Nayda Robyn, Cheri Johns
School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia.
Rural Remote Health. 2008 Apr-Jun;8(2):900. Epub 2008 Jun 13.
This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context.
A hermeneutic phenomenological approach guided the study because this employs the processes of description and interpretation to examine lived experiences. Following ethics approval, four rural hospitals were chosen as suitable sites for the study due to their combined proximity within a rural area. The administrators agreed to support the study and information sheets were distributed. The four participants, one from each hospital, self-selected and took part in an unstructured interview. All participants were ENs who had recently or were currently in the process of transition to RN. Data analysis used van Manen's holistic and selective approaches in conjunction with Hycner's more structured guidelines. Significant phrases or units of meaning were then identified and collated into relevant themes.
Three main themes identified were: (1) great expectations--self-expectations; adjusting to the new role; other's expectations; (2) support: sink or swim--peer, managerial and medical staff support; (3) Jacks and Jills of all trades--coping with the scope; proficiency equals specialising; positives of rural transition. The study found that these new graduates had very high expectations of their performance and experienced difficulty in adjusting to their new role. This was far more likely when the new RN had previously worked at the venue as an EN. Other staff and administrators expected these new RNs to be experienced beyond the new graduate level resulting in poor skill match to workload allocation and lack of support.
The expectations placed on these new graduates by clinicians and managers far exceeded their level of expertise and resulted in them experiencing high anxiety levels. Ensuring this unique group of graduates are well supported throughout their transition phase is of utmost importance and this has implications for nurse managers, organisational administrators, nurse clinicians and future graduates. Rural ENs are increasingly undertaking nursing degrees and are urgently needed in rural settings. Accordingly it is in the best interests of managers and others to encourage and support them through an effective transition process.
本文报告了一项关于南澳大利亚农村地区注册护士（RN）向登记护士（EN）角色转变的研究结果。农村地区的注册护士需要具备多种技能，能够为不同的客户提供广泛的护理服务。这种情况经常发生在没有医疗或专业协助的环境中。本研究的目的是了解在这种独特背景下登记护士向注册护士的转变过程。
本研究采用诠释现象学方法，因为该方法运用描述和解释过程来审视生活经历。在获得伦理批准后，选择了四家农村医院作为合适的研究地点，因为它们在农村地区的位置相对较近。医院管理人员同意支持该研究，并分发了信息表。四名参与者，每家医院一名，自行选择并参加了一次非结构化访谈。所有参与者均为登记护士，他们最近或正在向注册护士转变。数据分析采用了范曼的整体和选择性方法，并结合了希克纳更结构化的指导方针。然后确定重要的短语或意义单元，并整理成相关主题。
确定的三个主要主题是：（1）厚望——自我期望；适应新角色；他人期望；（2）支持：自生自灭——同事、管理人员和医务人员的支持；（3）万事通——应对职责范围；精通等于专业化；农村地区转变的积极方面。研究发现，这些新毕业生对自己的表现期望很高，在适应新角色方面遇到困难。如果新注册护士之前曾在该场所担任登记护士，这种情况发生的可能性会更大。其他工作人员和管理人员期望这些新注册护士具备超出应届毕业生水平的经验，导致技能与工作量分配不匹配且缺乏支持。
临床医生和管理人员对这些新毕业生的期望远远超出了他们的专业水平，导致他们焦虑程度很高。确保这一独特的毕业生群体在整个转变阶段得到充分支持至关重要，这对护士长、组织管理人员、护士临床医生和未来毕业生都有影响。农村地区的登记护士越来越多地攻读护理学位，农村地区迫切需要他们。因此，管理人员和其他人员通过有效的转变过程鼓励和支持他们符合各方的最大利益。
