Cognitive Apprenticeship in Hospital Orientation for Newly Graduated Nurses

Purpose: Most hospitals utilize the preceptor model for the clinical portion of orientation with newly graduated nurses. 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 nurses (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 or novice as they progress to expert (Collins et al., 1989). Moreover, the methods in CA are often seen in the promotion of the development of expertise (Collins, Brown, & Holum, 1991).The purpose of this mixed methods pretest-posttest design is to explore whether there is a difference in the NGN’s sense of confidence, clinical skills, and ease of transition to practice, after completing a CA based orientation.

Methods: A power analysis was performed using and G*Power to determine appropriate sample size, n = 51. Newly graduated, non-experienced, newly hired RNs who may have already taken or are preparing to take the National Council Licensure Examination (NCLEX) will be solicited for participation. This population was chosen selected because these are the individuals who experience role transition from student nurse to practicing nurse. Nurses, who currently serve as preceptors, will be solicited to attend training on CA. The training will include a preceptor manual, which will illustrate the principles of, and activities of CA, along with weekly clinical guidelines. The primary investigator using the ADDIE model for instructional design, review of literature information, and over twenty years of preceptor experience developed the manual.
The Casey-Fink Graduate Nurse Experience Survey (CFGNES) will be administered at the beginning of the clinical orientation and again at the end of the clinical orientation. This instrument was chosen because it generates data regarding the NGNs transition into practice, confidence, skill set, and aspects of job satisfaction. Additionally, data will be collected from a focus group of both NGNs and preceptors at the end of the orientation process. It is believed that the data collected both quantitatively and qualitatively will answer the research questions.
Data Analysis: Quantitative data analysis will be conducted with the latest version of SPSS, using independent sample t-tests. Qualitative data will be recorded and transcribed during the coding process using NVivo.

Results: It is expected that there will be an increase in confidence, skills and ease of transition to practice at the end of the clinical, preceptorship orientation process. Which could help with new nurse retention, improved patient safety, and improved patient outcomes.

Conclusion: Newly graduated nurses have a high rate of job turnover as they begin the transition from student nurse to practicing nurse. Nursing literature cites lack of confidence, skills, and stress as significant factors for NGNs during the transition to practice progression. Preceptor-based training is frequently utilized during the orientation phase as a means of support for NGNs. However, a gap exists in the literature regarding an exact pedagogical strategy for preceptorships, both during hospital clinical orientation and academic clinical preceptorships. This study will employ CA as an instructional strategy during the preceptorship phase of orientation to investigate its effectiveness as a transition to practice strategy.