Title : Nurse clinical reasoning: New graduates perceptions of preparation versus faculty assessment of preparation
Abstract:
New nurse graduates are entering the nursing profession unable to meet the demands and clinical responsibilities expected of them. Current and past literature shows that there is a lack of clinical reasoning abilities new nurse graduates possess to care for the nation's health care needs. There is a lack of literature to showcase the differences or similarities between new nurse graduates’ perceptions of their own clinical reasoning abilities with faculty assessments of those same abilities. The study's focus was to explore the differences in self-perceived clinical reasoning among new nurse graduates and their clinical reasoning skills as assessed by their clinical nursing faculty to enhance nursing clinical reasoning in future new nurse graduates. The purpose of the quantitative non-randomized comparative study was to compare clinical faculty’s assessment of graduating professional nurse candidates’ clinical reasoning abilities with the candidates’ self-assessment of their clinical reasoning abilities, and to assess differences in clinical reasoning assessment between Traditional Associate Degree Nursing Program, Mobility Associate Degree Program, and an Accelerated second-degree Baccalaureate Nursing Program in order to understand any differences that may be attributing to the lack of clinical reasoning abilities in a novice nurses’ first nursing position. The constructive alignment theory, coupled with Benner’s theory of novice to expert, guided the study. The population consists of nursing students within three programs of a National Proprietary Nursing School. The sample was made up of all subjects who met the inclusion criteria of being a graduating nursing student who was in their final medical-surgical clinical rotation. Inclusion criteria for faculty include all faculty who were assigned a final medical-surgical clinical group. Both research questions resulted in no statistically significant differences. The current findings show that as a new nurse graduate, all programs within the educational institution utilized for the study have the same level of clinical reasoning abilities overall. The overall findings demonstrate that the nursing educational arena in which the study was conducted prepares the nursing student to graduate and enter the nursing practice safely at an entry level position. However, within the Nurse Clinical Reasoning Scale there were specific areas within the clinical reasoning process/tasks that were areas of strength and areas of need. These findings support additional research to enhance the understanding of areas within the clinical reasoning scale. Findings may imply that the health care institutions hiring the new nurse graduate different expectations than the expectations of nurse educator institutions, suggesting a gap between practice needs and educational curriculum. The recommendation is that these leaders come together to have a national conversation regarding the theory practice gap and its subsequent impact on patient care safety.
Audience Take Away Notes:
- Explore areas within the clinical reasoning process that nursing students and new nurse graduates find difficulty in mastering and how to minimize those areas of need to promote patient safety.
- Nursing faculty will learn what areas to focus on to strengthen clinical reasoning abilities of nursing students.
- Nurse preceptors and health care facilities who employ new nurse graduates will learn what areas within the clinical reasoning process new nurse graduates need the most assistance with to promote positive patient outcomes.
- Replication studies are needed.
- This session/presentation will provide practical understanding of how to assess/measure clinical reasoning of a new nurse graduate or nursing student.
