EXPERIENCES OF NEWLY QUALIFIED NURSES TAKING ON THE NURSING ROLE IN FEDERAL MEDICAL CENTRE YENAGOA, BAYELSA STATE
Kenneth Belibodei Wasini1*, Beatrice Eyito Obende2
1Department of Medical-Surgical Nursing, Faculty of Nursing Sciences, Niger Delta University, Bayelsa, Nigeria.
2Department of Nursing Science, Faculty of Applied Health Sciences, Edo State University Uzairue, Nigeria
*Correspondence: Kenneth Belibodei Wasini; +2348034366806; firstname.lastname@example.org; email@example.com
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Background: Newly qualified nurses (NQNs) experience many stressful situations during the transition to practice.
Objectives: To determine experiences of NQNs taking on the nursing role in Federal Medical Centre Yenagoa (FMCY), Bayelsa State, Nigeria.
Materials and Methods: A hermeneutic phenomenological qualitative study design. Data were gathered from 15 purposively selected NQNs using a semi-structured interview guide. Interviews were audio taped, transcribed verbatim and analysed using the thematic analysis method.
Results: Four themes, seven categories, and twenty-six subcategories emerged. The overarching themes are clinical transitional experiences of NQNs, challenges faced by NQNs, supportive measures available to NQNs, and a mismatch between students’ expectations and professional practice reality. Under these themes, NQNs reported negative experiences when they started working as nurses.
Conclusion: Despite some reasons for positive feelings, the enthusiasm of NQNs entering the profession can diminish owing to unpleasant experiences.
Keywords: Transition, Experiences, Qualified, Nursing, Role
Cite this article: Wasini KB, Obende BE. Experiences of newly qualified nurses taking on the nursing role in Federal Medical Centre, Bayelsa State. Yen Med J. 2023;5(2):51–60.
New nurses have multiple roles including patient care and ward administration. Being professionals and not students anymore, taking on such roles makes newly qualified nurses (NQNs) feel anxious, unprepared1,2 and leads to describing their beginning working days as stressful.3 Such perception creates functional disabilities, communication and managerial challenges for the nurse at work4 which may also be associated with patient safety issues, work stress, and being happy on the job.5 The situation escalates during high work demands amidst inadequate support.6 Nevertheless, the standard of nursing practice must not reduce in order to achieve optimal care outcomes. Consequently, NQNs are wittingly required to effectively adapt and transit promptly to take up their professional duties.7,8
The stress experienced by NQNs in taking on the nursing role is related to factors like experience, opportunities, environment, personal characteristics, motivation, theoretical knowledge, ineffective university education, inadequate on-the-job trainings, and unavailability of qualified preceptors and mentors.9 These factors either facilitate or hinder NQNs’ successful taking on of the nurse’s role. In Nigerian settings, hindrances for NQNs include ineffective university education, inadequate on-the-job trainings, poor support-seeking behaviours, administrative weaknesses, ineffective communication, personal characteristics, and culture.9,10 These factors create difficulties and often make NQNs to feel unsure of themselves, unhappy, disinterested in personal learning and progress and threatened job satisfaction.5 It implies that if nurses (who spend significant time with patients) are unhappy, they may not give their best services, which will affect the quality of care. Progressive learning of the nurses and the profession’s image also will be negatively impacted.
It is therefore evident that successfully assuming the nursing role is crucial to all stakeholders in health. It would improve NQNs competence and job satisfaction and promote quality nursing care and patient outcomes. Consequently, this study explored the experiences of NQNs in Federal Medical Centre Yenagoa (FMCY), Bayelsa State as they assume the nursing role based on three research questions, which are: “What are the transitional experiences of NQNs taking on the nursing role? What are the challenges faced by NQNs while taking on the nursing role? What supportive measures are available for NQNs?
Study Design and Setting
A hermeneutic phenomenological qualitative research design involving NQNs at FMCY. FMCY is a tertiary hospital that has been providing nursing services to patients and training to student nurses, nurse interns and qualified nurses for over twenty years in Bayelsa State, Nigeria.
Newly Qualified Nurses employed not more than two years by FMCY.
All NQNs employed not more than two years by FMCY were eligible and withholding of consent was the only exclusion criteria.
Data Collection and Sampling Technique
Participants were purposively selected. Semi-structured interview guide and a field note were used to gather data. The researchers entered the units of the hospital one after the other. Ward managers’ permission was secured to contact the participants whose permission was verbally sought and obtained after assuring them of anonymity and confidentiality. Informed consents from the participants in the study were obtained. The nurses’ room of each unit was used for the interview to ensure privacy and conduciveness. Each participant’s interview duration was about 60 minutes, and an audiotape recording was done during the interview, which was later transcribed verbatim for analysis. Participants’ interview was conducted continuously until 15 NQNs were interviewed, and data saturation occurred. The information obtained was stored in the researchers’ email boxes to avoid any loss and to protect it from improper use and disclosure. Follow-up interview was not carried out as questions were adequately answered. The data collection duration was three weeks.
Collection and analysis of data proceeded simultaneously until no new information was elicited, thereby reaching a redundancy point. Thematic analysis was done with the aid of the interview notes and the interview audio recordings. A professional transcriptionist transcribed the audio-taped interviews verbatim, including any nonverbal interruptions, laughter, or pauses. The researchers then reviewed the audio recordings to confirm the accuracy of the transcribed data. Data triangulation was then used to ensure accuracy of the analysis by analysing the coded data for accurate representation and phenomena of the study.
Data analysis revealed several themes and sub-themes as presented.
Theme 1: Clinical Transitional Experiences of Newly Qualified Nurses
This theme revealed negative (Category 1) and positive (Category 2) categories of feelings that NQNs initially experienced. Each category has subcategories. The sub-categories under Category 1 show indicators of initial negative feelings of NQNs, including difficult experiences in the new setting, inadequate practical skills and experiences, fear and anxiety, role conflict or poorly perceived interpersonal relationship. Conversely, category 2 has sub-categories that identify role acceptance, expectations to contribute and fulfil professional goals in services to nursing and to patients, fulfilment and excitement of new level achievement, and a wonderful transition as indicators of the initial positive feeling that NQNs have in their clinical transitional experience. The excerpts are in Table 1.
Table 1: Feelings of NQNs during Transition
Category 1: Initial negative feeling
Difficult experiences in new work environment
“When I started it was not easy, very difficult and hectic working in a new environment especially in knowing your senior colleagues and your patients at that time. You see the work very difficult at that particular time” (P1).
“It wasn’t easy, very tough, everybody expect me as a graduate nurse to know all. I was asked to monitor v/s and wasn’t familiar with where the instruments are kept and the senior nurse shouted at me, run me down” (P8).
Lack of practical skills and experience
“My first experience was at A&E unit where I saw a gunshot case, so frightened and shaking because I don’t know what to do and it dawned on me that this is the reality of nursing practice” (P5).
Feeling of fear and anxiety
“As a new nurse moving into my new role was filled with so much anxiety and fears because as a student nurse, I wasn’t treated well so now entering into the workforce was filled with fear and anxiety” (P3).
“I had a lot of fear and anxiety because I wasn’t sure of the staffs I will be working with” (P3).
Role conflict/poorly perceived inter-personal relationship
“It wasn’t easy, there were some challenging factors like one day, I finished my morning work and sitting, so different team were entering into the ward which I don’t know about, the matron came and started shouting, “you don’t even know how to work, why are you guys seated”, the senior nurse that supposed to guide us said “they are adults, if they like they should not know, I cannot teach my kids at home and tell adults what to do. So, nobody really tells you what is expected of you or not” (P4).
Category 2: initial positive feeling
“I move into my new role with so many expectations having learnt a lot of things in nursing as a profession” (P9).
Expectations to contribute and fulfil professional goals in services to nursing and to patients
“…I move into nursing with the hope that I was going to make a change and my own contribution as a nurse, take care of my patients professionally” (P13).
“I was so excited; I was excited that I want to practice my profession (P12).
Fulfilled and excited over achievement of new level
“…I got fulfilled and excited” (P2).
“I was very excited moving into the workforce because as an individual that want to be useful to the society, doesn’t want to seat at home lazy, so I was happy and excited” (P6).
“It was a thing of joy because I was happy, I got a job, now I have a means of earning at the end of the month” (P7).
“I was so excited; I was excited that I want to practice my profession – nursing” (P14).
A wonderful transition
“I was excited as a new graduate nurse, having been employed into the workforce” (P15).
“It was a wonderful transition, going to the university, graduating and having a job was exciting because is something I have looked up to but dumbfounded coming into the workforce and seeing the way nursing is practice because what was taught in class was entirely an opposite of what is done in the clinical setting” (P10).
P = Participant
Theme 2: Challenges Experienced by Newly Qualified Nurses
Table 2 revealed a theme on challenges experienced by NQNs. It contains three categories that show evidence of poor behaviours and attitudes, infrastructural challenges and NQNs’ experiences in practice. Each category has sub-categories. Category 1’s sub-categories reveal challenges experienced by NQNs in transition; represented as poor behaviour or attitudes like harsh, condescending attitudes of seniors and inadequate collaboration with NQNs. Category 2 identifies infrastructural challenges like inadequate working equipment, instruments, and poor electricity, whereas category 3’s sub-categories identifies NQNs’ challenges in practice in form of much improvisation, archaic practices, fear, anxiety, attempting to cope with a new work setting, heavy workload, and stress of early wake-up and preparation for work.
Table 2: Categories of challenges experienced by NQNs
Category 1: Poor behaviours/Attitudes
Harsh, condescending attitudes of senior
Lack of collaboration with NQNs
“…many don’t understand the impact of being a newly qualified and working nurse which they also pass through. They don’t have listening ears, bully you, shout at you and make you lose confidence in yourself and for the profession” (P1).
“…senior nurses scolding junior nurses unnecessarily, “you said you are a graduate nurse; you can’t carry out simple procedures, you can’t do this, you can’t do that” (P3).
“Non friendly attitudes of senior colleagues, not ready to teach the NQNs coming into the system and also not ready to learn from them” (P12).
Category 2: Infrastructural challenges
Lack of working equipment/instruments/electricity
“The main challenges are unavailability of materials and equipment to work with, a lot of improvising, archaic practices” (P3).
“Lack of instrument to work, no source of power, no drugs, begging patient to buy hand gloves to work with. Using your mobile phone as source of power to work with, working with bare hands” (P1).
“Lack of equipment and instruments to work with, being made the shift head when they know you are new and don’t know much about leadership” (P7).
“Challenges of unavailability of materials to work with, not knowing where instrument are kept in the ward, shouting and being talked down on” (P8).
Category 3: NQNs experiences in practice
“One nurse cares for so many patients. It’s stressful”.
P = Participant
Theme 3: Supportive measures available for newly qualified nurses
This theme contains two categories showing evidence of encouragement and facilitation for NQN transition success. Each category has a sub-category. As indicators of encouragement, the subcategories under category 1 are encouragement from parents and friends, personal effort on constant reading and observation and encouragement from colleagues to stay focused. On the other hand, category 2 has sub-categories of periods of orientation, mentorship, and internship as facilitators to successful transitioning for NQNs. Details are in Table 3.
Table 3: Categories of support for NQNs
Category 1: Encouragement
From parent and friends
“Not really, this grace of I can do spirit even when the task is much, observation, asking questions, continuous reading and encouragement from spouse and friends| (P6).
“Things I don’t know I found out by myself, going online, asking questions from those that are calm” (P4).
“Yes, continuous reading, making research on cases that come to the ward, asking questions, observant and try to participate in whatever is been done in the ward” (P5).
“The supportive measure is what I told myself, encourage myself, have confidence in myself, read my books and go online and support from friends” (P10).
“Observation, constantly consulting books and more importantly encouragement from parents and friends” (P7).
“Any supportive measure is coming from me, I always tell myself that Rome was not built in a day, all those matrons, in charge that bully people they were once like me, they didn’t learn everything a day. Once it comes to the physician, I try to do my work, I don’t allow anyone to bully me around. I also try to observe, ask questions, read my books and go online to seek for information” (P8).
“Encouragement to stay focused by some senior matrons, continuous reading, parents and friends boosting your morale and having confidence in myself that I can do it” (P1).
“I worked with experienced and calm senior colleagues who are always ready to teach and correct in a calm and friendly manner. I always go online to read about patient conditions and constantly asking questions” (P2).
Category 2: Facilitation of transition
“To an extent, we were given a few periods of orientation which was somehow helpful and positive, some few senior colleagues who are already to teach and continuous reading” (P3).
“There should be internship program for the NQNs so that they can have more experience in practical and in the ward” (P12).
“Internship program should commence for the NQNs before they are employed into the workforce to boost their clinical skills and experience about the hospital environment” (P10).
“The management should assign the NQNs to senior colleagues to mentor them, teach them and guide them in areas of practice. There should be mentorship where senior ones put younger ones through in their work like 3-6months so that they will be firm and stable in the work” (P6).
“DNS and matrons should teach NQNs what they are expected to know as a newly employed staff” (P8).
P = Participant; DNS = Director of Nursing Services
Theme 4: Mismatch between students’ expectation and reality of professional practices
This theme (Table 4) has just one category with three sub-categories: “no clinical teaching to NQNs; depending on patients to provide needed materials to work with; and the misconception that the graduate nurse should know it all”. These depict a mismatch between students’ expectations and reality of professional practice experienced by the NQNs in their transition process.
Table 4: Categories of theory-practice mismatch for NQNs.
No clinical teaching to NQNs by senior nurse colleagues
“Most times the senior colleagues don’t teach, they send you messages, look down on the NQNs and you become like an odd person in their mist.
“Tell you to carry out procedure without explanation” (P8).
Some of the procedures were only done in demonstration room and have never been done in the ward and now as a staff, nobody is supervising you. Nobody is telling you how to do it, is assume that you should do it because you are no longer a student but a staff” (P9).
“Not been used to the environment, nobody is ready to put me through on how things are done in the ward. If you ask question, they reply to you with “you that is a graduate, don’t you know it all? But if their diploma colleagues ask, they will reply quickly” (P11).
“The main challenges are unavailability of materials and equipment to work with, a lot of improvising, archaic practices” (P3).
Misconception about graduate nurse
“When you ask question, their response is “the people you are asking are not graduate, why are you asking me, are you not supposed to know what to do?” (P15).
“…The graduate nurse knows it all, are you guys not scientific nurses? So do it scientifically, shouting and yelling always at you. They want you to perform magic to carry out procedures you have not been taught” (P14).
P = Participant
Table 5 shows participants’ descriptions of a mentor as a support during transition in clinical practice. They described a mentor as approachable, dedicated to work, competent, always prepared, professionally experienced, renders support, imparts knowledge calmly, and providing counselling. Conversely, participants describe a mentee as one who is respectful, calm, ready to learn, rule-abiding, ready to take corrections, loyal, obedient, willing to learn, teachable, honest, follows instructions, asks questions, and is zealous.
On having mentors or not, Table 6 shows that the majority (66.7%) did not have mentors, 20% had mentors, and 3.3% were not certain if they had a mentor during the transitional experience.
Table 5: Perception of newly qualified nurses about mentorship
Concept of a mentor
Expectation required of a mentee
Someone who is approachable
Be respectful, calm and ready to learn
Always ready to teach
Be rule abiding and ready to take corrections
Someone dedicated to work
Be loyal and obedient
Willingly to learn/teachable
Someone with experience in the profession
Someone who renders support when necessary
A person who has the attributes to impact knowledge in a calm and orderly manner
Someone that you meet once in a while to have a close talk or counselling
Table 6: NQNs with and without mentors
Do you have a mentor?
In answering the research question, “What are the experiences of NQNs taking on the nursing role in FMC Yenagoa, Bayelsa State?”, the experience of initial negative and positive feelings identified herein agree with existing literature. The negatives are due to a sense of responsibility and accountability which they feel unprepared to handle.11,12 Such feelings make some nurses to leave the profession within a year of qualifying.12 Contrarily, positive feelings stem from excitement and sense of belonging after securing employment, a finding which agrees with reports in other studies.3,13
The attitudinal and infrastructural challenges elicited in this study in response to the research question, “What are the challenges of NQNs while taking on the nursing roles in FMC Yenagoa, Bayelsa State?”, were also reported in other studies.4,10,14,15 NQNs were likened to visitors even as they themselves feel powerless and felt like strangers in the ward. They are exposed to resistance from older nurses and often humiliated with derogatory comments. Knowledge is often withheld from them, and they are overloaded with works without adequate equipment/resources. These challenges are distressing and dissatisfying.
The responses to, “What supportive measures are available for the NQNs taking on the nursing roles in FMC, Yenagoa, Bayelsa State?” showed that 66.7% have no mentors. It means that encouragement, proper orientation, clinical support etc., which are necessary to strengthen the gains during training were not quite available for the participants. Other research have reported similar insufficient support for newly qualified nurses.16,17 Nonetheless, the fact remains that the aforementioned measures are effective support for NQNs and they are capable of improving job satisfaction and retention among NQNs.
Despite some reasons for positive feelings, the enthusiasm of NQNs entering the profession can diminish owing to unpleasant experiences.
To achieve optimal transition of NQNs requires a well-designed structure with supportive environments. Organizational managers should provide structured support systems for NQNs, improve socialization in the ward, schedule designated follow-up visits with the NQNs and include NQNs in continuous development programs. Senior staff nurses should also assist NQNs to develop a sense of belonging in the units. NQNs should be assigned to experienced nurses who would provide formal feedbacks to them regarding their practice. Awareness of the challenges ahead should be created among final year students soon to be NQNs. The NQNs should participate in various orientation programs; work closely with experienced colleagues; be respectful and willing to learn; and have confidence in themselves to reduce stress, anxiety, and fear of transitioning.
Both authors significantly contributed to every step of the research as well as drafting of the manuscript.
CONFLICT OF INTEREST
There is no conflict of interest between the authors.
Research ethics committee approval from the Federal Medical Centre Yenagoa was obtained.
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