From student nurse to nurse professional:The shaping of professional identity in nursing

Het tekort aan verpleegkundigen is door een verminderd aanbod van verpleegkundigen en een toenemende zorgvraag een groot probleem. Yvonne ten Hoeve onderzocht waarom studenten kiezen voor een carrière in de verpleging, waarom de één stopt met de studie en wat een ander motiveert om te blijven. Het blijkt dat goede begeleiding en emotionele steun van docenten en mentoren onmisbare ingrediënten zijn om studenten te motiveren om hun studie af te ronden. Daarnaast spelen intrinsieke factoren (de uitdrukkelijke wens om verpleegkundige te worden en doorzettingsvermogen) en extrinsieke factoren (steun en aanmoediging van familie en vrienden) een belangrijke rol. Ze heeft vervolgens onderzocht met welke praktijksituaties jonge verpleegkundigen worden geconfronteerd. De resultaten laten zien dat de transitie van student naar professioneel verpleegkundige een uitdagend proces is dat gepaard gaat met existentiële en stressvolle situaties. De toenemende complexiteit van de zorg heeft een negatieve invloed op hun commitment met het beroep. Confrontaties met ernstig zieke patiënten en negatieve ervaringen met agressieve patiënten zijn geen redenen om het beroep te verlaten, maar hebben wel een grote impact op hun emoties, zoals gevoelens van verdriet, machteloosheid en boosheid. Een belangrijke strategie om met deze gevoelens om te gaan is het delen van emotionele ervaringen met hun collega’s en leidinggevenden. Om het tekort aan verpleegkundigen tegen te gaan is het essentieel om commitment van studenten en verpleegkundigen te bevorderen door het bieden van een veilige werkomgeving. Steun van collega’s en leidinggevenden is van fundamenteel belang voor het aantrekken en behouden van een gemotiveerde en goed-opgeleide beroepsgroep

Turnover prevention:The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses

Aims: Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions. Design: The study used an observational cohort design. Methods: Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013–September 2014. Results: Path modelling revealed that lack of support from colleagues, negative experiences ith patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work-life imbalance; only conflicting job demands, and lack of control related to professional commitment directly. Conclusion(s): To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events. Impact: Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention

An Archaeological Survey for the Eastham State Prison Farm A-1 and 7-1 Well Locations in Houston County Texas

An archaeological survey of two proposed natural gas well sites (2.5 acres each) on the Eastham State Prison Farm Unit of the Texas Department of Criminal Justice in southwest Houston County, Texas was performed by Brazos Valley Research Associates (BVRA) on February 18, 2008 under antiquities permit 4813. The areas were investigated through a 100% Pedestrian Survey and backhoe trenching. The 7-1 well site was very far from a water source and is a very unlikely setting for a prehistoric site. One backhoe trench was dug to two meters through heavy clay, and the results were negative. No surface evidence of a prehistoric or historic site was observed at either well location during the Pedestrian Survey that was hampered because of standing water from recent thunderstorms. At the A-1 well site, five backhoe trenches were dug to depths of 1.5 meters to 2 meters below the ground surface at which point they were terminated when standing water was encountered. Although the project area at the A-1 well site is on an elevated landform above a fairly large creek, no evidence of prehistoric occupation was found. BVRA believes the reason for this is the shallow loamy soils overlying very firm clay. In this area of Texas, prehistoric camps are typically found on sandy hills and terraces. The entire area had been plowed by inmates housed at the prison. Therefore, should any cultural materials be present in the shallow sandy mantle they would have been disturbed by this activity. No archaeological sites were found, and no artifacts were collected. Further work is not warranted

The importance of contextual, relational and cognitive factors for novice nurses' emotional state and affective commitment to the profession. A multilevel study

AIM: This study explored the effects of contextual, relational and cognitive factors derived from novice nurses' work experiences on emotions and affective commitment to the profession. BACKGROUND: With an increasing demand for well-trained nurses, it is imperative to investigate which work-related factors most affect their commitment to develop effective strategies to improve work conditions, work satisfaction and emotional attachment. DESIGN: A repeated measures within subjects design. METHODS: From September 2013-September 2014 eighteen novice nurses described work-related experiences in unstructured diaries and scored their emotional state and affective commitment on a scale. The themes that emerged from the 18 diaries (with 580 diary entries) were quantified as contextual, relational and cognitive factors. Contextual factors refer to complexity of care and existential events; relational factors to experiences with patients, support from colleagues, supervisors and physicians; cognitive factors to nurses' perceived competence. RESULTS: The first multilevel regression analysis, based on the 18 diaries with 580 entries, showed that complexity of care, lack of support and lack of competence were negatively related to novice nurses' affective commitment, whereas received support was positively related. The next multilevel regression analyses showed that all contextual, relational and cognitive factors were either related to negative or positive emotions. CONCLUSION: To retain novice nurses in the profession, it is important to provide support and feedback. This enables novice nurses to deal with the complexity of care and feelings of incompetence and to develop a professional commitment

Developing a model describing voluntary residency attrition: a qualitative study

Background: Many factors influencing residency attrition are identified in the literature, but what role these factors play and how they influence each other remains unclear. Understanding more about the interaction between these factors can provide background to put the available evidence into perspective and provide tools to reduce attrition. The aim of this study was therefore to develop a model that describes voluntary residency attrition. Methods: Semi-structured interviews were held with a convenient sample of orthopaedic surgery residents in the Netherlands who dropped out of training between 2000 and 2018. Transcripts were analysed using a constructivist grounded theory approach. Concepts and themes were identified by iterative constant comparison. Results: Seventeen interviews with former residents were analysed and showed that reasons for voluntary attrition were different for each individual and often a result of a cumulative effect. Individual expectations and needs determine residents’ experiences with the content of the profession, the professional culture and the learning climate. Personal factors like previous clinical experiences, personal circumstances and personal characteristics influence expectations and needs. Specific aspects of the residency programme contributing to attrition were type of patient care, required skills for the profession, work-life balance and interpersonal interaction. Conclusions: This study provides a model for voluntary resident attrition showing the factors involved and how they interact. This model places previous research into perspective, gives implications for practice on the (im)possibilities of preventing attrition and opens possibilities for further research into resident attrition

Professionele identiteitsontwikkeling van studenten en verpleegkundigen

Ziekenhuizen, verpleeghuizen en andere zorginstellingen kampen met grote tekorten aan verpleegkundigen. Deze tekorten worden onder andere veroorzaakt door een vergrijzend personeelsbestand, een vergrijzende patiëntenpopulatie en de toenemende complexiteit van de zorg. Een andere oorzaak is de uitval van verpleegkunde studenten en het voortijdig vertrek van, met name jonge, verpleegkundigen. V&VN noemt de gevolgen van personeelstekorten zelfs onmenselijk en roept de politiek en werkgevers op tot een noodplan (V&VN, 2016). Daarom is het belangrijk om te onderzoeken waarom studenten stoppen met hun studie verpleegkunde en wat de opleiding en de praktijk kunnen doen om hen te motiveren om hun studie af te maken. Waar lopen ze tegen aan? Wat gaat er mis en kan beter? Hetzelfde geldt voor beginnende verpleegkundigen. De overgang van student naar professioneel verpleegkundige is niet altijd gemakkelijk en kan leiden tot stress, burn-out en de beslissing om het beroep te verlaten. Wat hebben zij nodig om gemotiveerd te blijven? Waar schieten de praktijk en de opleiding tekort en wat kan worden gedaan om verpleegkundigen te behouden voor het beroep