Newly Qualified General Nurses' experiences and the perceived value of their internship period: a Republic of Ireland cross-sectional study.

Abstract

Background: A 36-week nursing internship was introduced as part of the undergraduate nursing degree programme in Ireland in 2002. This development was intended to provide final year nursing students with extended clinical experience, where they would work more independently and transition more seamlessly into the to the role of registered nurse. Aim: The aim of this thesis was to examine newly qualified general nurses’ experiences of their internship period and its value to their transition to the role of registered nurse. Methodology and Methods: A literature review was undertaken to ascertain background knowledge on the experiences of internship, and the transition to the role of registered nurse. Subsequently, a sequential explanatory mixed methods study, underpinned by a pragmatic philosophy, was selected as the most suitable research design to fulfil the study aims and objectives. Ethical approval was granted by the University and relevant Hospital Research Ethics Committees. Phase one data were collected using the Experience of Internship Questionnaire between November 2018 and December 2020. Data were analysed using the Statistical Package for the Social Sciences and an interview schedule was developed based on the phase one results. Phase two data were collected between 2021 and 2022 using online semi-structured interviews. The data were analysed using Braun and Clarke’s Thematic Analysis procedures. Data from both phases were integrated using the Pillar Integration Process Model. Findings: Pre-internship preparation experiences differed across hospitals. Some hospitals delivered a structured orientation programme while others provided information in an unstructured format as part of their fourth-year induction. A minority reported receiving no preparation. Internship helped to build confidence in communicating with staff nurses and families. The increased responsibility for patient care provided feelings of validation when the interns’ contributions were appreciated and acknowledged. Covid presented unique experiences that required the then interns to be adaptable and flexible to deal with the changing clinical setting. Reflection was viewed as highly beneficial for learning and provided reassurance that they were progressing as interns, and that many other interns were experiencing similar situations. Independent practice gave insight into the requirement to develop non-technical skills which are needed to provide timely patient care. While independent practice provided vital experience for the registered nurse role, balancing learning with competing patient priorities was often to the detriment of the interns’ own learning in practice. One such example related to medication rounds. Doctors’ ward rounds were viewed as essential learning opportunities, but again time limitations regularly deterred participation in the ward rounds. Because handover was not always practiced during supernumerary placements, interns were tasked with learning this skill, as opposed to perfecting it during their internship. Professional socialisation in the clinical areas was a challenge for some, as they formed their identity. Interns recognised that self- motivation and demonstration of enthusiasm and interest reaped dividends and resulted in greater support from preceptors and other staff. This support was essential for learning. Ward managers were generally admired for their expertise, approachability, and leadership. Professional socialisation experiences were sometimes negative, depending on the ward ethos and culture. Negative experiences impacted the interns’ development and their professional identities.viii Feedback was neither consistent nor consistently useful. Nevertheless, the acquisition of clinical skills was progressive, and by the end of the 36 weeks most could identify the value of internship in preparing them for transition to the role of registered nurse. Conclusion: The internship period as part of the undergraduate degree in general nursing programme provided opportunities to gain insight into the full extent of the role of the registered nurse. Skills not emphasised or realised during supernumerary placements were identified as essential to successfully managing internship, and the associated patient caseload. While there are many positive aspects to internship, there are areas that require further consideration. Internship was portrayed as survival of the fittest and a stressful time for many students. They had no choice but to learn on the job and sink or swim. However, it was recognised as valuable in preparing them for transition to the role of registered nurse.