Cognitive Apprenticeship in Hospital Orientation for Newly Graduated Nurses

Monday, 30 October 2017

Betty A. Key, EdD
Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA

The transition from student nurse to practicing, newly graduated nurse can be stressful. Many newly graduated nurses cite the transition period as a time of challenge, uncertainty, and lack of self-assurance, which may also affect patient safety (McDonald & Ward-Smith, 2012). Some researchers believe that this time of stress and uncertainty has contributed to the high rate of turnover for newly graduated nurses (Robitaille, 2013). Nurse retention has become a global issue. Other countries such as Australia, UK, and Canada are also studying transition to practice strategies for newly graduated nurse (Gordon, Aggar, Williams, Walker, Willcock & Bloomfield, 2014). Cognitive apprenticeship (CA) is an instructional strategy that may facilitate ease of transition for NGNs during the clinical portion of hospital orientation. The term cognitive apprenticeship, coined by Collins et al. (1989), describes the cognitive and metacognitive processes shared by a teacher or expert with a student or apprentice. Cognitive apprenticeship seeks to make learning visible by teaching the problem-solving processes used by experts in a way that promotes metacognition in the apprentice as they progress to expert (Collins et al., 1989). Moreover, the methods in CA have been used to promote the development of expertise by externalizing the thinking and inner conversation of the expert with the apprentice (Collins, Brown, & Holum, 1991). Methods used in CA are modeling - demonstrating, coaching – offering feedback, scaffolding – developing independence, articulation - questioning, reflection – looking back on what was learned, and exploration – applying what was learned to other situations (Collins et al., 1989). The purpose of this mixed methods pretest-posttest design is to explore if there will be an increase in confidence, increase in clinical skill, and ease of transition to practice, after completing a cognitive apprenticeship based orientation during the preceptorship phase of the hospital clinical orientation. A power analysis was performed to determine appropriate sample size, n = 51. Newly graduated, newly hired registered nurses will be solicited for participation in this study as well experienced nurses who currently serve as preceptors. The Casey-Fink Graduate Nurse Experience Survey will be administered as both the pretest and posttest. Data will also be collected from a focus group of both newly graduated nurses and preceptors. There is a gap in the literature regarding an exact pedagogical strategy for preceptorships. This study will employ cognitive apprenticeship as an instructional strategy during the preceptorship to investigate its pedagogical effectiveness as a transition to practice strategy.