Background: Given the increasing complexity of acute care settings, high patient acuity and demanding workloads,\nnew graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is\nknown about how change in new graduate nursesââ?¬â?¢ satisfaction with clinical supervision and the practice environment\nimpacts on their transitioning experience and expectations during first year of practice. This study aimed to examine\nchange in new graduate nursesââ?¬â?¢ perceptions over the 12-month Transitional Support Program, and identify how\norganizational factors and elements of clinical supervision influenced their experiences.\nMethods: Using a convergent mixed methods design, a prospective survey with open-ended questions was\nadministered to new graduate nursesââ?¬â?¢ working in a tertiary level teaching hospital in Sydney, Australia. Nurses were\nsurveyed at baseline (8ââ?¬â??10 weeks) and follow-up (10ââ?¬â??12 months) between May 2012 and August 2013. Two standardised\ninstruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS)\nwere used. In addition to socio-demographic data, single ââ?¬â??item measures were used to rate new graduate nursesââ?¬â?¢\nconfidence, clinical capability and support received. Participants were also able to provide open-ended comments\nexplaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent\nthemes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential\nstatistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content\nanalysis (CCA). The study was approved by the relevant Human Research Ethics Committees.\nResults: Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The\nmedian age was 23 years (Range: 20 to 53). No change was seen in new graduate nursesââ?¬â?¢ satisfaction with clinical\nsupervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean\nPES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus\n7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6,\np = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not\npractising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629).\nNegative responses to the open-ended questions were associated with increasing workload, mismatch in the level of\nsupport against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and\nTransitional Support Program as a foundation for success; and ii) developing clinical competence.Conclusions: While transitional support programs are helpful in supporting new graduate nurses in their first year of\npractice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nursesââ?¬â?¢\nexperiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to\nbetter support new graduate nursesââ?¬â?¢ and promote confidence and competence to practice within their scope.
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