Basic knowledge in critical care: A comparison of experienced and newly graduated nurses augmented with an examination of newly graduated nurses? Experience making clinical judgments

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Abstract

Newly graduated nurses (NGNs) are thrust into roles that some purport they are inadequately prepared to handle. Studies found that 4% of NGNs were comfortable with their skills, it took up to one year to feel competent and confident, and NGNs feel shocked, unprepared, and overwhelmed. The purpose of this mixed method study was to investigate the basic knowledge (BK) of NGNs working in the critical care (CC) setting and compare it to the BK of experienced nurses and to understand the experience of NGNs as they made clinical judgments. Triangulation linked the experiences of NGNs as they made clinical judgments and their BK scores. The Novice to Competent Nurse Process Model by Schoessler and Waldo provided the theoretical framework for this study. The Basic Knowledge Assessment Test (BKAT-7) and demographic tool were completed by 26 NGNs and 147experienced nurses on 14 adult CC units in 9 hospitals. Five NGN volunteers participated in interviews where they related challenging patient scenarios and shared their decision making experiences related to planning and providing care. A t-test was used to determine the hypothesis of difference of mean BKAT scores between the NGN and experienced nurses. ANOVA was used to analyze the NGNs' scores within the three stages as well as entry degree levels and other demographic variables. A regression analysis was completed to determine the relationship between experience and CC BK. The researcher was not surprised to find a statistical difference between NGN and experienced nurses' BKAT scores however the fact that nearly 40% of the experienced nurses did not reach the threshold of 82-84 set by Toth was astonishing. Therefore one focus of the research changed from determining when NGNs reach the BKAT score of experienced nurses to determining when CC nurses reach the BKAT threshold. Three themes emerged from the NGN interviews: Developing confidence in practice; Seeking assistance; and Decision making. Triangulation showed that NGNs' lack of experience, in-depth knowledge, and confidence coupled with low BKAT scores hinders their ability to make decisions as evidenced by NGN reliance on experienced nurses to guide them in crisis situations.