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A qualitative study of nursing didactic programs: Novice nurses' perception of competence, confidence, and retention

Dissertation
Author: Pamela Gueringer Poldervaart
Abstract:
The purpose of this qualitative method with a phenomenological research design study was to explore novice nurses' perceptions of workforce readiness provided by an associate degreed registered nurse (ADN) Nursing Program in metropolitan Denver, Colorado. A phenomenological design was used to understand confidence, competence, and the desire to remain in the profession, as perceived by recent graduate nurses. The study used a modified van Kaam method by Moustakas (1994). Fifteen novice associate degree-prepared nurses, interviewed by telephone, were the study subjects. The study purpose was to determine if novice nurses reported classroom or clinical settings as the greatest preparation. They defined expectations they perceived of the nursing program preparation for responsibilities and tasks required of them as nurses . The study results determined that in this study sample, clinical experiences provided the greatest perception of preparedness. This study revealed themes of participants' perceptions of their nursing program that pertained to the contribution of confidence, competence, and intent to remain in the profession. A model for nursing education reform was developed from these themes. Education may require reform to meet current needs of health care and the anticipated continuing nursing shortage. Nursing education curriculum leaders are responsible for program design that prepares students for their role in the nursing profession immediately after graduation.

TABLE OF CONTENTS LIST OF TABLES.........................................................................................................................vi LIST OF FIGURES……………………………………………………………………………...vii CHAPTER 1: INTRODUCTION................................................................................................... 1 Background of the Problem .................................................................................................1 Social Concerns…………………………………………………………………………...1 Theoretical Interests.............................................................................................................3 Problem Statement.............................................................................................................4 Purpose of the Study..........................................................................................................4 Significance of the Study..............................................................……. .…. .……………4 Current and Future Importance..............................................................................5 Significance of the Study to Leadership ...................................................................6 Nature of the Study. .............................................................................................................7 Overview of the Research Method...........................................................................8 Overview of the Design Appropriateness................................................................9 Research Questions............................................................................................................11 Theoretical Framework......................................................................................................12 Definition of Terms............................................................................................................ 17 Assumptions .......................................................................................................................19 Nature and Scope of the Research Design.........................................................................20 Limitations.........................................................................................................................21 Delimitations......................................................................................................................22 Summary ............................................................................................................................24

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CHAPTER 2: REVIEW OF THE LITERATURE………………………………………………26 Title Searches, Articles, Research Documents, and Journals ...........................................27 Historical Overview of nursing Education............................................................29 School Preparation for Perceived Successful Transition to Nurse........................37 Critical Thinking as a Competence Factor................................................38 Knowledge Base as a Confidence Factor..................................................41 Nursing Education Reform in Didactic Format ....................................................43 Traditional Lecture Format of Nursing Education................................................44 Learner-centered Classroom Format.....................................................................45 Problem-based Learning...........................................................................46 Inquiry-based Learning.............................................................................51 Other Classroom Formats in Nursing Education.................................................53 Reflective Thinking....................................................................................53

Mixed Format............................................................................................53 Conclusion.........................................................................................................................3 5 Summary ............................................................................................................................55 CHAPTER 3: METHOD………………………………………………………………………...57 Research Method and Design Appropriateness .................................................................59 Research Method...................................................................................................59 Appropriateness of Design.....................................................................................60 Disadvantages of the Design.................................................................................62 Research Questions ............................................................................................................62 Population ..........................................................................................................................63

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Sampling Frame .................................................................................................................64 Informed Consent...............................................................................................................65 Confidentiality ...................................................................................................................66 Geographic Location ..........................................................................................................67 Data Collection ..................................................................................................................68 Instrumentation..................................................................................................................68 Pilot Study of the Interview Instrument.................................................................69 Instrumentation Validation....................................................................................71 Validity and Reliability ...........................................................................................72 Data Analysis .....................................................................................................................75 Summary ............................................................................................................................77 CHAPTER 4: ANALYSIS AND PRESENTATION OF THE DATA.........................................78 Participant Selection.........................................................................................................79 Demographics and Description of the Sample................................................................. 80 Sample Selection ................................................................................................... 80 Demographics.........................................................................................................81 Pilot Study.........................................................................................................................83 Data Collection ................................................................................................................83 Reduction of Data.............................................................................................................85 Data Analysis................................................................................................................... 86 Content Analysis................................................................................................................87 Analysis of Interview Data................................................................................................88 Themes...................................................................................................................93

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Most Helpful and Least Helpful Component of the Classroom.................94 Confidence and Competence (Preparedness for being a New Nurse).......95 Classroom Contribution............................................................................96 Intent to Remain in the Profession.............................................................97 Summary............................................................................................................................98 CHAPTER 5: IMPLICATIONS, RECOMMENDATIONS, AND CONCLUSIONS ...............100 Conclusions......................................................................................................................102 Importance of the Study to Leadership............................................................................102 Proposed Nursing Education Reform Model...................................................................104 Recommendations for Further Research..........................................................................107 Summary and Conclusions. ............................................................................................107 REFERENCES…………………………………………………………………………………111 APPENDIX A: RESEARCH INSTRUMENT—PERCEPTION INTERVIEW (ORIGINAL INTERVIEW TOOL).................................................................................................135 ….…...…. APPENDIX B: INTRODUCTION LETTER AND CONSENT TO PARTICIPATE …….......137 APPENDIX C: MATRIX OF RELATIONSHIP BETWEEN RESEARCH QUESTIONS AND INTERVIEW QUESTIONS (ORIGINAL INTERVIEW TOOL)...…...….. .............................139 APPENDIX D: RESEARCH INSTRUMENT (REVISED INTERVIEW TOOL AFTER PILOT STUDY).................................................................................................................................…..141 APPENDIX E: MATRIX OF RELATIONSHIP BETWEEN RESEARCH QUESTIONS AND INTERVIEW QUESTIONS (REVISED INTERVIEW TOOL).................................................143

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APPENDIX F: CONSTRUCTED DIAGRAM DEPICTION OF ORGANIZATIONAL AND INDIVIDUAL FACTORS FOR INTENT TO REMAIN IN NURSING....................................................................................................................................146 APPENDIX G: CONSTRUCTED DIAGRAM OF DEPICTION OF RESULTS OF DATA IN SEVEN PREDICTOR VARIABLES .........................................................................................148

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LIST OF TABLES Table 1 Scholarly Books, Empirical Research, Dissertations, Articles, and Journals Review.....27 Table 2 Demographics of Respondents.................................................................................. .......82 Table 3 Perception Interview Reponses by Question and Respondent ID.....................................89

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LIST OF FIGURES Figure 1. Schema of educational components for professional registered nurses………….........29 Figure 2. Depiction of determinants of nurse intention to remain employed……………….…...32 Figure 3. Diagram of depiction of multiple correlations and multiple regressions of seven predictors in the relational study by Nogueras (2006)..…………………………….……………36 Figure 4. Depiction of organizational and individual factors for intent to remain in nursing..........................................................................................................................................152 Figure 5. Diagram of depiction of results of data in seven predictor variables in the relational study by Nogueras (2006)…………………………………………….…....…...........................154 Figure 6. Schema of Nursing Education Reform Model............................................................103

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CHAPTER 1: INTRODUCTION In the United States, nurses as the largest single group of health care providers are critical to the entire health care system (Miracle, 2005). Nursing instructors are leaders. They lead students to become nurses. Through learning, nurses influence the care through which they lead patients. To prepare nursing students to integrate into the discipline of nursing, nurse education leaders must achieve a balance between methodological purity in education and practical clinical application (Borbasi, Jackson, & Wilkes, 2005; Fitzpatrick, 2007). Professional nurses must possess competency that directs personalized care for patients orchestrated with other health care professionals. Novice nurses especially rely upon the principles of care and theoretical knowledge they learned in their nursing program (Ferguson & Day, 2007). Chapter 1 introduces the qualitative method with a phenomenological research design study that examined the perception of preparedness that nursing education contributes to confidence and competency in the workplace of novice nurses in Colorado. Chapter 1 contains the background of the problem, including social concerns and theoretical interests regarding nursing education and perceptions of recent graduates of an ADN nursing program in metropolitan Denver. The specific problem is identified. Chapter 1 also outlines the significance of the study for the industry and leadership as found in the literature. Chapter 1 includes the defined purpose, nature, and the study design. The first chapter recounts the research questions, scope, limitations, delimitations of the study, and definitions of terms used throughout the study. Background of the Problem Social Concerns Health care in America requires an impassioned response to the concerns over the nursing shortage and the resultant burden to health care (Bowers-Lanier, 2006; Elgie, 2007;

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Behrens, 2007; Harrison, 2008). Based upon Health Resources and Services Administration (2006) statistics, the shortage of nurses in America is multifaceted and a serious problem for many years. New nurses who leave the profession prematurely create a significant number of vacancies (Paolilli, Rodriguez, & Moto, 2007). Historically, new registered nurses in the United States leave the profession within the first 6-12 months at rates of 35% to 69% (Hayes & Scott, 2007; Holden & Hamblett, 2007; Fitzpatrick, 2007). The number of newly hired graduates who plan to leave after the first year of employment is 33% (Nelson, Godfrey, & Purdy, 2004; Bowles & Candela, 2005; Hayes & Scott, 2007). New nurse graduates who leave within the first year of employment do so in response to the unexpected heavy patient load and the inability to think critically while balancing multiple tasks (Starr & Conley, 2006; Crow, Smith, & Hartman, 2005; Walsh & Seldomridge, 2006). Wilson (2006) reported that 54% of nurses believe that the work responsibility was more than they could physically perform. In a separate study (Morrell, 2005), 70% of nurse graduates indicated the students were unaware of the responsibilities and roles of nurses. The scarcity of nurses can have a profound effect upon the health and welfare of the entire population, not just patients (Buchan & Calman, 2005; Ungos & Thomas, 2008). Nurse educators must prepare students for roles that demand leadership regardless of the number of patients for whom they provide care. Nursing education leaders must lead students through the learning process to become competent novice nurses. Nurses are leaders from the beginning of their new career. Practicing nurses have a responsibility to plan patient care and lead interdisciplinary teams (Granum, 2004). Meeting the crisis of the nursing shortage requires an innovative method to deliver the vast amount of ever-changing information, prepare leaders, and meet the need for nurse retention (Fitzpatrick, 2007; Gillette, 2008).

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In the quest for meeting educational and workforce needs, universities and colleges have been creative in the design of novel nursing school programs (Larson, 2008; Gillette, 2008). In many cases, this resulted in a truncated nursing program with less time devoted to clinical skills and practice. The burden of preparing novice nurses is shifted to the health care industry because some graduates who enter the workforce are not educationally prepared (Morrell, 2005; Wilson, 2006; American Association of Colleges of Nursing, 2008). Nursing leaders must also prepare students to meet the expectations of employers. Student nurses who have knowledge and skills without understanding the appropriate application of learning are ill-equipped for the transition to novice nurse. The health care industry must absorb the cost and time of teaching novice nurses they employ, reducing resources available for direct patient care. Facility nursing educators should be able to construct orientation programs around specialty area requirements rather than on general education (O'Leary, Gobel, Vancura, Smith, Witt, & Vo, 2007). Theoretical Interests Nursing education requires that nurse researchers consider both philosophical and pragmatic concerns when designing curriculum for evidence-based didactic programs. Nursing as a discipline requires a balance between methodological purity and practical application (Borbasi et al., 2005; Fitzpatrick, 2007). Nursing theories as a foundation for nursing education help establish prudent and evidence-based practice. Malcolm Knowles (1980) was a renowned theorist in andragogy who believed that adults, as self-directed learners, assume responsibility for their own learning. Adult learners recognize the need for knowledge and skills that support their work tasks and duties. They accomplish this by observing and doing (Koralek, 2007). The four characteristics of Knowles’ (1980) theory of adult learners define how instructors influence experiences and success of the learners. These characteristics include understanding and

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encouraging students’ desire for self-direction, incorporation of life experiences, competency in social and work roles, and the need to be active in their own learning (McMillan, Bell, Benson, Mandzuk, Matias, McIvor et al., 2007). Problem Statement Nursing educators and health care policy and decision makers agree that the general problem is the inability of novice nurses to transition from nursing student and apply theory to nursing practice as beginner experts (Benner, 2001, Brunt, 2005; Harjai & Tiwari, 2009). Most new nurses “did not feel adequately prepared for the challenges of nursing” (Lindsey & Kleiner, 2005, p. 26). Nursing education may require reform that prepares students for the transition to the work environment (Flanagan & McCausland, 2007). The specific problem in this qualitative method with phenomenological design research study is the perceived effectiveness of a community college associate degree nursing program curriculum in preparing graduates for the transition from student to registered nurse. Perceptions and lived experiences of recent graduates is the central focus of the current study. The foundation is the theory-practice factors of competence, confidence, and critical thinking, and other employment related factors during the first few years as a novice registered nurse. Nursing program curricular design must incorporate basic knowledge requirements into critical thinking situations that allow new nurses to practice with competence and confidence (Pine & Tart, 2007). Research (Fitzpatrick, 2007; Hofler, 2008) identified lack of preparation to apply theory and critical thinking in the workplace. Purpose of the Study The purpose of this qualitative method with a phenomenological research design study

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is to explore didactic elements in the selected associate-degreed nursing (ADN) education program. The study sample of novice nurses was a convenience sample from the 58 graduates of the nursing program. The 19 participants described what enhanced their perception of competence, and consequent confidence. The 19 novice ADN nurses who returned signed consents were included in the study. The nurses in the study defined themes of perceived adequacy or inadequacy as they transitioned from student to new nurse. Current nursing education is not preparing students for expectations once they graduate and begin their careers (Cooper & Spencer-Dawe, 2006). Educators in health care facilities often incorporate education plans to enhance and broaden learning during orientation programs (Holden & Hamblett, 2007). Health care facilities may realize reduced costs of education, shortened orientation periods, and lower turnover rates if classroom experiences prepare students for workplace expectations (Jones & Gates, 2007). Significance of the Study Current and Future Importance The proposal suggested that an expected number of nurses returning the signed consents and meeting the original inclusion criteria was at least 20 novice nurses in an ADN program. The actual number of responses to the introduction letter with returned signed consent forms were 19 novice nurses. The respondents were interviewed to gather their perceptions as they transitioned from student to novice nurse. Perceptions of competence lead to a perception of confidence that may result in increased job satisfaction and retention rates (Wagner, 2006). Early failure of a new nurse is significant to the self-perception of being a competent nurse (Takase, Maude, & Manias, 2006). Novice nurses’ perceptions may provide insight into the need for nursing education reform in didactic structure.

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The essence of this study is an exploration and discussion of the transition period from student to nurse within the first few years of employment. The responses to the interview questions may offer viable suggestions for curricular changes that prepare students for the reality of nursing practice. New nurses who participated in the study by Lindsey and Kleiner (2005) reported they did not have the preparation needed to accept the realities of the profession. McKenna and Newton (2008) and Hofler (2008) cite research from the 1990s and early 2000s that support need for additional research in this area. Björkström, Johansson, and Athlin (2006) reported that few current studies exist on the ability of the student to transition to nurse successfully. The results of this study may be an effective guide for future studies, qualitative and quantitative, in education, student to nurse transition, and nurse retention. Significance of the Study to Leadership Nursing students who learn application of theory in the classroom may require shorter orientations and may have the sufficient preparation that inspires them to remain in the profession. Because hospitals are experiencing a high rate of turnover for registered nurses, insight into better preparation to meet the responsibilities of novice nurses may be beneficial to leaders in health care (O’Brien-Pallas, Griffin, Shamian, Buchan, Duffield, Hughes et al., 2006). Experienced nurse preceptors frequently replace clinical instructors to reduce orientation costs of facilities’ novice licensed nurses (Jones & Gates, 2007). Novice nurses often leave either bedside care or the profession because of unrealistic expectations of their roles after graduation (Lindsey & Kleiner, 2005). Exiting nurses may secure employment in other areas of nursing, but competence in bedside nursing is a crucial skill in health care (Viney, Batcheller, Houston, & Belcik, 2006). This qualitative method with a

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phenomenological research design study explored responses by novice nurses related to the problem of retention. The advantage to health care leaders of retaining nurses may contribute to the solution of the growing nursing shortage in America (Etheridge, 2007). Nursing education leaders have a responsibility to meet the demand for increased nursing programs and to produce competent and skilled nurses (Hofler, 2008). When considering associated benefits and wages of nurses, the cost of turnover for each nurse in 2006 was $64,000 (O’Brien-Pallas et al., 2006). The expected increase in the vacancy rate will rise from 8% in 2006 to 29% in 2020, and the need for nurses is anticipated to exceed 800,000 (Wagner, 2006). Effective instruction that facilitates the transition of students to nurses is the foundation upon which learners can achieve growth through active engagement of their natural curiosity (Duchscher, 2008). Nature of the Study Overview of the Research Method The representative group in this qualitative method with a phenomenological research design study is recent graduates of an accredited ADN nursing program for years ending in 2008. The design of the study interview questions provided data about perceptions of the novice nurses. Although the accreditation agency (NLN) directs nursing program content, the instruction methods may affect the novice nurses’ perceptions of competence and confidence. Confidence and competence perceptions may affect the decisions to remain in or exit the profession. The reasoning and understanding of how respondents perceived their didactic structure to have contributed to their confidence and competence allowed data collection by open-ended questions. Significant attrition of new graduate nurses occurs during the first 5 years of employment (Wilson, 2006). Nursing students must embrace the importance of critical

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thinking, and instructors must prepare them, to assume the responsibility of multiple patients with complicated diseases and illnesses (Crow et al., 2005; Walsh & Seldomridge, 2006). The most stressful time for a new nurse graduate is the first 3 months after licensure. The greatest stress is the work itself. Novice nurses are often unaware of the scope or nature of the expectations of them in patient care and documentation (Morrell, 2005; Wilson, 2006). Approximately 35% to 60% of new graduates change career choices within the first year (Halfer & Graf, 2006; Starr & Conley, 2006). A phenomenological design allows investigation of lived experiences of participants concerning how didactic programs did contribute, or failed to contribute, to their practice as nurses. The raw data was organized into categories the participants defined during the interview process. The interview design permitted exploration of the direct experiences of the participants’ nursing education program because free expression was encouraged. The importance of this methodology is that it allows a rich and detailed discussion of the descriptive components of the responses to the interview questions from an individual viewpoint of the didactic nursing education phenomenon (Ireland, 2008). Classroom education can be the primary conduit to prevent failure of novice nurses and foster competence and confidence in the workplace. Education leaders have a responsibility to provide a realistic curriculum, introduce supporting nursing theory, and oversee skill development to prepare nursing students to meet requirements of nurses (Conceicao & Taylor, 2007). Using descriptive open-ended interview questions, respondents described their own classroom experiences that influenced the formation of their perceptions of self-confidence and competence. Prompting elicited elaboration by the participants on the changes in didactic education that they perceived to have been beneficial to them in their first position as a registered

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nurse. This information could be useful to curriculum leaders in nursing programs. The short demographic section proposed to provide data to support inclusion in or exclusion from the study. The expected diversity of the respondents would provide information to develop a nursing education model from the decision-making of the novice nurses and the reasons for those decisions. The result of the demographic survey revealed a very different perspective, as described in chapter 4. Overview of the Design Appropriateness Graduates with a Colorado RN licenses were mailed requests for consent forms, contained within the introduction letter (see Appendix B). The contact information is in a public record available from the Colorado Department of Regulatory Agency (2008c). The ADN nursing program chosen for the study had the highest RN-NCLEX® pass rate (Colorado State Board of Nursing, 2008a). Although individual student scores were not available, the Colorado State Board of Nursing (2008a) calculates the percentage of students who earned passing scores on the national licensure exam, evaluates schools, and publishes these ratings. Based on this information acquired from the official website, the selected associate-degree program had a 95% pass rate for 2008. The sample of respondents was the participants in the study. The time limit of 30 days from the date of the mailed introduction letters was the beginning of the data analysis. Anticipated participants were the first 20 responding graduates who also met the demographic inclusion criteria included in the signed consent form, contained within the introduction letter (see Appendix B). The current study sample was less than anticipated. Of the 19 respondents, 15 met the adjusted criteria and were study participants. The data collection is discussed in detail in chapter 4.

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The open-ended interview questions of the sample of responding new nurses explored their perceptions about the preparedness for independence with confidence and competence in their first employment after graduation. The community college, after approval by the school’s IRB approval, provided the names of the graduates of the program in 2008. The study sample is the associate-prepared (ADN) registered nurses who responded with signed consents. The qualitative method with a phenomenological research design approach provided a catalyst to prompt participants to elaborate on personal views in response to the open-ended questions without restrictive guidelines or boundaries. Attitudes, beliefs, culture, attitudes, and socioeconomic variables may have affected the perceptions of the participants, but were not a consideration in this study. Participants were asked to describe the extent to which they perceived themselves either prepared or unprepared for the duties and responsibilities in their workplace after graduation. The phenomenological design provided participants the opportunity to self define and elaborate on classroom experiences. Nurses responded to questions with individually perceived ideas of what defined education components concerning transition from student to nurse (Merriam, 1988). The open-ended interview design allowed participants to comment on suggestions for future instructional changes. Collation of the participants’ responses according to categories the participants defined in their didactic experience by like responses into an MS Excel® document. The narrative sections provided the opportunity to extract didactic options. Research Questions The research questions focus upon on the delivery of nursing education in the classroom. Specifically of interest was the didactic instruction that participants perceived to have developed a greater self-perception of competency and confidence in their first job as a registered nurse.

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This study is a medium used to explore participants’ perceptions of the areas of the didactic program to have been conducive to preparedness for their first placement after graduation. Specific research questions to achieve the purpose of the study include the following: 1. How well, if at all, do new nurses perceive themselves prepared for their first job after graduation? 2. How, if at all, do novice nurses contribute preparedness, confidence, and competence to their didactic nursing education? 3. What, if anything, will novice nurses say their didactic education contributed to competency and confidence upon graduation? 4. How, if at all, do novice nurses perceive their education helped them acquire and develop critical thinking skills to meet the demands of their new career as a nurse? Critical thinking, so vital to the success of new nurses, is a learned skill that evolves during the educational process (Harjai & Tiwari, 2009). Classroom instructors help students discern between opinion and truth (Olson, 2007). Critical thinking skills within the curriculum allow effective challenge on a deep level of students’ preconceived ideas on lesson development and knowledge sharing (Blackman & Benson, 2006; Walsh & Seldomridge, 2006). Inclusion of developing critical thinking skills can affect the perceptions of success of new nurse graduates (Brunt, 2005). Participants discussed their perceptions of the value of their classroom structure in the development and application of critical thinking and fostering the perception of confidence and competence as a successful novice nurse. Theoretical Framework A theoretical framework combines various concepts that underlie the process of research (Taborsky, 2008). The study incorporated concepts from nursing and education to develop the

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theoretical framework. Knowles’ (1980) adult learning theory and familiar well-established nursing theoretical frameworks, such as Orem’s (1995) self-care model, Watson’s (1988, 1997) human caring model, and Benner’s (2001) novice to expert model guided the exploration of perceptions of the contribution of classroom education to perceived competence and confidence of novice nurses. Maslow’s hierarchy contributes to how novice nurses perceive self- actualization in the context of class subject content and delivery constructs (Arruda, 2005). The individual concepts of the participants affected the participants’ perceptions of situations and experiences (Nemeth, Feifer, Stuart, & Ornstein, 2008). The participants elaborated upon what contributed to the factors of stress, unpreparedness, and reasons for wanting to leave the profession. The demographic portion of the interview provided a foundation for further studies about nursing education and external factors such as age, formal education, life experiences, and intrinsic influences such as study habits. Nursing is a profession in which the student should learn by doing, and classroom instruction should parallel that of clinical education (Doult, 2007; Hofler, 2008). Knowles’ (1980) theory of adult learning forms the basic theoretical foundations for this study. Nursing students are adult learners and are instrumental in the constructs of their own education. Benner (2001), a pioneer and established expert in nursing research, analyzed and discussed how nurses perform their work and gain expertise to meet individual patient needs. Benner (2001) supported the necessity of competence and confidence in novice nurses; and further established that nurses advance professionally by building upon knowledge they use in work (Wright, 2006). Practice and a knowledge base are necessary to perform tasks professionally and instinctively. When didactic programs provide opportunity for nursing students to acquire

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knowledge while demonstrating proficiency in the application of that knowledge, they are more likely to retain the information. Whitehead (1929), a noted philosopher of science and metaphysics and logical mathematician, asserted that individuals would easily retrieve continual information from the memory, but a casual need may require facts for which one must search. Whitehead (1929) argued that universities teach principles requiring mental habits to recall, and asserted that the mind reacts to stimuli that provoke an illustration of a circumstance. A nursing student who is stimulated to learn allows cultivation of knowledge through mental activity, not habit (Whitehead, 1929). The results of this study may have potential to add strength to the nursing profession with a stanchion for educational leaders to help deflect failure of novice nurses. Early failure may shatter the self-perception of being a competent nurse (Orsini, 2005). Students implement changes in the profession through application of critical thinking in work situations that they may encounter as nurses (Chang, Mu, & Tsay, 2006; Walsh & Seldomridge, 2006). Research (Bhoopathi, 2007; Gregory, Soderman, Ward, Beukkelman, & Hux, 2006; Pringle, 2004) determined that true learning does not occur passively. Students learn and retain knowledge more effectively with cooperative group activities and by actively questioning and researching to find answers. Both nursing theories and learning theories are the framework of the leadership model design constructed because of the interview response. The NLN provides the guidance for content material on a general scale. Students must have the opportunity to apply nursing theory to practice. Nurses are intelligent, critical thinkers, skillful achievers, active collaborators, and highly knowledgeable persons when providing care for patients (Ferguson & Day, 2007; Moody, 2004; Starr & Conley, 2006). Curriculum leaders in the nursing programs can establish an individualized theoretical framework that correlates to the NLN requirements.

Full document contains 167 pages
Abstract: The purpose of this qualitative method with a phenomenological research design study was to explore novice nurses' perceptions of workforce readiness provided by an associate degreed registered nurse (ADN) Nursing Program in metropolitan Denver, Colorado. A phenomenological design was used to understand confidence, competence, and the desire to remain in the profession, as perceived by recent graduate nurses. The study used a modified van Kaam method by Moustakas (1994). Fifteen novice associate degree-prepared nurses, interviewed by telephone, were the study subjects. The study purpose was to determine if novice nurses reported classroom or clinical settings as the greatest preparation. They defined expectations they perceived of the nursing program preparation for responsibilities and tasks required of them as nurses . The study results determined that in this study sample, clinical experiences provided the greatest perception of preparedness. This study revealed themes of participants' perceptions of their nursing program that pertained to the contribution of confidence, competence, and intent to remain in the profession. A model for nursing education reform was developed from these themes. Education may require reform to meet current needs of health care and the anticipated continuing nursing shortage. Nursing education curriculum leaders are responsible for program design that prepares students for their role in the nursing profession immediately after graduation.