Multiple factors exist that compound the nursing shortage phenomenon. Statistics report that the combination of nurses retiring and leaving bedside positions contributes to the vacancy of 195,000 nurses yearly through 2030 (Bureau of Labor Statistics, U.S. Department of Labor, 2021). The projected demand for critical care specialty nurses is greater than the supply of adequately trained nurses. As of 2021, the average turnover rate of acute care nurses reached 18.7%, with as much as 24% of new graduate nurses (NGNs) leaving within the first year of hire (NSI Nursing Solutions, Inc. [NSI], 2021). Southwest General Hospital’s (SWGH) current hiring practices do not include hiring NGNs directly to the intensive care unit (ICU). The hospital continues to struggle to recruit and retain critical care nurses. Will implementing a new graduate nurse NGN (P) critical-care internship and residency program at SWGH (I) help integrate NGNs to improve ICU recruitment and retention rates (O) compared to no critical-care nurse internship and residency program (C) during a 6-8-week timeframe (T)?
Article #1
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DeGrande, H., Liu, F., Greene, P., & Stankus, J.-A. (2018). The experiences of new graduate nurses hired and retained in adult intensive care units. Intensive and Critical Care Nursing, 49, 72–78. https://doi.org/10.1016/j.iccn.2018.08.005
Purpose
The study explored the experiences of new graduate registered nurses NGNs hired in adult ICUs who survived their transition from novice to competent. The research sought to explore the experiences and professional growth of NGNs hired into adult ICUs post-graduation. The study evaluated NGNs’ learning experiences, thoughts, feelings, perceptions, interpersonal relationships, and contextual factors of becoming an ICU nurse.
Research Method
The study used a qualitative hermeneutic phenomenology design that utilized Brenner’s novice to expert theory to examine the context of the NGNs’ experience over time.
Participants
Participants were recruited via a purposive snowball sampling of nurses hired into adult ICUs as NGRNs between December 2016 and July 2017. A total of eleven nurses, seven males and four females, from different types of ICUs, were selected for participation.
Data Collection Methods
One-on-one open-ended interviews were conducted via virtual meetings or in-person. Interview questions and guides focused on gathering information about participants’ experiences of becoming competent nurses.
Study Findings
The authors discussed the overall meaning of the experience of becoming a competent adult ICU nurse in adjusting to being comfortable with being uncomfortable. Common themes related to this phenomenon included confidence and uncertainty, gaining experiences and forever learning, intuition and intuitive knowing, difficulties and stress, courage and assertiveness, and the team and support persons. Regarding confidence and uncertainty, nurses who had initially felt well prepared to work in acute care settings reported experiencing reality shock and uncertainty when presented with life-threatening conditions. The participants’ reports of gaining experiences and forever learning added value and additional knowledge supporting Brenner’s novice to competent continuum. The participants described having developed intuitive knowing and intuition through experiences managing acute clinical situations. NGN participants described having had stress and difficulty while becoming competent. The participants who overcame the transition displayed the personality traits of courage and assertiveness and had natural coping methods for stress. Participating nurses reported having good collaboration and teamwork from support personnel that enabled them to endure the transition from NGN to competent critical care nurse.
Limitations of the Study
The researchers acknowledged that the study’s limitations reflected poor transferability of findings due to the participants’ small, mostly homogenous sample size.
Relevance to Practice Issue and/or Proposed Intervention
While this qualitative study did not examine the functions of an NGN critical care internship program per se, it identified strategies and factors that enable a successful transition for an NGN.
Article #2
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Özkaya Sağlam, B., Sözeri Eser, İ., Ayvaz, S., Çağı, N., Mert, H., & Küçükgüçlü, Ö. (2021). Intensive care experiences of intern nurse students: A qualitative study. Nurse Education Today, 107, 105098. https://doi.org/10.1016/j.nedt.2021.105098
Purpose
Researchers sought to define senior nursing students’ clinical experience of their critical care internship within a Turkish university ICU.
Research Method
The research was conducted using a descriptive qualitative method using focus group interviews to understand and define individual perspectives and lived experiences.
Participants
Participants were obtained using the purposeful sampling method targeting first-semester nursing intern students with no previous ICU experience. Thirty-one nursing students were included in the study between January 2018 and April 2019.
Data Collection Methods
Twenty-five participants were gathered into four focus groups of six to seven student nurses. Semi-structured interview processes and open-ended questions evaluated the student nurses’ experience during their ICU internships. The researchers analyzed the data using Braun and Clark’s (2006) thematic content analysis.
Study Findings
The predominant themes gathered from the participants’ interviews were fear, acknowledgment of nursing roles, self-improvement opportunities, caregiving difficulties, difficulties communicating with patients and the care team, and ambivalent feelings related to death and clinical environment adaptation. The student interns’ most fundamental experience was feeling fear related to acute care of patients in a complex ICU environment and not having adequate knowledge to care for critically ill patients. The researchers concluded that the student interns had positive experiences, gained confidence pursuing an ICU NGN position upon graduation, and felt empowered to continue self-improvement efforts.
Limitations of the Study
The small sample size of nurses from only one university in Turkey limited the transferability of the research. Data analysis findings cannot be generalized to other nursing students in Turkey.
Relevance to Practice Issue and/or Proposed Intervention
The resulting themes identified in this study are relevant to the consideration and design of NGN internship and residency programs. Providing adequate guidance through mentorship and preceptorship to NGNs during their ICU orientation ensures NGNs’ successful and positive transition to professional practice.
Article #3
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Van Patten, R. R., & Bartone, A. S. (2019). The impact of mentorship, preceptors, and debriefing on the quality of program experiences. Nurse Education in Practice, 35, 63–68. https://doi.org/10.1016/j.nepr.2019.01.007
Purpose
This study aimed to identify factors that enhance positive nurse residency experiences. Researchers developed questions to examine the direct effects of positive preceptor relationships and the moderating effects of decreased stress due to supportive preceptor experiences. The following questions guided the focus of the research: 1. Is there a significant relationship between higher preceptor ratings and higher residency ratings? 2. Is there a significant relationship between higher debriefing ratings and higher residency ratings? 3. Does decrease stress due to mentorship moderate the relationship between preceptor ratings and residency ratings? 4. Does decreased stress due to mentorship moderate the relationship between debriefing ratings and residency ratings?
Research Method
Researchers utilized a descriptive quantitative cross-sectional survey design using secondary analysis of original data from participating institutions to answer the proposed study questions. The study examined the use of a residency program with mentors, preceptors, and debriefing sessions to determine if the program supported an NGN’s transition to a competent nurse with lower stress levels.
Participants
The study participants included a convenience sample of 1078 NGNs who completed a Versant RN Residency Program deployed at various U.S. hospitals.
Data Collection Methods
The study used two surveys to collect data on the participating NGNs during the residency program. The Demographic Information Survey was conducted during the second week of the program, and the Evaluation of RN Residency Survey was completed during the final week of the program. The residency survey instrument includes 52 questions that had a Likert-type format for general information and open, and closed-ended inquiries solely focused on nurse residency, preceptors, mentoring, and debriefing topics.
Study Findings
The relationship between nurse residency experiences and participant demographics was not statistically significant. The two independent variables included debriefing experiences and preceptor experiences, and the moderating variable was reduced stress due to mentoring. The results indicated that the nurses had positive residency experiences with preceptorship and debriefing processes. Multiple linear regression models showed a significant relationship between higher nurse preceptorship and debriefing experiences and greater residency experience levels. Additional linear regression models indicated the moderating effect of reduced stress due to mentoring on the relationship between preceptorship and debriefing statistically relevant. However, the results showed no statistical relevance between the moderating effects of reduced stress on the relationship between preceptorship or debriefing experiences and the ratings of the nurse residency.
Limitations of the Study
The main limitation of this study was the restricted parameters related to using only the Versant RN Residency program curriculum. Data was only collected at one point in time, limiting the inference of cause-and-effect variables. Researchers also mentioned that participants might have response bias when answering survey questions because there had not been a variation in the scores—additional limitations related to using only one instrumental survey questionnaire.
Relevance to Practice Issue and/or Proposed Intervention
This study is relevant to the practice issue because it identified components of a nurse residency program that had enhanced the transition to professional practice experiences of NGNs. The inclusion of mentors, preceptors, resources nurses, and debriefing sessions in RN residency programs supports NGNs in gaining confidence, strengthening clinical skills, and providing professional development opportunities. This research provided evidence that adequate support for the NGN’s transition to critical care practice is vital for the recruitment and retention of nurses beyond their first year of employment at SWGH.
Article #4
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Yao, X., Yu, L., Shen, Y., Kang, Z., & Wang, X. (2021). The role of self-efficacy in mediating between professional identity and self-reported competence among nursing students in the internship period: A quantitative study. Nurse Education in Practice, 57, 103252. https://doi.org/10.1016/j.nepr.2021.103252
Purpose
This study explored the relationships between nursing students’ self-efficacy, professional identity, and competence variables. The research sought to investigate the the phenomenon of student nurses’ competence, professional identity, and self-efficacy during their internship experience, identify the relationship between the variables, and explore if self-efficacy affects the association between student nurses’ professional identity and competence.
Research Method
The research was completed using a descriptive quantitative cross-sectional survey of nursing students during their internship period between October 2020 and December 2020 in mainland China.
Participants
Convenience and snowball sampling was used to recruit a cross-sectional sample of 887 full-time nursing students during their internship periods with a four-year undergraduate or three-year associate degree program at university-affiliated Chinese hospitals.
Data Collection Methods
Time, funding, and Covid-19 pandemic restrictions influenced the restructuring of data collection methods using an electronic questionnaire platform called ‘Wenjuanxing,’ the Chinese equivalent of SurveyMonkey. Eight hundred and eighty-seven of 895 questionnaires collected were used for the final analysis. The researchers used Likert scales included in the Nursing Students Competence Instrument (NSCI) to measure the students’ responses and the Professional Identify Questionnaire for Nursing Students (PIQNS) to measure student nurses’ professional identity
Study Findings
The statistics showed there was no significant correlation between career choice and autonomy. The researchers surmised this finding was due to student nurses’ perception of a lack of independence when being supervised during the internship. Additionally, because the students could not change their clinical schedule or choose departments, the researchers were not surprised when finding no significant correlation between competence and career choice and autonomy in professional identity. The results did reflect that the more self-efficacy and professional identity a student nurse had the more significant evidence of competency existed. Regarding the mediating effects of self-efficacy on professional identity and competence, statistics show a direct impact of professional identity on competence at 48% and an indirect impact of professional identity on self-efficacy at 52%. Results highlighted that professional identity and self-efficacy improvement measures enhanced student nurses’ competence.
Limitations of the Study
The researchers acknowledge that using convenience sampling resulted in selection bias. The researchers cautioned against generalizing results to other nursing students because there are many internship requirements and nursing programs that vary for every country. The measurement of competence relied on self-reports which usually differ from in-person observations. The cross-sectional design study lacked verifiability as it did not allow for examining changes to the variable over time.
Relevance to Practice Issue and/or Proposed Intervention
The findings of this research study emphasize the importance of cultivating a student nurse’s professional identity and self-efficacy for improving nursing competencies. Despite the study findings reflecting nursing internship students, the results provide evidence that is vital to the success of an NGN critical care internship or residency program.
Article #5
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Zhang, Y., Huang, X., Xu, S., Xu, C., Feng, X., & Jin, J. (2019). Can a one-on-one mentorship program reduce the turnover rate of new graduate nurses in china? A longitudinal study. Nurse Education in Practice, 40, 102616. https://doi.org/10.1016/j.nepr.2019.08.010
Purpose
Researchers cannot readily duplicate studies examining the influence of NGN mentorship on decreasing NGN turnover rates because the strategies used in residency or mentoring programs vary depending on the facility, culture, or clinical setting. Additionally, researchers rarely analyze the turnover rates of NGNs after exposure to a residency program. Therefore, this study aimed to examine the trends in NGNs turnover rates and address research gaps related to NGN residency programs using the following questions: What is the trend in the turnover rates of new graduate nurses within three years of their first job in China? To what extent is a one-on-one mentorship program better than a basic preceptorship in decreasing the turnover rate over time?
Research Method
A three-year longitudinal non-randomized control quantitative research method was used for this study.
Participants
Participants included NGNs recruited to the research hospital in Hangzhou, China, in August 2013 and 2014. The nurses considered for the study were required to have had a bachelor’s degree, passed registration exams, and had no previous work experience. The 199 NGNs recruited in 2013 were assigned to the control group who received the basic preceptorship. The 239 nurses recruited in 2014 were designated as the experimental group exposed to the implemented one-on-one mentorship program.
Data Collection Methods
The researcher collected demographic data on all the NGNs at the date of hire, and the observation time began at employment and ended when a nurse left the job, or the study concluded. The researchers compiled an electronic spreadsheet of the NGNs that the human resources and nursing departments could update. A researcher was assigned to track the list of nurses who resigned every month and calculate the number of days each nurse stayed in their positions. Each group of NGNs was followed for three years, and the turnover rates of each were calculated separately. The annual turnover rate was quantified by the number of nurses who resigned during one year divided by the total number of nurses at the start of the year. A matching method was used to appropriately match study participants to maximize the study execution and minimize interrupting variables.
Study Findings
A total of 66 nurses (33.17%) in the control group left their job during the three years of the study, while 35 nurses (14.64%) in the experimental group left. The 1-, 2- and 3-year turnover rates for the experimental group were 3.77%, 3.48%, and 8.11% compared to 14.07%, 9.36%, and 14.19% for the control group, respectively. For the matched pairs, the 1-year turnover rate of new graduate nurses in the experimental group was significantly lower than that of the control group (p < 0.05), while the 2- and 3-year rates were not significantly different between the two groups (p > 0.05; Zhang et al., 2019, p. 4). The study results showed that the mentorship program decreased the nurse turnover rates compared to the basic preceptorship program.
Limitations of the Study
The generalizability of the research results is compromised due to the use of a non-randomized control study. Additional restrictions included using samples from different timeframes and isolating the study in a single organization.
Relevance to Practice Issue and/or Proposed Intervention
This longitudinal study provided essential evidence that supports how an exclusive mentorship program is more beneficial for NGN retention than a traditional preceptorship orientation. The evidence of this research can also support proposal efforts in favor of implementing an NGN critical care internship that could provide a return on organizational investments.
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