Perceptions of Graduate Nurses' Orientation Within the Emergency Department

Abstract

Session B presented Thursday, September 27, 11:30 am-12:30 pm Purpose: Emergency nursing is challenging and complex. Because of the current shortage of nurses, emergency departments (ED) must develop strategies to recruit, train and retain nurses. Many organizations are implementing graduate nurse internship programs to improve upon staffing demands. The purpose of this study was to gain an understanding of how new graduate nurses oriented to the ED perceived their orientation program at the mid-point and end of a six month internship program. Design: A replica study was conducted utilizing a qualitative and quantitative design. Setting: A hundred and thirty two bed Level One Trauma emergency department located in a large (1100 bed) public, tertiary care, teaching, research and referral medicine center in southeastern Michigan. Participants/Subjects: Study participants included 14 women and 3 men. All were employed full time in their first position as a graduate nurse. Ten of the nurses have their BSN while the other 7 have their ADN. Surveys and interview questionnaires were identified by the participants employee ID to assist with confidentiality. Methods: Semi structured interviews were conducted at the beginning of the 4th month and at the end of the 6 month orientation program. Each interview lasted approximately one hour and had two investigators present so that data collected could be confirmed and validated. A comparison of the perceptions was conducted individually pre and post as well as across interns. The Bowles and Candela Perceptions of First Job Nursing Experiences survey was administered at the final week of orientation. Results/Outcomes: Participants shared their perceptions of adapting to the role of professional emergency nurse, support of their colleagues and management team, preparation for practice in the ED, challenges of acclimating to emergency nursing, experience of being part of an internship program, and recommendations for future graduate nurse internship programs. According to the graduates, participating within the internship program provided them the opportunity to share both their frustrations and experiences allowing for professional growth and development. They identified the extended orientation as assisting them with the refinement of their assessment skills and increased their comfort level in functioning as a competent ED nurse. The interns enjoyed having regular classes and simulation experiences enabling them to put context to the skills they were learning on the unit ensuring safe patient care. When asked the graduate nurses stated the positive nature of the experience and were thankful they had the opportunity to participate in the program. Results of the quantitative survey on participant’s perception of their first job as a registered nurse indicated that the work was stressful but strongly agreed that their orientation prepared them for the position. Implications: Understanding the experience of new graduate nurses to the ED provides vital information for developing orientation programs and assisting with the transition of the novice to competent nurse. There is a demand for effective internship programs to prepare new graduate nurses in providing safe, competent and effective patient care. Graduate nurse retention is crucial and cost-effective. Implementing an internship program may help to prevent avoidable turnover among new nurse graduates within the first year of practice.