Elsevier

Nurse Education in Practice

Volume 19, July 2016, Pages 19-24
Nurse Education in Practice

Clinical education
New graduate nurses' experiences about lack of professional confidence

https://doi.org/10.1016/j.nepr.2016.04.001Get rights and content

Highlights

  • The development of professional confidence is a dynamic process that occurs throughout the first year of practice.

  • This study found that there are variable degrees of professional confidence; not an ‘all or nothing’ phenomenon.

  • Confidence fluctuated for some participants and was dependent on both positive and negative experiences.

  • Improved partnerships between undergraduate education and nursing practice are needed to best support new graduate nurses.

Abstract

Professional confidence is an essential trait for new graduate nurses to possess in order to provide quality patient care in today's complex hospital setting. However, many new graduates are entering the workforce without it and this remains to be explored. This study describes how new graduate nurses accounted for their lack of professional confidence upon entry into professional practice and how it developed during their first year of practice in the hospital setting. Two face-to-face, individual interviews of 12 participants were utilized to capture the lived experiences of new graduate nurses to gain an understanding of this phenomenon. After manual content analysis seven themes emerged: communication is huge, making mistakes, disconnect between school and practice, independence, relationship building, positive feedback is important, and gaining experience. The findings indicate that the development of professional confidence is a dynamic process that occurs throughout the first year of practice. New graduate nurses must experience both positive and negative circumstances in order to move toward the attainment of professional confidence. Knowing this, nurse educators in academia as well as in the hospital setting may better support the development of professional confidence both before and during the first year of practice.

Introduction

Professional confidence is an essential trait for new graduate nurses to develop to provide quality patient care in today's complex hospital setting (American Association of Colleges of Nurses, 2008, Clark and Springer, 2012, Perry, 2011). Patients admitted to the hospital have higher acuities, comorbidities, and multi-system disorders thereby intensifying the role and responsibilities of today's graduate nurse (Smart et al., 2014, Sturmberg and Lanham, 2014). Nursing education programs provide the foundation for student nurses to develop professional confidence and upon entry into practice; new graduate nurses are expected to display professional confidence in their roles in the hospital setting (American Association of Colleges of Nurses, 2008, Baldwin et al., 2014). Unfortunately, many new graduate nurses report a disconnect of clinical knowledge learned in nursing school and how it needs to be applied in actual nursing practice, thus leading to lack of professional confidence (Dowson et al., 2013, Dyess and Parker, 2012, Henderson and Eaton, 2013). The purpose of this descriptive qualitative study was to explore how new graduate nurses accounted for their lack of professional confidence and how it developed during their first year of practice in the hospital setting. The main research question was as follows: “How do new graduate nurses account for their lack of professional confidence and how does it develop during their first year of practice in the hospital setting?” To answer this question, participants were asked about circumstances that both challenged and promoted the development of professional confidence.

Section snippets

Literature review

The transition into nursing practice has been widely investigated and dates back to Kramer's Theory of Reality Shock (1974), which described the difficulties and stressors experienced by new graduate nurses during their first year of professional practice. Duchscher, 2008, Duchscher, 2009, Duchscher, 2012 extended Kramer's work (1974) and generated a grounded theory that described the progression of novice nurses as they began employment as registered nurses, which is called transition theory.

Research design

A descriptive qualitative design was utilized to explore the main research question “How do new graduate nurses account for their lack of professional confidence and how does it develop during their first year of practice in the hospital setting?” A semi-structured interview protocol was utilized and two sub-questions were employed that explored both positive and negative experiences of professional confidence development for new graduate nurses. Namely, what types of circumstances challenged

Findings

All participants agreed that they lacked professional confidence during their first year of practice in the hospital setting. Furthermore, they shared similar experiences related to circumstances that challenged as well as promoted the development of new graduate nurses' professional confidence. Seven key themes emerged from data analysis which provided an understanding of new graduate nurses' experiences about what accounted for their lack of professional confidence and how it develops during

Discussion

The findings gathered from this study suggested that there are variable degrees of professional confidence and that it is not an ‘all or nothing’ phenomenon as previously described in Transition Theory and Reality Shock (Duchscher, 2008, Duchscher, 2009, Duchscher, 2012, Kramer, 1974). Participants ranged from three to twelve months on the job and length of employment was insignificant. Feelings of professional confidence fluctuated throughout the first year on the job. Accordingly, a lack of

Limitations of the study

Data was collected from a small participant pool from two hospitals in the New York area making the study geographically limited. In addition, generalizability of the findings is also limited due to the small, purposeful selection of participants (Bogdan and Biklen, 2011, Creswell, 2014, Merriam and Tisdell, 2015). Hence, the findings may not be reflective of new graduate nurses' experiences in other hospitals in the county, state, or nation. Additionally, the study focused on new graduate

Conclusion

This study found that the development of professional confidence is a dynamic process that occurs throughout the first year of practice. In order to achieve professional confidence, new graduate nurses must experience both positive and negative circumstances even if it is uncomfortable or frightening. Knowing this, preceptors can more deliberately expose new graduates to a variety of patient cases and critical situations. Further, nurse educators in academia as well as in professional practice

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