Factors influencing the practice of new graduate nurses: A focused ethnography of acute care settings

Abstract

Aim To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency‐based undergraduate programme. Background In the last 15 years, nursing education has shifted to competency‐based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment. Design A focused ethnography of three acute care units from one academic hospital in Canada. Methods Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and nurse managers (n = 4). Data were collected through individual interviews, focus groups, observation and documentation. Data were analysed according to Roper and Shapira (Ethnography in nursing research. Thousand Oaks, CA: Sage Publications, 2000) ethnographic nursing analysis framework. Results Organisational and individual factors were identified as influencing NGNs’ competency deployment. Organisational factors are orientation, stability, workload and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognise nursing expertise. Conclusion One way to smooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies. Relevance to clinical practice Organisational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies.

‘Young saplings on fire’ newly graduated nurses in the COVID‐19 pandemic: A qualitative study

“…Frequent rotations may negatively affect their adaptation process (Innes & Calleja, 2018 ). Charette et al ( 2019 ) have found that a relatively stable clinic placement or shift change positively affects professional collaboration, clinical judgement and clinical leadership in newly graduated nurses (Charette et al, 2019 ). Garcia‐Martin et al ( 2021 ) reported that even senior nurses have difficulty adapting to another unit and feel unfamiliar with their practices, team dynamics and use of PPE and thus could not adjust (Garcia‐Martin et al, 2021 ).…”

“…They reported both the positive effects of nurse managers who encourage, comfort and support them and the negative effects of nurse managers who ignore them, do not listen to them, judge them and do not ask about their wishes. Studies emphasize the importance of nurse managers in the adaptation of newly graduated nurses (Charette et al, 2019 ). Participants should strengthen their identification with their leaders and organizations to facilitate their professional adaptation (Fallatah et al, 2017 ; Garcia‐Martin et al, 2021 ).…”

“…Garcia‐Martin et al ( 2021 ) have determined that the nurses mentioned a lack of orientation during the COVID‐19 pandemic (Garcia‐Martin et al, 2021 ). Orientation programmes, which are constantly changed and developed to reflect the needs of newly graduated nurses, affect their adaptation process and use of their existing competencies (Charette et al, 2019 ). Studies recommend that all newly graduated nurses be subjected to orientation programmes that include strong educational preparation and transition support, regardless of their age and previous work and career experience (Hawkins et al, 2019a ).…”

Newly Qualified Nurses’ Perception of Their Competency Achievement on Leaving University: A Qualitative Study

“…Williams et al [36] highlight the fact that nursing education providers need to ensure that students are effectively and safely prepared to respond to critical care challenges competently. On the other hand, Charette et al [37] expose a crucial fact influencing the deployment of competencies of NQN working in ICUs, which is the “orientation programme” prior to being hired. It consists of theoretical classes and 19 days of preceptorship orientation on a unit.…”

Orientation of the Registered Nurse to the Perinatal Setting

“…Nurse managers should provide structure; set expectations for the unit; and are responsible for managing human and financial resources, ensuring patient and staff satisfaction, maintaining a safe environment, ensuring standards and quality of care, and aligning unit goals with hospital strategic plans (Agency for Healthcare Research and Quality, 2012). Nurse preceptors, educators, and clinical nurse specialists should facilitate integration into the team by acknowledging that the nurse orientee has theoretical knowledge and some practical experience but is not an expert and is not expected to perform at the expert level (Charette et al, 2019).…”