Novice nurses gain confidence and competence through new graduate programmes but many preceptors are overloaded and fatigued, says newly released research.
The research report is the first major evaluation of the government-subsidised Nurse Entry to Practice (NETP) programmes that began in district health boards in 2006.
Key findings included that the programmes supported the development of “confidence and competence” in new graduate nurses. They also had a positive impact on recruitment and retention of new graduates with 75 per cent of trainees indicating on completing their programme that they would stay with their current DHB for at least another 12 months.
Preceptors were found to be a key component of the programmes but national consistency in training and support for preceptors was needed to address workload and preparation issues.
The 218-page document covers the period 2006-2009 and was conducted by Whitireia Community Polytechnic and Victoria University researchers under commission from the Clinical Training Agency. The team looked at specifically-funded areas of the programmes including the learning framework, clinical rotations, clinical preceptorship, development days and clinical training.
Most of the 21 boards offering NETP programmes had links with local tertiary education providers and six at the outset had decided to include a level 8 postgraduate course, said the report. Researchers noted that boards not offering a level 8 course held definite positions on the issue including that NETP should focus on developing confidence and competence and that new RNs should not be expected to take on extra study on top of programme requirements.
The researchers noted that while trainees appeared to want choice over whether or not they undertook a postgraduate course, in most cases the NETP work undertaken by the new graduates was equivalent to a postgraduate course anyway. “It is the research team’s strong recommendation that all DHBs should work with educational providers to ensure the inclusion of a level 8 postgraduate qualification as part of all NETP programmes,” the report says.
It also noted that while trainee surveys over the three years the programmes had been running indicated most trainees agreed their clinical workload “enhanced rather than interfered with their learning,” a “worryingly” high 21.3 per cent in 2006, growing to 27.7 per cent in 2009, disagreed or strongly disagreed with that statement.
The report went on to say that preceptors were a “significant aspect” of the programmes nationally and also “one of the most challenging”.
A questionnaire of preceptors found that only half believed the training they received had prepared them for the role. Themes that also emerged during DHB case studies were the need for ongoing training, regular feedback from NETP coordinators and that issues like over-subscribing and short-staffing meant nurses were starting as preceptors without having completed any training.
The researchers noted that “nationally consistent, recognised and formalized education programmes for preceptors” would benefit both NETP programmes and undergraduate education.
High numbers of part-time staff, patient acuity and staff shortages had also impacted on trainees being able to be rostered on with preceptors but overall two-thirds of trainees said they had had access to a designated preceptor.
It was noted that during the research project the workload of preceptors was an issue.
“Although most of the preceptors were positive about their role, they all acknowledged that at times it became overwhelming and that fatigue was a real issue,” the report said.
“Many preceptors reported that they were supporting not only trainees, but also undergraduate students, new employees as well as overseas registered nurses for whom English as a second language was often an additional issue. Add to this the acuity levels across the health care sector and many preceptors commented about tiredness and frustration.”
But overall the researchers said the evidence showed the programmes were seen to be working in developing confidence and competence in new graduates and providing for the transfer of knowledge and skill across the nursing workforce.
