Transition to practice has been a longstanding concern for the nursing discipline. Despite significant efforts to improve orientation and advocate for nurse residency programs, Saber, Anglade and Schirle, (2016) estimated that 15-60% of newly graduated nurses leave their first position within the first three years. While there are many reasons for this high attrition, a significant contributor is the tension created by the complexity of care and the consistent non-stop demands placed on the new graduate in acute care settings which are very different than the demands of a student nurse(Price, Hall, Murphy, & Pierce, 2018; Wareing, Taylor, Wilson, & Sharples, 2018). The transition to practice can leave novice nurses feeling unsure of their judgment, lacking in clinical skills and questioning their success (Kumaran & Carney, 2014). Moreover, McKenna and Brooks (2018) found that issues during transition to practice could be mitigated by using strategies familiar to the new graduate from their educational experiences. The purpose of this study was to explore the impact of the use of DML debriefing by novice nurses and their preceptors during transition to practice.
Debriefing for Meaningful Learning (DML) is a widely used theoretically derived and evidence-based method that emphasizes assimilation, accommodation, anticipation and thinking like a nurse (Researcher, 2015). It has been used extensively in prelicensure programs, but this is the first study during transition to practice. The DML debriefer uses Socratic questioning in a consistent process to help the novice nurse recall the events associated with patient care, uncover the thinking underpinning the actions implemented, and reflect in, on and beyond action (Researcher, 2015; Schön, 1983) to foster thinking like a nurse
Methods:
A six-month multi-site, qualitative study of six new BSN graduates entering clinical practice in five acute care hospitals in a large metropolitan city was initiated following Institutional Review Board approval. Participants were recruited from a school of nursing where DML was used consistently for clinical post-conference. Preceptors of the new graduates were trained to use DML and agreed to use it at the end of each clinical shift for the first six months. Participants were interviewed monthly for an hour. All interviews (N=36) were recorded and transcribed. A semi-structured interview guide was used during each interview with follow-up questions to understand their experience. Interviews were analyzed using thematic analysis. A content-analytic summary table as described by Miles, Huberman, and Saldaña (2014) was used to organize the codes with NVivo for Mac version 11.
Results:
Three themes with exemplars will be presented demonstrating the impact of DML on transition to practice and thinking like a nurse: 1) Living with the blues, 2) It isn’t easy being black and white and green 3) Being a real nurse and spot-on, despite uncertainty.
Conclusion:
Themes will be correlated with known aspects of DML and Benner’s Novice to Expert (1984) framework and implications for the discipline will be presented. Suggestions for additional research in the context of the complex care environment new graduates are entering will be discussed.