There is more than one way of nursing : new graduate nurses' experiences of their first year of practice : a thesis presented in partial fulfilments of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Albany, New Zealand

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Massey University
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This research was undertaken with the aim of generating a theoretical explanation of the experience of new graduate registered nurses (NGRNs) undertaking a nurse entry to practice programme (NETP) in Aotearoa New Zealand. The objective was to construct a theory from focus group data utilising constructivist grounded theory (CGT) method. An integrative literature review focused on NGRN experiences of practice showed that there was a strong deficit focus in research, with much written on clinical risk and transition shock. Minimal research focused on the strengths of NGRNs, and what benefit they may bring to the work areas they are a part of. There was no research on the impact of culture on new graduates other than related to negative nursing behaviour. Given that healthcare is multicultural, the workforce diverse, and Aotearoa New Zealand has an expectation of improving equity for Māori, a deficit in research related to cultural need, or indigenous new graduate need, demonstrates an opportunity for research. Waikato District Health Board (DHB) has been running a NETP programme under a bicultural model since 2018, and this provided an opportunity for research in a programme not run elsewhere. Nurses are continuing to experience a complex and stressful work environment which leads NGRNs to align with workplace culture and preceptor expectations in an attempt to prioritise safety and care that is most visible, but this research showed that NGRNs are also motivated to prioritise cultural safety. This research delivered the theoretical explanation that NGRNs are ‘valuing culture to connect to patient need’. The ability to value others’ cultures was seen in those who were able to take the time to first explore their own culture. Graduates experiencing NETP within a bicultural programme utilised a safe learning environment to reflect, reached the developmental stage to become aware of and understand other cultures, and over time and with clinical competence were able to discuss cultural needs with patients to connect to need. Through exploring their identity with others as part of their NETP programme, NGRNs had a clear idea of their own identity as nurses and as individuals. Those who were able to prioritise cultural safety and treating the patient as an individual found connection with patients. Connection was iterative, with NGRNs needing to approach patients more than once, share and communicate their availability and willingness to understand in order for patients to share of themselves. Barriers to valuing culture and making connection were complex and diverse across specialty areas, but short staffing, stress and fear, pressure to work to key tasks, and lack of insight into the cultural needs of patients from other team members were key features across multiple specialties. New graduates are entering the workforce with an openness and optimism to meet the expectations of health equity in their nursing care delivery. Graduate programmes need to provide a safe space for reflection and enough knowledge and stimulus to provoke insight and assist them on this journey.