Work readiness, transition, and integration: The challenge of specialty practice.

AIM: To determine how extended orientation enhances the work readiness of new graduate nurses as they transitioned to their professional role in a specialty care hospital. BACKGROUND: Given increased complexity of care and high-patient acuity, there is concern about the work readiness of new graduate nurses in specialty areas. DESIGN: Qualitative exploratory study using an inductive approach. METHODS: An integrative literature review was conducted to abstract characteristics of work readiness among new graduate nurses. Semistructured interviews were conducted with 41 participants from a large paediatric specialty hospital in Ontario, Canada, in 2014. The sample of nurses was stratified and included nurse managers, new graduates, and preceptors. Interview texts were interpreted using thematic analysis. RESULTS: A framework for enhancing work readiness of new graduates transitioning to specialty care was developed from the interview and literature findings. Interview data demonstrate an extended orientation that includes mentorship, a gradual increase in clinical responsibilities, and involvement in the professional role during the early stages of a nurse's career can enhance work readiness of new graduates. Four key areas of work readiness were identified in the literature: personal characteristics, clinical characteristics, relational characteristics, and organizational acuity. CONCLUSION: Based on the study results, new graduate nurses can be an integral part of the team in specialty care provided certain conditions are met during their transition to practice. Our study gives further evidence that extended orientation enhances new graduates' work readiness as they transit to their professional role.

Policy to practice: Investment in transitioning new graduate nurses to the workplace.

AIM: To analyse nurses' perceptions of the impact of an extended transition programme on key dimensions of care delivery 1-6 years after graduation. The dimensions included decision-making, communication, care management, system integration and commitment. BACKGROUND: Health care employers in Ontario, Canada, can apply for government funding to support an extended transition programme for new graduate nurses that includes orientation and mentorship. METHODS: A cross-sectional study design was used. Nurses who participated in the transition programme were compared with nurses who did not. A survey was administered to a convenience sample of 2369 nurses. RESULTS: There were statistically significant differences between the two groups. Nurses in the transition programme had higher mean scores on the key dimensions of care delivery. Results were confirmed when controlling for length of time since graduation. CONCLUSION: Extended transition benefits new graduate nurses. It has a lasting effect over time and impacts key dimensions of care delivery. It can also enhance workforce integration and reduce turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Responding to the needs of new graduate nurses has potential long-term advantages for health care organisations and can influence both quality and delivery of care.

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis.

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.

Psychometric evaluation of the family-centered care scale for pediatric acute care nursing.

BACKGROUND: Caring for families is fundamental to pediatric nursing. However, existing measures do not capture parents' experiences with family-centered nursing care. OBJECTIVE: The aim of this study was to describe the development and initial psychometric testing of the Family-Centered Care Scale, a seven-item instrument designed to measure a parent's experience of nursing care that embodies core principles of family-centered care. METHODS: In Phase 1, 18 items describing what nurses do to engage parents of hospitalized children were derived from the literature describing mutuality. After establishing face validity, pretesting, and revision for clarity, the scale was administered to a convenience sample of 91 parents of hospitalized patients. In Phase 2, two items on parents' perceptions of being well-cared-for were added. The 20-item scale was administered to 564 parents of children recruited from all inpatient units in a children's hospital. In Phase 3, the scale was shortened to seven items and retested for validity among 454 additional parents. RESULTS: Internal consistency reliability was high across all versions and testing phases. Confirmatory factor analysis with data from a subsequent sample supported the final factor structure, regardless of patient type and race. There was a linear association between the scale consistency scores and overall quality of care ratings, supporting predictive validity of the scale. DISCUSSION: The Family-Centered Care Scale showed initial evidence of reliability and validity among parents with hospitalized children.

The road to providing quality care: orientation and mentorship for new graduate nurses.

Clinical work demands can overwhelm new graduate nurses (NGNs) and cause significant stress as they begin practice in their first place of employment. The authors examine the impact of a government-supported extended orientation and mentorship program intended to facilitate the transition of NGNs to professional practice. A longitudinal trend study was conducted over 3 years of the program (2008, 2009, and 2010). In each year, 1 third of surveyed NGNs and over 3 quarters of surveyed employers responded. The researchers conducted 21 focus groups with 106 health-care organizations, 53 interviews with NGNs, and 15 interviews with nurse mentors from the frontline staff. The findings indicate that the program is instrumental in developing NGNs' ability to practise independently. Mentorship increased the NGNs' confidence and allowed them to make clinical decisions in a safe, protected environment. The program provided vital support and helped NGNs move from students to practising nurses.

Full-time work for nurses: employers' perspectives.

AIM: To examine an employer response to a government employment policy, the Nursing Graduate Guarantee (NGG), over a 2-year period (2008-2009 and 2009-2010). BACKGROUND: Healthcare organizations rely on a stable supply of nurses to meet their staffing needs. However, employment trends have indicated a propensity for part-time employment. The NGG was created to stimulate full-time employment of new graduate nurses in Ontario, Canada. METHODS: A mixed methods design was used, which included online surveys and focus groups. All healthcare providers (n = 1198) were surveyed in 2008-2009 and 2009-2010. Each year, a sample of NGG employers participated in sector-specific focus groups. RESULTS: Approximately 20% of potential healthcare employers participated in the NGG. Reasons for non-participation included lack of awareness of the initiative and lack of full-time jobs. Barriers to offering full-time employment to new graduates included lack of full-time vacancies and budget constraints. CONCLUSIONS: Employers perceive flexible staffing practices as a way to contain personnel costs but often at the expense of a stable full-time nursing workforce. IMPLICATIONS FOR NURSING MANAGEMENT: This research contributes to an understanding of employers' perspectives on full-time hiring and participation in a government employment policy.

The changing nature of nursing work in rural and small community hospitals.

INTRODUCTION: The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN. METHODS: Data collection occurred between August and November 2007. A qualitative descriptive study design was chosen to facilitate exploration of nursing in the rural setting. Study participants were identified through purposive snowball sampling. All nurses, nurse managers and nurse executives currently employed in the 7 study hospitals were eligible to participate. Data collection included the use of questionnaires and semi-structured interviews. Memos were also created to describe the relevance and applicability of concepts, categories and properties emerging from the data. Themes were compared across interviews to determine relevance and value. RESULTS: Twenty-one nurses from 7 different hospitals participated. The nurses reflect the aging trend in the provincial and regional workforces of Ontario. All study participants anticipate a substantial increase in retirements during the next decade, which will alter the structure and capacity of the rural workforce. Rural nursing practice is generalist in nature, requiring personal flexibility and a broad knowledge base. The nurses in the study preferred this type of practice. However, they felt that new nurses have different values and goals and are more likely to choose the specialized practice opportunities available in urban tertiary centres. Structural changes to the health system influenced relationships between hospitals and altered the internal organization of individual hospitals. Nurse executives were positive about new opportunities for cost savings, sharing best practices and continuing education. Yet they also felt that organizational changes significantly increased their administrative responsibilities and limited their opportunities for communication with frontline nurses. The nurses thought that the changing organizational structures increased opportunities to seek multiple employers to augment the lack of full-time positions in the region. Many reported that part-time and casual nurses often seek employment in other hospitals and long-term care homes to supplement their income. However, multi-site employment within and across healthcare organizations contributes to scheduling issues because casual nurses are unavailable to fill vacant shifts. Patient transports, the implementation of e-technology and emerging disease patterns in the patient population were identified as additional practice challenges. CONCLUSION: This study has implications for health human resource planning in rural and small community hospitals. The findings indicate that demographic trends pose an immediate threat to the sustainability of the nursing workforce in the rural setting. Many nurses are nearing retirement, but the lack of opportunities for full-time positions as well as specialized and expanded nursing practice are attracting younger nurses to urban centres. Government policies focussing on the retention of clinical expertise, the recruitment of new graduates and expanding the role of registered practical nurses have been more difficult to implement in the rural setting. Implications for future research include the need to address data gaps to facilitate workforce planning and to evaluate the effectiveness of provincial recruitment and retention strategies in the rural context.

Sustainability of the workforce: government policies and the rural fit.

OBJECTIVES: Critical workforce issues among health care workers have raised public concerns about the ability of health care systems to provide adequate service. Services, however, are influenced by geographical and social factors. One important source of variation is rurality. This study evaluated the perception of the applicability of health human resource policies for rural areas. METHODS: An exploratory design was used. Twenty-one nurse administrators and 44 staff nurses from a sampling of 19 rural health care settings were interviewed. Hospitals with less than 100 beds were targeted. RESULTS: The government policies most frequently mentioned by study participants were the goal of 70% full-time employment, the new graduate policy and the late career initiative. Each presented challenges to managers attempting implementation. Urban bias is apparent in health care policy including health human resource policies. Little data is available about rural health care workers because health care statistics tend to be reported regionally. CONCLUSION: Rural institutions have difficulty accessing government funding intended to build sustainable workforces. Policies meant to be broadly implemented across jurisdictions may not fit the needs of rural institutions and their clients. Health care databases should include a rural variable to enhance understanding about this population.

A government policy on full-time nursing employment in Ontario, Canada: An evaluation.

PURPOSE: To evaluate the impact of a government full-time employment policy targeting new graduate nurses in the province of Ontario, Canada, by comparing participants with non-participants. METHODS: The Policy Impact on Nurse Employment (PINEP) survey was administered in 2014 to nurses who graduated between 2007 and 2012. Backward multiple logistic regression analysis was conducted to determine the effect of participation in the policy on key outcomes: full-time employment, retention and perceptions of clinical proficiency. RESULTS: A total of 2369 nurses responded to the survey. Policy participants were 1.5 times more likely to be employed full-time and 2.3 times more likely to be retained in their initial position at the time of survey compared to non-participants. Participants also perceived their clinical proficiency to be higher. CONCLUSIONS: The evidence is converging around the importance of providing full-time employment to nurses to sustain the workforce, increase clinical proficiency and improve patient outcomes. In Ontario, the government created a policy to stimulate full-time employment for nurses. Results demonstrate that nursing employment has become more stable. Yet more needs to be done particularly in relation to the precarious employment trend.

Workforce integration of new graduate nurses: evaluation of a health human resources employment policy.

Historically, economic changes have negatively affected the nursing workforce in Ontario. The trend towards part-time and casual employment emerged from healthcare restructuring in the 1990s. The severe acute respiratory syndrome (SARS) outbreak in 2003 alerted the Ontario government to the issue of part-time and casual nursing. In 2007, the Nursing Graduate Guarantee (NGG), a health human resources employment policy, was developed as a financial incentive for employers to hire and mentor new graduate nurses for a six-month period. The purpose of this study was to examine facilitators and barriers to policy implementation and assess the impact of the NGG on full-time employment and workforce integration of new graduate nurses in Ontario. A mixed-methods approach was used and included surveys, interviews and focus groups. Results indicated that full-time employment of new graduate nurses increased during the study period and that mentorship facilitated workforce integration of new graduate nurses.

Sustaining the rural workforce: nursing perspectives on worklife challenges.

CONTEXT: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. PURPOSE: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. METHODS: Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. FINDINGS: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. CONCLUSIONS: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

Development and evaluation of an instrument to measure parental satisfaction with quality of care in neonatal follow-up.

OBJECTIVE: The goal of this study was to develop and subsequently evaluate the psychometric properties of a new discriminative instrument to measure parental satisfaction with the quality of care provided in neonatal follow-up (NFU) programs. METHOD: The methodological framework for developing and evaluating measurement scales described by Streiner and Norman (Health Measurement Scales: A Practical Guide to Their Development and Use. 3rd ed. New York: Oxford University Press; 2003) was used for the study. Informing the phases of the research was a sample of 24 health care professionals and 381 parents who use NFU services. RESULTS: A comprehensive list of items representing the construct, parental satisfaction with quality of care, was generated from published reliable and valid instruments, research studies, focus groups with health care experts, and focus groups with parents. Using a clinimetric approach, the 62 items generated were reduced to 39 items based on parents' ratings of importance and refinement of the items by the research team. After content validation and pretesting, the instrument was tested with parents and underwent item-analysis. The resulting 16-item instrument was composed of 2 subscales, Process and Outcomes. Evaluation of the instrument's psychometric properties indicated adequate test-retest reliability (intraclass correlation coefficient = 0.72) and internal consistency (Process subscale, alpha = 0.77; Outcomes subscale, alpha = 0.90; overall instrument, alpha = 0.90), as well as good content and construct validity. A confirmatory factor analysis supported the multidimensionality of the construct. CONCLUSION: This new instrument provides clinicians and policy-makers with a tool to assess parental satisfaction with the quality of care in NFU, so areas of dissatisfaction can be identified and changes implemented to optimize service provision.

Professional confidence in baccalaureate nursing students.

"You need to develop more confidence" is a common refrain noted by students and faculty alike. As nurse educators, we believe that encouraging students to develop their professional confidence is an important role. Moreover, the nursing profession demands that nursing care be delivered with confidence. Although the importance of professional confidence is acknowledged in the literature, there is surprisingly little written about its development or strategies that promote professional confidence in nursing education. A qualitative study was conducted to explore the meaning and influences on professional confidence as perceived by nursing students enrolled in a four year generic baccalaureate nursing program. Focus groups were audiotaped, transcribed verbatim and analyzed using thematic content analysis method. The meaning of professional confidence involved: feeling, knowing, believing, accepting, doing, looking, becoming, and evolving. Positive and negative influences in developing professional confidence centered around two time periods, prior to entering nursing, and within the nursing program. Students identified strategies to assist themselves in developing professional confidence. Faculty development is one recommendation for faculty.