New Graduate Nurses' Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife.

AIMS: To determine what extent are workplace empowerment, New Graduate Nurses' (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences? BACKGROUND: NGNs' perceptions of nursing leaderships' control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined. DESIGN: Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs' co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered. RESULTS: First, NGNs' perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs' perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs' perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs' perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled. CONCLUSIONS: NGNs' perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses.

AIM: To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses. DESIGN: Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model. DATA SOURCES: (2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar. REVIEW METHODS: (a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model. RESULTS: Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research. CONCLUSION: The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours. IMPACT: New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

Gamification in nursing literature: an integrative review.

OBJECTIVE: Gamification is an increasingly popular instructional strategy in nursing. The purpose of this integrative review is to explore gamification as it has been applied in nursing literature. This integrative review seeks to ask the question - What aspects of gamification have been explored in nursing literature and what aspects require further exploration? METHOD: Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Methodological Issues in Nursing Research, 52(5), 546-553 integrative review framework guided this review. Seventeen articles were reviewed and a quality appraisal tool (developed by Hawker, S., Payne, S., Kerr, C., Hardey, M., & Powell, J. (2002). Appraising the evidence: Reviewing disparate data systematically. Qualitative Health Research, 12(9), 1284-1299) was also used to evaluate the articles. RESULTS: Following the data analysis stage outlined in Whittemore and Knafl's integrative review framework, six themes emerged: construct conceptualization; relationship between engagement, satisfaction, and knowledge retention; knowledge translation, motivation, role of technology, and gamification elements. CONCLUSION: Gamification is of interest to the nursing profession. More study is needed to better ascertain the relationship between gamification and several of the main themes identified in this review.

Including administrators in curricular redesign: How the academic-practice relationship can bridge the practice-theory gap.

AIM: Health care administrators provided information through semi-structured interviews as to how one faculty of nursing (FoN) was preparing students for practice. BACKGROUND: There is a long-standing disconnect between the nursing education and the clinical arena known as the theory-practice gap. The FoN wanted to redevelop their curriculum to better prepare students for practice and bridge the gap. METHOD: Using developmental evaluation, 36 administrators were interviewed and asked about their expectations of newly graduated nurses, the FoN curriculum, and changes to be made. RESULTS: Four themes were identified: entry to programme; curricular content, delivery and structure; clinical recommendations; and stronger relationships. CONCLUSION: Strong academic-practice partnerships are still needed. The current lack of communication and partnership has compromised students' quality of education and their transition into the workforce. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders in both the education and practice settings can better prepare newly graduated nurses and bridge the theory-practice gap by co-creating a joint committee and creating more touchpoints with one another. A joint committee can develop appropriate entry-to-programme guidelines, discuss relevant trends in practice and shape the curriculum. Clinical experiences for students may also act as extra touchpoints whereby the two groups can discuss clinical mentorship needs and build stronger academic-practice relationships.

Participatory Action Research and Photovoice: Applicability, Relevance, and Process in Nursing Education Research.

ABSTRACT: Participatory action research (PAR) is a philosophy and approach to qualitative research. The purpose of this article is to generate a clearer understanding of PAR and its relevance to the discipline and profession of nursing. The authors provide a description of the principles and process of implementing PAR methodology, using photovoice as an innovative, participant-directed data collection method in rural nursing preceptorship. Participants were undergraduate nursing students and faculty advisors assigned to rural communities during the final clinical preceptorship. Participants described opportunities and challenges experienced during the preceptorship and how these experiences influenced their learning and overall preceptorship experience.

Crisis and continuity: Rural health care students respond to the COVID-19 outbreak.

The COVID-19 outbreak in Winter (2020) has caused widespread disruption for health sciences students undergoing clinical placements-vital periods of experiential learning that cannot be substituted with distance alternatives. For students placed in rural areas, already coping with isolation, precarious supply chains and shortages of essential personnel, the effects of the COVID-19 outbreak may have far-reaching implications for psychosocial wellness, self-efficacy and clinical judgment. Four nursing and eight medical students (n = 12) supplied photographs and commentary documenting the experience of withdrawing suddenly from clinical sites in rural Alberta. Collaborative, thematic analysis revealed continuities between pre- and post-outbreak life, both for the students and their rural hosts. Social determinants of health such as seclusion, environmental hazards, and health-seeking behaviors carried over and compounded the effects of the outbreak on the placement communities and clinical sites. Other continuities included the reliance on technology for clinical and social connectivity, and capitalizing on natural settings to cope with isolation and confinement. Prolonged liminality, lack of closure, and the loss of team identity were the greatest stressors brought on by the suspension of clinical activities. However, the participants felt well equipped to deal with these circumstances through the resilience, adaptability, and community ethos acquired during their placements.

'We have to drive everywhere': rural nurses and their precepted students.

INTRODUCTION: Travel safety culture is a vital aspect of nursing in rural western Canada, where long distances and severe weather are commonplace. However, this culture is poorly understood owing to the absence of official policy, and the tendency of rural nurses to take travel risks and burdens in stride, rather than advocating for change. Travel risks and burdens include extreme weather events such as tornadoes and blizzards; unmarked routes and hazards; distance, time and expense; and driver fatigue. In such rural settings, the safety and health of visitors, novices and students are of particular concern. The researchers sought to elicit the tacit knowledge of rural registered nurses, and their students undertaking rural nursing preceptorships, pertaining to rural travel issues and best practices for safety and wellbeing. METHODS: Through purposive and snowball sampling, the researchers recruited seven senior nursing students and five nurse preceptors. Seven rural acute and community care sites, between 42 km and 416 km distant from the students' primary place of study, were covered by the study. Photovoice, a participant action modality, was employed to collect photographic and qualitative interview data from participants over 10 weeks, between February and April 2016. The data were analyzed thematically, in collaboration with participants, who in turn validated the results. A digital storytelling initiative was attempted, to further involve participants in dissemination of findings, but only one participant took part in this phase of the project. RESULTS: The central finding of the study was that nursing students learn to accept and manage limitations - and to recognize and capitalize on opportunities - when undertaking rural preceptorships. With regard to road safety, the students were found to be particularly vulnerable to long distances, hazardous conditions, fuel and cellular data expenses, and fatigue. These issues were compounded by the students' reluctance to speak up, or to miss shifts, when they felt unsafe or unwell. Their preceptors role modeled autonomy and community ethos as the foundations of a frontline, extemporaneous road safety culture. This entailed personal safety measures borne from rural experience and background, familiarity with the countryside, and community connectedness with other healthcare sites in place of any official public alert system. The preceptors furthermore benefited from strong union protection for occupational health and safety concerns, but students being taught in rural settings had no such advantage. CONCLUSIONS: Nursing students should have the same occupational health and safety protections as their rural preceptors, especially the right to refuse travel, without penalty, in unsafe circumstances. Better travel subsidies and road safety measures during rural preceptorship may help increase the likelihood of students considering a rural career path. Furthermore, the frontline, community-based road safety experience of rural nurses is an untapped source of information for educators and policymakers. Such information will become more and more vital as a diminishing number of rural nurses are called upon to care for an aging client base.

Community Spirit, Cultural Connections, and Authentic Learning in Rural Preceptorship.

BACKGROUND: An authentic learning environment fosters socialization of nursing students to a particular community context and unique culture of the individuals who reside in that culture. The final preceptorship provides an extended clinical practice experience allowing for this immersion, while providing consolidation of learning as preparation to enter practice. METHOD: PhotoVoice was used as an innovative data collection method to engage participants throughout the research process. Participants self-selected photographic images that represented the unique rural preceptorship experience through their eyes. RESULTS: Rurality was described by participants as more than a geographic location, but as a sense of place, or a way of being and doing, that represented rural life. Rurality was depicted more specifically by participants in terms of community spirit and cultural contexts. CONCLUSION: Rural practice placements have the potential to enrich undergraduate nursing education and to expose undergraduate nursing students to the role of the rural nurse. More research is needed about rural health to understand the cultural and contextual factors that uniquely affect the health status of rural Canadians. [J Nurs Educ. 2019;58(3):144-151.].

Socializing for Authentic Caring Engagement in Nursing Practice: Nursing Student Moral Development in Preceptorship.

BACKGROUND: The purpose of this study was to explore the basic psychosocial process of undergraduate nursing student moral development in clinical preceptorship. METHOD: A grounded theory approach was used to explore the process within the context of clinical practice and the student-preceptor-faculty member relationship. RESULTS: Socializing for authentic caring engagement in nursing practice emerged from the data as the basic psychosocial process of nursing student moral development in preceptorship. This process included four key categories: (a) distinguishing nursing and moral identity in practice, (b) learning to recognize the patient's experience, (c) identifying moral issues in practice and creating meaning of practice encounters, and (d) becoming an advocate and reconciling moral issues in practice. CONCLUSION: Findings emerging from this study illustrate the processes of how nursing students work through moral issues and the role of faculty and preceptors in engaging students with moral encounters in the context of preceptorship.

Student-faculty relationships and its impact on academic outcomes.

OBJECTIVE: The aim of this review of the literature is to synthesis the knowledge attained about determinants of student-faculty relationships and its impact on student outcomes. While adding to the body knowledge, the researchers discuss the importance, barriers, and facilitators to student-faculty academic relationships in nursing education. DESIGN: We conducted a narrative literature review using a modified version of the framework of the Population, Intervention, Comparison, and Outcome method to develop the research question for this review. That question was: What determinants of undergraduate nursing students' relationships with faculty affect those students' academic outcomes? DATA SOURCES: To search and review the literature systematically, we entered the specific criteria into the EBSCOhost interface. The following databases were used for data sourcing: Cumulative Index to Nursing and Allied Health Literature Plus with Full Text; Teacher Reference Center; Education Resources Information Center; Medline; and Theses and Dissertations. We selected only full-text, peer-reviewed sources that were written in English for final inclusion. REVIEW METHODS: After the retrieval of 56 reports via an EBSCO host search, abstracts were reviewed and 29 were rejected based on the exclusion/inclusion criteria. The rejected reports met some or no criteria and not others; or showed little to no association with determinants of nursing student-faculty academic relationships or students' academic outcomes. An inductive method of analysis was used to review and extract emerging themes. RESULTS: Findings revealed four core determinants of student-faculty relationships: support, caring, diversity, and incivility. These determinants were interrelated and appeared to have an impact on student academic outcomes. CONCLUSIONS: Nursing institutions should be proactive to ensure that barriers such as incivility are reduced and that diversity is included and appreciated in the teaching and learning environment. Additionally, a caring and supportive climate of learning should be emphasized and enacted by nurse educators.

Work engagement in professional nursing practice: A systematic review.

BACKGROUND: Work engagement in professional nursing practice is critically important to consider when addressing key challenges of health systems, including the global nursing shortage, pressures to reduce health care spending, and increasing demands for quality care and positive outcomes for patients. However, research on work engagement in professional nursing practice has not yet been synthesized and therefore, does not provide a sufficient foundation of knowledge to guide practice and further research. OBJECTIVES: The overall aim of this systematic review is to determine what is currently known about the antecedents and outcomes of work engagement in professional nursing practice. DESIGN: Systematic review. DATA SOURCES: The search strategy included eight electronic databases: CINAHL, MEDLINE, PsycINFO, PROQUEST, SCOPUS, Web of Science, EMBASE, and Business Source Complete. The search was conducted in October 2013. Quantitative and qualitative research that examined relationships between work engagement and antecedent or outcome factors was included. REVIEW METHODS: Quality assessment, data extractions, and analysis were completed on all included studies. Data extracted from included studies were synthesized through descriptive and narrative synthesis. Content analysis was used to categorize factors into themes and categories. RESULTS: 3621 titles and abstracts were screened and yielded 113 manuscripts for full text review. Full text review resulted in 18 included studies. All factors examined were grouped into either influences or outcomes of work engagement. A total of 77 influencing factors were categorized into 6 themes: organizational climate, job resources, professional resources, personal resources, job demands, and demographic variables. A total of 17 outcomes of work engagement were categorized into 3 themes: performance and care outcomes, professional outcomes, and personal outcomes. Based on the results, we adapted the Job Demands-Resources (JD-R) model and developed the Nursing Job Demands-Resources (NJD-R) model for work engagement in professional nursing practice, which reflects key adaptations related to organizational climate and professional resources. CONCLUSIONS: Our findings indicate that a wide range of antecedents, at multiple levels, are related to registered nurses' work engagement. Positive outcomes of work engagement are valuable to both performance and the individual nurse. The NJD-R model offers nursing science a valuable beginning framework to understand the current evidence, further direct nursing research, and begin to guide practice and policy. The results offer opportunities for nurse leaders to promote work engagement in professional nurses through action on organizational level resources.

Preceptorship and the Nurse Practitioner Student: Navigating the Liminal Space.

BACKGROUND: The purpose of this study was to explore the process occurring in preceptorship to prepare nurse practitioner students for their future role in professional practice. The researchers examined this process through the eyes of the preceptors, nurse practitioner students, and faculty. METHOD: A grounded theory method was used to explore the process involved in preceptorship to prepare nurse practitioner students in the clinical setting. RESULTS: The process of navigating the liminal space emerged from the data to explain what actually was occurring throughout the nurse practitioner student preceptorship. This process was reflected on three levels: (a) positioning in preceptorship, (b) repositioning on the threshold of nurse practitioner, and (c) embracing the new nurse practitioner role. CONCLUSION: As the data emerged, the researchers uncovered a multidimensional process that was occurring in preceptorship. This process was identified as navigating the liminal space.

Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession.

BACKGROUND: The Canadian Nurses Association (CNA) estimates a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. Further compounding this crisis is the approximate 14-61% of new nursing graduates who will change nursing roles or exit the profession. AIM: To explore the factors and basic psychosocial process involved in the decisions of newly graduated registered nurses in Western Canada who permanently exit the nursing profession within five years. DESIGN: Data was collected through unstructured and semi-structured interviews using the Glaserian grounded theory method. FINDINGS: Participants were found to be in a process of letting go of nursing that commenced as students and continued as they entered practice as registered nurses. Four major themes were identified. 1) Navigating constraints of the healthcare system and workplace: participants encountered difficulties adjusting to shiftwork and workload. 2) Negotiating social relationships, hierarchies, and troublesome behaviors; specifically hierarchal and horizontal violence. 3) Facing fears, traumas and challenges. 4) Weighing competing rewards and tensions which resulted in leaving the nursing profession. CONCLUSION: Students and subsequently new nursing graduates require a variety of supports to establish a nursing identity and remain in the profession. These supports include a manageable workload; meaningful orientation; interprofessional teamwork; and engagement within transformational and authentic leadership constructs. New nurses require a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as constructive feedback, emotional support and debriefing to face workplace challenges.

Intergenerational conflict in nursing preceptorship.

BACKGROUND: Within the preceptorship model of clinical teaching/learning, the creation of a cohesive relationship between a preceptor and a nursing student highly influences the overall success of the experience. Invariably, preceptors and students tend to be of different generations and as such, there exists within this context the potential for generational misunderstandings and conflict. DESIGN: A phenomenological study guided by van Manen's approach to human science research was conducted. OBJECTIVE: The aim of this study is to explore the phenomenon of preceptorship in the intergenerational context. PARTICIPANTS: A purposive sample of seven preceptors and seven nursing students was recruited from an undergraduate nursing program. FINDINGS: The collective experience of all participants was illuminated through three key themes: being affirmed, being challenged, and being on a pedagogical journey. In this article we focus on encountering conflict, a key subtheme of being challenged, and one that emerged from the participants' narratives. CONCLUSIONS: The study findings suggest that interpersonal conflict continues to be a reality in our profession, owing to which a collective effort must be made by nurse educators, practicing nurses, and nursing students to effect change and create a more cohesive culture. The findings have the potential to enhance generational understanding and foster a more cohesive culture in clinical practice settings.

Nursing preceptorship experiences in rural settings: "I would work here for free".

AIMS: The primary aim was to capture the experience of preceptorship in a rural setting, via photographic narrative. It is hoped that this narrative will highlight areas that require greater support; communicate the experience of rural preceptorship for students, educators and policymakers; and emphasize the benefits of this experience for these current and future stakeholders. METHODS: In a photovoice study, preceptors (n = 4) and students (n = 4) in rural, Western Canadian health care settings were given digital cameras and asked to provide images and commentary about the experience of preceptorship. Participants selected the photographs to be included as data, and participated in thematic data analysis, through facilitated group discussions during and following the preceptorships. FINDINGS: This article explores the category of teaching and learning, encompassing three themes: confidence, conscientiousness, and mutual growth. Preceptors emphasized the importance of students bringing sufficient knowledge to the rural preceptorship, pertaining not only to the nature of care but also to the predominant health care issues in the community. IMPLICATIONS: The implications were generated in part by the participants, who indicated a need for more student practica in rural settings; curricular changes to incorporate knowledge about rural health care and communities; post-graduation rural mentorship programs; and site/community-specific preparation.

Generational clashpoints in nursing preceptorship.

The success of the preceptorship approach to teaching-learning depends on the formation of positive working relationships. Preceptors and nursing students are frequently of different generations and often have differing world-views. A phenomenological study, guided by van Manen's approach, was conducted to develop an understanding of how generational differences influence the formation of the preceptor-student relationship and the overall success of the experience. Three main themes were revealed: being affirmed, being challenged, and being on a pedagogical journey. A key subtheme of being challenged was colliding generational worldviews; in this article, our purpose is to explore this particular subtheme. The data suggest that generational clashpoints are occurring during preceptorship experiences, and the implications of these are serious, particularly from a nursing recruitment and retention perspective. It is vital that proactive measures be taken to inspire the future generation of nurses, rather than stifling their spirit and assertiveness.

Putting the evidence into preceptor preparation.

The term evidence-based practice refers to the utilization of knowledge derived from research. Nursing practice, however, is not limited to clinical practice but also encompasses nursing education. It is, therefore, equally important that teaching preparation is derived from evidence also. The purpose of this study was to examine whether an evidence-based approach to preceptor preparation influenced preceptors in a assuming that role. A qualitative method using semistructured interviews was used to collect data. A total of 29 preceptors were interviewed. Constant comparative analysis facilitated examination of the data. Findings indicate that preceptors were afforded an opportunity to participate in a preparatory process that was engaging, enriching, and critically reflective/reflexive. This study has generated empirical evidence that can (a) contribute substantively to effective preceptor preparation, (b) promote best teaching practices in the clinical setting, and (c) enhance the preceptorship experience for nursing students.

Preceptorship and affirmation in the intergenerational world of nursing practice.

Research has shown that while preceptorship offers a reality-oriented learning environment and facilitates competence of students, there are inherent rewards and stressors associated with the experience. Students and preceptors can be from different generations, and as such, they may often come to the learning space with differing values and expectations. The nature of the preceptorship experience in this intergenerational context was explored in a recent phenomenological study with seven preceptors and seven nursing students in an undergraduate nursing program in Eastern Canada. Overall the experience was found to be inclusive of three main themes: being affirmed, being challenged, and being on a pedagogical journey. In this paper we explore the first of these themes, being affirmed. Highlighting the positive aspects of the preceptorship experience in the intergenerational context is necessary to promote a culture of openness and respect for generational differences within clinical nursing practice settings and to improving the overall quality of the educational experience.

A phenomenological perspective on preceptorship in the intergenerational context.

Pairing a student with an experienced nurse through preceptorship is an approach to teaching/learning that promotes critical thinking, cultivates practical wisdom, and facilitates competence. Frequently, nursing students are of a different generation than their assigned preceptors and differences in worldviews and expectations can impact upon the success of preceptorship. A phenomenological study, guided by van Manen's approach to human science research, was conducted to explore preceptorship within this intergenerational context. Data were generated using unstructured interviews with a purposive sample of seven preceptors and seven students recruited from an undergraduate nursing program. The findings reveal three main themes: being affirmed, being challenged, and being on a pedagogical journey. The findings of this study have the potential to enhance generational understanding in the pedagogical context and foster a teaching/learning culture in the clinical practice setting inclusive of divergent generational expectations.