This research aims to develop and examine the effectiveness of a new transition to practice programme (TTPP) for newly qualified Registered Nurses (NQRNs) in their transition to practice (TTP) journey.
Methods:
A two-phase sequential study was conducted at a 1500 bedded tertiary hospital in Singapore. The phase one study consisted of a descriptive qualitative study that explored NQRNs’ (n=11) perceptions and helpful or challenging factors perceived by the NQRNs of their TTP journey during their first six months of employment. Through the phase one study, the findings were used to develop the TTP conceptual framework, and after that, a new TTPP was conceived spanning over a 12-month period.
The phase two study aimed to examine the effectiveness of the new TTPP for NQRNs in their TTP journey. Phase two of the study was a quasi-experimental two groups, pre-and post-study which examined the effectiveness of the new TTPP for NQRNs in their TTP in the hospital over a one-year period.
The nurses in the control group (n=113) undertaken the old TTPP spanning over a six-month period while the nurses in the intervention group (n=122) undertaken the new TTPP spanning over a 12-month period. Three fundamental areas that were focused included; (a) personal, (b) professional, and (c) organisational adaptations. The TTPP was further broken down into four sub-areas including, unit nursing orientation, hospital nursing orientation, preceptorship and social adaptation. Their assigned preceptors conducted continual clinical performance evaluation. A final performance appraisal was carried out by their nursing supervisor based on their performance and clinical performance evaluation progress.
Six hypotheses were listed at the start of the phase two study; (a) NQRNs enrolled in the TTPP has a higher intention to stay than NQRNs enrolled in the previous programme; (b) NQRNs enrolled in the TTPP has a higher job satisfaction than NQRNs enrolled in the previous programme; (c) NQRNs enrolled in the TTPP has a higher perception of the work environment than NQRNs enrolled in the previous programme; (d) NQRNs enrolled in the TTPP has a higher perception that information technology in their practice environment was supportive of patient care delivery than NQRNs enrolled in the previous programme; (e) NQRNs enrolled in the TTPP has a lower work-related stress than NQRNs enrolled in the previous programme; (f) NQRNs enrolled in the TTPP has higher coping strategies than NQRNs enrolled in the previous programme. The instrument consisted of six sections, including demographics and five validated research instruments.
Results:
The phase one study revealed that NQRNs faced role ambiguity and horizontal violence in the workplace with insufficient policies in placed to reduce stress induced by these challenges and to promote a culture that condemns horizontal violence. NQRNs also had to deliver safe, competent care despite facing knowledge deficit and taking a high patient workload. However, there was a lack of support to facilitate learning and monitoring of their competency. Assimilation into the working unit culture was also another challenge identified. Three domains; (a) Personal, (b) Professional, and (c) Organisational were derived from the literature reviews and results from the phase one study. The findings were used to develop the TTP conceptual framework, and after that, a new TTPP was conceived spanning over a 12-month period.
The phase two study revealed that four out of six hypotheses; (a) NQRNs enrolled in the TTPP has a higher perception of the work environment than NQRNs enrolled in the previous programme; (b) NQRNs enrolled in the TTPP has a higher perception that information technology in their practice environment was supportive of patient care delivery than NQRNs enrolled in the previous programme; (c) NQRNs enrolled in the TTPP has a lower work-related stress than NQRNs enrolled in the previous programme; (d) NQRNs enrolled in the TTPP has higher coping strategies than NQRNs enrolled in the previous programme. The remaining two hypotheses; (a) NQRNs enrolled in the TTPP has a higher intention to stay than NQRNs enrolled in the previous programme; (b) NQRNs enrolled in the TTPP has a higher job satisfaction than NQRNs enrolled in the previous programme; had no statistically significant difference, were therefore not supported and were rejected. Although they were rejected, there were significant results in their subdomains.
Conclusion:
This research identified that the new TTPP was a more effective programme for NQRNs in their TTP journey as compared to the existing TTPP. This study had revealed several implications for future development of TTPP for NQRNs. Firstly, a structured TTPP should adopt an educational pedagogy to induct NQRNs progressively from the basic to more complex competencies over the entire TTP journey. Secondly, assessment and evaluation of NQRNs’ competency should move from an apprenticeship-based model to using workplace based assessment methodologies. With the use of workplace-based assessment, the supervisors will be able to evaluate performance in the actual clinical context. This is designed to provide feedback on skills essential to the provision of excellent clinical care. Thirdly, preceptors have the responsibility to ensure that the NQRNs practice and perform safely and to provide accurate feedback on the NQRNs’ performance to their nursing supervisors Preceptorship training such as clinical supervision, clinical assessment and providing feedback courses should be provided to these assigned preceptors to standardise clinical supervision practices. Lastly, TTPP should encompass better institutional support, support services such as buddy system, staff support staff and nursing support systems that are in place to provide support and help NQRNs throughout their TTP journey.
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