Linking patient safety to clinical practice: The insight of new graduate registered nurses

New graduate registered nurses’ (NGRNs) transition to practice with limited clinical experiences and skills. The related anxiety and stress predispose new graduate nurses to increased risk of contributing to preventable errors or adverse events. This risk, together with the new graduate’s fledgling ability to manage clinical deterioration, potentially compromises quality and safety of patient outcomes. A longitudinal mixed methods design was used to develop an understanding of new graduate registered nurses’ patient safety knowledge and actions within the first year of nursing registration and offer important insights into NGRNs’ transition with a patient safety focus. New graduate registered nurses employed in graduate nurse programs at two Australian metropolitan hospitals were invited to participate. Data collection activities took place from August 2016 to February 2018. A closed-ended questionnaire, a modified version of the “Medical students’ questionnaire of knowledge, skills, and attitudes regarding patient safety”, was delivered at three time points during the graduate program to monitor the evolution of the NGRNs’ knowledge, feelings and attitudes regarding medical errors and patient safety over time. Qualitative data was collected by semi-structured one-on-one interviews to gain a deeper appreciation of the NGRNs knowledge of patient safety and challenges of integrating this knowledge into their clinical practice. Quantitative data were analysed using ANOVA One-way analysis of variance, or General Linear Model for repeated measures to measure vi difference, if any, between the time points. Qualitative data analysis was guided by Braun and Clark’s six steps of thematic analysis. Quantitative results were categorised into the four subcategories of knowledge of medical error; knowledge of actions regarding medical error; attitudes to compromised patient safety; and intentions regarding patient safety prior to analysis. Thematic analysis revealed five main themes: patient safety and insights; time management; making a mistake; experiential learning; and transition. Although confidence was low, participants intend to communicate, support, and intervene, when faced with compromised patient safety situations. However, self-reported knowledge of medical error and knowledge of actions regarding medical error decreased over the three time points. Medical errors and time management persist as stressors to the NGRNs early months of transition to the registered nurse role. New graduates reported moderate knowledge of safety and quality issues, however, their questioning of their own abilities overshadowed growth in their involvement in patient safety

New graduate registered nurses’ knowledge of patient safety and practice: A literature review

Aims and objectives To critically appraise available literature and summarise evidence pertaining to the patient safety knowledge and practices of new graduate registered nurses. Background Responsibility for patient safety should not be limited to the practice of the bedside nurses, rather the responsibility of all in the healthcare system. Previous research identified lapses in safety across the health care, more specifically with new practitioners. Understanding these gaps and what may be employed to counteract them is vital to ensuring patient safety. Design A focused review of research literature. Methods The review used key terms and Boolean operators across a 5-year time frame in CINAHL, Medline, psycINFO and Google Scholar for research articles pertaining to the area of enquiry. Eighty-four articles met the inclusion criteria, 39 discarded due to irrelevant material and 45 articles were included in the literature review. Results This review acknowledges that nursing has different stages of knowledge and practice capabilities. A theory-practice gap for new graduate registered nurses exists, and transition to practice is a key learning period setting new nurses on the path to becoming expert practitioners. Within the literature, there was little to no acknowledgement of patient safety knowledge of the newly registered nurse. Conclusions Issues raised in the 1970s remain a concern for today\u27s new graduate registered nurses. Research has recognised several factors affecting transition from nursing student to new graduate registered nurse. These factors are leaving new practitioners open to potential errors and risking patient safety. Relevance to clinical practice Understanding the knowledge of a new graduate registered nurse upon entering clinical practice may assist in organisations providing appropriate clinical and theoretical support to these nurses during their transition

New graduate nurses\u27 understanding and attitudes about patient safety upon transition to practice

AIMS: To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety. BACKGROUND: New graduate registered nurses\u27 transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care. DESIGN: Qualitative descriptive approach using semi-structured interviews. METHODS: Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1). RESULTS: Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses\u27 clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety. CONCLUSION: Transition shock leaves new graduate registered nurses\u27 focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses. RELEVANCE TO PRACTICE: Having an understanding of the new graduate registered nurses\u27 experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time

New graduate nurses\u27 clinical safety knowledge by the numbers

AIM: To explore new graduate registered nurses\u27 knowledge and attitudes concerning medical error and patient safety, during their first 6 months of professional practice. BACKGROUND: New graduate registered nurses demonstrate basic skills and levels of performance due to limited exposure and experience in actual situations. There is a concern held for their clinical reasoning skills required to recognize patient deterioration, posing a threat to patient safety. METHODS: An online questionnaire was used to survey new graduate registered nurses at three time points during graduate nurse programmes between August 2016 and February 2018. RESULTS: A decrease in self-reported knowledge and attitudes regarding medical errors was noted over the three time points. These results indicate initial confidence in theoretical knowledge and attitudes upon completion of undergraduate education, and prior to commencing professional practice. CONCLUSION: Results suggest that a theory practice gap persists with respect to medical error for transitioning new nurses. IMPACT FOR NURSING MANAGEMENT: New nurses lack confidence around compromised patient safety situations and a knowledge gap around actions related to medical error. Nurse managers and educators should be made aware of this gap to implement strategies to decrease risk during novice nurse transition

Benner\u27s model and Duchscher\u27s theory: Providing the framework for understanding new graduate nurses\u27 transition to practice

The transition to quality and safety in the new graduate registered nurses\u27 practice remains problematic directly impacting patient outcomes. Effective mentoring during transition serves to enhance experiential learning, allowing the development and establishment of safe, quality nursing practice. Comprehensive understanding of the transition process, including the barriers and effective enablers to transition is the key to effective mentoring. A theoretical framework guided by Duchscher\u27s Stages of Transition Theory and Transition Shock Model and Benner\u27s From novice to expert model can facilitate such understanding. Nurse Theorists play an important part in shaping nurse education and practice and have provided nurse educators and leaders an understanding to shape skill acquisition and the transition process for new graduate registered nurses. The res ultantresearchmodels and theory of these influencial nurses are pertinent to transition of new graduate registered nurses. This paper outlines the theories of Duchscher and Benner and how their research formed the theoretical framework to facilitate the measurement, understanding and improvement of the safety and quality of nursing care and impact the future nursing workforce

Contributions of maternal and infant factors to infant responding to the Still Face paradigm: a longitudinal study

Early mother–infant interactions are characterised by periods of synchronous interaction that are interrupted by periods of mismatch; the experience of such mismatches and their subsequent repair is held to facilitate the development of infant self-regulatory capacities (Tronick, Als, Adamson, Wise, & Brazelton, 1978). Infant responding to such interactive challenge is assumed to be a function of both maternal behaviour and pre-existing infant characteristics. However, the latter has received relatively little attention. In a prospective longitudinal study of a sample comprising high and low adversity dyads (n = 122), we examined the contributions of both maternal sensitivity and neonatal irritability to infant behavioural and physiological responding to the interactive challenge of the Still Face paradigm. Results indicated that higher levels of maternal sensitivity were associated with more regulated infant behaviour during the Still Face paradigm. Neonatal irritability also predicted poorer behavioural and heart rate recovery following the Still Face challenge. Furthermore, there was an interaction such that irritable infants with insensitive mothers showed the worst behavioural outcomes. The findings highlight the importance of the interplay between maternal and infant characteristics in determining dyadic responding

The nexus of nursing leadership and a culture of safer patient care

Aims and objectives: To explore the connection between +6 nursing leadership and enhanced patient safety. Background: Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation programme and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture towards safer practices. Design: The position of this article was to explore the need to form a nexus between safety culture and leadership for the provision of safe care. Conclusions: Safety is crucial in health care for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. Relevance to practice: Patient safety is the responsibility of all healthcare workers, from the highest executive to the bedside nurse, thus effective leadership throughout all levels is essential in engaging staff to provide high quality care for the best possible patient outcome