Factors influencing the practice of new graduate nurses : a focused ethnography of acute care settings

Aim: To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency -based undergraduate programme . Background: In the last 15 years, nursing education has shifted to competency -based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment. Design: A focused ethnography of three acute care units from one academic hospital in Canada. Methods: Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) , and nurse managers (n = 4). Data were collected through individual interviews, focus groups , observation and documentation. Data were analysed according to Roper and Shapira’s (2000) ethnographic nursing analysis framework. Results: Organizational and individual factors were identified as influencing NGNs ’ competenc y deployment. Organizational factors are orientation, stability, workload, and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognize nursing expertise. Conclusion: One way to s mooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies. Relevance to clinical practice: Organizational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors