Exploring experiences of the New Graduate Registered Nurse in caring for the deteriorating patient in rural areas: A qualitative study

Article

Towner, Elaine C., Lea, Jackie and East, Leah S.. 2025. "Exploring experiences of the New Graduate Registered Nurse in caring for the deteriorating patient in rural areas: A qualitative study." Journal of Clinical Nursing. https://doi.org/10.1111/jocn.17838
Article Title

Exploring experiences of the New Graduate Registered Nurse in caring for the deteriorating patient in rural areas: A qualitative study

ERA Journal ID14104
Article CategoryArticle
AuthorsTowner, Elaine C., Lea, Jackie and East, Leah S.
Journal TitleJournal of Clinical Nursing
Number of Pages14
Year2025
PublisherJohn Wiley & Sons
Place of PublicationUnited Kingdom
ISSN0962-1067
1365-2702
Digital Object Identifier (DOI)https://doi.org/10.1111/jocn.17838
Web Address (URL)https://onlinelibrary.wiley.com/doi/10.1111/jocn.17838
Abstract

Aim
To explore the experiences of new graduate registered nurses in caring for the deteriorating patient in rural areas.

Background
New graduate registered nurses often feel unprepared to care for the deteriorating patient. Whilst literature has recognised new graduate registered nurses working within metropolitan areas feel ill-equipped to care for deteriorating patients, there is a paucity of literature focused on experiences within the rural context.

Design
Qualitative, descriptive phenomenological approach.

Methods
In-depth interviews were undertaken with 7 participants in rural Eastern Australia with collected data being subject to thematic analysis.

Results
Three themes were identified that shares the lived experiences of the participants as they transitioned into the rural team: First encounters—Transition to the rural team; Practice support for managing deterioration; and The road to confidence.

Conclusion
New graduate registered nurses are unprepared to care for the deteriorating patient in rural areas. Practice support and barriers to ongoing education are influential on their experience with findings from this study supporting focused rural healthcare preparation from tertiary education providers, plus structured practice support from senior rural nurses and health facility orientation programs. Preparation should include the use of digital technologies and escalation and management of the deteriorating patient alongside rural policies and procedures to enhance patient safety and support new graduate rural nurses.

Implications for the Profession and/or Patient Care
The findings have implications for tertiary undergraduate nursing education and those supporting New Graduate Registered Nurses in their transition to practice in rural areas. Enhancement of new graduate nurses' skills and abilities in recognition and responding to patient deterioration through both technological and personnel support will enhance patient safety within rural health care.

Reporting Method
Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution
7 participants were involved in the study.

Keywordsdeterioration ; New graduates ; nursing ; patient safety; rural
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420505. Nursing workforce
Byline AffiliationsUniversity of New England
School of Nursing and Midwifery
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Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol
Issac, Hancy, Moloney, Clint, Taylor, Melissa and Lea, Jackie. 2020. "Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol." BMJ Open. 10 (7). https://doi.org/10.1136/bmjopen-2019-036060
Meaningful engagement with Aboriginal communities using Participatory Action Research to develop culturally appropriate health resources
Peake, Rachel, Jackson, Debra, Lea, Jackie and Usher, Kim. 2021. "Meaningful engagement with Aboriginal communities using Participatory Action Research to develop culturally appropriate health resources." Journal of Transcultural Nursing. 32 (2), pp. 129-136. https://doi.org/10.1177/1043659619899999
Investigating the processes used to develop and evaluate the effectiveness of health education resources for adult Indigenous people: a literature review
Peake, Rachel M., Jackson, Debra, Lea, Jackie and Usher, Kim. 2019. "Investigating the processes used to develop and evaluate the effectiveness of health education resources for adult Indigenous people: a literature review." Contemporary Nurse. 55 (4-5), pp. 421-449. https://doi.org/10.1080/10376178.2019.1633939
How nurses can ensure women's sexual and reproductive health is not forgotten during the pandemic
Bellia, Sharne and East, Leah. 2020. "How nurses can ensure women's sexual and reproductive health is not forgotten during the pandemic." Primary Health Care.
Registered Nurses' understanding, knowledge and perceptions of the association between sexually transmitted infections and domestic violence
Bellia, Sharne, Jackson, Debra, Hutchinson, Marie and East, Leah. 2020. "Registered Nurses' understanding, knowledge and perceptions of the association between sexually transmitted infections and domestic violence." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 27 (5), pp. 561-566. https://doi.org/10.1016/j.colegn.2020.01.003
A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations
Hutchinson, Marie, Doran, Frances, Brown, Janie, Douglas, Tracy, East, Leah, Irwin, Pauletta, Mainey, Lydia, Saunders, Annette, Sweet, Linda, van de Mortel, Thea and Yates, Karen. 2020. "A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations." Nurse Education Today. 84. https://doi.org/10.1016/j.nedt.2019.104209
Living with diabetes and disadvantage: A qualitative, geographical case study
Power, Tamara, Kelly, Ray, Usher, Kim, East, Leah, Travaglia, Jo, Robertson, Hamish, Wong, Ann and Jackson, Debra. 2020. "Living with diabetes and disadvantage: A qualitative, geographical case study." Journal of Clinical Nursing. 29 (13-14), pp. 2710-2722. https://doi.org/10.1111/jocn.15295
Nurse and patient satisfaction with intentional rounding in a rural Australian setting
East, Leah, Targett, Dianne, Yeates, Hamish, Ryan, Elizabeth, Quiddington, Louisa and Woods, Cindy. 2020. "Nurse and patient satisfaction with intentional rounding in a rural Australian setting." Journal of Clinical Nursing. 29 (7-8), pp. 1365-1371. https://doi.org/10.1111/jocn.15180
Intentional rounding in the context of student learning
Ryan, Liz, Jackson, Debra, Woods, Cindy, East, Leah and Usher, Kim. 2020. "Intentional rounding in the context of student learning." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 28 (3), pp. 289-295. https://doi.org/10.1016/j.colegn.2020.09.008
Disseminating research
Paliadelis, Penny, Parmenter, Glenda and Lea, Jackie. 2014. "Disseminating research." Jirojwong, Sansnee, Johnson, Maree and Welch, Anthony (ed.) Research methods in nursing and midwifery: pathways to evidence-based practice. Sydney, Australia. Oxford University Press. pp. 337-354
The development and evaluation of online stories to enhance clinical learning experiences across health professions in rural Australia
Paliadelis, Penny Susan, Stupans, Ieva, Parker, Vicki, Piper, Donella, Gillan, Pauline, Lea, Jackie, Jarrott, Helen Mary, Wilson, Rhonda, Hudson, Judith N. and Fagan, Anthea. 2014. "The development and evaluation of online stories to enhance clinical learning experiences across health professions in rural Australia." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 22 (4), pp. 397-403. https://doi.org/10.1016/j.colegn.2014.08.003
The support needs of new graduate nurses making the transition to rural nursing practice in Australia
Lea, Jackie and Cruickshank, Mary. 2015. "The support needs of new graduate nurses making the transition to rural nursing practice in Australia." Journal of Clinical Nursing. 24 (7-8), pp. 948-960. https://doi.org/10.1111/jocn.12720
Supporting new graduate nurses making the transition to rural nursing practice: views from experienced rural nurses
Lea, Jackie and Cruickshank, Mary. 2015. "Supporting new graduate nurses making the transition to rural nursing practice: views from experienced rural nurses." Journal of Clinical Nursing. 24 (19-20), pp. 2826-2834. https://doi.org/10.1111/jocn.12890
The role of rural nurse managers in supporting new graduate nurses in rural practice
Lea, Jackie and Cruickshank, Mary. 2017. "The role of rural nurse managers in supporting new graduate nurses in rural practice." Journal of Nursing Management. 25 (3), pp. 176-183. https://doi.org/10.1111/jonm.12453
Preparing for the transition to registered nursing practice
Lea, Jacqueline. 2019. "Preparing for the transition to registered nursing practice." Arnott, Nick, Paliadelis, Penny and Cruickshank, Mary (ed.) The road to nursing. Melbourne, Australia. Cambridge University Press. pp. 278-294
Patient safety content and delivery in pre-registration nursing curricula: a national cross-sectional survey study
Usher, Kim, Woods, Cindy, Conway, Jane, Lea, Jackie, Parker, Vicki, Barrett, Fiona, O'Shea, Eilish and Jackson, Debra. 2018. "Patient safety content and delivery in pre-registration nursing curricula: a national cross-sectional survey study." Nurse Education Today. 66, pp. 82-89. https://doi.org/10.1016/j.nedt.2018.04.013
Australian nursing students’ knowledge and attitudes towards pressure injury prevention: a cross-sectional study
Usher, Kim, Woods, Cindy, Brown, Janie, Power, Tamara, Lea, Jackie, Hutchinson, Marie, Mather, Carey, Miller, Andrea, Saunders, Annette, Mills, Jane, Zhao, Lin, Yates, Karen, Bodak, Marie, Southern, Joanne and Jackson, Debra. 2018. "Australian nursing students’ knowledge and attitudes towards pressure injury prevention: a cross-sectional study." International Journal of Nursing Studies. 81, pp. 14-20. https://doi.org/10.1016/j.ijmurstu.2018.01.015
The impact of patient safety culture on handovers in rural health facilities
Piper, Donella, Lea, Jackie, Woods, Cindy and Parker, Vicki. 2018. "The impact of patient safety culture on handovers in rural health facilities." BMC Health Services Research. 18 (889). https://doi.org/10.1186/s12913-018-3708-3
A systematic review of the prevalence and risk factors of smoking among Saudi adolescents
Alasqah, Ibrahim, Mahmud, Ilias, East, Leah and Usher, Kim. 2019. "A systematic review of the prevalence and risk factors of smoking among Saudi adolescents." Saudi Medical Journal. 40 (9), pp. 867-878. https://doi.org/10.15537/smj.2019.9.24477
Misperceptions and stereotypes in nursing care for sexually transmitted infections and domestic violence: a qualitative exploratory study
Bellia, Sharne, East, Leah, Hutchinson, Marie and Jackson, Debra. 2019. "Misperceptions and stereotypes in nursing care for sexually transmitted infections and domestic violence: a qualitative exploratory study." Contemporary Nurse. 55 (6), pp. 533-542. https://doi.org/10.1080/10376178.2019.1673667
An integrative literature review of pre-registration nursing students' attitudes and perceptions towards primary healthcare
Byfield, Zachary, East, Leah and Conway, Jane. 2019. "An integrative literature review of pre-registration nursing students' attitudes and perceptions towards primary healthcare." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 26 (5), pp. 583-593. https://doi.org/10.1016/j.colegn.2019.01.004
Australian perioperative nurses' attitudes, levels of knowledge, education and support needs related to organ donation and procurement surgery: A national survey
Smith, Zaneta, Woods, Cindy, Lea, Jackie and Usher, Kim. 2019. "Australian perioperative nurses' attitudes, levels of knowledge, education and support needs related to organ donation and procurement surgery: A national survey ." Journal of Perioperative Nursing. 32 (2), pp. 7-19. https://doi.org/10.26550/2209-1092.1044
Undergraduate nursing assistant employment in aged care has benefits for new graduates
Algoso, Maricris, Ramjan, Lucie, East, Leah and Peters, Kath. 2018. "Undergraduate nursing assistant employment in aged care has benefits for new graduates ." Journal of Advanced Nursing. 74 (8), pp. 1932-1954. https://doi.org/10.1111/jan.13691
Violated and vulnerable: women's experiences of contracting a sexually transmitted infection from a male partner
East, Leah, Jackson, Debra and Peters, Kath. 2017. "Violated and vulnerable: women's experiences of contracting a sexually transmitted infection from a male partner." Journal of Clinical Nursing. 26 (15-16), pp. 2342-2352. https://doi.org/10.1111/jocn.13723
Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature
Algoso, Maricris, Peters, Kath, Ramjan, Lucie and East, Leah. 2016. "Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature." Nurse Education Today. 36, pp. 275-280. https://doi.org/10.1016/j.nedt.2015.08.001
Deriving Consensus on the Characteristics of Advanced Practice Nursing: Meta-summary of More Than 2 Decades of Research
Hutchinson, Marie, East, Leah, Stasa, Helen and Jackson, Debra. 2014. "Deriving Consensus on the Characteristics of Advanced Practice Nursing: Meta-summary of More Than 2 Decades of Research ." Nursing Research. 63 (2), pp. 116-128. https://doi.org/10.1097/NNR.0000000000000021
Experiences of families who help young rural men with emergent mental health problems in a rural community in New South Wales, Australia
Wilson, Rhonda Lynne, Cruickshank, Mary and Lea, Jacqueline. 2014. "Experiences of families who help young rural men with emergent mental health problems in a rural community in New South Wales, Australia ." Contemporary Nurse. 42 (2), pp. 167-177. https://doi.org/10.5172/conu.2012.42.2.167
Implementation of the Clinical Facilitation model within an Australian rural setting: The role of the Clinical Facilitator
Sanderson, Helena and Lea, Jacqueline. 2012. "Implementation of the Clinical Facilitation model within an Australian rural setting: The role of the Clinical Facilitator ." Nurse Education in Practice. 12 (6), pp. 333-339. https://doi.org/10.1016/j.nepr.2012.04.001
The lure of the bush: Do rural placements influence student nurses to seek employment in rural settings?
Lea, Jackie, Cruickshank, Mary, Paliadelis, Penny, Parmenter, Glenda, Sanderson, Helena and Thornberry, Patricia. 2008. "The lure of the bush: Do rural placements influence student nurses to seek employment in rural settings? " Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 15 (2), pp. 77-82. https://doi.org/10.1016/j.colegn.2008.02.004
Use of the male condom by heterosexual adolescents and young people: literature review
East, Leah, Jackson, Debra, O'Brien, Louise and Peters, Kath. 2007. "Use of the male condom by heterosexual adolescents and young people: literature review." Journal of Advanced Nursing. 59 (2), pp. 103-110. https://doi.org/10.1111/j.1365-2648.2007.04337.x
The experience of new graduate nurses in rural practice in New South Wales
Lea, J and Cruickshank, MT. 2007. "The experience of new graduate nurses in rural practice in New South Wales." Rural and Remote Health. 7 (4). https://doi.org/10.22605/RRH814
Factors that influence the recruitment and retention of graduate nurses in rural health care facilities
Lea, Jackie and Cruickshank, Mary. 2005. "Factors that influence the recruitment and retention of graduate nurses in rural health care facilities ." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 12 (2), pp. 22-27. https://doi.org/10.1016/S1322-7696(08)60489-8