Good clinical support transforms the experience of new graduates and promotes quality care: A qualitative study.

AIM: To explore the clinical support experiences of new graduate nurses' (NGNs) and how these experiences influenced their learning, job satisfaction and skill development during their new graduate transition. BACKGROUND: As supervising NGNs is different to other groups, nurse managers must be aware of NGNs' unique needs to successfully transition to practice. Clinical support is crucial, but little is known about what is effective in supporting the learning and development of clinical capability in this critical period. METHODS: Using a qualitative exploratory design, semi-structured interviews were conducted with NGNs working in a tertiary level teaching hospital in Sydney, Australia. Nurses were interviewed upon completing their 12-month transitional support programme (TSP) in late 2013-2014. Data were thematically analysed. RESULTS: Twenty-six NGNs were interviewed. Three major themes identified were as follows: (a) clinical support facilitates learning; (b) conditions required for good clinical support; (c) transforming me. CONCLUSION: Themes identified specific supportive strategies, including informal and formal clinical support to nurture confidence, competence, professional growth and increase satisfaction of NGNs. IMPLICATIONS FOR NURSING MANAGEMENT: Findings describe essential clinical support practices for fostering successful NGN transition.

Clinical supervision and ward orientation predict new graduate nurses' intention to work in critical care: Findings from a prospective observational study.

INTRODUCTION: Clinical supervision and transitional support programs are important in supporting the successful transition and retention of new graduate nurses and their intention to work in specialty settings. However, little is known about which elements of support programs influence this intention. This study aimed to examine new graduate nurses' perceptions of clinical supervision and the practice environment, and how these influenced their intention to stay in critical and non-critical care areas following their transitional support program. METHODS: Between May 2012 and August 2013, new graduate nurses (n = 87) were surveyed towards the end of their 12-month transitional support program. In addition to demographic and ward details, participants completed the Manchester Clinical Supervision Scale (MCSS) and the Practice Environment Scale Australia (PES-AUS). The 'Intention to Stay in a Clinical Specialty' survey was used to measure new graduate nurses' intention to remain working in their current ward or unit. RESULTS: Predictors of new graduate nurses' intention to stay in their current ward/unit were not having to practise beyond personal clinical capability (AOR: 4.215, 95% CI: 1.099-16.167) and working in a critical care specialty (AOR: 6.530, 95% CI: 1.911-22.314). Further analysis of those nurses who indicated an intention to remain in critical care revealed that high satisfaction with clinical supervision (AOR: 3.861, 95% CI: 1.320-11.293) and high satisfaction with unit orientation (AOR: 3.629, 95% CI: 1.236-10.659) were significant predictors. CONCLUSION: While this study identified that new graduates who worked within their scope of practice were more likely to report their intention to remain in their current ward, new graduates assigned to critical care were six times more likely to indicate their intention to remain than new graduates in other wards/units. Ensuring new graduate nurses assigned to critical care areas receive good unit orientation and clinical supervision increases their intention to remain in this setting.

New graduate nurses' experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support.

BACKGROUND: Given the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is known about how change in new graduate nurses' satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses' perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences. METHODS: Using a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses' working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8-10 weeks) and follow-up (10-12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single -item measures were used to rate new graduate nurses' confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees. RESULTS: Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses' satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6, p = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629). Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence. CONCLUSIONS: While transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses' experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses' and promote confidence and competence to practice within their scope.

Predictors of new graduate nurses' satisfaction with their transitional support programme.

AIM: To examine the influence of new graduate nurses' (NGNs) personal and situational factors on their satisfaction with the practice environment. BACKGROUND: Transitional support programmes are widely used to provide professional support for NGNs' transitioning-to-practice. However, little is known about whether personal characteristics and situational factors influence NGNs' satisfaction with the practice environment. METHODS: This was a cross-sectional survey. NGNs were surveyed approximately 8 weeks after commencement of the support programme. In addition to socio-demographic and situational data, two validated, standardised instruments were administered: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS). RESULTS: A total of 109 NGNs completed the survey. Three independent and significant predictors of NGNs' satisfaction were: (1) unit satisfaction (standardised beta, ß = 0.41); (2) satisfaction with the clinical supervision (ß = 0.31); and (3) assigned unit: critical-care areas (ß = -0.17), explaining 32.5% of the variance. Conclusion This study demonstrates the importance of clinical supervision and unit level support on satisfaction, and the need for additional support for NGNs assigned to critical-care areas. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study suggest there are modifiable situational factors that influence NGNs' satisfaction with the practice environment, and allocating NGNs to critical-care areas on their first rotation should be avoided.