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The experiences of newly qualified children’s nurses during their transition into children’s community nursing teams. Dr Angela Darvill (presenter) Dr Debbie Fallon Dr Joan Livesley Children's and Young People's Nursing International Conference Building the evidence base for practice, Jersey 2014.
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The experiences of newly qualified children s nurses ...accnuk.org/wp-content/uploads/2014/10/C46-Angela-Darvill.pdf · The experiences of newly qualified children ... Shadowing Protection

Jun 11, 2018

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Page 1: The experiences of newly qualified children s nurses ...accnuk.org/wp-content/uploads/2014/10/C46-Angela-Darvill.pdf · The experiences of newly qualified children ... Shadowing Protection

The experiences of newly qualified children’s nurses during their transition into children’s community nursing teams.

Dr Angela Darvill (presenter)

Dr Debbie Fallon

Dr Joan Livesley

Children's and Young People's Nursing International Conference

“Building the evidence base for practice”, Jersey 2014.

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Background

Development of children’s community nursing

teams across each locality in England

(Department of Health 2004).

Making it Better (2006,2007).

Teams in local area employing newly qualified

children’s nurses for the first time.

Community as first post destination for newly

qualified nurses.

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Transitions in nursing

van Gennep (1960) Rites of passage

Reality shock (Kramer 1974)

Transition shock (Boychuk Duchscher, 2007,

2008)

Common processes, time span and

perception that all newly qualified nurses

experience (Meleis et al 2000)

Literature focused on adult acute care

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Aim and research

objectives

This study aimed to describe and analyse the transition experiences of newly qualified children’s nurses who work in children’s community nursing teams (in the North West of England).

• To identify, explore and describe the meanings that newly qualified children’s nurses attribute to their experiences during their transition into children’s community nursing teams.

• To identify and explore those factors, if any, that the participants perceive as facilitating, helpful or necessary to assist in their transition.

• To identify and explore those factors, if any, that the participants perceive as disrupting or impacting adversely on their transition.

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Study Design

• Qualitative descriptive study (Sandelowski 2000)

• Purposive sample – eight newly qualified nurses working in expanding children's community nursing teams – generalist

• Ethics Approval

• Data Collection - participant observation and semi structured interviews

• Data analysis – Thematic analysis

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Findings

Shadowing

The Visits

Emerging identity as a children’s

community nurse

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Shadowing

The participants saw the time when they were shadowing as a separate

period prior to working on their own as illustrated:

“It’s the time period between you being the student nurse and actually

becoming independent in your job and doing what you’re meant to be

doing. So it’s that sort of period where you’re going from being a

student, where you’re coming into your preceptorship period, where

you’re being supported, where you’re supernumerary and you’re just

watching what’s going on and you’re learning about the job and what

they’re doing. It’s sort of that period where you’re still not quite

Independent and working on your own and from being a student nurse”.

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Shadowing

Protection versus surveillance

“From speaking to some of my friends who have been dumped

right into the deep end basically and left to it, I’m glad, because I’d

rather have somebody there for support and do things right than

to be left to my own devices and do something wrong”.

“Im a lot more relaxed doing stuff on my own, whereas I think if

someone’s watching over me, I do become a little bit paranoid

and I start stammering and doing things wrong because I’m

thinking, I become very nervous. …But when I first started it was

literally there was somebody over your shoulder, observing you,

which is good, but it didn’t do much for my confidence, I’ll be

honest. So at first, it was frustrating, because the things that I

could do, it was like they were there all the time, looking over my

shoulder, but I am glad of it now” .

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Shadowing “Starting from scratch”

“It’s almost like putting down what I have achieved in three

years at University to starting from scratch in community and

not really being seen as being able to do anything ..you’re in

your third year being a student you’re confident you’re seen

as the top level of being a student and then ..you’re sort of

back at the bottom …..that you’re the newly qualified, and it is

talked about in like a negative tone”.

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Shadowing Being “signed off” - Assessment of competencies as a key milestone to independent visits

“That’s basically just trying to give us exposure to as

many things as we can.... .... so we never had to do

visits on our own, we were always accompanying

somebody. We have competencies to do like NG

passing, gastrostomies and things. But no, it’s really

good, really structured”.

“We have got to have observed, been taught and

practised so it’s either your preceptor or somebody

with experience”.

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Visiting

Progressing to occasional

independent visits

“I probably went to see a (child with a) circumcision within

the first few days because once you’ve seen a couple,

what we do is a visit where I’d lead the visit and then

the other nurse would stay in the background and once

you’ve done that really then you could go on your own”.

“Some visits by then I was quite happy to maybe go out on

my own and try a couple, you know, if they were just a

wheezy episode”.

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Visiting

Choosing independence

“If I didn’t feel ready then I wasn’t rushed out, I still got to

spend more time with different people and I only went

out when I felt ready and when everyone else was

confident that I was able to do my job. I think the help

is the support network you get and with everyone letting

..and it just gives you time to absorb everything and not

having to rush ..and panic thinking oh I’ve got three

weeks left, I’d better learn this, that, and the other” .

“I was so nervous, they’ve put me down for visits on my

own. I went, ‘I can’t, I can’t do them’, so one of our

sisters, she came with me and I was fine ”.

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Visiting

Undertaking

independent

uncomplicated care “You know a lot of our pathways, that we’ve done like

the wound assessment and the eczema and the

constipation. They are very quick, so it is literally

tick boxes which you can do”.

“Giving advice per the asthma guidelines that we use,

removing dressings, putting dressings on and

assessing wounds when you see them and then

redress it”.

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Visiting

Continued support

“ and even when that six weeks was up I’d see a

child that had been on the caseload for a while and

I’d go through it with someone before I left the office

so I knew what I was doing” .

“But in the community I think it's responsibility over a

patient and you've not got someone else there with

you, so the only thing you can do is come back to

the office and clarify with other nurses like I've been

doing anyway” .

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Emerging identity as

a children’s

community nurse

“You can see people starting to get more, seen more as …

you know … rather than the newly qualified. There are

actual members of staff who are training obviously they

acknowledge that I wouldn’t know everything, but, they do

acknowledge that I have been here for seven months now”.

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Emerging identity

Being part of the team

• “I thought “I’ve left her to write up all these notes now

which I could have helped her with. Then I’m

thinking she won’t have had a break and she’s got all

these other visits”.

• “Families have just been so appreciative … then you

get to that point where they’ve cracked it and you

can just see the relief in their faces and you feel like

you’ve done a good job”.

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An ideal transition

experience

A period of shadowing helped with knowledge, skill and confidence

development, however this was inhibited by feeling overprotected

and not having their previous experience recognised.

Good formal support with the physical presence of a preceptor

Achievement of job specific competencies within thresholds of

capability

Having the confidence and competence to choose to go on lone

visits was seen as beneficial.

They routinised their actions to help them cope with the cognitive

demands of lone visiting.

They were able to working independently as a children’s community

nurse showing an advancement in knowledge, skill and

experience but they were still reliant at times on the support of

others.

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References Boychuk Duchscher, J.(2007). Professional role transition into acute-care by newly qualified graduated baccalaureate female

registered nurses . Unpublished PhD thesis), University of Alberta, Canada.

Boychuk Duchscher, J.( 2008). A process of becoming: the stages of new nursing graduate professional role transition. The Journal

of Continuing Education in Nursing, 39 ,10, 441-450.

Carter, B. Coad, J. & Goodenough,T., Bray, L. & Anderson, C. (2009). Community Children’s Nursing in England: An appreciative

review of CCNs. Department of Health in collaboration with the University of Lancashire and the University of the West of

England

Chick, N & Meleis, A.I. (1986). Transitions: a nursing concern. In: CHINN, P. L. (Ed.) Nursing research methodology: Issues and

implementation. Aspen: Rockville.

Dearmun (1997). Paediatric nursing graduates' perceptions' of their first year of professional practice

Unpublished PhD thesis. University of Reading .

Dearmun, A. (2000), Supporting newly qualified staff nurses: the lecturer practitioner role. Journal of Nursing Management . 8, 159-

165.

Department of Health. (2004). National Service Framework for Children, Young People and Maternity Services. Department of

Health , London.

Department of Health .( 2007). Making it Better for Children and Young People. clinical case for change. Department of Health ,

London.

Eaton, N .(2000). Children’s community nursing services: models of care delivery A review of the United Kingdom literature.

Journal of Advanced Nursing, 32 ,1 49-56.

Eraut, M. (2007). Learning from Other People in the Workplace, Oxford Review of Education, 33 4, 403-422.

Farasat , H.(2011). The invisibility of being a new nurse: the experience of transition from student to registered children's nurse

Unpublished PhD thesis) University of Sounthampton .

Greater Manchester, East Cheshire and Higher Peak Children, Young Peoples and Families’ Network (2006,) Making it Better

Reconfiguration of In-patient services for women, babies, children and young people in Greater Manchester, East Cheshire

and High Peak Report for the Joint Committee of Primary Care Trusts..

Kramer, M. (1974) Reality shock: why nurses leave nursing. St Louis: Mosby.

Meleis, A. I., Sawyer, L., Im e.O. Messias, D. Schumacher, K. et al. (2000) Experiencing transition: An Emerging Middle-Range

Theory. Advances in Nursing Science, 23 12-28.

van Gennep, A. (1960,) The rites of passage. London: Routledge.

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Thank you for

listening

Contact details:

[email protected]

[email protected]

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Follow me on twitter @ALDarvill