Measures that can be used to teach critical thinking skills in nurse prescribers

Critical thinking is a pervasive skill that involves scrutinizing, differentiating, and appraising information and reflecting on the information gained in order to make judgements and inform clinical decisions. Studies inform us of the need for agreement on the approaches used to teach and measure critical thinking. Nurse prescribers undertake an advanced role that encompass the need to be able to make clinically based decisions about the appropriateness of a specific medication. This requires critical thinking attributes. A variety of teaching and learning approaches are offered which can be used by nurse educators to develop critical thinking skills in nurse prescribers

Paper 1: Conceptualizing the transition from advanced to consultant practitioner: career promotion or significant life event?

Background The diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. Objectives To explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results A challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. Conclusions Current emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey

Paper 2: Conceptualizing the transition from advanced to consultant practitioner: role clarity, self-perception, and adjustment

Background Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. Objectives To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. Conclusions This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition

‘Trying to pin down jelly’ - exploring intuitive processes in quality assessment for meta-ethnography

Background: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. Methods: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. Results: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? Conclusions: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies

New nurses burnout and workplace wellbeing:The influence of authentic leadership and psychological capital

The detrimental effects of burnout on nurses’ health and wellbeing are well documented and positive leadership has been shown to be an important organizational resource for discouraging the development of burnout. Intrapersonal resources also play a protective role against workplace stressors. This study investigated the influence of authentic leadership, an organizational resource, and psychological capital, an intrapersonal resource, on new graduate burnout, occupational satisfaction, and workplace mental health over the first year of employment (n = 205). Results supported the protective role of organizational and intrapersonal resources against burnout, job dissatisfaction, and mental health. © 2014 The Authors. Published by Elsevier GmbH. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/)

Do student nurses experience Imposter Phenomenon? An international comparison of Final Year Undergraduate Nursing Students readiness for registration

Background: The transition shock sometimes associated with moving from student to registered nurse can lead to feelings of self-doubt and insecurity especially with the increased expectations and responsibilities that registration brings. Known as Imposter Phenomena, individuals often express a lack of self-confidence, uncertainty in their abilities or that others have an over inflated opinion of them. Aim: The aim of this study is to examine the extent at which imposter phenomenon is evident in four final year nursing student cohorts in Australia, New Zealand and the United Kingdom. Design: A survey design. Settings: The study took place at 4 higher education institutes – two metropolitan campuses and two regional campuses between October 2014 and February 2015 in Australia, New Zealand and the United Kingdom. A sample of 223 final year nursing students undertaking nationally accredited nursing programmes were approached. Results: Each cohort exhibited mild to moderate feelings of Imposter Phenomena. A positive weak correlation between imposter phenomena and preparedness for practice was found. The New Zealand cohort scored higher than both the Australian and United Kingdom cohorts on both feelings of imposterism and preparedness for practice. Conclusions: Nursing students possess internalised feelings which suggest their performance and competence once qualified could be compromised. There is some speculation that the respective curriculums may have some bearing on preparing students for registration and beyond. It is recommended that educational programmes designed for this student cohort should be mindful of this internal conflict and potential external hostility

Transition shock: the initial stage of role adaptation for newly graduated registered nurses.

Abstract Title. Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. Aim. The aim of this paper is to provide a theoretical framework of the initial role transition for newly graduated nurses to assist managers, educators and seasoned practitioners to support and facilitate this professional adjustment appropriately. Background. The theory of Transition Shock presented here builds on Kramer's work by outlining how the contemporary new graduate engaging in a professional practice role for the first time is confronted with a broad range and scope of physical, intellectual, emotional, developmental and sociocultural changes that are expressions of, and mitigating factors within the experience of transition. Data sources. This paper offers cumulative knowledge gained from a programme of research spanning the last 10 years and four qualitative studies on new graduate transition. Discussion. New nurses often identify their initial professional adjustment in terms of the feelings of anxiety, insecurity, inadequacy and instability it produces. The Transition ShockÓ theory offered focuses on the aspects of the new graduate's roles, responsibilities, relationship and knowledge that both mediate the intensity and duration of the transition experience and qualify the early stage of professional role transition for the new nursing graduate. Conclusion. Transition shock reinforces the need for preparatory theory about role transition for senior nursing students and the critical importance of bridging undergraduate educational curricula with escalating workplace expectations. The goal of such knowledge is the successful integration of new nursing professionals into the stressful and highly dynamic context of professional practice

The new graduates' professional inheritance

Across North America, health care systems are experiencing an escalating shortage of qualified and committed registered nurses (RNs). There is mounting evidence that the perception of nursing as a challenging, satisfying, and fulfilling vocation by society’s youth is waning. The effect on health care workplaces is an increasingly limited pool of RNs available to fill nursing vacancies that crosses cultural, geographical, and economic boundaries