Background: The United States is suffering from a shortage of more than 500,000 nurses and the shortage will only intensify over the next ten years (American Association of Colleges of Nursing, 2014). New graduates are one of the resources expected to fill vacancies within the nursing shortage (Goode, Lynn, McElroy, Bednash, & Murray, 2013). However, there is a discrepancy between evaluations of new graduate readiness. Benner et al. determined that new nurses are underprepared for the challenges of patient care (2010). Ninety percent of undergraduate nursing education leaders feel new graduate nurses are prepared to practice; yet 90% of hospital nurse administrators disagree (AL-Dossary, Kitsantas, & Maddox, 2014). During self-assessment of readiness to practice, graduate nurses participating in nurse residency programs routinely rank ‘blood product administration/transfusion’ in the top three skills/procedures they feel uncomfortable performing independently (Lynn, 2014). Yet little is published regarding specifics within the procedure that prove to be more or perceived to be more difficult.
Research Objectives:
Specific aims of the study are to investigate the following Research Questions:
- Do nursing school training, observation, and direct experience of blood administration relate to self-reported level of comfort in graduate nurses?
- What essential steps are required in a blood administration assessment instrument to define proper performance, according to nurse experts at the study site?
- What aspect(s) of a blood administration simulation-based assessment do graduate nurses perform incorrectly as determined by study site experts?
- How accurate are graduate nurses’ self-ratings of ability to perform blood administration procedures compared to nurse expert ratings?
- Is there a relationship between blood administration assessment instrument results and graduate nurses’ self-confidence in performing the procedure independently?
- How effective is the blood administration simulation-based assessment in providing graduate nurses helpful self-assessment of skill performance?
Methods: This research study is a mixed-methods, multiphase educational needs assessment of up to 250 single site nurse residents for survey recruitment; up to 50 nurse residents for focus group recruitment; and up to 8 nurse experts for interviews during Phase I of the study. During Phases II and III, the same nurse experts will be used as in Phase I. Phase III will be a new sample of participants with a minimum of 30 nurse residents from the same study site.
Inclusion criteria – Participants will be:
- Phase I – Nurse residents, for whom are recently graduated from nursing school and have variable experience with blood administration in their clinical practice yet blood administration procedures are part of their performance requirements; and
- Phase III – New sample of nurse residents, for whom are newly graduated from nursing school and have variable experience with blood administration in their clinical practice yet blood administration procedures are part of their performance requirements BUT did not participate in Phase I; and
- Phases I, II, and III – Nurse experts from patient care units with high blood administration rates and the infusion specialist for the study site.
Conclusions: Anticipated results from this study include a thorough assessment instrument to guide self-reflection of graduate nurse performance gaps with blood administration procedures, recommendations for timing and improvements in instructional design of blood administration training in nursing school curriculum as well as identify nurse residency curriculum expansion opportunities.
Implications: To impact the nursing profession through the improvement of education, transition to practice, and ultimately patient outcomes.