INFLUENCES ON TRANSITION TO PRACTICE - The ScholarShip

119 Pages·2013·0.52 MB·English

INFLUENCES ON TRANSITION TO PRACTICE OUTCOMES AMONG NEW NURSES
By
Felecia S. Williams
April, 2013
Director of Thesis/Dissertation: Elaine S. Scott
Major Department: Nursing

This research explored the investigation of influences on transition to practice outcomes
among new graduate nurses in a nurse residency program. The study participants consisted of
641 nurse residents from the Versant RN Registry™ from 2010-2011. They represented 84
facilities in 14 states across the United States. A descriptive correlational design was utilized to
gain insight on the impact mentoring and debriefing had on gains in competence and confidence,
the degree of comfort in assuming a staff nurse role at the end of the residency, and job
satisfaction. A secondary data analysis was conducted using the Versant RN Nurse Residency™
database. Frequencies and percentages, chi-square analysis, and independent t-tests were applied
to the data set. The study results showed mentoring and debriefing as positive influences on
gains in competence and confidence, comfort in assuming a staff nurse role at the end of the
nurse residency, and job satisfaction. The results were moderated by nursing educational
preparation and previous healthcare experience. Bachelor-prepared new graduate nurses and
nurses with previous healthcare experience related a higher degree of comfort in assuming a staff
nurse role at the end of the nurse residency. Future research should include expanded analysis of
the new outcome variable of degree of comfort in assuming a staff nurse role at the end of nurse
residency programs. Continued evaluation of the effectiveness of mentoring circles would also
contribute to the nursing literature with regard to economic feasibility.
Key words: transition-to-practice, new graduate nurse, mentoring, debriefing, nurse
residency

INFLUENCES ON TRANSITION TO PRACTICE AMONG NEW NURSES

A Dissertation

Presented To the Faculty of the College of Nursing

East Carolina University

In Partial Fulfillment of the Requirements for the Degree

Doctor of Philosophy

by

Felecia S. Williams

April, 2013
© Felecia S. Williams, 2013
INFLUENCES ON TRANSITION TO PRACTICE OUTCOMES AMONG NEW NURSES

by

Felecia S. Williams

APPROVED BY:

DIRECTOR OF
DISSERTATION/THESIS: _______________________________________________________
Elaine S. Scott, PhD

COMMITTEE MEMBER: ________________________________________________________
Melvin S. Swanson, PhD

COMMITTEE MEMBER: _______________________________________________________
Carol E. Winters, PhD

COMMITTEE MEMBER: _______________________________________________________
Sylvia T Brown, EdD

CHAIR OF THE DEPARTMENT
OF NURSING: _________________________________________________________________
Sylvia T. Brown, EdD

DEAN OF THE
GRADUATE SCHOOL: _________________________________________________________
Paul J. Gemperline, PhD
DEDICATION
This research study is dedicated to new graduate nurses, nursing program faculty and
nursing leadership in healthcare organizations. Unit-based preceptors, nurse residency program
mentors and debriefers are also included in this dedication. Thank you for your efforts regarding
new graduate nurse transition to practice.
ACKNOWLEDGEMENTS
I would first like to acknowledge my mentor and dissertation chair, Dr. Elaine Scott.
Thank you for your diligence in the oversight and production of a research study that met our
approval. Your commitment to excellence is a role model for dissertation committee members
and leaders. I will forever be indebted to your faith and confidence in my abilities. I would like
to acknowledge my statistician, Dr. Melvin Swanson. Your commitment to students’ work is
unparalleled. You worked tirelessly on sorting, coding and analyzing data to assure that the
study design and analysis met your standard of excellence. Thank you to Dr. Carol Winters for
also serving on my dissertation committee. Your attention to detail in editing contributed to the
success of my efforts. Dean Sylvia Brown, your membership on my committee honored me with
the insight of a seasoned administrator and educator, and your collaboration gave meaning to the
interpretation of findings. I would like to acknowledge WakeMed Health and Hospitals
(especially Betsy Gaskins-McClaine) for providing support for my academic pursuits via
flexibility of scheduling, encouragement, and acknowledgement of my accomplishments
throughout the journey. My family has been my anchor in providing love, validation and
unquestionable commitment to my goals. To my husband Quinton, my parents Jimmie and
Carrie Stanley, and my brother Morris, you are the wind beneath my wings.
TABLE OF CONTENTS
LIST OF TABLES ............................................................................................................ xii
LIST OF FIGURES ............................................................................................................ xiv
CHAPTER 1: PROBLEM FORMULATION ...................................................................... 1
Introduction ........................................................................................................... 1
Statement of the Problem ............................................................................... 4
Background of the Problem ........................................................................... 6
Versant .............................................................................................. 9
Purpose of the Study ...................................................................................... 10
Theoretical Framework .................................................................................. 10
Research Model …………………………………………………………… 13
Significance of the Study …………………………………………………. 15
Research Questions ……………………………………………………….. 15
Theoretical and Operational Definitions ………………………………….. 16
Transition to Practice ……………………………………………… 17
Nurse Residency Program ………………………………………… 18
New Graduate Nurse ……………………………………………… 18
Debriefing ………………………………………………………… 18
Mentoring …………………………………………………………. 19
Clinical Competence ……………………………………………… 19
Confidence ………………………………………………………... 20
Job Satisfaction …………………………………………………… 20
Summary ………………………………………………………….. 21
CHAPTER 2: REVIEW OF THE LITERATURE ............................................................... 22
The New Graduate Nurse ........................................................................................... 22
Demographics …………………………………………………… 22
Challenges/ Outcomes …………………………………………... 24
Influence of Educational Preparation on Transition ……………. 24
Influence of Age on New Graduate Transition …………………. 26
Influence of Previous Healthcare Experience …………………... 28
Job Satisfaction in New Graduates ……………………………… 29
Development of Competence …………………………………… 31
Development of Confidence ……………………………………. 34
Transition to Practice …………………………………………………………… 37
Demographic Influences ………………………………………... 37
Nurse Residency Programs ……………………………………………………... 38
Debriefing ………………………………………………………. 39
Mentoring ……………………………………………………….. 42
Overall Perceived Value ………………………………………… 45
Summary ………………………………………………………………………… 49
CHAPTER 3: RESEARCH METHODOLOGY AND DESIGN ………………………. 50
Population and History of the Research Sample........................................................ 50
Protection of Human Subjects …………………………………………………… 52
Instrumentation ……………………………………………………………………... 53
Versant Metrics …………………………………………………….. 53
Description of Variables ……………………………………………. 53
Data Analysis ……………………………………………………………………….. 55
Methodological Limitations ………………………………………………………… 55
CHAPTER 4: RESULTS …………………………………………………………………… 57
Descriptive Statistics ……………………………………………………………….. 57
Research Question #1 ……………………………………………………… 57
Research Question #2 ……………………………………………………… 59
Research Question #3 ……………………………………………………… 60
Research Question #4 ……………………………………………………… 63
Research Question #5 ……………………………………………………… 65
Research Question #6 ……………………………………………………… 67
CHAPTER 5: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS ………. 73
Summary of Significant Findings …………………………………………………. 77
Conceptual Model and Research Model Findings ………………………………… 79
Strengths and Limitations …………………………………………………………. 79
Recommendations and Implications ………………………………………………. 81
Practice …………………………………………………………………….. 81
Education …………………………………………………………………... 81
Research ……………………………………………………………………. 82
Summary …………………………………………………………………………… 83
REFERENCES ...................................................................................................................... 85
APPENDIX A: THEORETICAL MODEL .......................................................................... 101
APPENDIX B: CONCEPTUAL MODEL ........................................................................... 102