Authors
- Villanueva, Dolly Maris RN, BN
- Taylor, Christine RN, PhD
- Dickson, Cathy RN, RM, DN
- Foster, Jann RN, RM, PhD
Abstract
Review question/objective: The overall objective of this systematic review is to identify, critically appraise and synthesize the literature regarding the experiences of new graduate nurses working in a pediatric setting. The specific review question is: what are the experiences of new graduate nurses working in a paediatric setting?
Background: It is estimated that there is a global shortage of 2.4 million nurses, midwives and doctors.1 This shortage has led to an increasing demand for additional new graduate nurses,2 and the need for employers to retain nurses in the workforce.2,3 However, a substantial proportion of new graduate nurses leave their employer or change positions within the first 12 months of employment.4-6 Turnover of new graduate nurses is costly to organizations, for example, expenses incurred in the hiring of temporary staff and additional induction programs.6-10 An important element in the reasons for new graduate nurses' turnover is the nature of their experiences during first year post-registration.5,11
New graduate nurses experience a period of role transition from student nurse to staff nurse.12 Transition is an important concept in nursing, and involves people's adaptation to new circumstances and responses to change over time.13 An individual's adjustment to role transition is complex, and involves personal development as well as interactions with socialization/organizational processes and role requirements.14 New graduate nurses can find transitioning from a student to a graduate nurse to be stressful,12,15 and challenging.16
One challenge that new graduate nurses may face is "reality shock". Reality shock describes the responses of new graduate nurses to the conflict between the expectations of a new graduate nurse and organizational expectations.17 As a consequence, new graduate nurses may feel inadequately prepared to carry out their new role.17 Other challenges that new graduate nurses consider stressful include their increased accountability and responsibility compared to student nurses,12,18 and perceived lack of skills such as time management,16 decision-making, 12,18 and clinical skills.16,19
Support is important for new graduate nurses to assist in the effective transition to their new role. Support can be provided by the organization or individuals. Colleagues may provide support such as feedback,20,21 debriefing22 and praise.23 Organizations may support new graduate nurses by offering structured preceptorship programmes, which can improve job satisfaction,24 reduce stress and anxiety,24,25 and increase confidence.26,27
The pediatric setting, in general, is different to adult settings in terms of patient population and philosophy of care. Children's anatomy and physiology are different to adults and vary with age and developmental stages,28 requiring specific knowledge, techniques and skills by the nurse that are age and developmentally appropriate.29,30 As children are a vulnerable population, delivery of atraumatic care, which is the avoidance of physical and psychological distress in children,31,32 becomes important. The overall philosophy underpinning pediatric nursing is family-centred care, where the child is considered part of the family unit and the family unit is the focus of care.33 As the pediatric setting and care of children are different to those of adults, the role transition experiences of new graduate nurses working in pediatric settings may also be different.
A search of databases including the Joanna Briggs Institute (JBI), Cochrane Library, CINAHL and MEDLINE identified no systematic reviews pertaining to the topic of the experiences of new graduate nurses working in a pediatric setting. A JBI systematic review by Edwards et al.24 includes some articles involving new graduate nurses working in a pediatric setting, however it is a quantitative review. A JBI systematic review protocol by Tseng et al.34 and a non-JBI qualitative systematic review by Higgins et al.15 have been published, but they do not focus specifically on the experiences of new graduate nurses working in a pediatric setting. This qualitative systematic review will synthesize data from relevant studies to describe and explore the experiences of new graduate nurses working in a pediatric setting. The results may provide evidence to assist nurse managers, nurse educators and other nursing staff to develop appropriate support strategies for new graduate nurses.
Article Content
Inclusion criteria
Types of participants
This systematic review will consider studies involving new graduate nurses of any age, gender and cultural background working for 12 months or less in a pediatric setting. A new graduate nurse is a person who has completed a baccalaureate course, associate degree, diploma or equivalent course in nursing, has qualified for registration and is working within the first year post registration as a registered nurse.
Phenomena of interest
This systematic review will consider studies that investigate the experiences of new graduate nurses working in a pediatric setting. The experiences include new graduate nurses' perceptions, perspectives, views, challenges, feelings, beliefs and thoughts of working within the first year post registration in a pediatric setting. The experiences may include, but are not limited to, communication, advocacy, education and minimization of distress in dealing with patients and their families.
Context
Any pediatric setting including, but not limited to, hospitals of any size and within the community in any country, excluding neonatal intensive care units (NICU) and special care nurseries. A pediatric setting is a place where care is provided to sick infants, children and adolescents.
Types of studies
This systematic review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography and qualitative components of studies using mixed method designs.
Search strategy
The search strategy aims to find both published and unpublished studies. Studies published in any language will be considered for inclusion in this review. Studies published from the years 2000 to 2014 inclusive will be considered for inclusion in this review. The time range was selected to capture a wide range of data as no systematic reviews have been undertaken in this topic, yet to be recent enough for the synthesis to be relevant to current practice. A three-stage search strategy will be utilized in this review.
Stage 1: An initial search of MEDLINE and CINAHL will be undertaken using a limited set of keywords. Initial keywords to be used will be: experiences, new graduate nurses, novice nurses, pediatric nursing and pediatric setting. The titles of studies in the initial search will be reviewed to expand the keywords and the index terms used to describe the studies will be identified.
Stage 2: Individual search strategies will be developed for each database using identified keywords and index terms. A second search will then be undertaken using the individual search strategies developed for each database. The databases that will be searched for published literature include:
CINAHL
MEDLINE via OvidSP
PubMed
Scopus
PsycINFO
ERIC
The database that will be searched for unpublished literature or grey literature will be: ProQuest Dissertations & Theses.
Stage 3: Thirdly, the reference lists of all identified studies will be searched for additional studies.
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological quality prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection/extraction
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details such as the phenomena of interest, participants and method.
Data synthesis
Qualitative research findings will, where possible be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible the findings will be presented in narrative form.
Conflicts of interest
The authors have no conflict of interest to declare.
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Appendix I: Appraisal instruments
Appendix II: Data extraction instruments
QARI data extraction instrument[Context Link]
Keywords: experiences; new graduate nurses; novice nurses; paediatric nursing; pediatric setting