A peer learning intervention in workplace introduction - managers’ and new graduates’ perspectives

Background Evaluation of a complex intervention are often described as being diminished by difficulties regarding acceptability, compliance, delivery of the intervention, recruitment and retention. Research of peer learning for nursing students have found several positive benefits while studies of peer learning for newly graduated nurses are lacking. This study aimed (1) to investigate the study process in terms of (a) first-line managers’ perspectives on the intervention study, the difficulties they face and how they handle these and (b) new graduates’ fidelity to the intervention and (2) to examine the effect of the peer learning intervention in workplace introduction for newly graduated nurses. Methods A mixed-methods approach using semi-structured interviews with eight managers, repeated checklist for fidelity and questionnaires conducted with 35 new graduates from June 2015 and January 2018, whereof 21 in the intervention group. The peer learning intervention’s central elements included pairs of new graduates starting their workplace introduction at the same time, working the same shift and sharing responsibility for a group of patients for 3 weeks. The intervention also included 3 months of regular peer reflection. Results Managers offered mostly positive descriptions of using peer learning during workplace introduction. The intervention fidelity was generally good. Because of recruitment problems and thereby small sample size, it was difficult to draw conclusions about peer learning effects and, thus, the study hypothesis could either be accepted or rejected. Thereby, the study should be regarded as a pilot. Conclusions The present study found positive experiences of, from managers, and fidelity to the peer learning intervention; regarding the experimental design, there were lessons learned. Trial registration Before starting data collection, a trial registration was registered at (Trial ID ISRCTN14737280).

Incentivizing Full-time Employment for New Graduate Nurses in Ontario: Impact of Policy on Care

There is consensus that a professional full-time nursing workforce leads to better patient outcomes and a safer health care environment. In 2007, the Ontario Ministry of Health and Long-Term Care introduced the Nursing Graduate Guarantee (NGG), a policy mechanism designed to strengthen the nursing workforce by increasing full-time (FT) employment for newly graduated nurses. Several factors have affected the supply and employment status of nurses in the province over the past two decades, including the introduction of unregulated health care workers and crises such as SARS and COVID-19. A secondary analysis of the College of Nurses of Ontario registration database was conducted to identify and evaluate trends in the supply and employment of nurses in Ontario prior to and following introduction of the NGG. The results demonstrate that full-time employment of new registered nurses and new registered practical nurses initially increased but has since fallen to below pre-policy levels. Part-time work among newly graduated nurses is increasing across all sectors, signaling a diminishing effect of the NGG investments over time. Investments in health human resources have a stabilizing effect on the nursing workforce. Ensuring an adequate number of nurses is necessary for crisis preparation, management and recovery, particularly in sectors with low surge capacity such as long-term care. However, sustained financial, political, public, and professional support is required.

Development and Testing of an Instrument for Summative Assessment of Practical Skill Performance: A Generalizability Theory Approach

Background and PurposeMany newly graduated nurses lack proficiency in practical skill performance. Presently, nursing students’ practical skill is assessed by summative instruments with overarching items. The purpose of this study was to develop a more detailed instrument to use in summative assessment of nursing students’ practical skill performance and to assess its psychometric properties.MethodsA 50-item instrument was developed. Video-recorded performances were rated by experienced clinical supervisors. A multifacet measurement design was developed. Relevant parameters were estimated by generalizability analysis.ResultsFindings indicated that error of measurement were mainly caused by raters far more than by items. Conclusions: The present study suggested that summative assessment in realistic settings may not apply one rater only. Two to three/four raters appear necessary to dependably measure most skills.