New Graduate Nurses Research Articles

Improving recognition of early clinical decline: Determining reliability and validity of the Garvey clinical warning curves.

New graduate nurses have difficulty recognizing and managing the early signs of clinical decline, resulting in a Failure to Rescue (FTR) event and preventable patient death. To address this gap, Garvey developed a series of Clinical Warning Curves as an instructional tool for new graduate nurses in an academic medical center. The Garvey Clinical Warning Curve models depict the progression of clinical changes in six body systems that occur before cardiac arrest. The purpose of this study was to establish the content validity, reliability, and usability of the Garvey Clinical Warning Curves among healthcare experts and new-graduate nurses. The current study was a cross-sectional, observational, validation survey design. Content experts used the content validity index (CVI) to evaluate the Curves. All but the temperature curves were rated as "acceptable" (CVI >0.60) for relevance, clarity, and ambiguity. The new graduate nurses who reviewed the case studies and placed patients onto the Clinical Warning Curves did so similarly, generating high intraclass correlation (ICC) scores. The usability survey components measured the perceptions of acceptability, appropriateness, and feasibility for the use of the six Clinical Warning Curves in practice settings. All components of the Curves had an average score of 4.0 or greater except for the level of complexity which scored 3.88. The Garvey Clinical Warning Curves emerged as valid and reliable tools that aid new graduate nurses in recognizing subtle signs of clinical decline. Because timely recognition and communication of clinical decline are key to preventing FTR events and avoiding patient deaths, it would be beneficial to provide the Clinical Warning Curves as a bedside resource for new graduate nurses during their orientation to the unit or within a nurse residency program.

Promoting Safe Practice in New Graduate Nurses: The Key Role of Support.

This article reports research that examined how registered nurses in practice develop clinical judgment in new graduate nurses (NGNs) and how NGNs respond. Teaching themes were setting the tone for learning, use of cognitive-focused teaching-learning strategies, including mentoring thinking, debriefing and reflection, and using real-life scenarios. NGN responses were learning focused, emotional, or resistant. Recommendations to support development of clinical thinking are made.

The core competencies in disaster nursing of new graduate nurses in Guangdong, China: A cross-sectional study

AimThis study aimed to assess the level of core competencies in disaster nursing of New Graduate Nurses (NGNs) and explore its influencing factors. BackgroundIn recent years, the overall frequency of disasters around the world has been on the rise. As the emerging workforce in clinical settings, NGNs play an integral role in future disaster relief efforts. NGNs’ level and influencing impact of core competencies in disaster nursing need to be understood. DesignA cross-sectional design. MethodsFrom June to September 2023, the Core Competencies in Disaster Nursing Scale - General Professional Nurse (CCDNS-GPN), designed according to the CCDN V2.0, was used to collect data from NGNs of six nursing schools and 15 hospitals in Guangdong, China. Descriptive analysis was conducted to examine the scores of core competencies in disaster nursing. Furthermore, one-way analysis of variance and multivariate linear regression analysis were used to explore the influencing factors. ResultsA total of 607 NGNs participated in this study. The scores of CCDNS-GPN of NGNs were 90.23 (SD 15.09) (score ratio: 51.56%), indicating a low level of core competencies in disaster nursing. The highest competency was the recovery (score ratio: 55.00%), while the lowest competency was the communication (score ratio: 45.44%). The predictor for core competencies in disaster nursing of NGNs were male (β = 0.091, p < 0.05), below bachelor’s degree (β = −0.109, p < 0.05), had received disaster nursing education at school (β = 0.087, p < 0.05), had participated in a disaster rescue drill at school (β = 0.140, p < 0.05), had been to the ICU during internship (β = 0.135, p < 0.05) and had the intention to be a disaster specialized nurse (β = 0.114, p < 0.05). ConclusionsThe NGNs exhibited insufficient core competencies in disaster nursing in Guangdong, China. Nursing schools and clinical institutions should collaborate and play their respective roles to enhance nurses' core competencies in disaster nursing, ensuring they can timely, safely and efficiently participate in disaster medical relief efforts.

Observed Use of Clinical Judgment Among New Graduate Nurses.

Despite the efforts of academic nursing educators to prepare students to make sound clinical judgments, the literature suggests new graduate nurse (NGN) competence with this critical skill continues to decline. This study sought to identify how practicing nurses describe their observations of the use and outcomes of clinical judgment by NGNs in nursing practice. A multisite, cross-sectional survey using multiple-choice, Likert scale, and open response items to identify participants' observations of NGN clinical judgment was sent with snowball sampling and resulted in a sample of 314 participants from 19 U.S. states. Practice partners identified a wide discrepancy between how they expect NGNs to use clinical judgment and what they actually see NGNs do, with resultant negative effects on patients and NGNs. These results provide a beginning understanding of NGNs' specific challenges with clinical judgment. Efforts to improve clinical judgment across nursing education and practice are needed. [J Contin Educ Nurs. 2024;55(8):399-406.].

BMT Bootcamp: Preparing Our New-Graduate Nurses for Complex Care

BMT Bootcamp: Preparing Our New-Graduate Nurses for Complex Care

Leveraging the Hawai'i Nurse Residency Collaborative to Optimize Statewide Workforce Goals.

This article describes the planning and implementation of the Hawai'i Nurse Residency Program (HNRP). The HNRP provides a shared, adaptable nurse residency program model. Through the HNRP, Hawai'i achieved high new-graduate retention and addressed other state initiatives. Since 2012, more than 1666 new-graduate nurses have participated, leading to an average 1st-year retention rate of 96.77%. Statewide nurse residency collaboratives are adaptable, may cost less than other alternatives, and may save on lost funds due to nurse attrition, resulting in an enhanced nursing workforce.

Structural and psychological empowerment among newly graduated nurses and related factors: A mixed methods study.

To discuss the levels of structural empowerment (SE) and psychological empowerment (PE) and the factors that influence perceptions of empowerment among newly graduated nurses (NGNs). Mixed methods study. The quantitative part of the study was conducted with 220 NGNs with <1 year of job experience. The study was conducted between February and May 2023. Focus group discussions were conducted with 30 NGNs. Data were collected by using the Conditions for Work Effectiveness Questionnaire (CWEQ-II), the Psychological Empowerment Scale (PES) and a Semi-Structured Interview Form. Quantitative data were analysed using stepwise regression analysis. Content analysis was used to analyse qualitative data. CWEQ-II and PES were moderate. The regression analysis showed that NGNs' SE scores increased in association with the following factors, including an increase in the total score on the PES, being married/having a partner, working a day shift, having career planning, increased satisfaction with the orientation programmes of the institution and increased satisfaction with the employing institution. As a result of the descriptive analysis of the focus group interviews conducted to determine the empowerment perceptions of NGNs, we identified three contexts along with the associated themes and subthemes. These three contexts were the 'concept of power', 'professional impression' and 'empowerment process'. The results of this study indicate that the SE and PE levels of NGNs are moderate, and their empowerment perceptions are influenced by many factors that can be individual, organizational and work environment relevant. This study's findings will guide policymakers, educators, researchers and administrators in empowering NGNs essential to the healthcare workforce. The paper adheres to the COREQ checklist. No patient or public contribution.

New Graduate Nurses' Competencies, Organizational Socialization, and Turnover Intention.

This study aimed to identify core competencies in new-graduate nurses (NGNs) by determining which competencies affected their organizational socialization (OS) and turnover intention (TI) in their 1st year of employment. NGNs face stressful transitions with expanded nursing responsibilities that motivate them to leave their jobs. Therefore, NGN turnover in the 1st year of practice is higher than the overall nurse turnover rate. Previous research suggested that NGNs' competency levels affect their OS and TI. However, little research has been done to determine which competencies affect these variables. Multiple linear regression analysis was performed on cross-sectional survey data to determine the effects of NGN work competencies on OS and TI. Health promotion, supervision, interpersonal communication, and direct care competencies significantly predicted NGNs' OS, and computer technology competency significantly predicted NGNs' TI. NGNs should be given early opportunities for expanded hands-on clinical experiences along with clear awareness of the organization's goals and values. Moreover, they should be offered roles that take advantage of their computer technology skills and that challenge them to contribute to their organization and nursing care in new ways.

Experience of New Graduate Nurses in Nurse Residency Programs During the COVID-19 World Pandemic.

Individuals who entered any nursing program during the coronavirus disease 2019 (COVID-19) world pandemic were exposed to a different and chaotic learning environment. The goal of this study was to describe the experience of 452 new graduate nurses (NGNs) who entered the profession between 2020 and 2022. This study was a qualitative thematic analysis of an open-ended survey from the American Nurses Credentialing Center Practice Transition Accreditation Program® (PTAP®). The thematic analysis resulted in five themes: the pandemic was a significant disruptor, the program was a generally negative experience, the quality of the preceptors and mentors made a difference, the content of the program made an impact, and the residency program prepared NGNs for the RN role by building confidence and promoting relationship building and a sense of community. The 2020-2022 world pandemic created a challenging environment for NGNs to enter nursing and had implications for practice. [J Contin Educ Nurs. 2024;55(2):87-93.].

Evaluating the Health of the Work Environment and the Perception of New Nurses During the Transition to Practice in Critical Care.

New nurses are the major source of hiring for most hospitals. They fill vacancies left by seasoned nurses creating an experience-complexity gap. Turnover among new-graduate nurses is as high as 85% in the first 2 years. The purpose of this study was to provide a deeper understanding of the factors contributing to turnover. The specific aims were (1) to better understand novice nurses' perceptions of their transition to critical-care practice and (2) to describe all eligible critical-care nurses' perceptions of a healthy work environment. A quantitative descriptive design was used. Data were collected over 3 weeks in February 2022 from novice nurses (n = 12) who completed the Casey-Fink Nurse Experience Survey and from novice and experienced nurses (n = 47) who completed the American Association of Critical-Care Nurses' Healthy Work Environment Assessment Tool. Data were analyzed using descriptive statistics. Respondents to the Casey-Fink Nurse Experience Survey (n = 12) indicated feeling well supported by family, friends, and preceptors, although they felt less positive about prioritizing care, organizing patient needs, and recommending changes to the plan of care. The overall mean score on the Health Work Environment Assessment Tool was 2.99 (n = 47), indicating the need for improvement. Responses varied by unit, years of experience, and certification status. This study contributes to the evolving body of nursing knowledge and has provided a more detailed understanding of the health of the work environment and perceptions of new nurses during the transition to practice.

Safety Behavior and Transition Shock among Newly Graduated Nurses: The Mediating Role of Feedback-Seeking Behavior

Aim. To determine the relationship between transition shock and safety behavior among newly graduated nurses (NGNs) and explore the mediating role of feedback-seeking behavior. Background. The safety behavior of NGNs plays a vital role in improving patient safety in clinical situations. The direct effect of the transition shock experienced by these nurses on safety behavior remains limited, and little is known about the mediating effect of feedback-seeking behavior. Methods. A descriptive correlational research design was conducted with a cross-sectional sample of nurses in China using an online survey. A convenience sample of 575 nurses from 17 hospitals completed the questionnaires. Correlation analysis and structural equation modeling were used to examine the hypotheses. Results. The sampled NGNs’ safety behavior score was 55.35 ± 5.46. Their transition shock was negatively associated with safety behavior (β = −0.225, p &lt; 0.001). In contrast, feedback-seeking behavior was positively related to safety behavior (β = 0.502, p &lt; 0.001). The feedback-seeking behavior partially mediated the relationship between transition shock and safety behavior, and the mediating effect was 58.29%. Conclusions. The results emphasized that the relationship between NGNs’ transition shock and safety behavior is mediated by feedback-seeking behavior. Implications for Nursing Management. Interventions focusing on transition shock relief could help improve NGNs’ safety behavior. This study highlights the importance of encouraging feedback-seeking behavior to improve patient safety outcomes, especially for junior nurses. It can therefore be assumed that the nursing managers’ training of NGNs in special skills, such as feedback-seeking, may be conducive to their positive coping and contribute to forming safety behaviors.

Decreasing Nurses' Anxiety About Pediatric End-of-Life Care With Simulation.

Caring for pediatric patients at the end of life (EOL) can lead to anxiety and burnout for critical care nurses. New graduate nurses (NGNs) often report receiving inadequate education related to EOL care and then enter the workforce with limited clinical experience in caring for patients at EOL. A quality improvement project at a pediatric academic hospital sought to determine whether a simulation-based educational program for NGNs working in critical care could reduce anxiety about EOL care. Eight NGNs participated in a case study and simulation-based educational program that encompassed topics such as communication, symptom management, postmortem care, and support for the family at EOL. Anxiety was measured pre- and postprogram with the Spielberger State-Trait Anxiety Inventory (STAI©). Anxiety levels after participation in the EOL educational program decreased by 24.1% from preprogram levels. Providing NGNs in critical care with a case- and simulation-based EOL educational program can reduce anxiety levels and potentially decrease caregiver burnout. [J Contin Educ Nurs. 2023;54(12):574-580.].

Résumé-Writing for Success: What every nursing student and new graduate nurse needs to know.

Creating a standout professional résumé can be challenging, particularly for new graduate nurses (NGNs) who may have limited work experience or those who want to go into specialty areas. This article outlines strategies to help NGNs draft a comprehensive résumé and help improve their chances of getting a nursing job.

Appraising differential capabilities of new graduate nurses: Development across the first nine months of employment

BackgroundEffective transition to practice for new graduate nurses (NGNs) is of national and international concern. Development of NGNs expands well beyond higher education studies and relies heavily on support during their first year of employment. Little is known of the differential development of NGNs, namely the trajectory of developing capability. AimThis study differentiates NGN development during their first year of employment through appraisal of universal domains of nursing practice relevant to the international community. MethodsUsing a quantitative evaluation design NGN performance was appraised at 1–, 3–, and 9–months from February 2020 to November 2021, using a 23-item appraisal tool and accompanying behavioural cues organised around four universal domains of practice: professional values and behaviours; comprehensive nursing practice; organisational capabilities; personal growth and development; and a fifth domain specific to Australia, that is, legislative requirements. Workplace performance was appraised by clinical supervisors and numerically rated according to intensity of coaching required to meet requisite standards of practice. ResultsThe shift in rating scores of intensity of coaching required, over three time periods across four key universal domains, were statistically significant (p < .001). These findings which indicate the intensity of required coaching for maintenance of standards reduced over the time period suggest advancing NGN capability. The domain representing professional values consistently rated the highest. The domain denoting legislative requirements largely flattened after three months. ConclusionThese findings corroborate the significant development of NGN capability during the first nine months of employment, especially during the initial three months. Furthermore, they provide empirical evidence that NGNs are most adept at demonstrating professional values; a recognised capability developed through employment during pre-registration studies. Discriminant data is of value to inform both targeted development of individual NGNs and when collated, the education needs of cohorts.

A successful nursing education promotes newly graduated nurses’ job satisfaction one year after graduation: a cross-sectional multi-country study

BackgroundJob satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs’ job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs’ job satisfaction.MethodsA cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression.ResultsMost of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs’ satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation.ConclusionsNursing education plays a significant role in NGNs’ job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs’ job satisfaction and ultimately the high-quality care of the patients.

Improving Staffing in the ICU with New Graduate Nurses: A Novel Critical Care Fellowship Program

Background: There is a growing shortage of critical care nurses. New graduate nurses (NGN) are increasingly hired into critical care settings, though NGN job turnover is estimated between 18-60% in the first year of practice. The COVID-19 pandemic exacerbated nurse turnover and the need to rapidly train new ICU nurses while also employing effective retention management strategies.&#x0D; Aim: To highlight the success of a NGN Critical Care Fellowship Program (CCFP) within the existing health system’s NGN Residency Program prior to and during the COVID-19 pandemic.&#x0D; Methods: The CCFP was launched in 2016 with 7 participating ICUs. The NGNs participate in the medical center’s existing 1-year NGN Residency Program and spend a total of 24 weeks orienting in 3 different ICUs. Orientation concludes based on a performance evaluation and readiness to work independently. NGNs are mentored and supported throughout their first year in practice through monthly debriefing of clinical and preceptor experiences.&#x0D; Results/Findings: Between 2016-2022, a total of 65 NGNs have participated in the CCFP. Sixty fellows completed orientation and were hired into an adult ICU during their orientation period. Retention of CCFP NGNs after 1 year was 96% (n=48/50), 2 years was 97% (n=33/34) and 3 years was 96% (n=23/24).&#x0D; Conclusions: Results demonstrate the development of an educationally robust, emotionally compassionate program, concentrated on the development, training and focused support of the NGN can be successfully implemented and sustained over time.

When and how does the practice environment most benefit the job outcomes of newly graduated nurses?

Providing a favourable practice environment has been regarded as an essential to improve the job outcomes of newly graduated nurses (NGNs). However, little is known about how and when NGNs can best utilize their practice environment to produce optimal job outcomes. The aim of this study, which is based on the Conservation of Resources Theory and the Social Cognitive Model of Career Self-Management, is to investigate whether NGNs who have a higher level of personal growth initiative are more likely to benefit from their practice environment and achieve better job outcomes by increasing their occupational self-efficacy. A cross-sectional study. From 1 September 2022, to 30 September 2022, 279 NGNs from five Chinese state-owned hospitals were recruited for this study. The participants completed measures of practice environment, personal growth initiative, occupational self-efficacy, job stress, job satisfaction, turnover intention and quality of care. A descriptive analysis and a moderated mediation model were computed. Reporting adhered to the STROBE statement. The influence of the practice environment on job outcomes was significantly mediated by occupational self-efficacy, with personal growth initiative acting as a moderator of this mediation effect. NGNs who exhibited a higher degree of personal growth initiative were more likely to derive benefits from their practice environment and attain positive job outcomes by enhancing their occupational self-efficacy. To boost NGNs' occupational self-efficacy and achieve optimal job outcomes, hospital administrators may not only provide a supportive practice environment for them but also conduct interventions that promote their personal growth initiative. This study was designed to examine the psychosocial factors associated with NGNs' job outcomes. The study was not conducted using suggestions from the patient groups or the public. Our findings indicate that favourable practise contexts may not always benefit the nursing job outcome if NGNs do not exhibit a high level of personal growth initiative and produce increased occupational self-efficacy. Therefore, hospital administrators should consider implementing an intervention to improve the personal growth initiative of NGNs so that they can take full advantage of the practice environment and gain resources at work to create optimal job outcomes.

Managing the Current Workforce: Status of New Graduate Nurse Well-being and Clinical Development 2018-2021.

A structured transition to practice (TTP) program is beneficial to the professional success and retention of new graduate nurses (NGNs). The COVID-19 pandemic impacted clinical preparation and the TTP experience of NGNs. Data from the Versant National Database between 2018 and 2021 were analyzed to determine the current state of NGN well-being and clinical development. Key findings from the analysis indicate that NGNs that are a part of a comprehensive TTP program remain highly committed to their organization, have increased satisfaction working with their colleagues, and indicate low intent to leave their position. However, there are opportunities to address individual rewards and recognition, clinical assignments, morale, feelings of belongingness, and well-being. These findings further support the importance of a nurse residency program as part of an overall workforce strategy and that individual, programmatic, and practice environment outcomes must be longitudinally measured and analyzed to be able to make necessary evidence-based changes to meet the future needs of NGNs and the profession.

Rural transition to practice: A phenomenological analysis of the new graduate nurses’ experience

Objective/Background: The nursing shortage uniquely impacts rural communities as staffing issues often result in emergency department closures and leave communities without adequate healthcare. One contributing factor in this crisis is difficulty recruiting and retaining new graduate nurses (NGN) rurally. Improving transition to practice for NGNs is a potential solution to this problem. This study explores the new graduate nurses’ lived experience when transitioning to rural nursing practice.Methods: A descriptive phenomenological approach was used. Seven participants completed virtual surveys and virtual, semi-structured focus groups exploring the new graduate nurses transition to practice experience, underpinned by Patricia Benner’s From Novice to Expert model. Transcripts were analysed using thematic concept mapping.Results: Three themes were derived across the stages of transition to practice: education, mentorship and both intrinsic and extrinsic expectations on NGNs. Each phase in the first two years of practice had unique characteristics, most significantly, a six-month delay occurs to accommodate acquisition of non-nursing skills, which deviates from Benner’s model.Conclusions: This research emphasizes the importance of supporting NGNs during the first two years of transition to rural practice. The complex role of the rurally practicing registered nurse requires approximately six months more time than what is described in Benner’s model to develop competence. A focus on nursing education that begins at the undergraduate level and continues into practice is required. A shift to focus on supporting the wellbeing of the NGN is a key intervention; as well as improving mentorship and management support through education and policy change.

Discussion Guide for the Rushton Article

Discussion Guide for the Rushton Article