Purpose: This study focuses on employer perceptions of new graduate nurse (NGN, as defined by less than 12 months of experience) readiness for independent practice given limited access to clinical rotations.
Background/significance: The definition of competence in nursing practice is ambiguous, with scarce appreciation of the thought processes and executive cognitive function required for competent practice (Levine & Johnson, 2014). In the complex and dynamic health care climate, acute care nurses voice growing concern regarding that the preparation and competence of health care professionals and their ability to autonomously provide high-quality patient care (Bennett, Grimsley, Grimsley, & Jodd, 2017; Edward, Ousey, Playle, Giandinoto, 2017). Conversely, health care employers need nurses that can demonstrate the competencies needed to work with interprofessional teams in various settings (NACNEP, 2010). There has not been much research reported on the employer’s perception of NGN preparation for autonomous practice given limited availability of clinical rotations.
Methods/design: Mixed methods (quant > qual) research design. For the quantitative portion, the researchers obtained permission to use a minimally modified version of the Casey-Fink Graduate Nurse Experience Tool (Casey & Fink, 2008). Participants (n=97) were recruited on the Magnet learning community website and email distribution lists. Upon completion, the results were assessed using the mean score for four survey domains and indicated perceptions of NGN comfort and confidence in performing nursing skills. As the survey was anonymous, consent for this portion was obtained using applied consent indicated in the survey. The aggregated data was assessed for potential themes, which informed the semi-structured interviews for the qualitative portion. A virtual interview was conducted with volunteer participants (n=11) recruited using the same website and distribution lists. Informed consent was obtained before the interview and retained in a file folder on the password-protected computer with the survey data.
The interview lasted approximately one hour, discussing the results of the quantitative portion and their perceptions of NGN readiness for practice surrounding the themes identified. Following the interview, the recording was transcribed verbatim and sent to the participants for validation. No names or identifying information were recorded in the transcription, and the transcript was stored on a password-protected device.
Data were analyzed by the descriptive phenomenology method of inquiry using bracketing, analyzing, intuiting, and describing (Kumar, 2012). The data was rigorously assessed using Colaizzi’s process for phenomenological data analysis examining the interviews (Creswell, 2009).
Results: Employer’s perceptions indicated that NGNs might some essential competencies for independent practice, such as clinical problem-solving, communication, documentation, prioritization, and delegation. Although NGNs have developed professional identity, academic learning techniques did not prepare NGNs for practice. The nursing skills that NGNs struggles with included code response, ECG/telemetry monitoring and interpretation, IV insertion, tracheostomy care, and giving verbal reports.
Conclusions/implications: This study adds to the growing body of evidence that calls for transforming nursing education. Although transition-to-practice programs assist NGNs in developing competence, changes to nursing curriculums are needed. More study is needed to guide the changes to nursing education.