Valerie Braddock and Monica Manchester
Associate Professor of Nursing, East Stroudsburg University, United States.
Corresponding Author Details: Valerie Braddock, DNP, RN, CCRN-K, Associate Professor of Nursing, East Stroudsburg University, United States.
Received date: 08th May, 2023
Accepted date: 06th June, 2023
Published date: 08th June, 2023
Citation: Braddock, V., & Manchester, M., (2023). New Graduate Orienetation: Has Competency Confidence Changed Since Covid 19. J Comp Nurs Res Care 8(1):189.
Copyright: ©2023, This is an open-access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Student nurses and new graduate nursing students perceived a lack of preparation to clinical practice due to the challenges of the Covid 19 pandemic. Hospitals needed to pivot hybrid orientation programs and nursing schools needed to adjust clinical time and experiences to meet new Covid guidelines and mandates. This article compared the new graduate nurse confidence surveys of 1,320 nurse residence in a Pennsylvania healthcare network from 2019-2022 to determine if the new graduate nurses’ perceived confidence when performing basic nursing skills such as medication administration, tracheostomy care, ventilator care, wound care, EKG interpretation, nasogastric tube management, central line care, chest tube management, blood administration, and bladder catheter insertion had changed. The results of this study suggested more confidence by new graduate nurses in 2020-2021 as compared to 2019 and 2022. The results indicate that these changes in nursing school clinical and hospital orientations did not impact the 6 month confidence survey negatively. In fact, confidence score were less in 2019 and 2022 when traditional “live” programming was offered.
Keywords: New graduate, Nursing student, Confidence, Skills Nursing School Hospital Orientation, Covid 19
The Covid 19 pandemic has led to many changes in healthcare and in nursing school curriculum. Due to lock downs, supply concerns, and transmission issues during the pandemic, hospitals limited nursing students’ access to clinical opportunities including intensive care experiences (ICU). These restrictions have led to nursing schools extending clinical days such as 12 hour shifts from 6 hour shifts but decreasing frequency of shifts in order to meet curriculum mandated time allotment for clinical. More simulated activities have also been utilized to bridge the lack of opportunities and potential learning gaps. Feedback from nursing students particularly in my? Or the primary university being studied university stated that they felt a lack of preparations in the clinical field due to these restrictions and limitation [1]. As a follow-up to the article “Student Nurses’ perspective of Clinical Rotation during COVID 19 Pandemic: A New Stressor” (2021), the education department was contacted in a large healthcare network in Pennsylvania to determine if nursing orientation was effected due to perceived learning gaps experienced during nursing school during the Covid 19 pandemic.
The purpose of this article to determine if there are any deficiency in skills during nursing orientation since the Covid 19 pandemic.
Multiple articles will confirm that the Covid pandemic effected nursing by creating a shortage in the profession. Nursing orientation to the hospital had to adjust to new mandates such as the lockdowns and social distancing that created onboarding through hybrid programs consisting of online and live classes. Literature supports that these hybrid programs met the need for safe practice [2]. However, these changes still impacted new graduate nurses. In an article by Bultaras & L’Eycuer [3], new graduate nurses felt that their preparation was negatively impacted in the first year of practice [3]. Furthermore, Crimsom et al. [4] also identified that new graduate nurses felt less prepared to the transition to nursing practice as a licensed nurse [4]. Kovanci & Ozbas [5] identified similar transitional issues with new graduate nurses [5]. For this article, new graduate nurses’ perceived confidence with specific skills were evaluated to identify if these new graduates had less confidence due to Covid 19 pandemic effecting their education and orientation.
Post-orientation evaluations were analyzed to determine if there were any changes in the confidence of specific skills from before the Covid 19 pandemic began and when “live” orientation and nursing school clinical rotations resumed. This timeframe was 2019— 2022. The evaluation surveys were generated from the education department of a healthcare network that has 13 hospital campuses in 10 eastern Pennsylvania counties. The post evaluation survey polled new registered nurses who were enrolled in the nurse residency program. The nurse residency program is designed for new graduate nurses so that they can work for 12 months alongside an experienced nurse to be mentored into the nursing practice on a unit of their choice. These nurses are polled initially, at 6 months, 12 months, 24 months and lastly 36 months to determine their perceived progress and support. In 2019, there were 396 nurse residence, 368 nurse residence in 2020, 293 nurse residence in 2021 and . 263 nurse residents in 2022. A likert scale was used in the survey using scoring from 1-4. A score of one indicated no confidence and four high confidence. For the purposes of this study, comparisons were made to the skill confidence which included the following skills:
1. Medication administration
2. Tracheostomy care
3. Ventilator care
4. Wound care
5. EKG interpretation
6. Nasogastric tube management
7. Central line care
8. Chest tube management
9. Blood administration
10. Bladder catheter
These skills were chosen because these are skills that are taught and evaluated in nursing school and nursing hospital orientation. The mean score of confidence was compared at the six month survey in each year.
Although nursing students and new graduates perceive that they are less prepared for the transition to licensed nursing, the results of the survey suggested the opposite. On the whole, scores are increased in 2020 and 2021 where students were most impacted by the pandemic. This increases in confidence can suggest that the longer clinical days and more simulated experiences prepare nursing students and new graduate nurses more so than the shorter clinical days and lack of simulated experiences. In the year 2020 which was the height of the pandemic, new graduate nurses seemed to be more confident with tracheostomy care and ventilator care even though these students expressed concerns about lack of opportunity in the ICU. Due to the respiratory complications of Covid 19, these student nurses and new graduate nurses may have actually been given more opportunity than when not in a pandemic.
In 2019 and 2022 when nursing schools and hospital orientations where provided in all “live” formats, the new graduate nurses’ scores reflect less confidence in skills. This finding may suggest that nursing schools and hospital based orientations should continue with hybrid programming, simulation experiences and longer nursing school clinical days.
Though student nurses and new graduate had grave concerns about readiness for clinical practice due to changes as a result of the Covid 19 pandemic, the results of these surveys would suggest that nursing schools and hospital-based nursing orientations did prepare the new graduate nurse for practice. In fact, based on these findings, it may behoove nursing schools to return to the longer clinical days (12 hour shifts) and more simulated experiences to provide the best experience to nursing students and prepare the nursing student for clinical practice. Furthermore, studies need to be conducted to determine that even though the new graduate nurse perceives herself/ himself confident if that does in fact imply safe patient care. Studies to compare and contrast safety concerns especially among these basic skills sets should be conducted to ensure safety standards have not been compromised.
The authors declare that they have no competing interests.
Braddock, V., DNP, RN. CCRN-K, & Manchester, M., DNP, RN, ONC. (2021). Student Nurses’ perspective of clinical rotation during COVID 19 Pandemic: A new stressor. International Journal of Nursing Healthcare Science, 1(9).
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