Abstract: This thesis examines Pacific women's experiences of becoming a nurse and their first year of practice post-registration, within the New Zealand context. The participants' stories of being students and beginning practitioners are inter-woven with the author's own reflections as a nurse and nurse educator who also claims a Pacific cultural heritage. To create the space in which the stories can be laid down, the thesis includes a description of the migration and settlement of Pacific peoples in Aotearoa/New Zealand. This description shows how Pacific people have been systematically stigmatised and locked into marginalised positions by mainstream dominant culture. The thesis deconstructs, what the author describes as, taken-for-granted and self perpetuating conceptualisations of marginality that currently underpin most theoretical explanations and proposes a reconstructed map of marginality. This deconstructed/reconstructed map of marginality is used as a template through which the experiences of the participants are filtered and interpreted. Radical Hermeneutics provides a philosophical underpinning for this project that has as one of its objectives the desire to resist reducing complexity to simplistic explanation and superficial solutions. The thesis challenges nursing to examine its role in reproducing the hegemonic power of dominant culture by applying unexamined cultural normative values that create binary boundaries between 'them' and 'us'. At the same time the thesis challenges Pacific people to move past hegemonically induced states of alienation and learn how to walk in multiple worlds with confidence and power.

Abstract: The function and implementation of clinical supervision in the practice setting presents a number of challenges for new graduate programmes for registered comprehensive nurses. There have been numerous reports and papers promoting its benefits as important and providing the impetus for change. Clinical supervision has been well established as part of social work, counselling, psychotherapy and psychoanalytic practice, and in mental health nursing and midwifery. Its utilisation for graduate nurses is clearly important and should be seen as integral to professional practice. This study evaluated a programme of clinical supervision as a component of a new graduate nurse programme in a secondary health care practice environment. The clinical supervision component aimed to support graduate registered nurses' transition from the role of student nurse to staff nurse in the context of professional clinical practice. This report is also intended to inform the ongoing provision of clinical supervision at Hutt Valley District Health Board. The evaluation process was guided by the work of Owen (1990) and used utilisation focussed evaluation as the framework on which to undertake the evaluation. A mix of quantitative and qualitative methodology was used to collect and analyse the data. Data were collected from nurse graduates of the new graduate programme using a postal questionnaire that covered three areas; clinical supervision, the Hutt Valley District Health Board new graduate programme and an evaluation of stakeholder roles. Twelve of the new graduates responded to the survey. Findings suggest clinical supervision provided professional support and assisted the new graduate in the identification of education needs. Difficulties associated with accessing the structured component of the new graduate programme and clinical supervision were highlighted. The recommendations made to Hutt Valley District Health Board to improve the programme include considering accessibility, consumer rights, acceptability, a comprehensive approach, the Treaty of Waitangi, efficiency and a coordinated approach.

Abstract: This research seeks to determine an evidence basis for selecting content for the clinical skills curriculum in an undergraduate programme. Thirty-three senior nurse clinicians from medical-surgical areas in 2 large hospitals offering student placements were asked to rate the frequency of performance of 77 skills for the beginning registered nurse. Those skills frequently used and rated over 65% were considers for inclusion in the undergraduate programme. Clinicians were asked to list the 10 most important skills and related level of competence expected from the newly-registered nurse.

Abstract: Use of health assessment skills is undeniably part of everyday nursing practice, guiding nursing decisions and a part of facilitating patient outcomes. Undergraduate nursing education in New Zealand includes the use of health assessment skills within the context of nursing practice. The registered nurse working in their first year of practice is required to use effective assessment skills to identify potential risks to a patient's health, while learning to adjust to the many other demands of practice, but little research has explored these experiences. The purpose of this research study was to describe the experience of using health assessment skills within the first year of practice as a registered nurse. Using a qualitative descriptive method, informed by phenomenology, interviews were conducted with six newly graduated registered nurses working within a New Zealand setting. Findings of this study revealed that graduates endeavour to incorporate the skills of health assessment taught at undergraduate level into their practice. Six main themes of health assessment philosophy; tuning in; mobilising health assessment skills; recognition; anxiety; and identification and facilitation of outcomes can be aligned with Benner's (1984) model of skill acquisition. The author suggests that these research findings are useful to inform nursing education, clinical practice and further research. An awareness of these graduate experiences provides opportunities for nurses in both clinical practice and education to facilitate and support graduate nurses' of health assessment within their nursing practice.

Abstract: The aims of this study were to determine the prevalence of horizontal violence, or bullying, experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence. An anonymous survey was mailed to 1169 nurses in New Zealand who had registered in the year prior to November 2000 with a response rate of 47%. Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour.

Abstract: The transition from student to registered nurse is a challenging and often stressful time in a nurse's career. This thesis is a case study research project that explores the graduate nurses' perceptions of preceptorship as a strategy to support this transition at Lakes District Health Board (DHB). As a provider of graduate nurse programmes since 1995, Lakes DHB has provided preceptorship for the nurse in the initial period of clinical practice. Annual evaluation by questionnaire identified that this has been applied in a range of ways in different clinical settings with varying degrees of effectiveness. Further inquiry into graduate nurses' perceptions of the preceptored experience during the first twelve weeks of practice within Lakes DHB forms the basis of this research project. The intention is to utilise this insight to further inform the development of preceptor education programmes and application of the preceptor role in the practice setting. Using the case study research method, data has been collected from fourteen participants using semi-structured interviews, focus groups and secondary data from the previous year's questionnaire undertaken by preceptors and graduate nurses. Thematic analysis of the data has resulted in two categories, each with three associated themes. The first category relates to functional factors in the way the preceptorship role is applied. This explores the role of the Clinical Nurse Educator (CNE), organisation within the unit and the teaching of clinical skills. The second category relates to psychosocial considerations and includes the graduate's sense of being scared and advocacy of the preceptor, socialisation and team support, and the preceptor's own experience as a registered nurse. Recommendations from the research include the allocation of a dedicated preceptor selected with consideration for relational ability; complementary rostering and workload allocation to ensure that the preceptor and graduate nurse work together; early notification when preceptor arrangements break down; implementation of a clinical coaching plan; and strengthening the CNE's role as a leader facilitating and supporting preceptorship in the units. Opportunities for further research that arise from the study include the perceptions of the preceptors and the nursing leadership in clinical areas. Structuring the application of preceptorship, to ensure that all of these aspects are woven throughout the graduate nurse's transition results in Korowai Aroha, a cloak of covering for a supported transition that facilitates the development of practice.

Abstract: This pilot descriptive study examines and measures the characteristics of preceptors of new graduate registered nurses undertaking the Nurse Entry to Practice Programme in an acute hospital in New Zealand. Thirty-three new graduate registered nurses at the five month stage of the programme completed a questionnaire pertaining to the characteristics of their preceptors. The questionnaires were adapted from the Ferrans and Powers (1998) Quality of Life Questionnaire. The adapted questionnaires were designed to measure the importance, satisfaction and overall quality of the preceptor's characteristics as perceived by the new graduate registered nurse, using a Likert Scale. Literature both international and national was examined to gain an understanding of the importance of the characteristics in question, in relation to the new graduate registered nurse preceptee experience. Descriptive data revealed the importance of characteristics as perceived by the new graduate nurse preceptee, and how satisfied the new graduate nurse was with their particular preceptor's characteristics. The results identified that the majority of new graduates were satisfied with the characteristics of their preceptor but there was evidence of negative discrepancies between the mean importance and satisfaction scores. The range of data between the scores of the overall quality of the preceptor uncovered areas where the quality of preceptorship was unsatisfactory as perceived by the new graduate nurse. The discrepancies in the data were examined and recommendations made for additional research, regarding selection and evaluation of preceptors of the new graduate registered nurse within the hospital environment.

Abstract: This report presents a longitudinal research study which evaluated the effectiveness of the twelve months New Graduate Orientation Programme introduced at Capital Coast District Health Board's Wellington Hospital in March 1998. The programme was implemented to assist new nursing graduate's transition into the role of registered nurse. The evaluation project took place over a three-year period. Three annual intakes of new graduates enrolled in the New Graduate Orientation Programme were surveyed by questionnaire on their completion of the programme.