Abstract
Severe staff shortages, the Covid pandemic, an increase in patient acuity and fiscal
restraints contributed to basic nursing students being allocated to intensive care units
(ICUs) during their placements at a private healthcare provider in South Africa. These
final-year nursing students are soon to be registered nurses, available to be employed.
They are expected to step up and “hit the floor running” but are confronted with
expectations and situations far beyond their preparation for practice. The researcher
acknowledged the need to employ the students in the ICU and recognised the lack of
sufficient support structures to assist the students in their transition from student to
newly qualified registered nurses, employed to work in the ICU. The researcher thus
identified a need to investigate final-year bridging course students’ readiness for
practice in the ICU, with the aim of identifying the factors that influenced their
readiness for practice. Only once these factors were identified and understood could
effective transition programmes and support structures be developed to empower the
newly qualified registered nurses of tomorrow to become practice-ready.
During this study, an explanatory, sequential mixed-method strategy was executed in
three phases. The quantitative method was applied first using census sampling, and
the data were collected using the Casey Fink Practice Readiness Survey. The survey
enabled the researcher to determine the students’ readiness for practice and the
factors that contributed to their perceived readiness for practice. The quantitative data
were statistically analysed with the use of IBM SPSS (version 25, IBM Corporation,
New York, USA). Demographic and response variables were described by frequency
analysis. Predictive relationships between readiness for practice and the identified
variables were assessed using multi-linear regression.
This was sequentially followed by a qualitative method and purposive sampling,
through the application of two semi-structured focus group discussions. The questions
for the focus group discussions were derived from the data obtained during the
quantitative phase. The data were analysed through domain analyses and enhanced
and validated the quantitative data. The integrated results identified four factors that
affected the nursing students’ perceived readiness for practice in the ICU environment:
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1) Support for new graduates, 2) their need for professional socialisation and
belonging, 3) orientation and skill development, and 4) rotation and exposure in the
clinical learning environment as a student.
During the third phase of the study, the researcher recommended that the students
receive orientation prior to their exposure to the ICU in a supernumerary capacity. The
students should be afforded the opportunity to attend a skills development programme
that allows them to practice the basic skills required to work in the ICU in simulation
until they are competent. The development of transition programmes should be
priorities and include the appointment of a clinical nurse specialist (CNS)
supernumerary. Each student should be paired with a mentor during their exposure to
the ICU. Programmes and support structures to empower the CNS and mentors
should also be developed. Standardised orientation programmes should be developed
through collaboration between the clinical facilitators and the CNS in each unit. Each
unit and the organisation should review their policies to include belief statements that
value student and staff development.
The trustworthiness of the data was accomplished by utilising a validated data
collection instrument during the quantitative phase of the study. Trustworthiness was
established by ensuring credibility, transferability, dependability, and confirmability of
the findings through triangulation. The researcher adhered to all ethical principles
during this study. Limitations were identified and the strengths of the study discussed.
Recommendations were offered for nursing higher education institutions, nursing
managers, policymakers and for future research on the topic.
Keywords: Practice Readiness, Nursing Student, Intensive Care Environment,
Private Hospital.