A Model for Bridging the Gap in the Perception of Self-efficacy Between Graduated Nursing School to the Receiving Hospitals

Original Article

Ann Nurs Res Pract. 2024; 9(1): 1063.

A Model for Bridging the Gap in the Perception of Self-efficacy Between Graduated Nursing School to the Receiving Hospitals

Yossi Weiss; May Shik*

Department of Health Systems Management, Ariel University, Israel.

*Corresponding author: May Shik Department of Health Systems Management, Ariel University, Israel. Email: mayshik1997@gmail.com

Received: February 02, 2024 Accepted: February 14, 2024 Published: February 21, 2024

Abstract

Objective: The study deals with the question of the gap in self-efficacy for the role of nurse, as it is perceived among new nurses and among the administrative staff in Israel.

Background: New nurses are required to meet the accepted standard from the beginning of their employment. Variables such as complex, changing realities and experience directly affect their perception of self-efficacy.

Methods: Two questioners distributed among 200 hospitals’ nurses and 102 management staff. Semi- structured interviews were conducted among nursing schools.

Results: The perception of the hospitals’ managing staff about the self-efficacy of the new nurses was significantly greater in all metrics, compared to the perception of the nurses as they reported themselves.

Conclusions: The curriculum will always be behind the changing reality, and thus the gap will always be existing. This gap is what should be bridged to strengthen the new nurse’s sense of self-efficacy and to overcome turnover intentions.

Keywords: Self-efficacy; Curriculum; Instrument development; Program outcomes assessment.

Introduction

In Israel, the duration to certificate a nurse takes four years. Of these, only about a quarter are intended for practical experience. Graduates of nursing schools are accepted into the ranks of nursing practitioners without prior experience, directly into the requirements of the provision and management of care in clinics in the HMOs and hospitals.

The need for research on the subject arose from sharing the personal feelings of the graduates at the beginning of their employment, in the face of interest in the satisfaction of the directors of the care institutions they employ.

The study deals with the question of the gap in self-efficacy for the role of nurse as it is perceived among new Registered Nurses (RN) and among the administrative staff in Israel. I will present the level of readiness of the graduates when entering the practice which will be determined by self-esteem, the level of confidence to manage and follow instructions and the ability to meet the required standards, in comparison to employers, i.e., hospitals. It should be noted that these criteria were not examined in the current study among HMO nurses. This work gives a deeper perspective according to which the gap is relevant not only to nurses but also to the rest of the medical professions. In other words, the prism of the research in terms of its structure, the results and the conclusions touch on the common aspects to all health system.

The research method is based on two validated research questionnaires. First, which examining the nurse's experience, "Casey-Fink Graduated Nurse Experience Survey" was distributed among nurses with up to 5 years of their certification in various departments in different hospitals [1]. Second, which examines the concept of professional level, "BELIMAGE", was distributed among the nursing and medical management staff in the same departments and hospitals [2].

The conclusions of the study are also based on previous studies with similar findings according to which there is a consensus that the new nurse isn't sufficiently prepared for her role. She possesses a great deal of knowledge but not the tools to channel it into the necessary nursing work. To get the best out of the new nurse, additional training is needed during the initial period of post-certification whose purpose is to teach her how to translate knowledge into practice and be accompanied by a nurse with experience who will serve as a role model.

Review of the Literature

Students during their studies are closely supervised and controlled for their activities, but at the moment they're employment as RN, they stand responsible for their actions and are accompanied by a receiving nurse- a RN to whom they delegated training positions of nursing staff in the care ward [3]. The Ministry of Health of Israel defined the term "self-efficacy" as self-assessment of the nurse that she can perform the professional role [4].

Unpreparedness, as a result of lack of practice, is related to the inability to cope alone in the clinical field. This is the gap between theory, practice and the nature of the work environment both in eyes of the graduates and the senior staff in hospitals [5]. Moreover, workload, past experiences, lack of orientation, the need for holistic assessment of a patient, help availability and inexperience are factors that directly affect the efficacy of the new nurse to do what is required from her [6].

In part of the departments designated for experiences, there is a shortage of nursing staff required for guidance and accompaniment. In such cases the student receives a partial orientation and inconsistent guidance resulting in a decreased sense of security and competence [7]. The advanced clinical experience is the last means of preparing the student to work in the nursing field. The purpose of the prolonged experience is to enable the student to integrate what is being studied on his own, and to express it in practice. If there is a lack of the factors mentioned before or if they are not sufficiently embedded in the curriculum - the student will refrain from functioning as a nurse or even turnover their profession [8]. The term "reality shock" came to explain anxiety, doubts and confusion in the transition between those roles, and causes the abandonment of the profession during the first year of employment among 30% of them [9]. However, it was found that internship programs for RN yielded positive results regarding their coping with the role transition [10]. It was found that the accompaniment of a receiving nurse assisted in integrating the material studied into the clinical field. Only 10% of all the graduates were sufficiently willing to provide proper nursing care, and only 25% of the nurses in charge were satisfied with the clinical skills of the RN. The term "theory-practice gap" refers to the gap between theory and practice, and in the nursing profession to the transition between roles. Gaps in efficacy were found in various areas such as critical thinking, communication, time management, physical examination and teamwork [11]. Previous studies showed that learning also through simulations would contribute to a more in-depth preparation because it will integrate the studied material into practice ahead of time [12].

During the transition period of the new nurse, she is oriented in the department and establishes contacts with caregivers whom role is important in dealing with clinical conditions and challenges. Therefore, implementing strategies to promote social support can have a far-reaching impact on the perception of efficacy [13]. Also, the clinical orientation itself has been found to be a factor with most noticeable influence on narrowing or deepening the gap [14].

Cognitive failure is defined as the inability to successfully complete tasks that can usually be performed daily. Failure in simple tasks can be exhausting to the extent that the individual perceives the event as threatening and uncontrollable. Hence, a student who had a negative experience will tend to suffer a cognitive failure that will affect his self-efficacy as a RN. The various circumstances reviewed put the new nurse under pressure to confront challenges regardless her cognitive abilities and skills, which has a negative impact on the development of efficacy [15].

Materials and Method

Study Design

The study involved 102 administrative hospitals staff members and 200 nurses with up to five years of experience, randomly selected in a convenience sample from twenty different hospitals in the country- privates, mental, government hospitals and HMOs to provide a diverse sample. The questionnaires were distributed twice. The response rate was high (70%). In addition, semi-structured interviews were conducted with academics and the Ministry of Health for extra depth to complete the results of the questionnaires.

Instruments

Casey-Fink Graduate Nurse Experience Survey [1]. Questionnaire for new RN. The first part of the questionnaire included 24 questions. Likert scale answers range between 1-4 when 1 strongly disagrees and 4 strongly agrees and included the following sub-indices: communication (a=0.40), performance of skills (a=0.50), order and organization (a=0.50), accompaniment and receiving (a=0.82), professionalism (a=0.46) and satisfaction (a=0.56).

BELIMAGE (BELgian professional self-IMAGE instrument for hospital) instrument. (2) Questionnaire for management staff. The second part of the questionnaire examined the perception of the ability of specific nursing skills in relation to the new RN. Likert scale answers range between 1-5 where 1 incompetent and 5 very capable. The metrics were made up of the average of the answers so the higher the score, the higher the perception of ability. The questionnaire included the following sub-indices: technical skills (a=0.86), intellectual cognitive skills (a=0.87), order and organization skills (a=0.89), communication skills (a=0.90) and professional approach (a=0.83).

Semi-structured interview. Interview with the directors of three nursing schools, director of the Accreditation Department at the Ministry of Health and acting department of Research and Innovation at the Nursing Administration. The interview included two questions: whether the nursing program is currently adapted to the needs of the Israeli health system? And according to which criteria is evaluated and determined the ability of the students during their studies to succeed as RN in the future?.

Results

The Sample of new RN

The average age of the respondents was 29.54 years, the average number of years from graduation was 2.56 years and the average number of receiving nurses per RN was 2.52. Furthermore, 76% were females, 36% of the respondents work in internal departments and 64% had previous experience in the health system during their studies. The duration of admission to the ward of more than half of the nurses was two months and less.

The Sample of Managerial Staff. The study involved 102 members, among them identified 19 head nurses, 33 clinical coordinators or instructor nurses and two department managers.

Statistical Analysis

An averages tests show that communication skills have the highest perception of ability comparing the two study populations (x=3.57 and x=3.75, respectively). Subsequently, technical skills were perceived as the least capable performing skills (x=2.77 and x=3.72, respectively). The transition period was also examined, and it was found that more than half of the answers (52%) indicated workload difficulty as most common. Workload included difficulties in order and organization and setting priorities. Participants were asked about the actions required to facilitate the transition period. Most respondents (46%) believed that improving their orientation would have been beneficial for their transition to the role of RN. The orientation aspect included the support and consistency of the receiving nurse, comprehensive orientation (i.e., familiarity with the department) and practice actions unique to the department.

Statistical Hypothesis Testing

To compare the gap in the perception of efficacy between the management staff and the new nurses, a t-test was conducted for the independent samples. It should be noted that for the purposes of statistical analysis, the scale of answers of the two questionnaires was adjusted. As can be seen in (Table 1), significant differences were found in the way in which the efficacy of the RN in the various nursing skills in all the measures examined is perceived: Technical capability (t(300)=7.08, p<.01), cognitive ability (t(300)=3.49, p<.01), organizing capability (t(300)=4.76, p<.01), communicative abilities (t(300)=2.15, p<.05) and professional abilities (t(300)=7.78, p<.01). The data show that the staff assesses the abilities of the new nurses higher in each of the different skills, than the nurses assess their own.