First Year Of Practice Research Articles

The Development of an Oncology Clinical Nurse Specialist Fellowship Program.

New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.

Dealing with your first complications: Strategies for anticipation, management, communication, and support

The first years of practice are a time of high pressure and rapid professional maturation. Young surgeons are more likely than their senior colleagues to encounter clinical issues they have never considered. At the same time, because their referral systems are not developed, they will see a higher proportion of patients with urgent conditions that compound the risk for clinical complications. This paper examines how to deal with the non-clinical aspects of your first complications and specifically how to prepare for and manage yourself, your patients, your practice, and your relationships after these adverse events.

An assessment continuum: How healthcare professionals define and determine practice readiness of newly graduated registered nurses

BackgroundHealthcare services require graduate nurses to be practice ready, however growing evidence implies that this is not the case. There is a lack of clarity in the literature around the concept of practice readiness and how this is determined. Without a clear definition to guide assessment processes, decisions about graduate nurse practice readiness will remain poorly defined and graduate nurses inadequately supported. AimAs part of a larger body of work, this paper reports on how healthcare providers in one state in Australia define and determine graduate nurse practice readiness. MethodsThis study employed an instrumental collective case study design using multiple methods of data collection and grounded theory methods of data analysis. Sixty-seven healthcare professionals located in four sites in one state in Australia participated. FindingsThis study found that practice readiness is a multidimensional concept encompassing overlapping personal, clinical, industry and professional capabilities. These capabilities held true for participants in all contexts of practice. Practice readiness is assessed across a continuum as the graduate makes the transition from student to registered nurse. Graduates’ level of confidence was found to be a critical factor in both demonstrating and determining practice readiness. DiscussionDecisions about graduate nurse practice readiness are largely subjective. An agreed understanding of practice readiness is required to ensure assessments and decisions about practice readiness are reliable and consistent and support the needs of graduate nurses and healthcare providers. ConclusionA graduate nurse’s first year of practice is an extension of their learning and development to become a competent registered nurse. Graduate nurses require experience as a registered nurse to be practice ready and achieve the necessary confidence and required competence for safe practice. In the current model of nurse education, meeting this need is difficult.

A Mixed-Methods Exploration of the Educational Climate and Safety Climate During the First Year of Clinical Practice in Ireland.

Educational climate (EC) and safety climate (SC) are key determinants of residents' professional development. The goal of this study was to gather longitudinal EC data and data on perceptions of SC in residency, and provide data on practices related to perceptions of EC and SC, by identifying factors associated with and changes in perceptions of EC and SC across the first year of practice, and elucidating good and poor practice relating to key elements of EC and SC. A mixed-methods design was adopted. First, 131 first-year residents in Ireland were surveyed at the end of each of their first 3 rotations (August 2016-March 2017). The survey measured EC and SC using established measures. Next, 69 semistructured interviews were conducted with a representative sample of residents (March-May 2017). An interview schedule was developed to aid in-depth probing of EC and SC perceptions. A deductive content analysis approach was adopted. Perceptions of EC worsened over time. The EC and SC of surgical rotations were significantly poorer than those of medical rotations. Residents were more likely to describe team practices, rather than organizational practices, that contributed positively to their perceptions of EC and SC. Further research is necessary to facilitate improvement of EC and SC for residents, particularly within surgical training. Future research exploring the contribution of organizational practices to EC and SC, the impact of targeted improvement activities, and best practices for involving residents in quality and safety initiatives is recommended.

Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork.

To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. Semi-structured interviews were conducted with nurses (N=11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.

Midwives transition to practice: Expectations and experiences

• The first year of practice can be challenging for newly qualified midwives. • The theory practice gap can be distressing and disorienting. • Learning within a caseload model fosters a deep commitment to woman centred care. • New midwives draw on their continuity experiences to manage the transition to practice.

Clinical Practice of Midwifery Graduates During Community Service Placement, Limpopo Province South Africa

Midwifery graduates are placed in health facilities for community service during their first year of practice. The purpose of the study was to explore how midwifery graduates experienced their clinical practice during community service placement in Limpopo province. A qualitative study which is explorative and descriptive in nature was conducted in five selected hospitals. Population comprised of all midwifery graduates who have undergone a comprehensive nursing programme regulated by R425 of 19 February 1985, as amended; working in selected hospitals. Non-probability, purposive sampling method was used to select five graduates working in maternity unit of each selected hospital. Sample comprised of twenty-five participants. In-depth face to face interviews were used to collect data. Findings revealed that graduates experienced differences between theory and practice at different levels. Loss of students’ status, high level of responsibility and inadequate clinical learning opportunities made their transition difficult. In conclusion, graduates felt exposed to two different worlds of midwifery practice resulting in frustration and reality shock. Study recommends that midwifery training programme include opportunities to discuss realities of transition period, to enable graduates to deal with midwifery issues in a real and practical situation. Mentors should help graduates to bridge the gap between theory and practice. Structured support programmes should be offered to alley feelings of fear and insecurity resulting from increased levels of responsibility and accountability graduates are faced with.

Optimizing Transitional Support for Novice Nurse Practitioners

Navigating the unique challenges associated with the role transition from experienced nurse to novice nurse practitioner requires engagement from all levels within the health system. This article describes a new onboarding process supporting the nurse transitioning into advanced practice. Beginning with recruitment and continuing throughout the first year of practice, the process is designed to facilitate ease of assimilation into this new role. Navigating the unique challenges associated with the role transition from experienced nurse to novice nurse practitioner requires engagement from all levels within the health system. This article describes a new onboarding process supporting the nurse transitioning into advanced practice. Beginning with recruitment and continuing throughout the first year of practice, the process is designed to facilitate ease of assimilation into this new role.

Evaluation of the use of a handheld prescribing card in supporting Foundation year one doctors in End of Life (EOL) prescribing.

This article was migrated. The article was marked as recommended. Background Literature reports disquiet in junior doctors' abilities in palliative care prescribing; including distress and low confidence ( Charlton and Smith, 2000). We confirmed similar findings following local research thus identifying a development need. This led to the design and implementation of a hand-held prescribing card. Objective Usefulness of the prescribing card in supporting foundation year one doctors was evaluated. We hypothesised this intervention would help improve End of Life (EOL) care. Methods A mixed methods approach was employed using a specially designed questionnaire, distributed to 39 foundation year one doctors (doctors in their first year of practice after graduating from medical school). Focused questions were on utilisation, levels of prescribing confidence and exploring further interventions that might help, as well as feedback on card design. Results 25 doctors completed questionnaires; a response rate 86%. Almost half routinely used the card. 40% were not yet prescribing for EOL situations at the time of the study because of their specific job rotation (e.g. ophthalmology). The commonest motivator was accessibility. All doctors reported increased confidence in prescribing and approximately three quarters said it enhanced practice. "Usefulness" was the commonest free-response descriptor. Feelings included it being a good reference and preventing errors. A development idea included an electronic version. Conclusion Results highlight that a simple hand-held prescribing card is useful. To our knowledge, this is the first UK study of its kind employing an educational intervention in palliative care in a hospital setting. It is important to implement this educational intervention early to support doctors.

Opioids, the pharmacist and the junior doctor: reducing prescribing error

AbstractAimThis pharmacy and medicine collaborative project investigated the effectiveness of teaching and learning strategies to enhance opioid prescribing by junior doctors in their first year of practice. A key strategy tested was that of pharmacists engaging with junior doctors on the ward to coach and develop their prescribing skills.Data SourcesAn evaluation research framework was implemented that went beyond collecting reaction and self‐reported learning to include impact on patient outcomes. Pre‐ and postintervention prescribing audits were undertaken to identify changes in prescribing practice over the period of the intervention.ResultsLearner reaction feedback was extremely positive for all facets of the intervention. Coaching by the ward pharmacists was recognised and valued. As predicted, there was no significant change in knowledge of the pharmacology and use of opioids but there was a reduction of dose errors, from 54% pre‐intervention to 7% post‐intervention.ConclusionWhile this is a small targeted intervention, we appear to have made a contribution to patient safety through enhanced prescribing practice. The programme has highlighted the potential for further development of the medical–pharmacy relationship as a true teaching and learning partnership. The context of a hospital ward offers unparalleled opportunities to promote learning and develop team‐based understandings.

The contribution of reflective thinking to the professional development of pre-service teachers

ABSTRACT Reflective thinking is an important facet of meta-cognitive thinking. Studies show that reflective journals help students consolidate and assess their practices. The aim of this study was to characterize the reflective thinking process over two years of pre-service teachers in their practical work. Statements from reflective journals, written in each of their practical years, were analyzed by a mixed method approach. 10 pre-service teachers’ dairies, in each of their tow practical years was collected, overall 100 reflection were angelized. Statements were sorted; the themes noted were planning, implementation, emotional considerations, and insights. Research Findings strongly indicated, students in their second year of practical teaching focused more on the aspect of personal processes and emotional aspects rather than technical aspects, likely the result of experience garnered during their first year of practice. In both years, it was apparent that reflective writing led students to increased self-awareness.

Boomerang Nurses: Why They Leave and Why They Return

Nursing turnover within hospitals is a nationwide problem, with over 20% of new nurses leaving their position in the first year of practice. Of these some return to work at the same institution they left within 2 years. The impact on patient outcomes and cost to the institution are similar to those of training new nurses. There is plethora of literature evaluating nurse turnover, however little is known about the turnover of boomerang nurses, specifically how the turnover is related to work environment. The purpose of this quantitative survey study was to discover if boomerang nurses perceptions of their work environment changed upon returning, what factors influenced their decisions to leave the organization, and what factors influenced their decisions to return at this organization. The sample consisted of 21 boomerang nurses who left the organization and returned within the study timeframe after two years or less of being away. The Practice Environment Scale of the Nursing Work Index (PES-NWI) (Lake, 2002) survey, along with demographic questions, was emailed to all potential participants and reminder emails were automatically sent out to those who had not completed the survey at two-week intervals for a total of three emails. Results were analyzed using IBM SPSS Statistics version 23 program. Participants were primarily female (n=17) and age 36-45 years (n=7) or greater than 56 years (n=7). There was no significant improvement for the PES-NWI overall composite score or the subscales for perceptions of the participants’ work environment before they left the institution and after they returned to the institution. When subscales were coded as favorable (>2.5) or unfavorable (<2.5), a chi-square test for independence indicated a significant association between perceived nursing manager ability, leadership, and support of nurses previously and their current perceptions (p=.02). Most participants selected working conditions (n=6) as their reason for leaving and sited nursing manager ability, leadership, and support of nurses the biggest reason for their working conditions (n=5) influencing their decision to leave. Most participants selected that they prefer working at this organization (n=7) as their reason for returning to work at this organization. Most participants did not return to the same unit in which they left (n=10). These results suggest that nurses left the organization because of the leadership of the unit they left, but that they returned to a different unit because they prefer to work for this organization. The organization could benefit from assessing leaderships’ ability to manage and support the nurses on their units, and to provide leadership with the education on how to be effective leaders.

Comparison of specialties participating in the BEST-CLI trial to specialists treating peripheral arterial disease nationally

BackgroundThe Best Endovascular vs Best Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI) trial compares open surgery and endovascular therapy for the treatment of critical limb ischemia (CLI). This report describes the types and proportion of investigators participating in BEST-CLI and determines how these compare with those specialists treating peripheral artery disease (PAD) outside of the trial. MethodsTo be credentialed to enroll in BEST-CLI, investigators must be approved by the Surgical and Interventional Management Committee to have sufficient experience and skill in the management of patients with CLI. Investigators must attest to having completed at least 12 below-knee interventions in the last 2 years on CLI patients for endovascular approval and 10 lower extremity below-knee bypass procedures in the last 2 years for open surgical treatment. Investigators who met these criteria but were within their first year of practice were conditionally approved to do procedures under the oversight of a fully approved investigator. The type and proportion of specialists credentialed in BEST-CLI were compared with those treating PAD on a national basis by auditing 10% of Medicare claims for PAD. ResultsAs of September 2017, a total of 865 physicians were credentialed to enroll in the BEST-CLI trial. Of these, 596 (69%) are vascular surgeons, 128 (15%) are interventional cardiologists, 123 (14%) are interventional radiologists, 7 (1%) are vascular medicine specialists, and 11 (1%) are other. Of the 596 vascular surgeons enrolling in the trial, 113 (19%) are credentialed for open surgery only, 409 (69%) are credentialed for both open surgery and endovascular therapy, and 3 (1%) are credentialed for only endovascular therapy. The remaining 71 participating vascular surgeons were conditionally approved. Of the 136 centers enrolling patients, multispecialty involvement is present in 98 (72%). In 38 (28%), vascular surgery alone is the service enrolling CLI patients. Endovascular treatment by specialty in BEST-CLI vs national Medicare claims is as follows: vascular surgery, 55% vs 51%; interventional cardiology, 17% vs 13%; interventional radiology, 16% vs 25%; and other, 2% vs 10%. ConclusionsBEST-CLI contains a diverse group of specialists enrolling and treating patients with CLI. Whereas a majority of the participating practitioners are vascular surgeons who do both open and endovascular procedures, a broad variety of specialists are represented in BEST-CLI in a pattern that represents national treatment patterns outside of the BEST-CLI trial. These treatment patterns will help ensure that findings from BEST-CLI are applicable to the real-world practice of treatments for PAD.

Transition and Adjustment to Professional Identity as a Newly Qualified Social Worker

ABSTRACTThis article discusses the lived experience of professional identity during the transition from student to newly qualified practitioner. Current literature emphasises the first year of practice as an important time of transition to a job-role as student social workers move into postqualification practice. However, little research has explored how professional identity is experienced during this significant transition period. A phenomenological research project was undertaken with 17 newly qualified social workers in Australia. Three in-depth semistructured interviews were conducted with each participant across the first 12 months postqualification period. Participants described how they resolved personal, relational, and professional questions about becoming and being a qualified social worker. The findings indicate a need for educators, employers, supervisors and the profession to consider how to better integrate professional identity within curricula, policy, and systems of support, including supervision.

Factors developing nursing students and novice nurses' ability to provide care in acute situations.

Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses' ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.

Reflection of New Graduate Nurses on the Transition Program Conducted in the Selected Malaysian Private Hospitals

Transitions are passages or movements from one state or condition to another, and they can profoundly influence and alter the lives of the individuals involved as well as their significant others such as friends, family, and co-workers. While transitional support programs helps to support the new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses’ (NGNs) experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses’ attain the new graduates’ perception on the Transition Program implemented in three (3) private hospitals. This study is intended to determine the new graduate nurses’ (NGNs) reflection towards the transition program in medical, surgical and multidisciplinary wards in the selected private hospitals. The study used a descriptive, cross-sectional design using purposive sampling technique. Reflections on the transition program implemented were assessed using the instrument which was adopted and modified from previous study questionnaires, Hamad Medical Centre (HMC) questionnaires. The Descriptive statistics were employed to express demographic data and reflections of the NGNs towards the transition program. One hundred new graduate nurses with less than three-year experiences participated in this study. The transition program runs in two stages, two weeks for the orientation program followed by six-month preceptor ship. The researchers used a 5-point Likert scale for data collection. Data were analysed using SPSS version 20. The overall reflection expressed by NGNs on experiences during the transitioning, 70% agreed and 28% had strongly agreed the program conducted was well organized. If both results to be combined, 98% of respondents reflected excellence for the transition program conducted. In conclusion, the transition program which comprised of orientation and preceptor ship program is the most significant approach of helping the adaptation of the NGNs working in the clinical environment. Thus, these programs should be regularly conducted in every hospital which indirectly helps in decreasing the rate of turnover among the NGNs.

An educational intervention to enhance nurse practitioner role transition in the first year of practice.

Role transition is a natural process that occurs when the registered nurse pursues additional education to become a nurse practitioner (NP). Role transition generates feelings of anxiety and insecurity, leading to a longer and more tumultuous adjustment. This study investigated whether an evidence-based role transition webinar would support NP role transition during this critical period. This study was a nonrandomized, pretest-posttest, and single-group study using a convenience sample to address the research question: "Does completion of a role transition webinar enhance the perception of new NPs of their ability to perform well in their role?" The educational webinar was shown to have a positive influence on some aspects of the participant's reported perceptions of NP role transition. Having practical and assessable educational interventions to optimize NP role transition and determining factors that contribute to the success of these interventions would be prudent. This is the first quantitative study to investigate the positive association between an online educational intervention and NP role transition. A timelier and less tumultuous transition would allow NPs to perform more effectively in their new role.

Transition to practice experiences of first- and second-career nurses: A mixed-methods study.

To explore the transition to nursing practice experiences of first- and second-career nursing students. To address the nursing shortage, alternative educational programmes have been increasingly developed and implemented with to help individuals with prior career experiences transition into a career in nursing (second-career nurses). However, we know little about the transition to practice experiences of second-career nurses. This mixed-methods study utilised qualitative interviews with nurses who had completed a year of practice and a longitudinal survey of nurses' perceptions of stress, coping and burnout throughout their first year of nursing practice. Qualitative data (n=15) were analysed using latent thematic analysis and following COREQ guidelines. Descriptive and effect size analysis of quantitative data (n=122) was conducted in order to assess for significant differences across time points. The thematic analysis identified three themes: Stressors and Coping, Prevalence of Burnout and Presenteeism, and Difficulty Describing Nursing's Role. The quantitative findings showed that participants' self-compassion decreased over their first year of practice. Levels of stress, presenteeism and burnout increased by the year mark. These increases were meaningfully significant between time points. Differences in the stressors and coping of first- and second-career nurses should be considered in developing transition to practice programmes for new nurses. Increasing rates of stress, burnout and presenteeism highlight the ongoing need to address these issues. Improving the nurse work environment may aid in the transition to nursing practice of both first- and second-career nurses. First- and second-career nurses have increasing rates of stress, burnout and presenteeism that need to be addressed. However, there are differences in stressors and coping between first- and second-career nurses.

Developing Leadership Capacity in New Rural School District Leaders: The Kansas Educational Leadership Institute

Understanding the context of rural school settings is critical to beginning school district leaders. Rural communities present multifaceted challenges that leaders must embrace as diverse community expectations unfold. The majority of Kansas school districts are in rural settings. Mentoring and induction shapes the experiences encountered during the first year of practice. The Kansas Educational Leadership Institute provides high quality mentoring and induction for new superintendents and principals in Kansas. Mentoring and induction provided by veteran superintendents familiar with leadership complexities in rural communities is offered through on-site visits. In addition, new superintendents participate in activities focused on building capacity through regional cohort networks, attendance at professional organization and state meetings, and in professional learning seminars. The rural superintendent wears many hats in serving their local district. Professional learning opportunities that provide leaders with strategies to focus on achievement, plan for change, and build leadership capacity in rural environments are critical for success.

Experiences of Occupational Balance Among Novice Occupational Therapists

Abstract Date Presented 4/19/2018 Finding balance between work and personal life for novice occupational therapists is difficult because the first years of practice are inherently stressful. Implications of this study examining experiences of novice therapists include providing better support to promote their health, quality of life, and occupational balance. Primary Author and Speaker: Mary Wagner Additional Authors and Speakers: Renee Causey-Upton, Dana Howell, Melba Custer