The study, carried out by Victoria University of Wellington nurse researchers, involved analysing 54 reflective essays written by 27 graduate nurses during their nursing entry to practice (NETP) programme.

The research team, led by Professor Jo Ann Walton, said the analysis shed light on the experiences of new graduates and showed that the reflective essay was a “powerful tool” for helping both new graduates (and their lecturers) to learn from clinical practice.

The analysis also backed other researchers who found that new graduates find it “challenging to deal with their own emotional reactions, to stand up for themselves and their patients,to feel part of the team, and to ask for help (which they fear may signal failure)”.

“We suggest that there is scope for more focus on emotional labour, resilience, and professional composure in programmes leading to nursing qualifications,” said the researchers. “Arming new graduates with these skills would ease their transition into a workplace where emotional work is core.”

The researchers identified five key themes (see below) and shared examples illustrating these themes from some of the graduates’ reflective essays.

For example Clare identified a situational challenge ­ that required her to regain her composure and draw on both personal and professional attributes:

It was a typical busy afternoon. I went in to the patient’s bedroom to take

a set of observations. I noticed his breathing appeared laboured and a slight

decrease in consciousness. I had a bad ‘gut feeling’ about the situation. I

called over a nursing colleague and the nurse in charge to assist with my

assessment.

At the time I was feeling anxious, I was not sure how I was going to

objectively describe the slight change nor did I know how to explain my ‘gut

feeling’ to the nurse in charge. I was feeling worried because if I did not act

quickly he may rapidly deteriorate. I knew at that point I was stressed. I

remember my face feeling hot, palms sweaty, thoughts becoming disorganised

and feeling like I just wanted to cry. I knew I needed a minute to

compose myself and so I stepped out of the room while the nurse in charge

waited for me to handover my assessment. I took two deep breaths and wiped

away the tears. I walked back into the room with a smile on my face and

spoke to my nursing colleague, nurse in charge and patient in a concise, kind

and succinct manner.

In another example Lucy reflected on the situational challenge of dealing with a very distressed client with an intellectual disability and her own inexperience in dealing with the distressing verbal assault:

This experience was so emotionally challenging that it shook and tested

my whole philosophy as a genuinely kind and caring nurse. The insults were

extremely derogatory and against my cultural values. I resented the patient

and knew I definitely had disengaged with the patient. I was feeling and

thinking like a victim and not the nurse that I knew I was. 

Through my training I learnt that a good nurse needs to know when to

ask for help. I had to ask for assistance from my mentor who advised administering

a depot [intramuscular injection] to settle the patient for safety

reasons. After the incident I had a good talk with my preceptor which made

me feel better. My colleagues said I had looked defeated, so maybe the client

had noticed as well and responded negatively. It also helped when my colleagues

gave me their maximum support by validating my feelings, sharing

similar experiences and checking on me regularly to give me breaks. I wish I

had talked to them sooner. 

In a third example a pressured new graduate Paula gets spoken to abruptly by charge nurse manager (CNM) after Paula intervened to stop a patient being discharged:

I felt uncomfortable and embarrassed, as she had belittled me, my nursing

practice and rationale in front of the wider multi-disciplinary team

(MDT) who are my professional colleagues. The CNM made me feel as

though I was doing an inadequate job, when in fact I knew I was delivering

safe, kind and patient centred care. 

When discussing the situation privately with a fellow nursing colleague, I

learnt that this outburst was not personal towards me or my nursing practice.

I was able to better understand the ward culture and I felt more positive that

my nursing practice was not inadequate. In hindsight, I realise I could have

requested the RMO (doctor) to review the patient’s pain and whether they

were (ready) for discharge earlier. I had not done this due to the pressure he was also

put under to complete discharge paperwork. I also should have discussed the

concerns I had with the shift coordinator. This could have prevented the

situation from arising, as the coordinator and CNM communicate (about) where

patients are regarding their discharge.

The researchers concluded that their analysis showed the reflective process worked and could be used as a “means of unearthing students’ concerns” and helping them understand what they had done well, could have done differently, why something arose and how to handle challenging events.

“It can be used as a means to bolster their confidence, and to discriminate between personal success (or failure) and systemic strengths and weaknesses,” said the team.  “It also provides teachers with rich data on which to build discussions, support students and aid them in their transition to fully fledged professionals.”

FIVE KEY THEMES

• Individual attributes: personal and professional strengths and weaknesses;
• Professional behaviour: actions such as engaging help and support, advocating for patients’ needs and safety and putting their own feelings aside;
• Situational challenges: like communication difficulties (both systemic and interpersonal) and the pressure of competing demands;
• Rewards: the results graduates experienced, such as achieving the nursing outcomes they desired;
• Reflection as a useful tool: graduates commenting on how reflection has helped them.

Source: Jo Ann Walton, Natalie Lindsay, Caz Hales & Helen rook. Glimpses into the transition world: New graduate nurses’ written reflections.  Nurse Education Today. (published online prior to print publication in 2018)

Rowe – a University of Auckland lecturer, neonatal ICU nurse and nurse consultant – will step into the role at the Whakatane-based nursing school in February to replace current director Ngaira Harker.

Harker, who has been director for the Te Ōhanga Mataora Paetahi (Bachelor of Health Science Māori Nursing) programme since September 2013, has resigned to take up a post as Director of Nursing, Māori Health, in late January at Hawke’s Bay District Health Board.

The appointment of Rowe was a “real coup” for the programme, said Harker.  “It bodes well for the programme that we have people of that calibre wanting to apply for head of school.”

Harker was with the school for the duration of the first Whakatane-based student cohort to complete the kaupapa Māori degree programme.  That cohort sat their state final exams on November 21.

Rowe, a keen surfer, is affiliated to Ngāi Tahu.

But there were 583 new graduate applicants without job offers vying for those remaining 139 positions. So many new nurses will once again start the summer job-hunting and hoping more positions will open up over the Christmas/New Year break.

The Ministry of Health this week released initial data on the 2017 ACE Nursing end-of-year job ‘match’ between the 1357 new graduate nurses who applied and the 901 positions on NETP (Nurse Entry to Practice) and NESP (new entry to specialist practice, mental health and addictions) programmes being offered via the 20 district health boards and Southern Cross.

In the first round in mid-November 774 applicants (57 per cent) were matched and were sent job offers on November 22, leaving 139 positions still to be filled by the remaining 583 applicants in the talent pool.

The proportion of graduates matched with jobs by mid-November appears to be slightly up on last year. Statistics released on December 9 last year for the 2016 round showed 779 new grads had jobs (54 per cent of applicants) but that figure included 16 applicants who secured jobs after the initial mid-November match and 13 applicants known to have got non-NETP or NESP positions. The number of applicants in 2016 was the highest ever with 1455 initial applicants of which 1434 took part in the job match.

Further information on the latest round will be made available in mid-December including which clinical settings the new nurses have been offered jobs in and how many graduates have accepted the initial job offers and how many jobs were still to be filled from the remaining talent pool.

The Ministry of Health says data trends from previous end-of-year new graduate recruitment rounds have followed a similar pattern with about 50 per cent of graduates gaining employment before they know the outcome of the Nursing Council State exam and that almost all (96-98%) graduates applying though ACE will be employed within 12 months.  But a number of these will be employed outside of the government-subsidised and mentored NETP and NESP programmes – including in residential aged care – which has prompted continued calls from nursing organisations for all graduates to be offered new graduate programme places.

New graduate Nov ACE job trends

*Number of applicants can drop by the time job offers are made in mid-November as graduates either get jobs with other employers or withdraw for other reasons. From 2014 onwards eligibility for applying to ACE nursing was extended so new graduates could apply for NETP/NESP positions for up to two years (i.e. up to four times) after passing state finals.

**The cut-off date for supplying job offer data can vary slightly from year to year from – so sometimes includes additional jobs offered in late Nov/early December. Employers keep offering jobs over the summer so the number who actually start NETP programmes in the New Year is always higher.

NA = not available

The New Zealand Herald reported yesterday that the university sent a voluntary redundancy offer to all 1000 staff in its College of Sciences and Health on October 31, aiming to cut costs by $11.1 million in 2018 and $15.7 million from 2019.

University spokesman James Gardiner said of the 70 staff that have applied to take up the offer 20 were from health and five of those from Massey’s School of Nursing.

Particularly hard hit is the nursing school’s Wellington campus which, Gardiner confirmed to Nursing Review, had started the year with 11 staff and – four of those staff had resigned and four more had applied to take voluntary redundancy. But he added that three of those would not be leaving until the end of semester one next year.

One other nursing school staff member from the Manawatu campus had applied for redundancy and none from the Albany campus.

NZ Nurses Organisation chief executive Memo Musa told the New Zealand Herald  that the cuts would be “very short-sighted” if they affected nursing graduate numbers.

“We will be alarmed if this impacts on New Zealand’s ability to continue to have a nursing workforce with the right education, skill and experience,” he said.

Gardiner told the Herald that the reduced staff would not affect the viability of the school or the quality of the programme offering to students. He said Massey would be recruiting more staff to meet the need of the school.  “The aim is to maintain the quality of the programme for students and boost the overall research capability of the staff.”

He said the cuts were required to achieve a surplus of 3 per cent of the university’s income to fund future investment.

The graduate destination survey of the 502 graduates who passed state finals this winter found that 346 had jobs by September 30.

That is equivalent to 77 per cent of the nearly 420 mid-year graduates who responded to the annual NETS (Nurse Education in the Tertiary Sector) survey or 69% of the 502 new graduates who passed state finals in July).

Of the remaining 156 mid-year graduates 64 (12.7%) were actively looking for work, eight were not seeking RN work and there was no data from 83 (16.5%)*.

About 294 of the graduates had gained places in NETP (nurse entry to practice) programmes by the end of September, which is up on the 278 mid-year graduates known to have gained NETP jobs by the end of August, according to the Ministry of Health statistics released in September.  Most of the NETP positions were in medical (74) or surgical wards (68) followed by 47 in mental health (i.e. NESP or new entry to specialist practice positions), 29 in child health and 23 in primary health care.

The NETs graduate destination survey also captures data on graduates who find jobs outside of the NETP scheme, with 53 known to have gained non-NETP positions.

The majority of the non-NETP jobs were once again in continuing care elderly – with 33 in the residential aged care sector. Concern was expressed last year by the New Zealand Nurses Organisation at the high number of new graduates being employed in aged care without the support of a mentored NETP programme. Nursing Review also reported earlier this year that the number of new graduates employed into supported NETP places in the aged care sector had nearly halved to 16 at the start of this year compared to 30 at the same time the previous year.

The next most common areas for non-NETP jobs were primary health (8) and surgical (3). One new graduate had gained a nursing position overseas.

Eight nursing schools had mid-year cohorts sitting state finals in July (a further eight graduates from five other schools also successfully sat state finals in July). The nursing schools’ graduate job rates, ranged from 68 per cent to 90 per cent of their mid-year graduates having nursing jobs by the end of September.

*No survey data was received for the 50 Unitec new graduate nurses who passed state finals in July or from 33 graduates from five other schools. 

In this article I share some advice I think could be useful for you beforen start your clinical placement.

Some advice for your first clinical placement

1. Be prepared and have a solid support system in place

You are likely to encounter situations and cases you have never been exposed to before. Take a moment to process these experiences and, if needed, vent to your family and friends (while protecting patient confidentiality, of course).

2. Introduce yourself to the healthcare team and be a positive team member

Introducing yourself helps start a friendly and open relationship with your colleagues. Being a positive team member makes you stand out as someone who wants to be there. And you won’t be labeled as just ‘the student’.

3. Mistakes happen

We are only human! Try not to dwell on your mistakes. Instead focus on what you could have done better and how you can learn from the situation. Don’t be afraid to talk through your mistakes with your preceptor; they are there to support and guide you on how to learn from your mistakes.

4. Be prepared for your first patient death

Watching families and friends in emotional pain while their loved one dies is a hard pill to swallow. You may be present for the deaths of babies, children, adults and older people. I found the best way to support someone who is grieving is by providing privacy and comfort. This may involve being ‘all ears’ or simply providing cups of tea. It all makes a difference.

5. Be ready for the long hours

If you’re anything like me you may not be used to working 8-12 hour shifts for three to four days a week. Standing and walking for eight-plus hours, holding your bladder, moving and handling patients weighing more than 120kgs; these are just a few of the physical battles you may deal with each day. So it is important to take care of yourself too. Many nurses develop back problems from lifting patients, so learn to use proper techniques and don’t be afraid to ask for a helping hand. A good pair of comfortable shoes is also essential!

6. Don’t be afraid to put your hand up and ask to do new things

We’re there to learn, right? So don’t shy away or expect the nurse to always come to you. Be assertive and step out of your shell. The best learning happens with practice, so give it a try while you have supervision.

7. Volunteer to make beds and hand out meals

I know these aren’t the best jobs and you’re probably thinking I didn’t come to nursing school to make a bed, however you are part of a team. Helping out your team members and doing little jobs really makes the difference. It shows people you are a helping set of hands and are willing to do pretty much anything.

8. Learn what to do if there is an emergency

It’s easy to feel like you’re in the way of nurses and doctors when there’s an emergency. Ask your preceptor what your role should be if an emergency occurs. This may just be clearing and decluttering the surroundings or being a runner. But be ready to put yourself out there and ask if you can do the vital signs or assist in other ways.

9. Have a notebook in your pocket to jot down key words

I’ve found it helpful to have a notebook in my pocket to jot down medications, illnesses, procedures, and anything I need to learn at a later date. It’s hard to remember things when you have a busy schedule, so this helps get around that.

10. Workplace bullying can happen

Students can sometimes be seen as a burden for nurses who don’t want a long, dragged-out shift. My advice is to tell your preceptor upfront what you can currently do within your scope of practice, and what you would like to achieve from the shift. This will hopefully sway the preceptor to seeing you as an asset rather than a burden.

Try not to get frustrated if you have a new preceptor daily and you are repeating the same small tasks each day. Your preceptor needs to see that you are competent doing these tasks in order to build trust.

If bullying does occur, try to raise the topic with the preceptor in a nice manner. However, this is way easier said than done. Don’t suffer in silence. I’d recommend speaking to either the charge nurse or your nursing school clinical mentor if an issue arises. And don’t leave it until it’s too late to solve.

Also, try not to lose focus on the real reason why you are there.

Top tips for getting along with your preceptor

Discuss your weekly goals and objectives

Letting your preceptor know your weekly goals is essential as it gives them direction on what they need to teach you. Tell them what you’re not so confident in doing and what you would like to learn, so they can make sure you get hands-on practice.

Give them feedback on what you enjoyed learning and what you found helpful

Preceptors like to hear feedback just as much as students do. Let them know if they are doing a good job and ask them for feedback too. For example: “Did I do this well? or “What can I do better next time?”

Answer call bells and phone calls

Show initiative by answering not only your call bells but also other nurses’ call bells. And, if you are near the phone, answer phone calls too. There is nothing more frustrating to staff than seeing a student sitting next to a ringing phone and not answering it.

Answer the phone professionally by introducing yourself and naming the ward. Always take a message or pass the phone on. And always remember to report information back to your nurse.

Ask questions and show you are interested in being there

Instead of clock-watching, show that you’re willing and excited to be there learning. When drawing up medications or doing an assessment, ask reasonable questions that show you have insight and critical thinking skills. For example, ask why something is happening and what the outcome will be, as this shows forward thinking.

Home baking

Home baking works a treat! This may seem like a bribe, but it really is a great way to show your appreciation for your preceptor’s support and time.

Author: Mady Watt is currently a third-year nursing student at the University of Auckland’s School of Nursing.

NB First published online September 21.  Re-published October 27 in Issue 5 of Nursing Review.

Doctoral researcher Jennifer Roberts is asking for nurse educators to take part in an anonymous survey about their preparedness and experiences of working with Māori nursing students in nursing schools.

Roberts is head of EIT’s School of Nursing, which has a high percentage of its nursing student population identifying as Māori – about a third in its Hawke’s Bay campus and about half in Gisborne.

“It’s an important study body for us in our region and we take that responsibility seriously given the national emphasis on growing the Māori nursing workforce.”

In 2015 the HWNZ Nursing Workforce Governance Group set a date of 2028 for the Māori nursing workforce to match the percentage of Māori in the population with the goal of helping improve access to quality health care for Māori. (Currently nurses identifying as Māori make up about six per cent of the nursing workforce, while Māori are 15 per cent of the New Zealand population.)

Roberts said she initially considered looking at what were the barriers and enablers for Māori nursing students’ success for her doctoral research topic. A literature search discovered that a lot of work had been done in that area but where there was a gap in knowledge was how nurses educators and nursing schools worked with Māori nursing students.

So she decided to flip the question around and focus on how nursing education practice in nursing schools and institutes may be contributing or inhibiting Māori student success. “And success is more than just achieving the qualification, it is about having a positive experience through learning as well,” said Roberts.

She said little was known about nursing educators’ preparedness for working with Māori students or their experiences in doing so.

“As (nursing) lecturers I think we all understand the importance of cultural safety in nursing practice,” said Roberts. But she wondered how that translated into how teachers themselves taught and interacted with student nurses. “Are we (ourselves) culturally safe in the classroom?”.

Roberts said if you look at the population of nurse educators, most were Pakeha like herself. “I think so many of us are well intentioned, but we maybe don’t have the tools…” said Roberts. “We want to do a good job, but are we?” She stressed it was “not a witch-hunt in any way” and instead her research’s aim was to help figure out how best to equip the nurse educator workforce to deal with cultural aspects of education.

Roberts said helpful work had been done by Ngā Manukura o Āpōpō  – a workforce project to foster the professional development of Māori nurses and midwives that has included publishing performance scorecards of nursing schools. Informal work had also been done by NETS (Nursing Education in the Tertiary Sector) looking at what systems nursing schools had in place for supporting Māori students. Roberts’ work was to focus on the preparation and experience of nurse educators

She is inviting nurses currently working in undergraduate nursing education as nursing lecturers, nursing programme co-ordinators or undergraduate nursing programme managers to take part in an online survey and/or interviews.

Her research questions include:

• What are the institutional and school strategies that seek to support Māori nursing students?
• What are nurse leaders’ and educators’ perceptions of barriers and enablers in providing nursing education to Māori nursing students?
• How do nurse educators understand and interpret cultural safety in nursing education?
• How do nurse educators practice and apply the concepts of cultural safety in nursing education?

Nurse educators who wish to take part in the anonymous questionnaire can click here or email Jennifer Roberts to find out more.

The third-year Ara Institute of Canterbury nursing student has won the Sacha McKnight Cup for 2017, which is awarded to a student showing tenacity and overcoming personal challenges to succeed. The cup was established by the family of young nursing star Sacha McKnight, who passed away during her first year of nursing due to cancer.

Tapiata, 26, has persisted in her nursing studies despite personal trials, including facing “incredible loss, grief and mental health-related issues amongst her own family”, and dealing with self-harming and suicide attempts within her inner circle. She is currently in her final clinical placement at Hillmorton Hospital and wants to work in mental health in Canterbury, Wellington or Rotorua after sitting her state finals in November.

“I have seen the positive impact that mental health nursing can have and I want to be a part of that journey to wellbeing for others,” said Tapiata.

“I absolutely love it [mental health],” she said. “I completed my second-year mental health placement at Hillmorton and I immediately knew that mental health was for me.”

“Mental Health as a field of nursing is more aligned with my personal belief system, because it is essentially holistic. With a focus on therapeutic relationships, nursing in this field relies less on the biomedical model of health and more on the social model; [it’s] more patient-centered. This is where I excel.”

She said despite some challenging days and working with people who can be acutely unwell “there is nowhere else I would rather be”.

Tapiata (Te Arawa/Ngāti Porou) said her nursing principles were nurtured by her upbringing in the world. She is a student member of Te Kaunihera o Ngā Neehi Māori (the National Council of Māori Nurses) and Ara’s Māori Student Rōpu.

She once held aspirations to be a professional squash player and represented Bay of Plenty for most of her pre-teen/teenage years before heading overseas. On her return, she worked in administration and kōhanga reo, before moving to Christchurch with her family and starting nursing at Ara.

Tapiata said she was incredibly grateful for the support of Ara staff, who had been stronger advocates for her during her studies. “For example, when I was dealing with self-harming and suicide attempts amongst my inner circle, the team here continued to support and encourage my efforts,” she said. Nursing school academic Anna Richardson said staff liked to see nursing students applying theory to practice and Tapiata had achieved that.

“Awhina has done so well and she is just glowing,” said Richardson.

On top of placement as undergraduates, since 2014, junior doctors have been required to take three-month stints in community-focused service, which is most often undertaken in general practice.

The research found that most general practices surveyed in the lower North Island and South Island were already involved in training doctors, nurses and other health care professionals. Most of the training GP clinics undertook was for medical trainees.

Two papers in today’s New Zealand Medical Journal have found 86 per cent of the practices surveyed in the lower North Island and South Island took at least one type of medical trainee, but in a comparable survey undertaken in northern New Zealand, the figure dropped to only 40 per cent.

The study of the lower North Island and South Island, led by Otago University researchers, found GPs needed more support to take more trainees as the current system was poorly co-ordinated.

Further, more were interested in taking junior doctors than undergraduate medical students.

The study of northern New Zealand, led by the University of Auckland, suggested that about 70 practices needed to start taking trainees by 2020 to meet demand, and that the proposed School of Rural Health will help with capacity issues.

“GPs and practice staff say there is little space at present for increasing numbers of trainees in practices,” Otago University researcher Dr Samantha Murton said of the clinics her team surveyed.

“In the future, under the current system, they say they would have to reduce the number of undergraduate trainees if they are going to take on more of those who are in a postgraduate or vocational training position [junior doctors and GP registrars],” she said.

It came at a time when there was increasing numbers of students in both medical schools, increasing numbers of postgraduate and vocational trainees and reducing numbers of GPs to supervise due to the ageing GP workforce.

“High quality primary care is an essential and pivotal part of New Zealand’s health system, and adequate training in primary care settings, for any health professional, is essential to support the present and future health of all New Zealanders.

“To resolve the training capacity issue, three key things are needed – robust and equitable co-ordination between all agencies involved in placing trainees, more training and support for teaching staff at practices, and for smaller practices, help to build additional consultation rooms,” co-author Professor Sue Pullon said.

“To achieve that we need a co-ordinated effort across the training system.”

Murton added: “The survey results suggest that there also needs to be support for teaching in different ways, which will help to make more room for quality teaching in general practice.”

The young achiever from Whakatane is the first recipient of the Wintec Midlands Hockey Scholarship which gives her a fee-free year to start pursuing her Bachelor of Nursing at Wintec.

The former deputy head girl of Whakatane High School completed NCEA Level 3 last year with Merit while also competing in sports at a regional and national level.

Muru said the scholarship will enable her to study for the career she wants without financial burden and as a result she hopes to pursue both her passion for sport and caring for people next year.

Wintec’s Sport Science and Human Performance director Greg Smith says this scholarship is an opportunity for Ngahuia to be supported in her journey as a young Māori female achiever.

The annual undergraduate performance scholarship entitles the winner to one year of ‘fee free’ study at degree level. All students enrolled in the Midlands Hockey performance pathway are eligible to apply.