Educational preparation of newly qualified nurses and factors influencing transition : a mixed methods case study

Mawson, Lauren and Warin, Jo (2020) Educational preparation of newly qualified nurses and factors influencing transition : a mixed methods case study. PhD thesis, Lancaster University.

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Abstract

This thesis discusses a mixed-methods case study exploring newly qualified nurses’ (NQNs) educational preparation for autonomous professional practice and factors influencing the transition process. The ontological perspective is pragmatism advocating that the research question itself is central to the study influencing methods employed. It draws on concepts of professional learning and competence (Eraut, 1994: 2004), situated learning theory (Lave and Wenger, 1991, Wenger, 1998) and workplace learning (Illeris, 2011). Engeström’s (2001) Cultural Historical Activity Theory (CHAT) framework is used as a theoretical lens to explore the NQNs’ two main activity systems: a higher education nursing programme and first-post employment as an NQN. The framework aids identification of disturbances in the systems. Methods of data collection included an online survey of 63 participants, 3 focus groups and individual interviews with 15 participants from across all fields of preregistration nursing: Adult, Children’s; Learning Disabilities and Mental Health. Findings suggest transition from student nurse to NQN is exciting but stressful. In preparation to be an NQN, graduate skills such as evidence-based practice and reflection skills were recognised as beneficial and transferable for problem-solving new situations. Main sources of anxiety included: the reality of being professionally accountable for their practice; fear of making mistakes; delivering complex care; missing signs of patient deterioration; and loss of confidence in their own competence and clinical decision-making. There was lack of equity in provision or type of preceptorship with some NQNs feeling unsupported. Supportive preceptorships and gaining confidence were key factors in successful transition gained by experience of significant events and advocating for patients. Confident clinical decision-making requires tacit knowledge and experience so simulation of complex case-based learning with advanced clinical decision-making with final-year nurses is suggested. Final year placements allowing supervised practice of complex communication and care delivery supported by experienced mentors fostering learning is advocated. National standards for preceptorship need to be developed and made mandatory with guidance on content and preceptor training to include pastoral support as well as technical skills training. Universities and their local placement providers as potential employers could work more collaboratively to understand students’ previous learning and how that could be built upon in joint planning for transition.