Transition to practice and the
theory of organisational
socialisation for newly qualified
graduate nurses
Dr Craig Phillips
March-April 2015
Acknowledgements
• This study tour has been funded by a travel grant award on behalf of
the University of South Australia.
• I also wish to acknowledge the Nurses Memorial Foundation of
South Australia Incorporated, who have funded the current
intervention trial.
Presentation content
• Brief overview and findings from Doctoral thesis
• Adaptation of the model of Organisational Socialisation
• Current intervention trial at two South Australian hospitals
Background
3 year nursing degree
Student loan from government-Higher Education Contribution Scheme
Most students work due to being broke
85% engage in paid employment 15 or more hours per week
Perceived advantage of employment in clinical settings.
If this is true, then all undergraduate nursing students should work in
clinical settings and not retail ones.
My thesis was all about, Does it really matter what paid employment
undergraduates do in relation to preparation for graduate transition?
Background
Recently completed doctoral study
Focus on pre-registration paid employment choices:
• Employment in a health service
Enrolled nurses
All other health care roles
• Employment in hospitality and retail sector
• Non-participation in paid employment
Methods
Three phase exploratory retrospective mixed method design
• Focus groups with new graduate nurses (n=68)
• Survey questionnaire with new graduate nurses (n=392)
• Secondary analysis of above two data sets
Study findings
Reasons for working:
• $$$$$$$$$$$
• Experience of the work place
• Advantages for pending transition.
Study findings
Transition index (TI) score:
1 (worst transition possible) to 10 (brilliant transition)
Mean of TI scale by employment type:
•
•
•
•
All clinical roles
Hospitality and retail sector
Enrolled Nurses
Did not work
7.22
7.05
6.65
6.27
(n=152/39%)
(n=95/24%)
(n=82/21%)
(n=63/16%)
So….
No statistically significant difference between 3 employment types, but
there was significance between working and no work.
Therefore,
Better to have engaged in some form of undergraduate paid
employment than not to…however, choice of employment in relation to
impact on transition is arbitrary.
If the type of work undertaken in the final year is not associated with
good transition, would it be that post-registration factors determine
transition success?
Post registration factors
We examined:
Dealing with sick and complex patients, orientation to new job,
preceptorship, study days, roster that addressed work/life balance.
Family orientated environment, being respected by colleagues,
Being involved in the team, friendly/supportive staff, having confidence
recognised/rewarded, being receptive to my learning needs.
All factors were rated for importance and satisfaction, using multiple
linear regression, we found 3 factors were best able to predict transition
success…
And these are…
• A comprehensive and enduring orientation
• Patient allocation with an acuity reflecting the beginning skill set of a
neophyte practitioner
• Respectful feedback from colleagues (particularly senior nurses)
As well as these factors, there were issues made by hospital
management about the previous employment that graduates had done!
In addition…
Recommendations from the study suggest:
• Transition is an individual process regardless of previous life
experiences
• All forms of paid employment should be encouraged
• Additional considerations for mature aged and international
graduates
• Formal testing of Bauer and Erdogan’s (2011) model of the theory of
organisational socialisation in an intervention trial
Concerns with transition
Graduate nurse turnover and attrition
• Australia 20%
• Globally 20-60%
Implications for workforce planning
Implications for patient safety
Economic considerations
Our findings suggest that successful transition to practice is an
individual construct rather than a homogenous framework
Concerns for graduate nurses
• Generic orientation programs
‘there was not enough initial practical orientation to the wards
and then again in specialty unit areas. My transition was very poor, but
would have been so much better with more skilful preceptoring, ongoing
mentoring, increased supernumerary time, and more supervision by
grad nurse educators’
• Issues with bullying and horizontal violence
‘none of my prior knowledge and skills were recognised…many
senior RNs were such poor role models, gave very little feedback
and support…nurses educators tried to knock me down and I lost
my passion for nursing’
Concerns for graduates
• Lack of support, constant need to ‘fit in’
‘ I have been given a really hard time, so much so that I hate
the wards…nurses slagging me off, treating me like an idiot’
‘there was NO interest by the nursing unit manager, you are not
paid to be here to think, but only to work’
Is there a better solution to transition to practice?
A theory of organisational socialisation
Organisational socialisation is defined as:
a process where a new employee learns the processes and rules of a
particular role, thereby acquiring the necessary knowledge and skills to
function in that role (Saks and Ashforth, 1979).
Furthermore:
Bauer and Erdogan (2011), suggest that organisational socialisation, or
onboarding, results in new employees moving from organisational
outsiders to organisational insiders.
Phase One
Phase Two
Phase Three
New employee
characteristics
•Proactive personality
•Extraversion
•Openness
•Veteran employee
New employee
behaviors
•Information seeking
•Feedback seeking
•Relationship building
•
•
•
•
Organisational efforts
•Socialisation tactics
•Formal orientations
•Recruitment/realistic
previews
•Organisational insiders
Adjustments
Role clarity
Self-efficacy
Acceptance by
organisational
insiders
Knowledge of
organisational
culture
•
•
•
•
Outcomes
Satisfaction
Commitment
Turnover
Performance
Adaptation of Bauer and Erdogan’s (2011) model of the process of socialisation based on our research findings.
Phase One
Phase Two
Phase Three
New graduate nurse
characteristics
•Personality
•Life experience
•Academic education
•Previous
undergraduate paid
employment experience
New graduate nurse
behaviours
•Information seeking
•Feedback seeking
•Relationship building
•
•
•
•
Health service efforts
•Poor orientation
•Inappropriate patient
allocation
•Lack of respect
•Incorrect assumptions
Adjustments
Role ambiguity
Non-acceptance by
organisational insiders
Lack of knowledge of
organisational culture
Loss of confidence and
increased patient risk
•
•
•
•
•
Outcomes
Decreased satisfaction
Decreased
commitment
Increased turnover
Decreased
performance
Risk to patient safety
An adaptation of the model of organisational socialisation for an ideal graduate nurse transition.
Phase One
New employee characteristics
•Personality
•Life experiences
•Academic education
•Undergraduate paid employment
experiences
New employee behaviors
•Information seeking
•Feedback seeking
•Relationship building
Phase Two
•
•
•
Organisational efforts
•Socialisation tactics
•Formal and informal
orientations/follow up
•Reduction of clinical rotations
•Organisational insiders,
preceptors and mentors
•Acknowledgement of prior life
experiences/skill sets
Phase Three
•
Adjustments
Thorough, effective and
enduring orientation(s)
Appropriate patient
allocation
Respect for a job well
done
•
•
•
Outcomes
Improved
satisfaction
Increased
commitment
Decreased
turnover
Increased
performance
Current intervention study
Based on the findings from the PhD
• Rigorous orientation
• Appropriate patient allocation
• Respectful feedback
Intervention trial to improve transition experiences and equally to inform
health services so they may respond.
Current study cont…
Based on the transition index (TI) scale developed by Phillips et al.
(2012) we hypothesise that mean TI score of 7 can be increased to 88.5
Baseline (control group) of graduate nurses who completed their
transition to professional practice program (TPPP) in 2014, completed a
survey
https://www.surveymonkey.com/s/FQ6XYXP
The 2015 (experimental group) of graduates who undertake their TPPP
are completing a monthly survey rating satisfaction with transition to
practice experiences.
https://www.surveymonkey.com/s/L3GBMRK
Study design
2014 Graduate
Baseline survey
2015 Graduates
Monthly survey
2015 graduate nurses repeat 2014 baseline survey, to
ascertain increase in satisfaction scores.
Quality assurance feedback loop to hospital management
Preliminary findings
2014 survey:
• 80% worked (Clinical 60%, EN 20%, Hospitality/retail 20%).
3 factors seen as most helpful for transition:
• Conflict resolution, 3.78/5
• Patience, 4.33/5
• Teamwork, 4.22/5
Cont…
Question 4
Importance of:
Dealing with sick and complex patients, orientation to new job,
preceptorship, study days, roster that addressed work/life balance.
Family orientated environment, being respected by colleagues,
Being involved in the team, friendly/supportive staff, having confidence
recognised/rewarded, being receptive to my learning needs.
All of these factors rated 4/5 or higher
Cont…
Question 5
Satisfaction with:
Of the identical factors highlighted in question 4, it appears that
importance rates more highly than satisfaction.
Only graduate nurse study days, dealing with sick and complex
patients, friendly staff and respect by colleagues rated higher than 4/5
Question 6
TI score slightly higher than original study, smaller study, only views
from two health services.
Cont…
Question 7:
Response to transition index score
‘Overall, it has been a good experience for my TPPP in 2014. I have
definitely gained confidence in both my clinical knowledge and
professional skills... However, each rotation takes about 4 to 6 weeks
for me to settle in, especially, moving from a specialty area, for
example, peri-operative nursing, to a general ward environment’
The good, the bad and the ugly
‘Supported environment that allowed for professional development as a
registered nurse’
‘The constant supervision and the mistrust of some nurses and patients’
‘All areas need to have a preceptor program so issues can be managed
in an appropriate and timely manner, not having one is just dangerous!’
Current 2015 graduates…satisfied?
37 participants to date.
Question 1:
80% satisfied
Questions 2-5:
Satisfaction with clinical progress, orientation, patient allocation, and
respect all at 3.5
Still some work to do…
‘Have not received constructive feedback throughout the program,
whether it be positive or negative…feel like I'm lagging behind but
nobody has told me formally’
‘Safe allocation of patients fluctuates greatly in the critical care
area…When an influx of patients arrive…it can be overwhelming to
have the responsibility to determine priorities and can often leave a
feeling of failure to provide timely care... I am beginning to understand
this may not just be my inexperience in this department, but possibly an
accepted thought process among the nurses who work there’
References
Bauer, T., Erdogan, B., 2011. Organizational socialisation: The effective onboarding of new employees. In Zedeck, S., (Ed), APA
handbook of industrial and organizational psychology, Volume 3: Maintaining, expanding, and contracting the organization. APA
Handbooks in Psychology. 51-64. Washington, DC, US: American Psychological Association, viii, 960 pp. doi:10.1037/12171-002
Phillips, C., Kenny, A., Smith, C., Esterman, A., 2012. Pre-registration paid employment choice: The views of newly qualified
nurses. Nurse Education Today 32 (1), 10-14.
Phillips, C., Esterman, A., Smith, C., Kenny, A., 2013. Successful Transition to Registered Nurse Practice. Journal of Advanced
Nursing 69 (6), 1314-1322.
Phillips, C., et al., A secondary data analysis examining the needs of graduate nurses in their transition to a new role, Nurse
Education in Practice (2013), http://dx.doi.org/10.1016/j.nepr.2013.07.007
Phillips, C., et al., Does the choice of pre-registration paid employment impact on graduate nurse transition: An Australian study.
Nurse Education Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.06.024
Phillips, C., et al. Pre-registration paid employment practices of undergraduate nursing students: A scoping review, Collegian
(2014) http://dx.doi.org/10.1016/j.colegn.2014.09.012
Phillips, C., et al. The theory of organisational socialisation and its potential for improving transition experiences for new graduate
nurses, Nurse Education Today (2015) http://dx.doi.org/10.1016/j.nedt.2014.07.011
Rush, K., Adamack, M., Gordon, J., Lilly, M., Janke R., 2013. Best practices of formal new graduate nurse transition programs: An
integrative review. International Journal of Nursing Studies 50, 345-356.
Saks, A., Ashforth, B., 1997.Organisational Socialisation: Making Sense of the Past and Present as a Prologue for the Future.
Journal of Vocational Behaviour 51, 234-279.
Thanks for the great opportunity to speak
to all the wonderful people in
Vancouver!!!
Any questions??