First Year Of Practice Research Articles

Improving the evaluation of novice advanced practice nurse transition.

Novice advanced practice registered nurses (RNs) experience decreased self-confidence, anxiety, and identity confusion in their first year of practice, which leads to poor job satisfaction and turnover. Advanced practice RN fellowship programs, developed to bridge the gap from the RN to the advanced practice role, lack standardized measures for program evaluation. A large Midwestern pediatric hospital's advanced practice nurse fellowship program lacks a structured program evaluation. A quasi-experimental evidence-based improvement project was implemented to evaluate fellowship program outcomes for novice nurse practitioner transition and retention. All novice advanced practice RNs (APRNs) were enrolled in the site's 12-month APRN fellowship program. The transition experiences of enrollees who completed the fellowship program were assessed using the novice nurse practitioner role transition scale. In addition, role transition scores were compared for two subgroups: fellows in acute care and fellows in primary care roles. Fellowship participant retention 1 year after hire was measured. Postintervention data showed that most fellowship graduates had a positive transition experience as evidenced by at least a 4.33/6.0 mean total novice nurse practitioner role transition score. There was not a statistically significant difference between the transition scores of the acute care fellows and primary care fellows. The APRN fellowship program was effective in promoting a successful role transition from RN to novice APRN. Similar APRN fellowship programs may benefit from using this tool for program evaluation.

Developing Clinical Judgment During Transition to Practice With Rapid-Cycle Deliberate Practice Simulation.

New-to-practice nurses (NPNs) make more errors than their experienced peers, affecting patient safety and contributing to sentinel events. Additionally, new nurses have a high attrition rate in their first year of practice. Simulation-based education may bridge the gap between education and practice by supporting the development of clinical judgment of NPNs. With quality improvement methods, an intradisciplinary team implemented a quality improvement project to improve NPNs' clinical judgment skills. A multipatient simulation that used rapid-cycle deliberate practice gave NPNs an opportunity to refine clinical decision-making and communication skills. In total, 24 NPNs participated in the pilot simulation. Pre- and postsurvey scores using the simulation effectiveness tool-modified showed self-reported improvement in clinical judgment and communication skills, among other competencies. Rapid-cycle deliberate practice simulation may support the development of essential nursing competencies, along with increased confidence and enhanced psychological safety among NPNs. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

International students' perspectives on medical school and internship: 'Oh international? Are you international?'

International students account for a significant proportion of medical graduates Australia-wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID-19 pandemic on international medical students specifically. A qualitative design was used to explore the perspectives of final-year international medical students at an Australian medical school as they prepared for transition to internship during the COVID-19 pandemic. Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. Seven out of 34 final-year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries. While the COVID-19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment.

Discourse Analysis and the Newly Qualified Social Worker: Liberty Protection Safeguards and Beyond

This article explores the application of Critical Discourse Analytic methods learnt during a (Social Work) Master’s degree, in the author’s first year of practice as a newly qualified social worker. The focus is the Liberty Protection Safeguards and how the discourse analytic techniques utilised may be translated into specific practice learning. An extract from the author’s Critical Discourse Analysis of the Liberty Protection Safeguards factsheets is presented before further exploration of analytic methods in the context of both literature and personal practice reflections. Specifically, the four issues addressed are: A. Considering how language signals a certain (ethical, social, political, moral) position. B. How language helps construct and reconstruct practice. C. What it means for social work practice to remain open to the consequences of language. D. Considering writing as a form of social work practice. Discourse analytic methods may complement social work values, considering the ethical stance that underpins our work. It is argued that critical discourse analytic tools and the learning arising from them can have a direct influence on social work practice through encouraging practitioners to remain open to language and questioning of the role of power in communication.

The First Years of Practice of Young Spine Surgeons in Latin America

To describe the experiences and current situation of AO Spine Fellows in Latin America, as well as the concerns of junior spine surgeons in their first three years of practice. A multiple-choice questionnaire was sent to AO Spine Associate Fellows who completed their studies within the past five years. This survey aimed to gather information on their professional activities during the initial three years of practice following their fellowship. By comparing the responses and activities undertaken by surgeons on a country-by-country basis, it will be possible to describe and analyze the local and regional outcomes in Latin America. The countries with the highest participation in the AO Spine Fellowship program are currently Argentina (30.7%), Brazil, and Colombia (28.21%). Participants aged 36 to 45 are the age group with the highest engagement (30.7%). Among program participants, 75% are orthopedists. Other notable findings include that 95% of respondents have greater experience and feel more comfortable working in degenerative spine pathology. Currently, junior fellows in the AO Spine program report a high level of comfort with the initiative. However, our study reveals valuable insights that can contribute to its improvement. It is worth noting that there is a clear preference for the standard posterior approach persists. Nevertheless, there is a growing interest among junior surgeons in endoscopic and minimally invasive techniques. This study serves as a gateway to essential data for future studies and the enhancement of the Fellowship education program in Latin America.

Big Bang Implementation of Electronic Health Records in a BSN Prelicensure Program for Documentation Competency.

Only ten percent of nursing schools in the US are currently using EHRs in their curriculum. This is seen to decrease students' effectiveness as new nurses. We began implementation of EHR use in Spring 2024 and have started collecting data as to the effectiveness of this process. This is a starting point using semester 1 junior (J1) students and we plan to have this process follow these students throughout all 4 semesters and assess them in their first year of practice to gain full understanding of the benefits.

A toolbox for transitioning from student to veterinarian: Setting yourself up for success and reframing failure in your first year of practice

The transition from veterinary student to private practice vet­erinarian is difficult. As a practitioner, one must put into action what was learned in veterinary school. Being a mixed large ani­mal veterinarian poses additional challenges due to the ambu­latory nature of the job. Clinical skills are important to master, and they will develop over time; but it is important to also con­sider intangible skills, such as cultivating fingertip facts, un­derstanding appropriate applications of chemical and physical restraint, honing one’s planning abilities, communicating with clients, maintaining relationships with mentors, and refram­ing failure. This presentation will highlight the experience of Dr. Dayna Locitzer as a recent graduate in mixed large animal practice and illustrate how she used these intangible skills to help with the transition from student to practitioner.

Bile Duct Injuries During Urgent Cholecystectomy at a Safety Net Teaching Hospital: Attending Experience and Time of Day May Matter.

Background: Bile duct injury (BDI) is one of the most severe complications during cholecystectomy. Early identification of risk factors for BDI may permit risk reduction strategies and inform patient consent.Objective: This study aimed to define patient, provider, and systemic factors associated with BDI; BDI incidence; and short-term outcomes of BDI after urgent cholecystectomy.Methods: Patients who underwent urgent cholecystectomy for acute cholecystitis were retrospectively screened (2020-2022). All patients who sustained BDI were included without exclusions. Demographics, clinical data, and outcomes were collected and compared with descriptive statistics.Results: During the study period, BDI occurred in 4 (0.5%) of 728 patients who underwent urgent cholecystectomy for acute cholecystitis. Most BDI cases (75%) took place overnight or during the weekend. The attending surgeon was almost exclusively (75%) in their first year of practice. BDI was recognized during index operation in 2 cases (50%). Hepatobiliary surgery performed the bile duct repair in all 4 cases. Two complications occurred (50%). All patients were followed by hepatobiliary surgery in the outpatient setting and returned to their baseline level of function within 2 months of hospital discharge.Conclusion: Most BDI occurred in procedures attended by first-year faculty during after hours cholecystectomies, suggesting a role for increased proctorship in early career attendings in addition to in-hours cholecystectomy for acute cholecystitis. The timely return to baseline function experienced by these patients emphasizes the favorable outcomes associated with early recognition of BDI and involvement of hepatobiliary surgery. Further examination with multicenter evaluation would be beneficial to validate these study findings.

Epidemiology of Knee Injuries in Baseball Players from the State of São Paulo.

Objective This study aimed to identify the main knee complaints and injuries associated with baseball and their prevalence in the state of São Paulo, Brazil. Methods This epidemiological study analyzed data from an online questionnaire sent to baseball athletes from the state of São Paulo, Brazil, from 2019 to 2022. Results Ninety-eight athletes participated in the study. Their average age was 24.3 years, and 85.72% of the subjects were men. The most prevalent ethnicities were yellow (50%) and white (42.86%). Most athletes had incomplete or complete higher education (75.5%). Most (88.77%) have been training for over 1 year, and 40.82% played in more than 1 position. More than half also practiced another sport. Most (66.32%) athletes present knee complaints or symptoms, and 37.75% had suffered a knee injury playing baseball, with several mechanisms (contact with the ground, contact with another player, or no contact). More than half (59.45%) of the athletes required time away from baseball due to complaints, symptoms, or injuries. Conclusion Among the athletes interviewed, 66.32% had a knee complaint, and 37.75% had already had a knee injury, especially meniscal and ligament injuries. The injury rate was highest in the first year of practice.

The impact of transition programs on well-being, experiences of work environment and turnover intentionamong early career hospital nurses.

Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups. To explore the long-term impact of having attended a transition program on the nurses' experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables. A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups. The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small. Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

Factors associated with practice readiness among newly qualified nurses in their first two years of practice

BackgroundNewly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession. ObjectivesTo examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession. DesignA cross-sectional study. Settings and participantsA total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore. MethodsParticipants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice. ResultsMore than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03). ConclusionsIt is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.

Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice.

The aim of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice. Medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. To better understand nursing workflow and documentation workload in today's clinical environment, it is important to understand patterns of medication administration and alert generation during barcode-assisted medication administration. Study objectives were addressed through a descriptive, longitudinal, observational cohort design using secondary data analysis. Set in a large, urban medical center in the United States, the study sample included 132 new graduate nurses who worked on adult, inpatient units and administered medication using barcode-assisted medication administration. Data were collected through electronic health record and administration sources. New graduate nurses in the sample experienced a total of 587 879 alert and medication administration encounters, administering 772 unique medications to 17 388 unique patients. Nurses experienced an average medication workload of 28.09 medications per shift, 3.98% of which were associated with alerts, over their first year of practice. In addition to high volume of medication administration, new graduate nurses administer many different types of medications and are exposed to numerous alerts while using barcode-assisted medication administration.

Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice.

Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice.

Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey

BackgroundHealthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. ObjectiveTo investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and settingAn anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the Würzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. ResultsThe results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. ConclusionFuture and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice

BackgroundThe purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency.MethodsAnesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016–2017, 2017–2018, and 2018–2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology.ResultsA total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes – workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists’ value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles.ConclusionsAnesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

"Surthriving" Hand Rehabilitation: Proposing Interventions to Support Novice Occupational Therapists Working in Underserved Contexts.

Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries.

Perceptions of New Graduate Nurses’ Transition to Practice Post-Pandemic

Registered nurse turnover is a challenge facing nurse leaders across the country with almost one-third of nursing turnover occurring in the first year of practice. Therefore, support during transition to practice is critical for new graduate nurses. The COVID-19 pandemic further exacerbated workforce challenges, preceptor development, and skill acquisition. The purpose of this article is to describe the perceptions of recent new graduate nurses transition to practice within the context of post-pandemic workforce challenges.

Mortality and Severe Complications Among Newly Graduated Surgeons in the United States.

To evaluate severe complications and mortality over years of independent practice among general surgeons. Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons. We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics. The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice. Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.

Individual and environmental factors that influence longevity of newcomers to nursing and midwifery: a scoping review.

The objective of this review was to identify the literature and map the individual and environmental factors that influence registered nurses' and midwives' decision to stay or leave their professions within the first 3 years of practice. Nursing and midwifery workforce sustainability is an international concern. One aspect is the retention of new registered nurses and midwives in their first years of practice. Several factors are thought to influence the decisions of new registered nurses and midwives to leave or stay in their professions. This review sought to identify and map those factors to enable further research for workforce sustainability development strategies. The study cohort included registered nurses and midwives in their first 3 years of practice, which we called newcomers . Nurses who were required to work under the supervision of registered nurses and midwives (ie, enrolled nurses, licensed practical nurses, and licensed vocational nurses) were excluded. Papers were included only if they explored individual or environmental factors influencing nurses' decision to stay in or leave the professions of nursing or midwifery. Studies could be from any country or care environment, and participants were newcomers providing direct clinical care. Newcomers employed in other health roles, such as education, research, administration, or non-nursing/midwifery roles, were excluded. All research designs and peer-reviewed papers were included; policy documents were excluded. The date of inclusion was from the earliest publication on this topic, which was 1974, to the date of the search. The JBI methodology for scoping reviews was followed, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. The search strategy aimed to locate published and unpublished primary studies, reviews, and text and opinion papers. The initial search of relevant databases was conducted in January 2020 and updated in January 2022. Reference lists of included articles were also screened. Following data extraction, descriptive qualitative content analysis was undertaken. Twelve articles from 11 studies were included in this review. They were published between 2005 and 2020, and originated from 5 countries. Two studies were observational, 3 were cross-sectional, 5 were longitudinal studies, 1 was a pre- and post-program evaluation, and 1 was a scoping review. All studies focused on registered nurses; no publications on registered midwives met the inclusion criteria. Individual factors we identified that impact newcomers' intention to stay in or leave the profession included physical and psychological health, professional identity, professional commitment, and development. Environmental factors included workplace culture, engagement, and management. Professional self-image, identity, and a sense of pride in the profession are important components of newcomer retention. Strategies that positively support transition to practice and create realistic expectations were highlighted. Managers play an important role in registered nurse retention, as they can influence many of the newcomers' experiences. It is concerning that no studies about newcomer midwives were found. Many studies explored turnover or intention to leave the job/employer rather than the profession. These are important considerations for future research.

Design a Model for the Association among Transition Shock, Empathy, Resilience, and Coping Strategies with Professional Quality of Life

Background: Many newly graduated nurses left nursing careers within the first year of practice. So, the high turnover rate of new nurses exacerbates the nursing shortage and causes a serious waste of nursing education resources and the financial costs of hospitals. Aims: To design a model for the association among transition shock, empathy, resilience, and coping strategies with professional quality of life among newly graduated nurses. Design: a predictive correlational study design was used. Setting: The study was conducted at Assiut University Hospitals, (General Medical Surgical, Pediatric, Obstetrics and Gynecology, Urology, Neurology and Psychiatry, EL- Rajhi-Liver, and Cardiology hospitals). Subject and Method: A convenient sample was used with a total numbers of 256 newly graduated nurses (within the first year of employment) working at the mentioned hospitals. The data collected through self-administered questionnaires includes socio-demographic data, a transition shock scale, an empathy scale, a resilience scale, a coping strategies questionnaire, and a professional quality of life scale. Results: There was a statistically significant positive correlation between empathy, resilience, coping strategies, and professional quality of life, except between transition shock and professional quality of life. Conclusion: More than one third (40.6%) of the studied participants suffer from moderate levels of transition shock.