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ABSTRACT
Background: Nursing shortages, increased patient acuity, and early discharges have increased demands on newly graduated nurses. At the same time, financial constraints have curtailed orientation programs.
Method: Open-ended interviews were conducted with 11 nurses employed in acute care settings at 3 months following graduation.
Results: New nurses defined their work as a set of skills and attended to procedural aspects of care. Most lacked the capacity for helpful communications with patients and families. They relied heavily on routines learned from experienced nurses.
Conclusion: At 3 months, new graduates are apprehensive about their work. Approaches to nursing are largely procedural and guided by the routines of senior colleagues.
Most contemporary university nursing graduates begin their careers as did decades of graduates before them - in direct caregiving at the bedside in an acute care setting. Much has changed, however, both in the educational preparation of nurses and in the practice settings where they work. According to the Canadian Association of Schools of Nursing (CASN), the body that accredits its member schools, the purpose of undergraduate nursing education is "preparing nurses to work with individuals as well as families and communities in health promotion activities, as well as to care for persons with acute and long-term illness and those who are dying" (CASN, 1998, p. 1).
Many undergraduate nursing curricula now place major emphasis on nurses' participation in and knowledge of public health policy and health promotion and on preparing nurses for a central role in a reformed system of health care organized around health. On the other hand, most nurses still work in acute care settings where well-informed clinical judgments and skills are necessary and respected, and where resources for comprehensive orientation programs and clinical nursing education are limited. Caregiving expectations on acute care units have increased in significant ways. For one, the number of beds and length of stay have decreased dramatically, leaving only very ill persons on acute care units. The complexity of caregiving has risen because of the introduction to general units of the technology necessary to sustain very sick patients. Tasks such as drawing blood, starting intravenous lines, and central line care that were once classified as delegated medical acts have entered the mainstream of nursing care. The Advisory Committee...