Objectives: Nursing service faces a challenge in trying to retain qualified and competent practitioners in the health care arena today. A particularly difficult situation arises when trying to orient and mentor new graduate nurses to acute care settings. This study was designed to discover the issues new graduates encounter at a Veterans Medical Center and how reflecting on practice would affect problem solving and impact on retention. Design: A comparative descriptive design was used to examine data written in journals by the sample and then compared to a sample of new graduates in a community hospital. Population, Sample, Setting: The sample consisted of 14 new graduate nurses in a clinical internship transitioning onto various acute care units in a Veterans Medical Center in the southeastern United States. The mean age was 30 years and they all worked 40 hours/week during the journaling period. Two internship groups were sampled from the Spring of 2000 through the Fall of 2001. Concepts: Self-regulation learning strategies were used as prompts for reflective journaling after each week’s clinical experiences. The self-regulated learning strategies included metacognitive self-evaluation, behaviorial self-monitoring and environmental structuring described in the self-regulation learning model by Kuiper (1999). Methods: The sample responded to 10 self-regulated learning prompts in a journal after each clinical week, for 8 weeks. Measurements also included a demographic questionnaire. Findings: There were a total of 79 separate journal entries with an approximate count of 13,500 words. Qualitative analysis using the verbal protocol technique revealed the majority of noun referents as metacognitive. Observations over time revealed a consistent use of thinking strategies, a low level of knowledge work and use of resources, and a high level of reaction. Significant correlations existed between knowledge use as a noun and reactions (r=.80) and knowledge as a self-regulated learning strategy (r=.75) and reactions. Assertional analysis revealed present tense verbs used most frequently with primarily connotative phrases. Cognitive operator analysis revealed that all strategies of the self-regulated learning model were used with behavioral self monitoring 45-53% of the time. Script analysis revealed the common themes of knowledge work observations, thinking strategy observations, judgments of self-improvement, judgments of self-competence, self-reactions, self-correction strategies, judgments of resources, and skill activities. When compared to a community hospital group of new graduates, this sample differed in the number of nouns used except for reference to situations and reference to the environment. This sample used less comparison and causal type statements but there was a similar use of the self-regulated learning strategies Conclusions: Journaling using self-regulated learning strategies prompted the persistent use of thinking strategies in this sample. It also revealed a low level of knowledge work and a high level of reaction. Implications: The data suggests that nurse educators and preceptors can benefit new graduate nurses in a variety of institutions by prompting self-regulated learning strategies to promote thinking. The retention of new graduates in this setting may be related to the better use of a knowledge base, resources, and attention to activities that would decrease levels of reactivity and improve time management. Future research with self-regulated learning strategies is needed after the interventions are in place to promote the development of competent practice and to improve retention.
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