Support is paramount in all occupations and is of particular importance in nursing given the interactivity between persons and the nature of the profession. An ‘induction period’, which received remarkable positive appraisal from newly qualified nurses in this study can provide the support for those who are newly qualified in the initial stage following graduation. The purpose of induction training is to enable the newly qualified nurse to focus on ones' own learning needs and to gradually ease into the role of staff nurse (Wangersteen et al, 2008,). This is supported by research overseas where supernumerary periods are established in the transition period (Gerrish, 2000). Those respondents who have experienced an induction period post-qualification have overwhelmingly endorsed this supernumerary status for the newly qualified nurse in the initial stages of their new career. Therefore it is recommended that a structured
induction period be provided after qualification is in all hospitals for at least six weeks.
A recurring theme identified in this study was that of lack of support for both newly qualified nurses and student nurses though the concern lay predominantly with the student nurse. The following recommendations attempt to address this issue. Preceptorship staff supporting roles are already in place (An Bord Altranais, 2005), though the role of supporting roles needs national clarification and national implementation again at a cost to the HSE. In order for nurses/preceptors to fully support student nurses with particular attention to facilitating learning at ward level, protected time is essential for qualified nurses to focus on the learning needs of the student. This will relieve the pressure on the nurse to try to focus on the needs of the patient and the needs of the student at the same time will enhance the quality of both.
Therefore it is recommended that ‘protected time’ be allocated to preceptors to focus on the learning needs of the student nurse.
While the role of the clinical placement co-ordinator is pivotal in supporting the student nurse on clinical placement, support appears to be lacking for the newly qualified nurse. This has prompted a call for grater support in the initial months post- qualification. It is therefore imperative that health service provides supporting roles for qualified nurses to enhance performance and quality of care. Therefore it is
recommended that a supernumerary staff member be assigned to newly qualified nurses to facilitate learning and support staff in transition.
Staff preparation for preceptorship is facilitated by a preparatory course on preceptorship and the role of the clinical placement coordinator is instrumental in supporting both staff nurse and student in the clinical environment (Drennan, 2002).
This needs to be further expanded to education on preceptorship on an ongoing basis.
Respondents from the newly qualified cohort commented on the positive effect of having a ‘buddy’ in the first clinical placement as newly qualified. The ‘buddy system’ is in place in Australia (Walker et al, 2008). Effectively, the buddy is a registered nurse that is randomly chosen by the shift leader and assigned to a particular junior nurse or student nurse for whom to guide, support or ‘shadow’ during the shift. This person has no involvement with the student assessment, does not replace the preceptor, clinical placement coordinator or education facilitator. In light of the multiple comments advocating this role in the study, this role would be of great benefit to all student nurses and all newly qualified nurses. The value of this role is not only in its impartial involvement with the junior staff, but also in its deliberate exclusion from any assessment of that person. This provides an opportunity for student nurses to voice their opinion, express their ideas without fear of negative evaluation. This comes at a time when student nurses responses appeared focused on relationship difficulties with other nurses. Therefore the introduction of an official
‘buddy’ system’ is recommended for both student nurses and newly qualified nurses.
Knowledge of the stress encountered by nurses both before and after qualification could inform the planners of the pre-registration programme in an effort to pre-empt
the difficulties that face nurses undertaking the degree programme in general nursing in Ireland. Clegg (2001) has endorsed the benefits of a multifaceted approach to stress management in the clinical setting. These include a transformational leadership style, occupational stress management and clinical supervision in stress management, which includes reflective practice. If stress is addressed in the final year of training, issues related to the transition may be ameliorated or prevented in adequately preparing the nurse for this transition from student to newly qualified nurse. Effective management and leadership are needed at ward level (Office of Health Management, 2005) with resulting retention of nurses, when effective ward leadership is in place (Kleinman, 2004). Clearly attention needs to continue on developing the clinical environment for both student nurse and newly qualified nurse to enhance skill, confidence and performance in nursing and to increased satisfaction in the workplace, reduce stress and retain nurses. Improved leadership and management styles serve to reduce conflict both within and beyond the profession (McVicar, 2003) by identifying the antecedent factors such as staff shortage or rapid change (Marquis and Huston, 2000).
Therefore it is recommended that management training be provided for all managers emphasising the value of transformational leadership style and that stress awareness, management and prevention is part of this training.
This study has revealed valuable insights into the perceptions of nurses working in the clinical environment who are on both sides of the transition between student and newly qualified nurse. The findings can inform those who have the power to address these issues in effort to improve the wellbeing and retention of this precious resource at a critical period in their nursing career.