Nurse leader agency: Creating an environment conducive to support for graduate nurses

Abstract

Aim:The aim of the study was to gain insight on how nurse leaders manage a culture of safety for graduate nurses.Background: Current theoretical approaches to safety culture tend towards a checklist approach that focuses on institutional characteristics, failing to examine the quality of interpersonal relationships. These interpersonal interactions are often seen as separate from the institutional realities of resource allocation, nurse-patient ratios, patient acuity or throughput. A theoretical approach is required to illuminate the dialectic between the structure of an organisation and the agency created by nurse leaders to promote patient safety.Design: Qualitative exploratory descriptive study.Methods: Semi-structured interviews were undertaken with 24 nurse leaders from hospital and aged care settings. Thematic analysis and Giddens structuration theory was used to describe the findings.Results: Nurse leaders identified a range of reciprocal communicative and cultural norms and values, decision-making processes, personal nursing philosophies, strategies and operational procedures to foster patient safety and mentor graduate nurses.The mentoring of graduate nurses included fostering critical thinking, building and affirming formal structural practices such as handover, teamwork, medication protocols and care plans. Conclusions:The study provides insight into how nurse leaders foster a culture of safety. Emphasis is placed on how agency in nurse leaders creates an environment conducive to learning and support for graduate nurses.Implications for Nursing Management: Nurse leadership functions and decisionmaking capacity hinges on multiple factors including practicing agency and aspects of the social structure such as the rules for safe communication, and the various institutional protocols. Nurse leaders enforce these forms of engagement and practice

Individual and environmental factors that influence longevity of newcomers to nursing and midwifery: a scoping review

“…While this review focused on the factors influencing newcomer RNs, it is important that nurses who support graduates are provided with opportunities to develop the skills necessary to influence newcomers’ experience. Nurse managers are vital in this transition, 82 with newcomers more likely to remain in the profession when they work in areas with “good” managers who adopt authentic leadership styles 39 . Similarly, the allocation of empathic mentors and preceptors to support newcomers can positively influence their transition to the workforce and retention in the profession 13 .…”

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

“…It is well known about the direct influence of practice environment on nursing job outcomes, for example, favourable practice environment is associated with reduced job stress and turnover intention, as well as increased job satisfaction and quality of patient care (Dilig‐Ruiz et al, 2018; Lee & Scott, 2018; McDermid et al, 2020). Although researchers have emphasized the significance of providing a conducive practice environment for NGN (Ma et al, 2021; Sahay et al, 2022), little is known about the intervening variables that explain how practice environment affects the job outcomes of this population. In addition, researchers typically viewed the practice environment as a structural resource, ignoring its interplay with personal and occupational resources in determining job outcomes.…”