May 6, 2024

May Newsletter

May Newsletter

May 6, 2024

New at NTF!

We are so pleased to announce another fantastic month of engaging, issue-driven content at NTF. Read on to find out what we have been up to, as we work to serve newly graduated nurses and their supporters!

Nurses week is coming up! We look forward to celebrating all the amazing work that is done in nursing, so watch our social media for an upcoming contest, where you can win a ton of great NTF swag and prizes for your unit!
Don't miss this month’s NTFLive! Go to https://nursingthefuture.ca/ntf-live/ to discover key strategies for building a safe, supportive workplace for newly graduated nurses. Learn how to tackle challenges and promote a culture of safety and inclusion!


We have been so grateful for our previous Masterclass session with the renowned Dr. Jean Watson. Not only was it an honour for Director Dr. Duchscher to complete this series, but the response to the content has been very encouraging. View the past sessions here

Our next Masterclass Series is going to be of a similar highly inspiring calibre, with nursing leaders that are incredibly influential in their fields! This next series will start with a conversation between Dr. Leigh Chapman, Chief Nursing Officer for Canada and Dr. Judy Duchscher in May, 2024 with the discussion focused on the overall status of nursing in Canada. We count ourselves so fortunate to be entering this upcoming series, and will keep you posted!


"The Resilient Nurse" by Karen Furr

Karen Furr's "The Resilient Nurse" offers a practical guide for nurses aiming to enhance their resilience in both personal and professional spheres. Drawing from her background as a pediatric nurse and professional coach, Furr shares insights and strategies to help nurses navigate the challenges and stresses of their profession.

The book emphasizes the importance of self-care, mindfulness, and maintaining a positive mindset. Furr provides practical advice on communication, setting boundaries, and building supportive relationships, all of which are essential for nurses to thrive in the demanding healthcare environment.

Based on her research and work with The Resilient Nurse Project, Furr outlines six key areas of resilience that nurses can focus on to strengthen their ability to cope with the demands of their roles."The Resilient Nurse" serves as a valuable manual for nurses seeking to enhance their well-being and effectiveness in their nursing practice. Whether you're a new graduate or an experienced practitioner, this book offers practical tools and strategies to help you navigate the challenges of nursing with resilience and grace. To learn more about "The Resilient Nurse" and other fantastic books for nurses, visit Book Club - Nursing the Future


In a new feature of The Interview Series, Dr. Judy Duchscher joined the Safe Spaces made Simple Podcast, with Trace Hobson, and Jon and Victoria Schmid. Trace Hobson brings over 25 years of executive leadership and coaching expertise to the healthcare sector, specializing in creating resilient, psychologically safe environments for healthcare teams facing high stress and pressure. A professionally credentialed coach with the International 

Coaching Federation, Trace's unique journey through personal and professional high-stress situations has shaped his mission, which is to create a world where clinical leaders, managers and educators are inspired by their work, create a safe space with their team, and go home fulfilled and energized by their work. Jon Schmid is a Canadian health systems expert, experienced executive leader, nurse, educator, improvement consultant and Veteran leading transformation and Innovation in healthcare. Victoria Schmid is the first CEO of SWITCH BC (Safety, Well-being, Innovation, Training, and Collaboration in Healthcare). SWITCH BC was created to represent unions, employers, Doctors of BC, the Ministry of Health, and WorkSafeBC as a collaborative force for change. Listen to this great podcast exploring the meaning and pursuit of safety for new graduates here!


This month we will be featuring the experience of Occupational Nursing, as a growing field of recognized special practice within nursing. Occupational Health Nurses (OHNs) are certified professionals who integrate health and wellness business expertise to maintain a safe and healthy workplace environment.Committed to upholding high occupational health standards, OHNs work collaboratively with internal leaders and external regulatory bodies, taking a holistic approach to employee well-being and risk management. Hear from Occupational health leader XXXXX at the Alberta Occupational Health Nurses Association, detail the path to this exciting field of work, sharing the journey through personal story here.


At NTF, we are passionate about recognizing and celebrating excellence. When we discover a Rising Star among new graduate nurses or supporters, we are eager to share their successes with our community!If you know someone who deserves to be celebrated for their achievements, please let us know by emailing us at newgraduates@nursingthefuture.ca Your nominations help us shine a spotlight on those who are making a difference in the nursing profession.


The transition into practice for the first 12 months after nursing school is more of a process of becoming a professionally practicing nurse. As with most journeys, it isn’t a straight line from novice to expert, but more of a winding road, full of twists and turns, detours, and the occasional pothole. To be clear, this critical life experience will be very unique to every individual but given the research into this experience, we can offer a sense of the experiences that the majority of NGs go through.

At this point, it is prudent to revisit the importance of FAMILIARITY, CONSISTENCY, PREDICTABILITY and STABILITY in the NG’s personal AND professional life, particularly during the initial 6 months post-orientation. And it is equally important to remind ourselves that while we strive to plan, organize and direct our lives, by doing so we often fail to leave enough ‘space’ for:

  1. new events (moving, getting married or divorced, buying a car or a house, or starting a full-time job as a new nurse);
  2. complicated relationships (conflicts in the workplace with co-workers, starting or ending personal friendships or intimate relationships); and 
  3. unfamiliar or complex practice situations or contexts (going to work as a professional nurse in an area that you never had the opportunity to experience as a student or simply navigating the higher level of acuity that exists in all areas of nursing practice).

These interruptions can significantly disrupt the flow of things and may cause the transition to look different than what had been envisioned, or to be more challenging than had been anticipated. 

“It’s all happening so fast! But it’s exciting at the same time. Just knowing that you’ve come this far and you’re going to go that much further. Every month I put $200.00 away for a trip to Australia and now that I’ve got some kind of security and I think, ‘this really is going to happen. You’re going to get to do these things and you can do them cause you’ve worked hard’. I didn’t think I’d ever finish nursing, but here I am!”

Now, I do NOT want to rain on anyone’s parade, but upon entering the practice environment as a new nurse, these professionals may quickly come to realize that although they have been well PREPARED to assume the roles of a nurse (completing an educational program held to high accreditation standards), they may not feel READY to carry the full weight of responsibility expected of them, nor prepared to manage the significantly increased workload that comes with a fully accountable role.

“I’ve been experiencing numerous or various mixed emotions actually.  At first it was nervousness and excitement and now it’s more ‘Wow, this is actually for real and I’m feeling overwhelmed, stressed, still excited, but also wondering if this is the profession for me.  I’ve actually had that thought.  It runs across my mind a couple of times.  I’m not really sure and I’ve been told that that’s a normal feeling. It’s just all happening really fast for me I guess.  I didn’t really have a whole lot of time to let it all sink in I guess before actually starting’.”

“It’s strange. I don’t really feel like I am finished school. Like I walked to work one morning and as I was walking, I was thinking, ‘I’m getting paid to do this,’ because it’s like I was still in school. And then, within my orientation week I was told that the staff had just run off this nurse who wasn’t doing very well. They told me that they had made it so miserable for her that she would leave . . . and I think they were proud of it—that they had gotten rid of her. I think it’s maybe to maintain quality control, but it’s definitely one of my fears that I won’t be accepted. That if I am failing, they won’t come alongside me, but will show me the door.”

This is not because the graduate is not a capable, competent and highly intelligent graduate. It is just that learning how to manage dynamic, complex situations that are as variable as the people in those situations, takes time and experience; that’s why they call it a career!

“I think part of the pressure for me is that I got the silver medal, and I think ‘Well, OK, so if I had the highest marks in the whole province for my year and I’m floundering…was I marked accurately? Do I really have the potential to be as good a nurse as my professors all thought?”

Many NGs enter their professional transition with expectations and anticipations that are more idealistic than they are realistic. The trick is to strike an appropriate and realistic balance. Leaders in every profession, discipline and workplace fall a bit short in their attempts to create the right set of circumstances for their employees to reach the pinnacle of their potential. While we seek perfection, we also need to be realistic. New nurses tend to blame a lack of educational preparation for the differences between what they had anticipated regarding their roles as professionals and what they are expected to do when they actually begin working in practice. Very few of the participants in my research over the years seriously consider the culpability of their workplaces in failing to adequately (in other words, gradually and strategically) introduce them to the roles and responsibilities of a fully practicing nurse. As a nurse educator I can appreciate that striking a balance between what we want to create as contemporary nursing practice with what we are able to actualize in the highly limited context of the healthcare system is difficult to achieve.

“I have a big problem with my final practicum because you go to school for years and you put in a lot of work and a lot of time. You finish school and you start your job and I feel that we shouldn’t have the feeling of anxiety or the feeling that we aren’t ready or aren’t prepared. In school we didn’t get our hands or noses into things enough. It’s in the back of our head but maybe we weren’t taught how to use our hands or wrap our head around those things but the knowledge is in there. They kept telling us to apply our knowledge but they needed to help us to do that more. But it’s hard to take information from this class and this class and this class and put it all together. We maybe needed more clinical experience.” 

Attempting to lay blame for what we are all clearly responsible for is natural, but generally not a good use of time and energy. Instead, I suggest educators and employers work closely together to identify and then seek to resolve the issues that prevent new nurses from experiencing a healthy integration into professional practice.

The fact that new nurses are surprised by the workload intensity and level of responsibility afforded them once they become ‘practicing’ nurses (particularly those working within an acute-care setting) is similar to what many non-nursing professionals experience when they first start their careers. Nurses who experience significant discrepancies in their practice environment relative to what they have come to expect during their educational preparation can feel disappointed by their work; some may even feel a sense of betrayal.

“I was scared. Very scared. I guess about a week in we had a buddy shift and then a week off and they were starting to call us. They needed staff and they started to call us to work on our own. I just said ‘no’ because I was too scared to start yet even though I only had two buddy shifts left. I just wanted to get those done first ‘cause I was so scared to start on my own. Then I’m like, ‘OK, I’m ready to start now’, but you’re completely on your own. There aren’t even senior nurses there to double check your meds with you or ask questions….

These feelings can escalate over time, particularly if the new nurse is unable to reconcile the discrepancies, if they witness or experience further disempowerment, or if they feel personally or professionally devalued within their new workplace. 

“It’s gotten to the point where I don’t even know if I like nursing anymore. When I was at that fair I had a ticket and I got to spin the wheel and I…put my ticket into this draw and I got to spin the wheel and you could win various prizes like T-shirts and buttons and mugs and it stopped and I won a button and I looked at it and it said, “I love nursing” and I said, “I don’t want it”. I don’t really like nursing anymore.”

The 1st stage of entry into professional practice is marked by tremendous intensity and a fluctuation of emotions as you work through the processes of discovering, learning, performing, concealing, adjusting, and accommodating

“Like some days its perfect—I had this day and I remember driving home thinking, ‘I had a good night’ and I was like ‘I’m so glad I’m a nurse.  I love this and I love working’.  And then the next day I had a bad experience and was like in tears on my way home and it’s just like it’s one extreme to the next.”

REMEMBER: Transition is a process

Progress through the stages of transition will vary according to the length and quality of the NG’s orientation, the transition and integration programs they are enrolled in upon hiring, the level of support they feel (or don’t feel) from the colleagues they are working with, the level of resilience they have developed, and how they cope with change. Within the transition theory described here, stage one begins after the NG’s initial orientation or introduction into the workplace; the start of this stage correlates with their first shift ‘on their own’ where, for the first time since graduating they feel the weight of a full clinical workload. If they are fortunate enough to have an extended support period, they may experience a more ‘muted’ intensity and duration of this stage, though my research tells me that new nurses WILL experience each of these processes (learning, performing, concealing, adjusting, and accommodating) to some degree within their 4 months of professional practice.

Research and Education

The breadth of nursing knowledge extends to the pursuit of evidence through programs, initiatives, and research. Join us as we highlight and discuss what emerging findings mean 

Lee, S. E., Dahinten, V. S., Seo, J. K., Park, I., Lee, M. Y., & Han, H. S. (2023). Patient Safety Culture and Speaking Up Among Health Care Workers. Asian Nursing Research, 17(1), 30-36.

Patient safety is a paramount concern in healthcare, with nearly one in ten patients experiencing harm during their hospital stays in high-income countries. Effective communication and speaking up behaviours among healthcare professionals are critical for preventing errors, improving patient outcomes, and enhancing the overall quality of healthcare delivery. Speaking up, also referred to as employee voice behaviour, safety voice, or assertive communication, involves the discretionary expression of concerns, suggestions, information, or opinions regarding safety issues in healthcare settings. It plays a vital role in identifying and addressing potential risks, enhancing team collaboration, and fostering a culture of safety within healthcare organizations.

Method

This study employed a descriptive correlational design and utilized secondary data collected from a private, nonprofit, tertiary-level teaching hospital in Seoul, South Korea. The sample comprised 831 healthcare workers, including nurses, physicians, and other healthcare personnel. Patient safety culture was assessed using the Korean version of the Hospital Survey on Patient Safety Culture, which measures eight factors related to safety culture. Promotive and prohibitive voice behaviours were measured using a 10-item, 2-dimension scale developed by Liang et al., with higher scores indicating higher levels of speaking up behaviours. Data were analyzed using Pearson bivariate correlations and hierarchical multiple regression analyses to examine the relationships between patient safety culture, profession, and voice behaviours.

Results

The findings revealed that nurses tended to report less positive perceptions of patient safety culture and lower levels of speaking up behaviours compared to physicians and other healthcare professionals. Specifically, nurses scored lower on dimensions such as organizational learning, communication openness, and supervisor/clinical leader support for patient safety. However, physicians and other healthcare workers showed higher scores on these dimensions, indicating more positive perceptions of safety culture and higher levels of speaking up behaviours. These findings highlight the need for healthcare organizations to address the unique challenges faced by nurses in speaking up for patient safety.

Discussion

The results of this study underscore the importance of creating a supportive environment for speaking up in healthcare organizations, particularly for nurses. Nurses play a crucial role in patient care and are often the first to identify potential safety concerns. Therefore, it is essential to empower nurses to voice their concerns and suggestions for improving patient safety. This can be achieved by fostering a culture of open communication, providing regular feedback and recognition for speaking up, and addressing any barriers or concerns that may prevent nurses from speaking up. By creating a supportive environment for speaking up, healthcare organizations can enhance patient safety, improve the quality of care, and create a culture of safety that benefits both patients and healthcare workers. The results indicate that nurses, compared to physicians and other healthcare workers, tend to have less positive perceptions of patient safety culture and exhibit lower levels of speaking up behaviors. This finding aligns with previous research suggesting that nurses often face barriers to speaking up, such as hierarchical structures, power differentials, and fear of reprisal.

One possible explanation for nurses' lower levels of speaking up behaviours could be the cultural norms and values that shape communication patterns in healthcare settings. To address these challenges, healthcare organizations must prioritize the development of a supportive and empowering environment for speaking up. This can be achieved through leadership commitment to patient safety, transparent communication channels, and a non-punitive approach to error reporting. Additionally, providing education and training on assertive communication and conflict resolution can help empower nurses to voice their concerns effectively.

Furthermore, healthcare organizations should recognize the importance of supporting both promotive and prohibitive voice behaviours. While promotive voice involves suggesting improvements and innovations, prohibitive voice focuses on identifying and addressing potential risks and safety concerns. Both types of voice are essential for enhancing patient safety and driving continuous quality improvement in healthcare settings.

Future research should explore additional factors that influence speaking up behaviours among healthcare professionals, including individual characteristics, organizational culture, and the impact of specific interventions aimed at promoting a speak-up culture. By gaining a deeper understanding of these factors, healthcare organizations can develop targeted strategies to support speaking up and ultimately improve patient safety and quality of care.

In conclusion, this study highlights the importance of patient safety culture and speaking up behaviours in healthcare organizations. By understanding the factors that influence speaking up behaviours and the differences in perceptions among healthcare professionals, organizations can develop targeted interventions to improve patient safety and quality of care. Creating a supportive environment for speaking up, particularly for nurses, is essential for fostering a culture of safety and improving patient outcomes in healthcare settings.

House-Kokan, M., & Jetha, F. (2024). Teaching to learn, learning to teach: Clinical thinking tools to support novice clinical educators, preceptors and students. Journal of Nursing Education and Practice, 14(5).

Introduction and Background

In the contemporary healthcare landscape, nurses face increasing complexity in patient care, necessitating sophisticated skills in critical thinking, clinical reasoning, and clinical decision-making. These skills are directly linked to patient safety and care outcomes, making their development crucial in nursing education and practice. However, novice and student nurses often exhibit linear decision-making based on limited knowledge and experience, emphasizing the need to enhance these abilities to ensure patient safety. Despite various theoretical frameworks existing to support nursing education, operationalizing them in clinical practice can be challenging, particularly for inexperienced clinical instructors and preceptors.

The Significance of Clinical Instructors and Preceptors

The current nursing shortage and a parallel scarcity of nursing academia underscore the critical role of skilled clinical instructors and preceptors in educating and developing the nursing workforce. However, many clinical nurse instructors are hired primarily for their clinical expertise, lacking training in pedagogical methodology or past experience as educators. Similarly, nurse preceptors are responsible for validating the competencies of new graduate and post-licensure nurses, yet many lack the necessary education, training, or preparation for this role. Additionally, the severity of the nursing shortage has resulted in many clinical instructors and preceptors being relatively inexperienced themselves, further challenging their ability to guide learners' critical thinking and clinical decision-making effectively.

Purpose of the Article

The primary aim of this article is to introduce Clinical Thinking Tools (CTTs) as convenient and effective strategies for teaching and promoting critical thinking, clinical reasoning, and clinical decision-making among nursing students. These tools are also designed to support the development of teaching skills in novice clinical instructors and preceptors. Originally intended to support the use of a new clinical evaluation tool and process, the CTTs have proven valuable for both students and instructors in developing and teaching these essential skills.

Development of the Clinical Thinking Tools

The CTTs were initially developed to support clinical instructors and preceptors in adopting a new objective, evidence-based clinical evaluation process. This process aimed to shift the responsibility for demonstrating attainment of clinical learning outcomes and competencies from the instructor to the student. The CTTs were designed to help instructors objectively assess learners' critical thinking, clinical reasoning, and clinical decision-making. However, they were found to be equally valuable for students in learning these skills and for novice instructors in developing their teaching abilities.

Theoretical Foundations of the Clinical Thinking Tools

Both critical thinking and clinical reasoning are essential for sound clinical judgments in nursing. However, teaching these skills has proven complex, with many educators unsure of how to integrate them into clinical education effectively. The CTTs are theoretically underpinned by the Situated Clinical Decision Making Framework (SCDMF), which emphasizes the social and contextual nature of learning. This framework aligns with existing models of clinical judgement but extends them by incorporating the multi-layered context of clinical practice, which significantly influences clinical decision-making.

Practical Application of the Clinical Thinking Tools

The core team developed five CTTs, to guide learners through a sequence of prompts that engage them in critical analysis using inductive and deductive reasoning. They are designed to help gather, interpret, and synthesize information for clinical decisions and care priorities. The CTTs can be used in various ways by both clinical instructors/preceptors and students, such as guiding clinical discussions, framing post-conference discussions, or completing mini assignments to prepare and reflect on clinical experiences.

Initially developed to support the use of a new clinical evaluation tool and process in the context of post-licensure specialty nursing education, the Clinical Thinking Tools offer a structured approach to prompt guided discussions and questions that stimulate deeper thinking and promote reflection in how learners arrive at clinical decisions. By utilizing these tools, students approach clinical decision-making and priority-setting systematically and reflectively, gaining insight into their thinking processes and identifying their learning needs and areas for development. The tools also provide clinical instructors and preceptors with insightful and objective data on the learners' critical thinking and clinical reasoning processes. This insight allows novice educators to provide accurate feedback in assessing and evaluating learners' clinical decision-making, moving beyond mere observation.

One of the most significant impacts of the Clinical Thinking Tools on novice clinical instructors and preceptors is their ability to discern the origin of issues within learners' clinical decision-making. Assessing and identifying students' challenges in clinical practice can be challenging for novice educators and preceptors. Using the CTTs provides novice educators with a concrete way to differentiate issues with anticipatory thinking and priority-setting from deficits in foundational knowledge, enabling them to tailor individualized teaching and learning strategies more effectively.

Conclusion and Implications

The global shortage of nurses and nursing educators has resulted in many clinical instructors and preceptors being new to teaching and relatively new to nursing. Utilizing the Clinical Thinking Tools as a teaching strategy in clinical practice education can better support both students and novice clinical instructors and preceptors in teaching, assessing, and developing critical thinking, clinical reasoning, and clinical decision-making in today's complex healthcare environment.

Nursing The Future™ acknowledges that nurses across this country live, work and play on the lands of our Indigenous Ancestors and we join our members in expressing respectful gratitude for this privilege.
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