The Similarities and Differences in Transition to Practice Experiences for New-Graduate RNs and Practical Nurses in Long-term Care.

OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings. BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN. METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC. RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting. CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting.

Protocol for a Case Study to Explore the Transition to Practice of New Graduate Nurses in Long-Term Care.

A qualitative case study protocol for an exploration of the transition to practice of new graduate nurses in long-term care is presented. For the new graduated nurse, the transition to professional practice is neither simple nor easy. This time of transition has been examined within the hospital setting, but little work has been done from the perspective and context of long-term care. As the global population continues to age and the acuity of persons accessing services outside of hospital continues to increase, there is a need to better understand the transition experience of new graduate nurses in alternative, tertiary settings such as long-term care. Therefore, the purpose of this report is to situate a study and describe a protocol that explored the transition to practice experience of seven new graduate nurses in long-term care using Yin's case study methodology. The case or phenomenon being explored is new graduate nurse transition to practice. This report presents an overview of the literature in order to situate and describe the case under study, a thorough description of the binding of the case as well as the data sources utilized, and ultimately reflects upon the lessons learned using this methodology. The lessons learned include challenges related to precise case binding, the role and importance of context in conducting case study research, and difficulties in disseminating study findings. Overall, this report provides a detailed example of the application of the case study design through description of a study protocol in order to facilitate learning about this complex and often improperly utilized study design.

Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

INTRODUCTION: Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. PURPOSE: The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. METHODS: We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. RESULTS: Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. CONCLUSIONS: Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care.

Exploring new graduate nurse confidence in interprofessional collaboration: a mixed methods study.

BACKGROUND: Confidence is required for effective engagement in interprofessional collaboration. New graduate nurses often lack confidence in interprofessional interactions, and this may compromise the delivery of safe and effective healthcare. OBJECTIVES: The overall objective of this study was to explore new graduate nurse confidence in interprofessional collaboration. DESIGN: An explanatory sequential mixed methods design was used. METHODS: New graduate nurses from Ontario, Canada (N=514) completed a cross-sectional descriptive survey in 2012. The survey measured perceived confidence in interprofessional collaboration, and it included items that were proposed to have a relationship with new graduate nurse confidence in interprofessional collaboration. Follow-up qualitative telephone interviews were conducted with 16 new graduate nurses. RESULTS: The quantitative findings suggested that several factors have a positive relationship with new graduate nurse confidence in interprofessional collaboration: availability and accessibility of manager, availability and accessibility of educator, number of different disciplines worked with daily, number of team strategies, and satisfaction with team. The qualitative phase supported the quantitative findings and also provided new information about factors that facilitated and challenged new graduate nurse confidence when engaging in interprofessional collaboration. The facilitators were: experience, knowledge, respect, supportive relationships, and opportunities to collaborate. Challenges included: lack of experience, lack of knowledge, communication challenges, and balancing practice expectations. The overall findings relate to team and organizational support, and new graduate nurse development. CONCLUSION: Interventions that provide support for interprofessional collaboration at the team and organizational levels, and develop new graduate nurse knowledge and experiences regarding collaborative practice, are essential for enhancing new graduate nurse confidence in interprofessional collaboration.

A mixed methods exploration of the team and organizational factors that may predict new graduate nurse engagement in collaborative practice.

Although engagement in collaborative practice is reported to support the role transition and retention of new graduate (NG) nurses, it is not known how to promote collaborative practice among these nurses. This mixed methods study explored the team and organizational factors that may predict NG nurse engagement in collaborative practice. A total of 514 NG nurses from Ontario, Canada completed the Collaborative Practice Assessment Tool. Sixteen NG nurses participated in follow-up interviews. The team and organizational predictors of NG engagement in collaborative practice were as follows: satisfaction with the team (ß = 0.278; p = 0.000), number of team strategies (ß = 0.338; p = 0.000), participation in a mentorship or preceptorship experience (ß = 0.137; p = 0.000), accessibility of manager (ß = 0.123; p = 0.001), and accessibility and proximity of educator or professional practice leader (ß = 0.126; p = 0.001 and ß = 0.121; p = 0.002, respectively). Qualitative analysis revealed the team facilitators to be respect, team support and face-to-face interprofessional interactions. Organizational facilitators included supportive leadership, participation in a preceptorship or mentorship experience and time. Interventions designed to facilitate NG engagement in collaborative practice should consider these factors.

Decision making by baccalaureate nursing students in the clinical setting.

Many researchers who have explored nurse decision making have concluded that decision making is a learned skill that must be taught by nurse educators. Yet little research has been conducted to explore nursing students' decision making. If nurse educators are to teach this skill, it is necessary to have a better understanding of the kinds of decisions students are making in the clinical setting and the factors that influence this process. Once we have a greater knowledge in this area, curricular materials can be developed to ensure this skill is taught throughout an undergraduate education, resulting in graduates who possess strong, independent, and interdependent decision making skills. This article will describe one component (the kinds of decisions) of a larger qualitative case study that explored the kinds of decisions and the factors that influenced nursing students' decision making throughout a baccalaureate degree program.

The moral development of baccalaureate nursing students: understanding unethical behavior in classroom and clinical settings.

Unethical behavior in both classroom and clinical settings is a concern for nurse educators and has the potential to greatly influence the quality of patient care. A review of the literature suggests that students may view unethical clinical behaviors as different from unethical classroom behaviors because they recognize that clinical behaviors may have a direct effect on patient care. An overview of three moral theories, proposed by Kohlberg, Gilligan, and Rest, provides insight into the reasons for unethical behavior. These theories provide the foundation for strategies nurse educators can use to help reduce unethical behavior in both classroom and clinical settings in an attempt to ensure quality patient care.