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Novice nurses’ work experience during their first six months in indonesia

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novice nurses’ work experience during their first six

months in indonesia

Maftuhah1,Junko TASHIRO2

1 Faculty of Medicine and Health Science, Islamic State University Syarief Hidayatullah, Jakarta Indonesia 2 Professor, St. Luke`s College of Nursing, Japan

Abstract

Studies have shown that some novice nurses indicated intention to leave the workplace after being exposed to their first job experiences during role transition (McCharty et al 2007; Bowles et al., 2005). In Indonesia, there is little information concerning nurses at their first job assignment or role transition from student to staff nurse. The study purpose was to explore novice nurses’ work experience during their first six months in attempting to have better understanding of novice nurses’ role transition incorporated to bridge the gap between educations and practice. A focus group discussion (Krueger, 2000) used to collect data. A qualitative content analysis (Neuendrorf, 2002), a human coding conducted by three different persons, a blinded coding and an inter-rater agreements were used data analysis. A total of 37 nurses were involved in seven focus group discussions. The study revealed the novice nurses had experienced both positive and negative situations. Confusion and stress frequently expressed as their impression about their first job experience. Opportunities to gain clinical experience acknowledged as the factors that make them feel good about their job. Lack of support from senior, lack of clinical skill and knowledge, unfamiliarity with work

environment and procedure, work schedule system, relationships with patients and doctors, and limited autonomy were reported as causes creating negative feelings about their job. Consequently, dissatisfaction and turnover intentions were expressed in the focus group. This finding supports that role transition is a stressful situation lead to turnover intention attitude. Structured transition support is necessary.

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Introduction

Indonesia is a heavily populated, multiethnic country. Since monetary and political crisis in 1998, Indonesia has to face challenges to keep survive economically and politically. In term of healthcare issues, Indonesia is still struggling with infectious diseases, effect of natural disaster and shortage of manpower for healthcare services, including the shortage of nurses (MoHRI, 2007). Regarding the nursing shortage and healthcare density, Heywood (2009) reported 11 out of 15 districts in West Java and Central Java had provider densities was low by international standard.

Although facing shortages in the country, Indonesian nurses have left Indonesia for their own personal reason and joined the healthcare workforce in several more developed foreign countries, for example, Netherland (de Veer et al., 2004). Most of those nurses who left Indonesia are young nurses. It shows that retaining Indonesian young nurses is important and is necessary. Retaining novice nurses to keep them working in the workplace is one way of meeting the demand of nursing personnel. Given the fact that the problem of nursing shortage is present in Indonesia, it has become important to pursue initiatives such as retaining Indonesian novice nurses. However, retaining novice nurses is a challenging initiative. Studies have shown that some novice nurses report an indicated intention to leave the workplace after being exposed to their first job experiences (McCharty et al., 2007; Bowles et al., 2005).

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increase while turnover rate also tends to increase, the worldwide nursing shortage grows worse.

The novice nurses’ negative experience during their role transition is implicated in their intention to leave job or nursing profession. Since there were various factors contributing to novice nurses’ intention to leave, it is necessary to understand what is needed during novice nurses’ transition from school to workplace to provide the best possible way of retaining novice nurses in the workplace and nursing.

In Indonesia, there is little information available concerning Indonesian nurses at their first job assignment. Therefore, little is known about what factors might contribute to better nurse retention in Indonesia. The purpose of this study was to explore work experience of Indonesian novice nurses during their first six months, in attempting to have better

understanding of novice nurses’ role transition from nursing student to nursing staff,

incorporated to recruitment and retention program, in order to fulfill the demand of staff nurses for the hospitals and also to bridge the gap between education and practice

Methods and Procedures

This study was use a qualitative descriptive approach (Polit & Beck, 2008) to describe novice nurses’ work experience during their first six months in Indonesia. The study conducted at a general hospital and a nursing school that provide extension program to upgrade degree of nurses from diploma to bachelor. Non-probability purposive sampling was used to select participants. The inclusion criteria were; participants were novice nurses graduated from diploma or bachelor nursing program; working for the first time since graduating, have been working for six months or less, and willing to freely participate.

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their institutions. A participation-request letter submitted to participants through the director of nursing and dean of the nursing school. Informed consent information and forms were given to each participant regarding the study. Participation to the study was voluntarily. Participants may refuse or withdraw from the study at anytime, without losing any benefit. Confidentiality was regarded to the focus group process and result.

Focus group discussions (Krueger, 2000) used to collect data. Focus groups were chosen to encourage interactions among participants to share their experiences to increase the richness of information. To the senior nurses group, focus group conducted after focus group of novice nurses was finished in purpose to focus in comparing the similar issues. Each group had a moderato and an assistant. Data from focus groups were collected tape electronic recorder, a field note and a session journal, transcribed and analyzed soon after the focus group is

finished. The focus groups responded to questions related to their impressions about their first job experience and situations during their transition from student to staff. They were asked to include descriptions of the factors or situations that made them feel positive or negative and, whether or not they had an intention to leave their employment.

A qualitative content analysis (Neuendrorf, 2002) used to data analysis. A human coding conducted by three different persons, a blind coding in which the coder do not know purpose of the study was included in the inter-rater agreements ,and rechecked the results to two novice nurses and their nursing manager were implemented to maintain content validity of the study result. Translation checked from Bahasa Indonesia into English was conducted by the expert to prevent possibility to have different meaning due to inappropriate translation.

Table 1. Nurses' work experience during their first six month in Indonesia

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Positive feeling of having a job

Attitudinal response Job attitude Negative feeling facing the fact that the job is not

ease

Perceived there is a theory practice gap Working condition Job attitude factor Unfamiliar with work environment, scheduling

Lack of professional / organizational commitment

Turnover Intention

Low performance related to tiredness, low motivation

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Lack of competency

Result

A total of 37 nurses were involved in the study. Data came from seven focus group discussions of 45 to 50 minutes each, with three groups of nurses with work experience six months or less and four groups with over six months of work experience.

The study revealed the novice nurses had experienced both positive and negative situations during their transition (Table 1). Opportunities to gain clinical experience were acknowledged as the factors that make them feel good about their job. Lack of support from senior nurses, lack of clinical skill and knowledge, unfamiliarity with the work environment and procedure, work schedule system, relationships with patients and doctors, limited autonomy were reported as causes creating negative feelings about their job.

Confusion, fear and stress were oftentimes expressed as their impression about their first job experience. As a result, dissatisfaction and turnover intentions were expressed in the focus group. Interestingly, the nurses who had over 10 years of work experience expressed similar experiences during their transition as these novice nurses. Presumably there has been little change regarding role transition from student to staff over the years in Indonesia.

Differences from theory and practice were reported in the area of documentation system and clinical procedures in which related to limited supplies and equipment.

Role transition support existed in the form of a formal orientation to provide

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novice nurses’ security feeling. The senior nurse is playing an important role of successful transition from student to staff.

Discussion

Indonesian nurses seem to have a similar stressful experience during their first job assignment. The study supported findings that role transition from student to staff is a stressful situation (Bowles et al., 2005; Newhouse et al., 2007) also indicated that the Kramer’s reality shock phenomena seems continue to have great relevance to the current nursing situation

The factor that might be contributed to the novice nurses’ turnover intention as shown in the studies were novice nurses experienced burnout (Suzuki et al., 2005 Flinkman et al, 2008), felt dissatisfaction with their job (Roberts B.J. et al., 2004; McCharty, 2007; Beeckroft et al, 2008; Flinkman et al., 2008) and experienced horizontal violence (McKenna et al., 2003; Lea et al., 2007), these factors also indicated to happen to the novice nurses in Indonesia.

The benefit of having an opportunity to improve clinical skill was become the factors that improve retention among novice nurses, in which it was become a unique intrinsic motivation of novice nurses. A structured transitional program such as preceptorship program is to believe to have impact decreased retention, cost, quality and professional development (Lee et al., 2008).

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Conclusion and recommendation

This finding supports that role transition is a stressful situation lead to turnover intention attitude among novice. Nurse administrator and educator must have a consideration to work together to develop a structured transition program that necessary and fit to Indonesia context. Consequently, novice nurses’ role transition could be at ease and retention could be improved

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