Zealand Nurses Research Articles

What Matters to You? A Qualitative Investigation of Factors That Influence Aotearoa New Zealand Early-Career Nurses to Thrive in the Workplace

Globally, there is a nursing shortage which is expected to worsen in the next two decades. To increase nursing workforce numbers, retention of early-career nurses is vital. One such method stipulated to improve workforce retention is increasing thriving in the workplace. This study aimed to investigate the factors that influence the thriving of early-career nurses in Aotearoa New Zealand. Guided by a qualitative descriptive design, this study used semi-structured interviews to explore factors influencing the thriving of New Zealand nurses from an urban hospital. Data analysis was completed using reflexive thematic analysis. Participants included nine early-career nurses. We identified four themes affecting thriving in the workplace: interpersonal relationships, work environment, finding positive meaning, and ongoing learning and development. Early-career nurses experience multiple factors that increase and decrease thriving. Early-career nurses commonly reported high workloads, which affected multiple dimensions of their ability to thrive in the workplace. Interpersonal relationships can increase or decrease elements of thriving at work depending on the nature of the relationship. Early-career nurses also experienced a large amount of job satisfaction from the act of caring. Roles that promoted ongoing learning similarly increased thriving. Early-career nurses play an important role in the future of the Aotearoa New Zealand health workforce. Results from this study can help inform organisations on the experience of thriving for early-career nurses in order to improve retention and wellbeing of early-career nurses. Te reo Māori translation He Aha ngā Mea Nunui ki a Koe? He tūhura kounga i ngā āhuatanga whakaawe i ngā tapuhi tau tuatahi o Aotearoa kia toiora i te wāhi mahi. Ngā Ariā Matua Tērā tētahi korenga tapuhi puta noa i te ao i ēnei rā, ā, e matapaetia ana ka hē kē atu hei ngā ngahuru tau e rua e tū mai mai. He mea taketake te whakapiki i te maha o ngā kaimahi i te ohu mahi, he mea nui te puritanga o ngā tapuhi tau tuatahi. Tētahi tikanga e pēnei ai te pupuru i te kāhui kaimahi ko te whakapiki i te noho taurikura i te wāhi mahi. I whai tēnei tirohanga kia tūhuratia ngā āhuatanga āki i te noho taurikura o ngā tapuhi tau tuatahi i Aotearoa. I aratakina tēnei tirohanga e tētahi hoahoa whakamārama kounga, ā, i whakamahia ētahi uiuinga i āta whakatāhuhutia i roto, hei tūhura i ngā āhuatanga e āki ana i te noho taurikura o ētahi tapuhi tau tuatahi tokoiwa i tētahi hōhipera tāone nui kotahi. I tātaritia ngā raraunga mā te whakamahi i te tātari tāhuhu huritao. I tautohutia e mātou e whā ngā tāhuhu ka pā ki te noho taurikura i roto i te wāhi mahi: ko ngā hononga tangata, te taiao mahi, te kite i ētahi tikanga whai hua mō te tangata, me te akoranga me te whanaketanga tonutanga. Ka hōkai ēnei tāhuhu i ngā āhuatanga mahi i tautohutia hei mea e piki ai, e heke ai rānei ngā wheako taurikura o ngā tapuhi tau tuatahi. E ai ki ngā tapuhi tau tuatahi, mā ngā hononga i te wāhi mahi ka piki, ka heke rānei ētahi āhuatanga o te noho taurikura i te wāhi mahi, kei te āhua tonu o te hononga. I kōrero rātou mō te taumaha o ngā kawenga i te mahi, i pā ki tō rātou āhei kia noho taurikura i te wāhi mahi. He nui hoki tō rātou koa, nā te mahi taurima i te tangata. Waihoki, nā ngā tūranga whakatairanga i te akoranga mutunga kore i piki ai te toiora. He tino nui te wāhi ki ngā tapuhi tau tuatahi mō ngā tau kei mua o te kāhui kaimahi hauora o Aotearoa. Mā ngā kitenga mai i tēnei rangahau ka te taea ētahi atu whakahaere te whakamōhio mō te wheako nei, o te noho taurikura o ngā tapuhi tau tuatahi, hei whakapiki i te puritanga me te toiora o ngā tapuhi tau tuatahi. Ngā kupu matua te whati o te tuarā, ngā tapuhi tau tuatahi, te harikoa mō te tūranga mahi, te noho taurikura, te rangahau kounga, nga puritanga kāhui kaimahi, te taiao mahi

Factors That Impact Nurses Use of Technology: A Qualitative Study.

The use of technology in nursing has increased, most notably since the Covid-19 pandemic which highlighted benefits of digital health in nursing practice. Understanding the enablers and barriers associated with nurses' use of digital technology is important as these can impact adoption and engagement. To understand the factors that impacted New Zealand nurses' use of technology a national online survey was undertaken in August 2022. Participants (n=191) came from varied clinical settings across the country. Their responses to the open-ended questions were thematically analyzed and are reported here. Four themes were identified: 1) Knowledge of digital technology, 2) connectivity, 3) devices and systems, and 4) training and education. Understanding the factors that impact nurses use of technology can support actions to build the digital competency of nurses, enhance the nursing workforce and therefore benefit patient care.

Supporting Digital Health Integration in a National Curriculum: The New Zealand Experience.

The World Health Organisation considers that digital health can play a vital role in strengthening health systems, including increasing equity in access to health services; however, to realise the benefits of digital health this subject needs to be included in nursing education. In New Zealand the recent establishment of the centralised Te Pūkenga Institute of Skills and Technology allows for the creation of a common unified curriculum for entry to nursing programmes among the community-based tertiary education providers. Expertise to advise on the digital health component of the curriculum was sought from the New Zealand nursing and midwifery informatics group and this group's contribution is reported here. Delays in implementing the new curriculum means that by the end of 2023 no students had yet graduated, and evaluating their success, combined with research into the students' preparedness for working in a digital health environment is recommended.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study.

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. A cross-sectional survey design. An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively. Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health. All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence. We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). No patient or public contribution.

New Zealand Nurses: Caring for Our People 1880 – 1950

Pamela Wood’s New Zealand Nurses: Caring for our People 1880-1950 reveals nursing through the eyes of fierce pioneers of New Zealand nursing. It provides a valuable window on the foundations of professional nursing and is likely to be of interest to nursing scholars and other curious readers. At the same time, however, it is missing the voice of Māori, the tangata whenua of Aotearoa New Zealand. By failing to consider the nursing practices before colonisation, or the impact of colonisation, Wood falls into the trap of colonial nostalgia, focussing on imported systems, rather than on their contextualisation in Aotearoa.

"Recognize nurses for what they are: invaluable"

Appointed Director General of the International Council of Nurses (ICN) in February 2019, Howard Catton is committed to ensuring that the ICN can effectively represent nursing around the world. He firmly believes that nurses must be at the heart of health policy decisions. With a nursing diploma and a master's degree in labor relations, he held a number of nursing positions in England and the United States before joining the New Zealand Nurses Organisation. For ten years, he directed the political and international affairs of the UK's Royal College of Nursing, then led ICN's action during the Covid-19 pandemic, while positioning himself in favor of protecting and investing in the nursing profession.

Support mechanisms that enable emergency nurses to cope with aggression and violence: Perspectives from New Zealand nurses

BackgroundAlthough efforts to reduce aggression and violence in emergency departments are important, it is also critical to minimise harm and support staff where this occurs. This research describes support mechanisms emergency nurses value when they experience occupational aggression and violence. MethodsA mixed-methods design including thematic analysis of six interviews and descriptive analysis of fifty-one surveys, with experienced emergency nurse participants and respondents from a single large urban emergency department. ResultsFour key themes summarised coping with aggression and violence: Minimising exacerbating factors (mental health, lack of understanding of zero tolerance in practice, and wait times); Support before violence (use of huddles and having experienced nurses on each shift); Support during violence (education including restraint, self-defence, de-escalation and legalities); and Support after violence (debriefing, incident reporting and a sense of ‘toughness’) ConclusionEmergency nurses need preparation and support to competently manage complex mental health presentations, understand legal rights, communicate effectively with patients, families and colleagues and access event debriefing. Security staff are valued team members but also need adequate resourcing and preparation.

From Incivility to Turnover Intentions among Nurses: A Multifoci and Self-Determination Perspective

Purpose. We investigate the associations between incivility from multiple sources (i.e., doctors, supervisors, fellow nurses, and patients/visitors) and nurse turnover intentions. We take a self-determination perspective to explore whether psychological needs for autonomy, belongingness, and competence explain the relationship between incivility and turnover intentions. Finally, we examine whether incivility from doctors, supervisors, fellow nurses, and patients/visitors may primarily relate to one of the three basic psychological needs and whether the autonomy need may have the strongest relationship with turnover intentions. Design. A three-wave time-lagged design was used. Each measurement point was separated by one workweek. New Zealand nurses were asked to evaluate their workplace incivility at Time 1, three basic psychological needs at Time 2, and turnover intentions at Time 3. Findings. Supervisor incivility directly related to turnover intentions. The autonomy need was the only significant mechanism underlying the relationships of incivility from doctors, supervisors, and fellow nurses with turnover intentions. In addition, doctor incivility related to the autonomy need, patient/visitor incivility was not significantly related to any psychological needs, and incivility from fellow nurses and supervisors related to psychological needs for belongingness and autonomy. Originality. This study takes a multifoci perspective to examine nurse incivility from multiple sources. The novelty lies in the introduction of self-determination theory to the understanding of workplace incivility. Finally, we turn the spotlight on the importance of examining whether incivility from different sources may be primarily related to different psychological needs and whether the autonomy need plays a key role in turnover intentions.

“New Zealand Nurses: Caring for Our People 1880-1950”: An Interview With Author Pamela Wood

New Zealand nurses: Caring for our people 1880-1950, published in 2022 by Otago University Press, is authored by Pamela Wood, a nurse and historian. This article provides insight into the structure and content of the book, acknowledging its value in recording the history, proactive leadership, and practice of modern nursing as instigated by the British nursing diaspora. The book is carefully researched and engagingly written. It is explicitly limited to ‘modern’ nursing, drawing on written evidence published and archived within the colonial systems. The article draws on a conversation between Wood and Adams, both tauiwi (non-Māori) academics, exploring challenges, innovations, and paradigms of care at a time when colonising processes had already deeply harmed Māori communities. Rural, district, and Plunket nursing evolved with an intent to improve health outcomes, particularly for impoverished and underserved people; nurses practiced autonomously in isolated areas, engaging collaboratively with communities; and nurse leaders were politically active and determined implementers of change. While some stories from Māori nurses have been recorded, the voice and histories of Māori, te ao Māori (Māori worldview), and mātauranga Māori (Māori knowledge) is absent. It is time we redressed this omission, to give effect to Te Tiriti o Waitangi, and rewrote the future of nursing in Aotearoa New Zealand. Te reo Māori translation “New Zealand nurses: Caring for our people 1880-1950”: He uiuinga i te kaituhi i a Pamela Wood Ngā Ariā Matua Ko New Zealand nurses: Caring for our people 1880-1950, tētahi pukapuka i whakaputaina i te tau 2022 e Otago University Press, ā, ko te kaituhi ko Pamela Wood, he tapuhi, he kaituhi tātai kōrero. Tā tēnei tuhinga he hora māramatanga ki te takoto me ngā kai o roto i te pukapuka, e whakamihi nei ki āna hua mō te takutaku i ngā tātai kōrero, i ngā mahi hautū kakama a ōna kaiarataki, me ngā mahi tapuhi o te ao hou, i takea mai i ngā toronga o te ao tapuhi o Peretania ki ao whānui. He mea āta rangahau tēnei pukapuka, he tino pai hoki te āhua o te tuhi. Ahakoa ērā āhuatanga, kua whakawhāititia ki ngā mahi tapuhi ‘o te ao hou’ anake, me te koutu i ngā rangahau, i whakawhatatia hoki i roto i ngā pūnaha o ngā kāwanatanga tāmi whenua o tāwāhi. I takea mai te tuhinga i tētahi kōrerorero i waenga i a Wood rāua ko Adams, nō tauiwi ēnei mātanga rangahau, e tūhura ana i ngā pīkauranga, i ngā auahatanga, me ngā ritenga taurima tangata i te wā kua tino nui ngā wharanga o ngā mahi tāmi iwi ki ngā hapori Māori. I tupu mai ngā mahi tapuhi ā-tuawhenua, ā-takiwā, Plunket hoki i runga i te hiahia kia whakapikia ngā putanga hauora, otirā mō te hunga rawakore, te hunga kua wareware te tino aronga; i mahi ngā tapuhi i ngā rohe pāmamao, i mahi tahi me ngā hapori i runga i te wairua pāhekoheko; ā, i te kaha tonu ngā mahi tōrangapū o ngā tapuhi, he kaha ki te panoni tikanga. Ahakoa kua tuhia ētahi o ngā pūrākau a ngā tapuhi Māori, kei te ngaro te reo me ngā tātai kōrero o te tangata Māori, o te ao Māori me te mātauranga Māori i konei. Kua tae tātou ki te wā hei whakatika i tēnei korenga, kia whakatinanatia Te Tiriti o Waitangi, kia tuhia houtia hoki ngā mahi tapuhi i Aotearoa. Ngā kupu matua: arotake pukapuka, tāmi iwi, tātai kōrero tapuhi, hauora tuawhenua, tiaki toiora ā-whenua

Broken nurses: an interrogation of the impact of the Great War (1914–1918) on the health of New Zealand nurses who served – a cohort comparison study

IntroductionNew Zealand’s initial contribution of 50 nurses to WWI was thought to be sufficient. However, by the time of Armistice Day, at least 550 nurses had served for the New...

Australian and New Zealand Nurses: Social and Emotional Attributes and Work Engagement

The COVID-19 pandemic presented significant job engagement challenges for the nursing workforce with increased pressures and workplace changes. Nursing staff shortages have increased nurse anxiety, burnout, fear, low morale and intentions to leave the profession. Nursing care is inherently stressful and at times complex, with stress often due to work inconsistencies, a lack of role clarity, workloads and time pressures. This study explores nurses job engagement, by looking specifically at nurses social-emotional attributes – Occupational Commitment, Self-efficacy Beliefs, Collective Efficacy Beliefs, Resilience, Adaptability and Emotional Labour. This protocol describes a mixed methods convergent parallel study, incorporating a survey questionnaire. The survey comprised of quantitative and qualitative questions, with data collected simultaneously, analysed separately, and integrated in the final analysis step. The survey design used validated social-emotional items, sorting and ranking questions and short answer responses. Analysis will involve individual and comparative analysis of the two participants groups, they are: Australian nurses ( n = 86) and New Zealand Nurses ( n = 275). Data collection was conducted during two different time periods – Australian pilot (2020-21) and in New Zealand (2022–2023). Recruitment involved the use of professional and personal nursing networks, newsletters and social media communications. Ethics approval was obtained through participating universities in both countries. Results will be disseminated through peer-reviewed publications, conferences, blogs, newsletters and reports to nursing networks. The study will provide valuable insights into nurses’ social-emotional attributes and the role they play in job engagement.

New Zealand Nurses: Caring For Our People 1880–1950 by Pamela Wood (review)

New Zealand Nurses: Caring For Our People 1880–1950 by Pamela Wood (review)

Evaluating an undergraduate nursing student telehealth placement for community-dwelling frail older people during the COVID-19 pandemic.

To evaluate a rapid response student telehealth placement experience implementing interRAI assessments of community-dwelling frail older people during the COVID-19 pandemic. To identify lessons to inform future telehealth clinical placements. New Zealand undertakes assessment of older people with disabilities using the interRAI contact assessment tool for less complex conditions and home care assessment tool for complex needs. New Zealand entered lockdown in March 2020 in response to COVID-19. New Zealand's most vulnerable community members required urgent needs assessment. A clinical placement whereby 3rd year undergraduate nursing students trained by interRAI-NZ educators worked remotely from home delivering telehealth assessment for 'at risk' older people across the Waikato District, New Zealand. This represented the first telehealth experience within an undergraduate nursing program approved by the New Zealand Nursing Council. A case study evaluation utilising mixed method questionnaire and qualitative techniques within an interpretive paradigm. 19 third year students in the fifth semester of a Bachelor of Nursing program and 5 nursing staff members engaged in delivery of the initiative completed pre- and post-placement short answer questionnaires. Reflective diaries were maintained by students on placement. Post-placement interviews and focus group discussions provided in-depth data. COREQ guidelines informed analysis and reporting. Student and tutor responses showed consistent themes: tackling COVID-19; implementation requirements; nursing competencies; provider relationships; and community insights. These provide insight and highlight lessons learnt from this initiative. Student confidence in therapeutic engagement and clinical assessment and interest in aged care was increased, confirming the viability and importance of this inaugural telehealth student placement initiative. Graduate work readiness is enhanced through telehealth placement experience and interRAI assessor training. These are recommended as core components of future nursing education programs.

Are human resource practices the key to managing job burnout in New Zealand nurses? Testing a path model.

To explore if human resource practices are the key to manage job burnout in nurses. To determine if human resource practices provide more meaningful work to nurses, subsequently leading to enhanced work-life balance and lower job burnout (emotional exhaustion and cynicism). Job burnout is a global phenomenon, particularly relevant in the nursing profession due to pressures within the health sector. Job burnout is also a result of nurses not balancing work with their life roles and maintaining meaning in one's work. High-performance systems are tools that hospital human resource departments can use to increase core employee factors that ultimately reduce the risk of job burnout. Using cross-sectional data from 114New Zealand nurses, we tested a path model to distinguish whether human resource practices can influence job burnout, with meaningful work and work-life balance mediating. The data were analysed using structural equation modelling and indirect effects for mediating. This research adhered to the STROBE Statement. Human resource practices are positively related to meaningful work and work-life balance, and meaningful work was positively related to work-life balance and negatively related to cynicism. Finally, work-life balance is negatively related to emotional exhaustion and cynicism. Given the influence of human resource practices on job burnout is fully mediated by meaningful work and work-life balance, indicating that managing job burnout is best understood via human resource practices enhancing nurses meaning from work and role balance, which subsequently reduces job burnout. Human resource practices can enhance work factors, such as meaningful work and work-life balance, that can enable nurses to have reduced job burnout. This will help prevent cynicism, exhaustion and will therefore prevent absenteeism, enhance performance and overall aid long-term employment benefitting not only patients but hospitals.

General well-being of intensive care nurses: A prototype analysis.

Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses. To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized. Prototype analysis. Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. Sixty-five New Zealand nurses participated. For study 1 (n=23), the most frequently reported elements of well-being included physical health (n=26), work-life balance (n=20), and personal relationships (n=18). For study 2 (n=25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r= 0.33, P< .005). For study 3 (n=17), confirmatory analyses did not reach statistical significance (P= .15). Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being. Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

Workplace bullying, psychological hardiness, and accidents and injuries in nursing: A moderated mediation model.

Workplace bullying are prevalent among the nursing workforce. Consequences of workplace bullying include psychological stress and workplace accidents and injuries. Psychological hardiness is proposed as a buffer for workplace bullying and psychological stress on workplace accidents and injuries. This study adopted the Affective Events Theory and Conservation of Resources Theory to develop and test a moderated mediated model in two field studies. Study 1 (N = 286, Australian nurses) found support for the direct negative effect of workplace bullying on workplace accidents and injuries with psychological stress acting as the mediator. The mediation findings from Study 1 were replicated in Study 2 (N = 201, New Zealand nurses). In addition, Study 2 supplemented Study 1 by providing empirical support for using psychological hardiness as the buffer for the association between psychological stress and workplace accidents and injuries. This study offers theoretical and empirical insights into the research and practice on psychological hardiness for improving the psychological well-being of employees who faced workplace mistreatments.

Aotearoa New Zealand nurses and national health policy: Navigating a new professional space [Editorial].

Aotearoa New Zealand nurses and national health policy: Navigating a new professional space [Editorial].

New Zealand emergency nurses knowledge about forensic science and its application to practice

IntroductionViolence is a major public health problem worldwide. Emergency nurses are often in a unique position to identify, assess, evaluate, and treat these patients, but there is limited forensic knowledge and skills to enable emergency nurses to feel confident to guide their practice in New Zealand. The purpose of this study was to establish the level of forensic knowledge and skills currently known and used by nurses in clinical practice working in New Zealand District Health Boards (DHB)’s emergency departments. The study aimed to develop a tertiary education course based on the needs and the knowledge required, to enable nurses to practice confidently and safely with Forensic patients in the emergency department setting. MethodsA descriptive approach using online questionnaires including both quantitative and qualitative components was sent to all emergency departments in New Zealand DHB’s as well as the New Zealand Nurses Organisation (NZNO) emergency nurses’ section. Open-ended questions were analysed by thematic analysis. Closed questions were analysed by SPSS version 15 data analysis software (SPSS Inc, Chicago, IL). Themes identified focused on the knowledge and skills emergency nurses currently possess and the level of specialist education required to ensure patients receive the best medicolegal care. ResultsResults of the questionnaire revealed limited knowledge in being able to correctly identify all forensic patients, insufficient knowledge around evidence preservation and collection and limited knowledge around legislation or legal processes governing clinical care were discovered. However, 84% of all participants felt that having forensic knowledge was important for their practice, indicating a need for increased forensic education. Practice implications indicate that forensic education is warranted, needed and desired among ED nurses within the clinical setting. DiscussionAs forensic patients generally require emergency medical attention, it is important that nurses as part of the front-line first responders have forensic knowledge around preservation and collection of evidence during the provision of medical care. It was found that, emergency nurses do not have enough knowledge around forensic issues indicating that forensic education is warranted, needed and desired among ED nurses within the clinical setting. The study also provides support for the implementation of tertiary forensic science nursing postgraduate study in New Zealand.

Moral distress revisited: the viewpoints and responses of nurses.

To present and discuss the main themes that were revealed following an analysis of the qualitative research findings that were extracted from a national survey regarding the causes and effects of moral distress amongst New Zealand nurses. Moral distress continues to be a major concern amongst nurses around the world. In New Zealand, a country where nurses have just been on strike over their working conditions and the deteriorating state of their roles within the health services, it remains a major issue. In the original research project, large numbers of nurses supplied not only quantitative data that revealed the extent and impact of moral distress on their practices, but also extensive notes that more specifically explained the causes and effects of their moral distress. This material has since been thematically analysed and is now presented. The data strongly suggested that New Zealand nurses experienced and attempted to respond to several major issues; that is, they were not properly supported by 'the system', frequently experienced problems with managers and bullying, witnessing poor care practices and collegial incompetence, and suffered from ongoing problems caused by moral residue. Under current working conditions, nurses are struggling under an increasing weight of moral residue to maintain their ethical standards within an increasingly difficult ethical climate. This research suggests that although nurses clearly seek out and use various ways to cope with moral distress in their practices, there is a continuing need for moral courage and strengthening of moral resilience that involves greater input from not just nurses themselves, but nurse managers, educators and other health services representatives.

Exploring case based clinical learning in graduate-entry nursing

&#x0D; &#x0D; &#x0D; The Master of Nursing Science (MNSc) has been developed as a Graduate Entry to Nursing (GEN) programme. It is an accelerated, intensive two-year degree involving the completion of 1100 clinical practice hours to meet New Zealand Nursing Council registration requirements, together with achieving a level of critical thinking that will support excellence in clinical practice. GEN programmes are well known to attract diverse, motivated graduates often with successful careers that want a change of direction (Stacey, Pollock &amp; Crawford, 2016; Pellico, Terrill, White &amp; Rico, 2012).&#x0D; In 2019 the MNSc was in its first iteration, therefore the three lecturers involved had scope to consider the design and delivery of the learning to best support student understanding and engagement. Together with institutional teaching and learning development mentors we brainstormed different approaches to teaching and learning. There is dearth of evidence regarding the development of clinical reasoning and critical thinking for post-graduate nursing students in Australasia. The aim was to develop teaching approaches that encouraged students to engage with the content and foster the development of critical thinking and clinical reasoning. Meyers and Nulty’s (2009) adoption of Biggs (2003) 3P Model of learning and teaching influenced the development of content across multiple discrete units of study. An evolving case study approach supported with podcasts was developed. The first evolving case study focused on a client with a rural New Zealand address and health status common to his age group and life experience. The podcasts aligned with the weekly development of the case. International content experts participated in topics as varied the management of analgesia, history of consent, and assisted dying and others.&#x0D; To iteratively explore and understand the effectiveness of this teaching approach the authors concurrently undertook research. Informed by educational design research (EDR) methodology we explore the process of constructing an authentic learning experience for students. Educational design research (EDR) evolved from design-based research and is recognised as being practical and eminently suitable to explore a small teaching and learning project (Jetinikoff, 2015; McKenney &amp; Reeves, 2018). The aims of this research were to 1) explore and describe the process of constructing an authentic learning experience enabled by technology; and 2) understand and reflect on student learning using an evolving case-study with podcasted content. The research team is currently undertaking the reflection, adaption, and evaluation stage of the EDR methodology. The results of this and the theory stage will be resented at SoTEL. In this presentation, the analysis of the teaching teams’ reflections will be explored. Key to our discussion with the audience will be sharing our reflections and in turn seeking their advice to explore how to engage students in technology enhanced delivery in a fast-paced course.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;