More than 90 per cent of final-year nursing students feel comfortable communicating with doctors, but only about 60 per cent feel comfortable knowing what to do in the care of a dying patient.

These are some of the findings of research led by Ara Institute of Canterbury nursing academic Dr Isabel Jamieson into just how ready to practise final-year students considered themselves.

The researchers surveyed five cohorts of third-year students on their final clinical placement and found that more than 95 per cent felt ready for the professional nursing role. Just under half (nearly 250) of eligible students took part in the anonymous survey, with the vast majority of students being female, under 30 years old and of New Zealand European ethnicity.

Students showed high levels of confidence in communication, with 85 per cent feeling comfortable delegating tasks to others, while nearly all felt confident communicating with patients from diverse populations and coordinating care with other members of an interdisciplinary team.

When it came to clinical procedures, about half of the students felt uncomfortable with their skills in bladder catheter insertion, and about a quarter were uncomfortable with chest tube care.

One of the professional responsibility areas in which the students showed reduced confidence was knowing what to do for a dying patient. Jamieson says this could be an area in which to consider a stronger teaching focus.

“But having said that, you’d need a reasonable amount of experience to feel comfortable in that role,” she says. The young age of the cohort meant they may not yet have experienced a loved one dying, she added, let alone a patient.

The vast majority of students felt that writing in reflective journals had helped to develop their clinical decision-making skills and high numbers also felt that simulation had helped to prepare them for clinical practice. When asked what could have been done to make them feel more prepared, students called for more clinical time (they were evenly divided on wanting longer placements or more diversity of placements) and more simulation time across all topics.

High numbers of students expressed confidence in being able to care for two patients at one time; this fell to the majority feeling confident in caring for three patients but then fell markedly to very few students feeling confident in caring for four or more patients.
“I think that’s a completely understandable concern,” says Jamieson. “They are recognising that they don’t have the skills yet to manage large numbers.”

She says the findings on patient numbers mirrored almost exactly a recent US study covering three different nursing programmes.
How the students fare as new nurses in the reality of the workplace will become clearer through a longitudinal study of these graduates.

Jamieson has begun analysing the research findings from tracking these new nurses across the beginning, middle and end of their first year of practice.
“It will be interesting to see whether that degree of confidence in their readiness [to practice] pans out,” she says.


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