fall 2019, the new curriculum was well received by learners for its many benefits into learning and applying bedside sonography to clinical care. This paper outlines our process for POCUS curriculum development and implementation in pregnancy care. This POCUS continuing education course should continue to be offered in the future to give more practitioners the ability to perform point of care pregnancy scans.

Incorporating Evidence-Based Practice Learning Activities Throughout Family Nurse Practitioner Clinical Practicum Courses.

Evidence-based practice (EBP) is crucial to high-quality health care, yet nurse practitioner graduates report low levels of confidence in their EBP abilities. This may be because of limited incorporation of EBP learning opportunities outside of foundational course-work. Family nurse practitioner (FNP) program faculty incorporated EBP learning activities across the three-semester clinical year curriculum, and the activities scaffolded in complexity. Initial activities included appraisal and application of clinical practice guidelines to patient case scenarios. Later, students used the seven steps of EBP to present frequently asked patient questions and EBP clinical challenges in their clinical rotations to their peers. This innovative way to thread EBP across the clinical year allowed faculty to continue to evaluate and guide students toward EBP competency. The integration of EBP learning activities across the clinical year is a feasible strategy to further expand FNP student competency in EBP. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Exploring nursing students’ experiences of contemplating self-injury during their clinical practicums: A phenomenological study

AimTo explore nursing students’ thoughts and feelings about self-injuring during their clinical practicums. BackgroundUnfamiliar clinical environments pose challenges for nursing students, potentially leading to high levels of stress. When students find it difficult to cope with emotional triggers, some contemplate self-injury. Yet, it is rare to explore nursing students’ thoughts and feelings related to self-injury during their clinical practicums. DesignA phenomenological approach was used. MethodsPurposive sampling was used and the participants were drawn from nursing students who graduated from universities in Taiwan. In-depth, semi-structured interviews were conducted from August to November 2023. Data saturation was reached after interviewing 15 participants. Colaizzi's seven steps and NVivo software were used for data analysis. ResultsFour themes and 14 subthemes emerged. They were: (1) Sensing an emotional crescendo: participants experienced anxieties about clinical educators, assignments, homework and the clinical practicums and these intensified across time. (2) Physical and mental dysregulation: participants experienced physical discomfort, psychological distress and negative thoughts when subjected to overwhelming pressures during their clinical practicums. (3) Unwholesome self-protective behaviors: participants expressed thoughts of self-injury, engaged in self-injurious behaviors, experienced suicidal ideations and attempted suicide as measures of relieving stress. (4) Compassionate self-protective behaviors: participants coped with stress through emotional voicing, modifying situations to adjust stress, reaching out for help, self-compassion and self-care. ConclusionsFindings raise awareness of the need for clinical educators to demonstrate empathy with nursing students who have thoughts of self-injury during their clinical practicums. Further, it is crucial for them to offer timely guidance on the healing process while simultaneously creating nurturing clinical environments wherein students could flourish and grow.

Self-Efficacy in Nursing Competencies during Students' Clinical Practicum: The Development of a Self-Assessment Scale.

The evaluation of the competencies corresponding to the different professional profiles of future nursing graduates is fundamental to their training. In this regard, students' self-evaluation must be part of their training. This study aimed to develop and psychometrically test the Perceived Self-Efficacy in Nursing Competencies (PSENC) Scale. This study was conducted in two phases: selecting and adjusting items and assessing the instrument's psychometric properties. A sample of 1416 students completed the scale online. Exploratory factor and confirmatory factor analyses were conducted. Inferential analysis was carried out. The exploratory factor analysis of the PSENC scale with 20 items resulted in five factors (76.3% of variance). All factors showed Cronbach's alpha coefficients > 0.70. The confirmatory factor analysis measurement model showed satisfactory and adequate goodness-of-fit indices. The developed scale showed the psychometric adequacy and usefulness to the self-assessment of nursing students regarding their self-efficacy expectations in competencies during their clinical practicum. This study was not registered.

HEALTH ASSESSMENT SKILLS OF NURSING STUDENTS: DESCRIPTIVES STUDIES

The integrated clinical practicum equips prospective nursing students with the essential skills required to operate effectively as healthcare professionals who will transition into physicians following licensure. The population of nursing students at STIKes Budi Luhur Cimahi is 632 students. The sample was 244 students with cluster random sampling techniques, 36 nurses, 148 nursing S1 students, and 60 nursing D3 students. Data analysis used chi square and kolmogorov Smirnov tests. Based on the results of P-Value 1.00 with the age of 18-20 years with a total frequency of 18 with skilled skills of eight twenty-two points two percent (22.2%), ages 21-23 years with a total frequency of 30 with skilled skills of twenty point four percent (20.4%) and ages 24-26 years with a total frequency of 5 with skilled skills of twenty-one point seven percent (21.7%). Regarding gender, based on the results of P-Value 0.244 with male gender with a total frequency of 73, sixteen point four percent (16.4) were obtained. And the female gender with a total of twenty-one point seven percent (27.1%) is skilled. In acquiring health assessment skills while in the undergraduate program, nurse educators must consider the variables of age profile, gender, and type of student. Hence, it is imperative for nurse educators to cultivate diverse pedagogical approaches in order to cater to the varying requirements of diverse student populations. Keywords: Age, Gender, Skills, Nursing

Effects of virtual reality training on clinical skill performance in nursing students: A systematic review, meta-analysis and meta-regression.

This review examined the impact of virtual reality (VR) training on nursing students' clinical skill performance and identified essential features of VR training. VR provides immersive content, simulating real-life scenarios and preventing errors in clinical settings. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies were obtained from Ovid-EMBASE, MEDLINE, CINAHL and PubMed. Studies related to VR training published from 1 January 2000 to 8 May 2024 were included. Comprehensive Meta-Analysis 4.0 software was used for meta-analysis and random effects meta-regression. The overall effect was assessed with Hedges' g and Z-statistics (p < 0.05). Heterogeneity was measured using I-squared (I2) statistics. Among the 31 476 studies, 11 randomized controlled trial studies were included. Meta-analysis demonstrated a significant improvement in clinical skill performance, with a medium to large effect (g = 0.61) in the VR group (Z = 3.80, p < 0.001). Subgroup analyses highlighted higher nursing skills in the VR training topic. Meta-regression revealed that the VR training topic (β = 1.23, p < 0.001) and method of VR training (β = -0.53, p = 0.05) were significant covariates influencing clinical skill performance. VR training improves nursing students' clinical skill performance, addressing shortcomings in the clinical practicum.

High stress during clinical practicum placement is associated with bullying among nursing students: A mixed-method study

BackgroundNursing students are often subjected to bullying during their clinical practices, but few study has examined associations of bullying with psychological status among these groups, and how they cope with the bullying. ObjectivesThis study aimed to evaluate the experience and psychological status of clinical placement setting bullying among nursing students attending clinical practices, and explore students' coping strategies when bullied. DesignA mixed methods. SettingsSix tertiary hospitals in Northwest China. ParticipantsA total of 687 nursing students completed the questionnaire survey, of which 18 nursing students participated in the qualitative interview. MethodsA two-phase hybrid study was produced. During first phase, data were collected by using the Bullying Behavior Scale in Nursing Education (BNEQ) and the Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who have experienced bullying in the workplace were invited to participate in a face-to-face interview (second phase) which focused on exploring students' deeper insights. ResultsOf the 687 students involved, 72.19 % had experienced various types of bullying. Of them, 92.11 % experienced implicit violence. Those with higher education levels and from rural were more likely to experience bullying. Students were prone to greater psychological stress when exposed to bullying. “Pretending not to see” (33.16 %), “reporting to superiors” (30.10 %), and “doing nothing” were the most common ways students responded. Four themes were obtained from the qualitative interviews: (a) impaired self-esteem; (b) career rejection; (c) psychological stress; and (d) the decline of humanistic care. ConclusionOur findings suggest that senior nursing students experience multiple types of bullying during the clinical practices, leading to a high level of psychological stress, which further effect students' professional approval and self-esteem. To prevent such incidents, we need to call on university and hospitals' support to help students successfully cope with bullying.

Nursing Students’ Experience and Perception towards Online Education during Covid-19 Pandemic in Nepal

Background: The COVID-19 pandemic forced educational institutions worldwide to adapt swiftly. This study explorednursing students’ experiences and perceptions towards online education during the pandemic in Nepal.Method: Using a cross-sectional descriptive design, data were collected from 416 nursing students across the country usingnon probability convenient sampling technique via a google form questionnaire. Ethical approval was obtained from NHRCand for the data analysis, descriptive analysis was done by using appropriate statistical tools and SPSS version 20.Result: Key findings on online class experience, 93.5% participated in live online classes, 62.3% preferred a blend ofsubjective and objective evaluation methods and 58.9% favored pre- and post-classroom assignments. Similarly, regardingbenefits of online education 25.0% strongly agreed that technical skills (email, internet, apps) improved, 53.1% recognizedteachers’ facilitative role in student learning and 45.2% believed online classes reduced psychological stress. There werechallenges on theory classes and clinical practicum where 38.8% acknowledged skill gaps for effective online teaching and44.0% strongly agreed on curriculum redesign respectively.Conclusion: Online learning is crucial for a variety of reasons, including time savings and learning flexibility. Despite these,constrained technology infrastructures, connectivity issues and clinical practicum continued to be obstacles. Effective onlineeducation requires increased internet access, faculty and student digital training, and the support of regulatory authorities.

Development of the Hybrid Clinical Practicum Environment Scale for Nursing Students.

This study aimed to develop a Hybrid Clinical Practicum Environment Scale for Nursing Students (HCPES-NS) and verify its validity and reliability. The HCPES-NS was constructed following the DeVellis guidelines. The initial items were written based on a literature review and individual in-depth interviews. Content validity was verified through an expert panel review. To confirm the validity and reliability of the scale, a survey was conducted with 449 nursing students enrolled in 12 nursing colleges. Data were analyzed using item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability tests. Factor analysis showed that the HCPES-NS consists of 15 items on five subdomains: clinical site atmosphere, interpersonal relationship, alternative online practicum contents, provision of learning information, and clinical performance facilitation. A higher score indicated a more positive perception of the clinical practicum environment. The concurrent validity of the HCPES-NS was confirmed by its positive correlation with the Clinical Learning Environment Scale (r = .77). The Cronbach's α reliability of the HCPES-NS was .84. The HCPES-NS is both valid and reliable. This scale reflects the clinical practicum environment and includes an online practicum factor. It may be used effectively by faculty members and educators to evaluate nursing students' perceptions of clinical practicum environments.

Evaluation of a psychological readiness program and final clinical practicum among final year nursing students: A mixed methods study

BackgroundFinal year nursing students may experience higher levels of stress owing to the increasing complexity and expectations from their clinical practicums. Enhancing psychological readiness may be a potential strategy to enhance nursing students' transition to the clinical area. ObjectiveTo evaluate the effects of a psychological readiness enhancement for transition to professional practice program and a 10-week clinical practicum on students' psychological wellbeing, resilience, practice readiness and confidence. DesignA sequential mixed-methods approach comprising of a single-group evaluation and descriptive qualitative study. SettingFinal year nursing students enrolled in an undergraduate nursing program from one autonomous university in Singapore was recruited. Participants148 final year nursing students participated in the single-group evaluation study. A total of 24 participants who completed the psychological readiness program were recruited in the qualitative study. MethodsThis study included two phases. Phase I comprised of an evaluation of a blended psychological readiness program and clinical practicum. Data was collected across three waves to assess nursing students' psychological wellbeing, resilience, practice readiness and confidence. In Phase II, a qualitative study using individual semi-structured online interviews was conducted to examine students' experiences of the psychological readiness program and clinical practicum. ResultsThe psychological readiness program led to significant changes in students' anxiety and patient centeredness scores. The accumulated effects of the psychological readiness and clinical practicum showed significant improvements in students' practice readiness and confidence. Although there were no significant improvements in depression, stress and resilience scores, there were improvements in the trend across three waves. Students attributed these improvements to the psychological readiness program and sharing by the alumni. ConclusionsThe findings of this study laid the foundation for the development of psychological readiness programs. However, larger scale studies using randomized controlled trial designs should be used to confirm the effects of these interventions.

임상실습에서 비대면 실습 교육으로 전환하는 간호대학생의 경험

Objectives The purposes of this study were to nursing students' experiences of transitioning from clinical practice to untact practice education. Methods A phenomenological study was conducted with 13 university students in City C who experienced contactless practicum during the pandemic. Data collected through semi-structured individual in-depth interviews after completing clinical pediatric practicum developed by a professor of pediatric nursing were analyzed using Colaizzi's procedure. Results 3 categories were identified: questioning whether clinical pediatric practice should be replaced, perception of the effectiveness of online practice, and perception of the complexity of pediatric nursing, and 10 subthemes were identified: clinical practice limitations and regrets, nuring career concerns, limitations of online practice, reducing stress and tension levels, self-directed learning experiences, reducing negative feelings about clinical practice, team collaboration experiences, perceived difficulties, ignorance, and uncertainty in practicing pediatric nursing. Conclusions It is necessary to discuss the deficiencies of post-corona pediatric practice sites, and to development and systematize various untact practice education contents and established various educational environments.

Mediating Effect of Mindfulness between Clinical Practicum Stress and Emotional Stability of KAFNA Cadets

Mediating Effect of Mindfulness between Clinical Practicum Stress and Emotional Stability of KAFNA Cadets

Stressors and coping styles of nursing students in the middle period of clinical practicum: a qualitative study

BackgroundNursing students encounter various stressors during their clinical practicum; however, the stressors are not the same during different periods. At present, studies on the stressors and coping styles of nursing students in the middle period of their clinical practicum are rare.AimsThe current study aimed to explore the stressors and coping styles of nursing students in the middle period of their clinical practicum.MethodsA qualitative study with a descriptive phenomenological method was conducted to collect data from 10 nursing students undergoing the middle period of their clinical practicum from December 2020 to February 2021. The data were collected by semistructured interviews using interview outlines prepared in advance. The data were analyzed by Colaizzi’s analysis method.ResultsThe stressors experienced by nursing students in the middle period of their clinical practicum mainly included personal reasons, teaching arrangements, interpersonal relationships, occupational particularity and career planning. Additionally, nursing students coped with the stressors that they face in the clinical practicum by eliminating stressors and regulating emotions.ConclusionsNursing students experienced various stressors and used a variety of coping styles in the middle period of their clinical practicum, which was different from what occurred in the early and late periods. Targeted interventions should be formulated and implemented to relieve nursing students’ stress and guide them to adopt effective coping styles.

The early career resilience experience of generation Z newly graduated registered nurses in standardized training in the emergency department: a qualitative study in Shanghai

BackgroundThe period of standardized training is a transitional stage when Generation Z newly graduated registered nurses (Gen Z NGRNs) change their role from student to nurse. Affected by the COVID-19, they lack clinical practice and practicum experience in emergency departments in their university studies. At the beginning of career, they are under great pressure. Resilience is one of the factors that reduce their stress level and increases endurance. It is of interest to understand how this representative group of nurses gained and played the experience of resilience early in their careers.ObjectiveTo explore Gen Z NGRNs’ experience and process of resilience, to provide a new perspective and theoretical basis for psychological rehabilitation or intervention of medical staff who experienced transition shock.MethodsThis study employed a qualitative design based on the phenomenological approach. 18 nurses from a third-level class-A hospital in Shanghai who participated in standardized training in emergency department were enrolled using purposive sampling. Data collection was through in-depth and semi-structured interviews and continued until reaching data saturation.ResultsThe investigation uncovered three themes and ten subthemes. Pressure and challenge contained high workload and high risk coexist, death’s stress response, more emergencies and high professional requirements. Coping and adaptation contained team help, psychological restructuring, peer support, transformational leadership. Reflection and planning contained enhance learning, appreciate life.ConclusionsOur study described the embodiment and coping experience of the physical and mental stress faced by Gen Z NGRNs during their standardized training in the emergency department. It is emphasized that nurse educators should pay attention to the character and actual needs of Gen Z NGRNs, explore and formulate strategies, so as to guide NGRNs to quickly adapt and grow in the new role. The ultimate goal is to increase nurse retention and improve the quality of nursing.