A Model to enhance support for newly-qualified registered nurses in selected hospitals Limpopo Province, South Africa

Abstract

Background: Despite newly-qualified registered nurses (NQRNs; R.683) being in possession of previous nursing experience, and that on graduation as registered nurses, they were allocated in units where they had previously worked as enrolled nurses (ENs). The change of identity, roles, responsibilities and adopting a new scope of practice with increased accountability became a source of stress. It is evident that NQRNs (R.683) were prematurely placed in nursing units and expected to lead shifts on graduation as registered nurses. However, it was uncertain as to how these NQRNs (R.683) were being supported in clinical practice areas within their initial period of employment. Currently, there seemed to be no model in Limpopo Province to support NQRNs (R.683). Purpose: The purpose of this study was to develop a model to enhance support for NQRNs (R.683) in selected hospitals of Limpopo Province, South Africa. Methodology: The study was done in four phases, namely, empirical, concept analysis, model development and validation. In Phase 1, a concurrent mixed method approach was used. For the qualitative component in Phase 1A, seven (7) focus group interviews were used for NQRNs (R.683) (n=51). For the quantitative component in Phase 1B, unit nurse managers or experienced registered nurses (n=265) were recruited using convenient sampling, and a self-administered questionnaire was used for data collection. In Phase 2, Rodgers & Knafl’s six steps guided the analysis of the concept ‘support’. In Phase 3, Dickoff, James & Wiedenbach’s survey list guided the framework for model development, based on Chinn & Kramer’s approach. In Phase 4, the model was validated following Chinn & Kramer’s criteria of clarity, simplicity, generality, accessibility and importance. Results: The results from both the qualitative and quantitative components revealed the need for a support model. The findings formed the basis for the development of a model to enhance support for NQRNs (R.683). The model comprised of the following components: Agent, Recipient, Context, Dynamics, Procedure and Terminus. Conclusion: Support for NQRNs is a widely echoing concept used in clinical settings in many countries, SA inclusive. However, a variety of challenges associated with supporting NQRNs (R.683) have been identified by both NQRNs (R.683) and Unit Nurse Managers (UNMs). Shortage of staff, negative staff attitude and behaviour, inadequate support from UNMs were highlighted as impacting negatively on the effectiveness of support. The dire need for a model to enhance support for NQRNs (R.683) cannot be overemphasized. This model will direct the planning and execution of supportive procedures by UNMs to enhance the effectiveness of support for NQRNs (R.683) in the nursing units. Recommendations: The model should be disseminated to NQRNs and UNMs through in-service training, workshops and scheduled clinical meetings for acceptance and support. The developed model and guidelines for operationalizing the model should be incorporated as part of clinical nursing practice frameworks by policymakers. The model should be piloted to identify areas that will further enhance effectiveness of support. Follow-up studies on the effectiveness, practicability and relevance of the model are recommended.