Becoming and being a nurse: a research informed theory to guide contemporary university and industry approaches to preparing and supporting graduate nurses

Becoming and being a nurse: a research informed theory to guide contemporary university and industry approaches to preparing and supporting graduate nurses

Globally, a nursing shortage exists, placing the health and wellbeing of patients at risk. Furthermore, nurses in their first year of their new career have a high attrition rate, exacerbating the shortage. The problem is double-sided in that the health and wellbeing of new nurses who are responsible for the health care of individuals and communities are in jeopardy. Despite the magnitude of this problem, there has been a paucity of research exploring the contributing stress factors to aligned education and support to ensure nurses retain their health and wellbeing and are enabled to be effective carers for others. Graduate Registered Nurses (GRNs) are uniquely positioned to provide insight about these very aspects through sharing their first year experience to contributing to addressing this gap. This study addressed this gap by exploring the experience of first-year GRNs’ work, study and personal life (developed and defined in this study as the Load Triad) and identified the factors impacting their Load Triad and their overall life balance. A mixed-methodology was applied and data was collected in 2 phases, with Phase 1 informing Phase 2. In Phase 1, an in-depth inquiry (interpretive) was conducted with 4 first-year GRNs (in their 11th month), employed within health facilities from a single regional city in Queensland Australia. Findings revealed the GRNs first year was ‘hard’ causing them to question their level of preparedness for the reality of work and life as a nurse. This lack of a broader preparedness experience has led to the identification of a number of negative and positive indicators impacting the GRNs first year experience and its relationship to thoughts of either attrition and or retention. The main negative indicator included GRNs being situated within a workforce in juxtaposition to the ‘world of nursing’ values. Other negative indicators included GRNs actively prioritising their work role over their personal life and self-care roles, creating a life not in balance and experiencing a decline to their overall personal sense of wellbeing. Other associated negative indicators included a lack of and or absence of targeted and tailored holistic support. GRNs in the throes of this ‘hard’ year demonstrated resilience and thus positive indicators leading to resilience and thoughts of retention have been equally identified. The main positive indicator included GRNs being situated within a workforce that mirrors the ‘world of nursing’ values. At the individual level, important positive indicators were found to be the possession of a temperament towards strong work role salience, intertwined with previous heightened undergraduate study role salience and a strong sense of fellow GRN peer friendship within the work place. Other positive indicators included possession of personal qualities such as agency and internal locus of control. In Phase 2, 71 GRNs, from settings across Queensland were surveyed to confirm, deny or challenge the Phase 1 results (derived from four first-year nurses) with a larger, more diverse sample size. Overall, the Phase 1 themes were confirmed and strengthened in Phase 2. The outcome of this study is the realisation that real opportunities exist to improve the GRN experience. Key takeaways from this research include a set of recommendations to assist in improving nursing preparation and transition support. A key recommendation is to improve the co-ordination, collaboration and communication between key nursing stakeholders by the use of reiterative feedback loops, formal annual reports and timely sharing of these reports. Timely sharing of reports is to facilitate an evidenced based and timely response by education and transition providers to enact reforms that will guide the continual quality improvements to nurses’ education and transition support. Additionally, this study recommends inviting GRNs to ‘partner’ with higher education institutions, health organisations and governance bodies to contribute to decision making and discussions about the delivery and evaluation of nurses’ preparation and transition support. Furthermore, the overarching proposition derived through this research is that university-led education and transition support for future and in-practice nurses must exist and be nuanced and informed by the ‘Becoming and being a nurse’ transition theory, situated during and post-university (within the workforce) and is my original contribution to knowledge. This new theory is further supported by 2 other new theories entitled, ‘Nursing preparedness’ theory and ‘21st century life career preparedness’ theory.