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The experiences of newly qualified children’s nurses during their transition into children’s community nursing teams.
Dr Angela Darvill (presenter)
Dr Debbie Fallon
Dr Joan Livesley
Children's and Young People's Nursing International Conference
“Building the evidence base for practice”, Jersey 2014.
Background
Development of children’s community nursing
teams across each locality in England
(Department of Health 2004).
Making it Better (2006,2007).
Teams in local area employing newly qualified
children’s nurses for the first time.
Community as first post destination for newly
qualified nurses.
Transitions in nursing
van Gennep (1960) Rites of passage
Reality shock (Kramer 1974)
Transition shock (Boychuk Duchscher, 2007,
2008)
Common processes, time span and
perception that all newly qualified nurses
experience (Meleis et al 2000)
Literature focused on adult acute care
Aim and research
objectives
This study aimed to describe and analyse the transition experiences of newly qualified children’s nurses who work in children’s community nursing teams (in the North West of England).
• To identify, explore and describe the meanings that newly qualified children’s nurses attribute to their experiences during their transition into children’s community nursing teams.
• To identify and explore those factors, if any, that the participants perceive as facilitating, helpful or necessary to assist in their transition.
• To identify and explore those factors, if any, that the participants perceive as disrupting or impacting adversely on their transition.
Study Design
• Qualitative descriptive study (Sandelowski 2000)
• Purposive sample – eight newly qualified nurses working in expanding children's community nursing teams – generalist
• Ethics Approval
• Data Collection - participant observation and semi structured interviews
• Data analysis – Thematic analysis
Shadowing
The participants saw the time when they were shadowing as a separate
period prior to working on their own as illustrated:
“It’s the time period between you being the student nurse and actually
becoming independent in your job and doing what you’re meant to be
doing. So it’s that sort of period where you’re going from being a
student, where you’re coming into your preceptorship period, where
you’re being supported, where you’re supernumerary and you’re just
watching what’s going on and you’re learning about the job and what
they’re doing. It’s sort of that period where you’re still not quite
Independent and working on your own and from being a student nurse”.
Shadowing
Protection versus surveillance
“From speaking to some of my friends who have been dumped
right into the deep end basically and left to it, I’m glad, because I’d
rather have somebody there for support and do things right than
to be left to my own devices and do something wrong”.
“Im a lot more relaxed doing stuff on my own, whereas I think if
someone’s watching over me, I do become a little bit paranoid
and I start stammering and doing things wrong because I’m
thinking, I become very nervous. …But when I first started it was
literally there was somebody over your shoulder, observing you,
which is good, but it didn’t do much for my confidence, I’ll be
honest. So at first, it was frustrating, because the things that I
could do, it was like they were there all the time, looking over my
shoulder, but I am glad of it now” .
Shadowing “Starting from scratch”
“It’s almost like putting down what I have achieved in three
years at University to starting from scratch in community and
not really being seen as being able to do anything ..you’re in
your third year being a student you’re confident you’re seen
as the top level of being a student and then ..you’re sort of
back at the bottom …..that you’re the newly qualified, and it is
talked about in like a negative tone”.
Shadowing Being “signed off” - Assessment of competencies as a key milestone to independent visits
“That’s basically just trying to give us exposure to as
many things as we can.... .... so we never had to do
visits on our own, we were always accompanying
somebody. We have competencies to do like NG
passing, gastrostomies and things. But no, it’s really
good, really structured”.
“We have got to have observed, been taught and
practised so it’s either your preceptor or somebody
with experience”.
Visiting
Progressing to occasional
independent visits
“I probably went to see a (child with a) circumcision within
the first few days because once you’ve seen a couple,
what we do is a visit where I’d lead the visit and then
the other nurse would stay in the background and once
you’ve done that really then you could go on your own”.
“Some visits by then I was quite happy to maybe go out on
my own and try a couple, you know, if they were just a
wheezy episode”.
Visiting
Choosing independence
“If I didn’t feel ready then I wasn’t rushed out, I still got to
spend more time with different people and I only went
out when I felt ready and when everyone else was
confident that I was able to do my job. I think the help
is the support network you get and with everyone letting
..and it just gives you time to absorb everything and not
having to rush ..and panic thinking oh I’ve got three
weeks left, I’d better learn this, that, and the other” .
“I was so nervous, they’ve put me down for visits on my
own. I went, ‘I can’t, I can’t do them’, so one of our
sisters, she came with me and I was fine ”.
Visiting
Undertaking
independent
uncomplicated care “You know a lot of our pathways, that we’ve done like
the wound assessment and the eczema and the
constipation. They are very quick, so it is literally
tick boxes which you can do”.
“Giving advice per the asthma guidelines that we use,
removing dressings, putting dressings on and
assessing wounds when you see them and then
redress it”.
Visiting
Continued support
“ and even when that six weeks was up I’d see a
child that had been on the caseload for a while and
I’d go through it with someone before I left the office
so I knew what I was doing” .
“But in the community I think it's responsibility over a
patient and you've not got someone else there with
you, so the only thing you can do is come back to
the office and clarify with other nurses like I've been
doing anyway” .
Emerging identity as
a children’s
community nurse
“You can see people starting to get more, seen more as …
you know … rather than the newly qualified. There are
actual members of staff who are training obviously they
acknowledge that I wouldn’t know everything, but, they do
acknowledge that I have been here for seven months now”.
Emerging identity
Being part of the team
• “I thought “I’ve left her to write up all these notes now
which I could have helped her with. Then I’m
thinking she won’t have had a break and she’s got all
these other visits”.
• “Families have just been so appreciative … then you
get to that point where they’ve cracked it and you
can just see the relief in their faces and you feel like
you’ve done a good job”.
An ideal transition
experience
A period of shadowing helped with knowledge, skill and confidence
development, however this was inhibited by feeling overprotected
and not having their previous experience recognised.
Good formal support with the physical presence of a preceptor
Achievement of job specific competencies within thresholds of
capability
Having the confidence and competence to choose to go on lone
visits was seen as beneficial.
They routinised their actions to help them cope with the cognitive
demands of lone visiting.
They were able to working independently as a children’s community
nurse showing an advancement in knowledge, skill and
experience but they were still reliant at times on the support of
others.
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registered nurses . Unpublished PhD thesis), University of Alberta, Canada.
Boychuk Duchscher, J.( 2008). A process of becoming: the stages of new nursing graduate professional role transition. The Journal
of Continuing Education in Nursing, 39 ,10, 441-450.
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England
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Unpublished PhD thesis) University of Sounthampton .
Greater Manchester, East Cheshire and Higher Peak Children, Young Peoples and Families’ Network (2006,) Making it Better
Reconfiguration of In-patient services for women, babies, children and young people in Greater Manchester, East Cheshire
and High Peak Report for the Joint Committee of Primary Care Trusts..
Kramer, M. (1974) Reality shock: why nurses leave nursing. St Louis: Mosby.
Meleis, A. I., Sawyer, L., Im e.O. Messias, D. Schumacher, K. et al. (2000) Experiencing transition: An Emerging Middle-Range
Theory. Advances in Nursing Science, 23 12-28.
van Gennep, A. (1960,) The rites of passage. London: Routledge.
Thank you for
listening
Contact details:
Follow me on twitter @ALDarvill