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Turner, R. S. (2007). Preceptorship in nursing: Preceptors' and preceptees' experiences of working in partnership. Ph.D. thesis, , .
Abstract: This research is about preceptorship in nursing. There is considerable emphasis placed on health care organisations to support newly appointed graduate nurses, and preceptorship is a recommended model. Despite this emphasis, the author suggests that little is known about how preceptorship partnerships work in practice. The primary focus of this exploratory descriptive qualitative study was to explore the perspectives that preceptors and preceptees, who had worked in partnership, had about how they established and sustained their respective roles. Three sets of registered nurses who had recently completed a preceptorship experience were interviewed about their partnership. Content and thematic analysis of this descriptive data revealed four main themes. The preceptorship relationship grows out of respect for each another and develops as a result of honest and open communication. Preceptees who have an initial positive experience into their new work area settle quickly and efficiently into their new role. Preceptees appreciate preceptors who are welcoming, supportive and willing to undertake the role, while preceptors are happy to undertake the role if the graduate displays an interest in learning and are willing to be guided. The preceptee learns what it means to be a registered nurse in the particular working context, while the preceptor learns how to support learning processes and evidence-based practices. The author goes on to say that further exploration and investigation of these themes and of the relationships that evolve during preceptorship partnerships is needed. By understanding these findings, organisations can prepare both the preceptor and preceptee as they begin to undertake their role to ensure future partnerships will be successful.
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Southwick, M. (2001). Pacific women's stories of becoming a nurse in New Zealand: A radical hermeneutic reconstruction of marginality. Ph.D. thesis, , .
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.
Keywords: Pacific peoples; New graduate nurses
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Roud, D., Giddings, D. L. S., & Koziol-McLain, J. (2005). A longitudinal survey of nurses' self-reported performance during an entry-to-practice programme. Nursing Praxis in New Zealand, 21(2), 37–46.
Abstract: The researchers conducted a study to compare self-reported changes in both frequency and quality of performance of nursing behaviours in a cohort of recently graduated nurses undertaking a one year entry to practice programme. Thirty-three nurses were surveyed, seven weeks after beginning the programme and again seven months later, using a modified version of Schwirian's (1978) Six-Dimension Scale of Nursing Performance (6-DSNP). Over the study period participants reported significant increases in frequency of performance for the domains of leadership, critical care, teaching/collaboration, and planning/evaluation. Significant increases in the quality of nurse behaviours in the domains of critical care, planning/evaluation and interpersonal relations/communication were also reported. The modified Schwirian 6-DSNP was found to be a useful instrument for measuring nurses' self reporting of performance during periods of transition.
Keywords: New graduate nurses; Methodology; Professional competence; Training
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Magrath, K. L. (2005). From chrysalis to butterfly: Transition experiences of new graduates in primary health care nursing practice in New Zealand. Ph.D. thesis, , .
Abstract: Primary health care is a dynamic and ever-changing area of practice which has undergone many changes in the last ten years. Traditionally, primary health care was not a routine choice for new graduate nurses as they were encouraged to work in a hospital setting before seeking a position in the community. Bachelor of Nursing programmes emphasise primary health care practice and increasingly nurses and their employers are moving away from the traditional belief of 'doing your time in the hospital' before contemplating the move to primary health care. Currently in New Zealand increasing numbers of graduates from Bachelor of Nursing programmes want to begin their working life as registered nurses in this area. A constructivist approach was taken to explore the experience of five nurses who entered primary health care practice as new graduates. Participants were interviewed using a semi-structured format. They constructed their experience as role transition and identified a number of significant factors which had impacted on their practice. These factors included both the personal and practice challenges they experienced and the strategies they used to address them. Further research findings were a transition time of one year, the importance of both formal and informal support, planned orientation and opportunities for reflection. A number of mediating factors including new graduate programmes, peer support and mentorship were also discussed. Key implications for practice, education, employers and future research regarding transition to primary health care for new graduates are discussed. This research emphasised the importance of appropriate resources and support for new graduates from Bachelor of Nursing programmes. These factors are suggested as integral to the development of new graduates' practice in primary health care and reduction of the challenges inherent in this transition.
Keywords: Primary health care; New graduate nurses; Mentoring
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Kwai, K. (2004). The value of a programme of clinical supervision for graduate nurses: An evaluative study. Ph.D. thesis, , .
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.
Keywords: Clinical supervision; New graduate nurses; Mentoring
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Stewart, L. (2004). Stories from Pacific Island nurses: Why do Pacific Island Bachelor of Nursing students not return to their own countries after being scholarship recipients? Ph.D. thesis, , .
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Walker, J., & Bailey, S. (1999). The clinical performance of new degree graduates. Nursing Praxis in New Zealand, 14(2), 31–42.
Abstract: This study aimed to identify how graduates perceived their clinical performance during their first year of practice. A convenience sample of 30 graduates was surveyed after 3 months and 7 months in practice, using an adapted form of a questionnaire devised by Ryan and Hodson (1992). The results showed that over time, graduates generally required less direction in all areas of clinical competence. After 7 months in practice, the majority of the graduates rated their performance in nursing skills, communication skills, and professionalism at the expected level or above. However, some still required direction with using theory and research in practice, with meeting client's psychosocial needs and with teaching clients. In the leadership competency, after 7 months, most graduates saw themselves functioning at the expected level related to client care and needed less direction in unit management skills. However, many of the unit management skills were rated as 'not applicable' indicating that new graduates are not initially placed in a management role. Implications for nursing education and limitations of the research are discussed.
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Holloway, K. T. (1999). Developing an evidence base for teaching nursing practice skills in an undergraduate nursing program. Nursing Praxis in New Zealand, 14(1), 22–32.
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.
Keywords: Nursing; Education; Curriculum; New graduate nurses; Evaluation
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McKenna, B., Poole, S., Smith, N. A., Coverdale, J., & Gale, C. (2003). A survey of threats and violent behaviour by patients against registered nurses in their first year of practice (Vol. 12).
Abstract: For this study, an anonymous survey was sent to registered nurses in their first year of practice. From the 1169 survey instruments that were distributed, 551 were returned completed (a response rate of 47%). The most common inappropriate behaviour by patients involved verbal threats, verbal sexual harassment, and physical intimidation. There were 22 incidents of assault requiring medical intervention and 21 incidents of participants being stalked by patients. Male graduates and younger nurses were especially vulnerable. Mental health was the service area most at risk. A most distressing incident was described by 123 (22%) of respondents. The level of distress caused by the incident was rated by 68 of the 123 respondents (55%) as moderate or severe. Only half of those who described a most distressing event indicated they had some undergraduate training in protecting against assault or in managing potentially violent incidents. After registration, 45 (37%) indicated they had received such training. The findings of this study indicate priorities for effective prevention programmes.
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Clarke, R. (2006). New graduate nurse experiences of using health assessment skills in practice: A descriptive qualitative study. Ph.D. thesis, , .
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.
Keywords: New graduate nurses; Clinical assessment
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Rydon, S. E., Rolleston, A., & Mackie, J. (2008). Graduates and initial employment. Nurse Education Today, 28(5), 610–619.
Abstract: This research project was undertaken to inform nurse educators in the Department of Nursing and Health Studies of Manukau Institute of Technology of the employment opportunities for new graduate nurses emerging from the three year degree and registration programme. Graduates from the programme for the previous three years were surveyed for their experiences in gaining employment. 89.8% of graduates were successful in gaining employment in the first three months post registration. The number of graduates employed within a district health board declined across the three years but there were no significant differences between cohorts. Overall, 73% of graduates were employed into new graduate positions. The majority of graduates felt that their nursing education prepared them well for their role as a registered nurse. The findings of the qualitative data identified a strong need for science throughout the degree; longer clinical blocks; increased hands on experience; more practice with skills and less theory in relation to practical experience.
Keywords: New graduate nurses; Curriculum; Work
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McKenna, B., Smith, N. A., Poole, S., & Coverdale, J. (2003). Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), 90–96.
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.
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McGirr, S. (2007). New graduate nurses clinical decision making: A methodological challenge. Ph.D. thesis, , .
Abstract: New graduate nurses, particularly in the first year of clinical practice, face challenges with making clinical decisions about patient care. A review of the literature revealed no studies that reported using fundamental qualitative descriptive methodology to investigate new graduate nurses' clinical decision making. Aspects of decision making by new graduates have been studied using observational and interview methods, the findings from which have been interpreted using various theoretical decision making models. There has been little research outside of the context of critical care or intensive care units, but anecdotal reports in 2006 from the New Zealand Nursing Entry to Practice Programme (NetP) coordinators network suggest that new graduates are seldom employed in critical care or intensive care units in New Zealand. Nursing educators involved in undergraduate nurse training and NetP programmes need to understand how new graduates perceive, experience and manage decision making in clinical practice, in order to assist them to develop and refine those skills. There is a need for studies utilising fundamental qualitative descriptive methodology in order to explore the experiences of new graduates' decision making in clinical practice. The author notes that the topic is particularly relevant in light of the introduction of the national NetP programmes framework in New Zealand, and to her role as a NetP programme coordinator. This dissertation examines the relevant literature about decision making by new graduates and the research methods that were used, and concludes that fundamental qualitative descriptive method is a highly appropriate method by which to study new graduates' decision making.
Keywords: New graduate nurses; Clinical decision making; Methodology
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Atherfold, C. (2008). Will someone walk with me? A case study exploration of graduate nurses' perceptions of the preceptored experience. Ph.D. thesis, , .
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.
Keywords: Preceptorship; New graduate nurses
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McDonald, S., Willis, G., Fourie, W., & Hedgecock, B. (2007). Graduate nurses and their experience of postgraduate education within a Graduate Nurse programme (Vol. (Monograph Series 2/2007)). Manukau: Manukau Institute of Technology.
Abstract: The authors note that the literature identifies that the transition from tertiary based training to the realities of industry expectations can be a stressful period for graduates. Various District Health Boards offer postgraduate papers within their graduate nursing programmes, resulting in graduates being expected to perform the role of a beginning practitioner as well as embark on postgraduate education during this first year. As yet, the authors note, there is little evidence available to substantiate the efficacy and impact of such papers. The purpose of this study was to explore graduate nurse's experience of postgraduate education within the Graduate Nurse Programme. The report contains the results of a survey of nurses within the Programme. This report details the results of that survey and make recommendations for consideration.
Keywords: Nursing; Education; New graduate nurses; Teaching methods; Students
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