Personal, Structural, And Social Characteristics Associated With Newly Licensed Registered Nurses' Confidence In Clinical Decision-making

Abstract

Large numbers of newly licensed nursing graduates are entering the workforce and are immersed into complex care situations requiring high stakes decision-making. These nurses are expected to transition from a student nurse, supported by faculty, to a competent nurse caring independently for high acuity patients with multiple co-morbidities. Employers have reported new graduates are not fully prepared to provide safe, effective patient care. The purpose of this cross sectional, descriptive, correlational study was to examine relationships between demographic, personal, structural, and social characteristics of the work environment and newly licensed registered nurses’ perceived confidence in clinical decision-making in acute care nursing units. A web-based survey was accessed by 421 nurses working in acute care settings resulting in 177 completed surveys. Data were exported into Excel from SurveyMonkey® then imported into Statistical Package for the Social Sciences (SPSS) for data cleaning. The extent of incomplete or missing data was determined and an analytic data set was created. A researcher developed instrument was piloted. Statistical assumptions were tested. Data analysis using descriptive statistics and multiple linear regressions addressed the research questions and results were reported. Results demonstrated nurse-nurse collaboration along with self-confidence and gender were the strongest predictors of newly licensed registered nurses’ perceived confidence in clinical decision-making. Additionally, social characteristics of collaboration, trust, and communication had positive relationships with newly licensed registered nurses perceived confidence in clinical decision-making. Nurse researchers must explore ways to enhance nurse-nurse collaboration by providing reflection and experiential learning activities designed to enhance social characteristics within the work environment. Future research is needed to examine nurse-nurse collaboration to determine if critical thinking competencies are being met and patient outcomes are improving. Researchers must also explore ways to enhance other desired social characteristics in newly licensed registered nurse training programs and promote intellectual collaboration in decision-making. This study offers multiple avenues for future research around newly licensed registered nurses’ desired social characteristics within the workplace related to enhancing clinical decision-making and improving patient outcomes.