Aproximación cognitiva

Clearly then, there were differences in participants expectations of themselves and others expectations of them. Interestingly, in the literature this tends to be discussed most often in terms of the tensions between unrealistic expectations placed on newly qualified staff and the need for increased support and opportunities to consolidate skills learnt during undergraduate programmes (Brown & Edelmann 2000; Evans 2001; Ross & Clifford 2002; Jackson 2005; Toal-Sullivan 2006; Thomka et al.,2008; Morley 2009a). These studies show that newly qualified practitioners value being given some autonomy to act independently but in the acute setting they are generally expected to hit the ground running (Lauder et al., 2008) which reflect the often unrealistic expectations of others (Dearmun 1997, Trysennar & Perkins 2001 and Boychuk Duchscher 2007).

Significantly, this was not the case for the participants in this study. The participants were not expected to hit the ground running, indeed they felt that they were not expected to be able to do anything independently prior to being observed and assessed as competent. This meant that whilst the notion of informal observation may have been seen as problematic for some, the more formal process of observation - particularly of clinical skills, was welcomed. Indeed the participants regarded the development and assessment of competence in specific skills as an important part of their transition. More specifically, having their performance observed and being assessed formally as competent by a supervisor was a necessary task or a key milestone prior to working on their own; and was therefore a significant marker of

124

transition. The participants acknowledged that they were working towards mastery here (as explained by Meleis et al., 2000) because they perceived that being assessed as competent would lead to them working independently as a children’s community nurse. The competencies were in the main skills based, related specifically to the area in which they were working and developed from the specification of the job.

“That’s basically just trying to give us exposure to as many things as we can.... So we never had to do visits on our own, we were always accompanying somebody. ..We have

competencies to do like NG passing, gastrostomies and things. But no, it’s really good, really structured.

Yan explained that not visiting on her own during the shadowing period and being given the opportunity to develop competency in certain clinical skills was valued and viewed as a positive aspect of her experience. The participants in this study recognised that being assessed as competent in the job specific competencies gave them the opportunity to develop their professional capability and facilitated their transition. According to Eraut (1998) the purpose of professional education and training (in this case after qualification) is to develop professional capability, which normally includes competence in a specified minimum range of tasks, roles and jobs required of the post.

Eraut et al., 1995 found that frontloading of additional capability at the start of a career may militate against later conversion of that capability into practical use. In this study this was demonstrated and therefore may have improved their ability to demonstrate capability when they moved to working on their own. Several studies suggest the advantages of a bridging period during the initial stages of transition where newly qualified practitioners can gain experience and exposure to the required skills (e.g. Boychuk Duchscher 2007) and it is generally acknowledged that one to one relationships during these periods facilitates competence (Clark & Holmes, 2007; Luhanga et al., 2010). Eraut’s (1998) definition of

125

competence as the ability to perform the tasks and roles required of a particular job to the expected standard is useful here. The participants were exposed to these job specific skills, usually during the shadowing period. They then practised under supervision and were then assessed in terms of their ability to carry out the skill independently, leading to what they termed “signing off” as Jesse described:

“We have got to have observed, been taught and practised so it’s either your preceptor or somebody with experience”.

Achieving competence was something to work towards during the shadowing period, providing a time in which the participants could identify, learn and demonstrate competence in a number of key clinical skills. Similar findings were identified by Miller and Blackman’s (2003) study of 30 newly qualified nurses during their first three years of employment in hospital settings. They found that completing such competencies in the first year of employment seemed to give newly qualified nurses something to work towards and clarified expectations of them at this stage. In this study, having the job specific competencies signed off was a clear expectation where formal assessment of competence facilitated their transition.

4.5 Summary

This chapter has described the experiences of a group of newly qualified children’s nurses during the initial stages of their transition, termed by them and described in some literature as the shadowing period. This was a period where they were supervised by a qualified children’s community nurse and had the opportunity to be supernumerary. The participants

126

described the benefits and disadvantages associated with this period of transition which mirrored much of the available literature.

However what this study adds is that acknowledgement of their undergraduate community experience was a key issue as it fostered notions of acceptance into the group and facilitated their emerging identity as children’s community nurses. Lack of acknowledgement of this experience by established staff impacted on their confidence because potential transferable experience was not accounted for, leading them to perceive themselves as “starting from scratch” which in turn hindered their transition experience. As identified by van Gennep (1960) acceptance into the established group is an outcome indicator of a successful transition.

At this stage I started to conceptualise what they were telling me as an ideal experience of supervision which involved a balance between protection and surveillance during joint visiting to ease their feelings of trepidation, particularly related to increase in accountability, and being able to observe different styles of practice. They also welcomed formal assessment of their skills as this provided them with something tangible to demonstrate their movement towards working independently.

127