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The purpose of this assignment is to explore the topic ‘Does stress and burnout impact on a nurse’s transition from student to registered nurse’ by critically appraising and analyzing quantitative and qualitative research methods using the Holland and Rees critical appraisal framework tool (Holland and Rees, 2010). Critical appraisal involves critically analyzing the best research which is credible and relevant and which improves the quality and expense of positive patient care, decisions, and interventions.
It is crucial for graduates and registered nurses to put this into practice (University of Kent, 2017). The first article chosen is found in the ‘Journal of Clinical Nursing’ titled as ‘Stress and stressors in the clinical environment: a comparative study of fourth-year student nurses and newly qualified general nurses in Ireland (Suresh, Matthews and Coyne, 2012). This paper is quantitative. It is relevant to the chosen statement as it evaluates and relates stress and stressors of student nurses and newly qualified nurses and shows that this can trigger burnout and health implications for the nurse (Suresh, Matthews and Coyne, 2012).
The second article selected is ‘Role transition from student nurse to staff nurse: Facilitating the transition period’ which appears in Nurse Education in Practice by (Kumaran and Carney, 2014). This article is qualitative and relevant to the state as it investigates experiences of the transition from student to registered staff nurse (Kumaran and Carney, 2014).
An essential aspect of contemporary nursing care is the competence to recognize and respond to people in your care who are in distress, ensuring that their psychological needs are considered and managed properly (Nursing and Midwifery Council, 2015). The statement is relevant to contemporary nursing practice as the ability to recognize stress and burnout enables this to be managed more effectively whilst providing high-quality patient care (Nursing and Midwifery Council, 2015). Heinen et al. (2013) discovered that there was a high connection between stress and the plan to leave the nursing profession. It was also established that students and newly qualified registered nurses (aged 27-32) desire to leave the profession due to burnout and stress at work which then affects contemporary nursing practice. Beecroft, Dorey, and Wenten, (2008) revealed that there was no association between young graduates receiving their first ward as it was in older graduate nurses. This indicates that it could be due to the transition period and the challenges that nurses encounter, therefore this is a crucial subject to study in relation to nursing research. Reducing student and nurse burnout improves the transition stage from a student nurse to a newly qualified nurse, quality of care in patients and provides job satisfaction (Flinkman, Isopahkala-Bouret, and Salantera, 2013).
Stress can be described as the impairment of ability to adapt to a situation and can manifest as anxiety and fear. How one individual reacts to a situation is how they identify it themselves and is not general to everyone in the population (Brooker and Nicol, 2011). The Health and Safety Executive (2011) describes ‘stress as a negative response to demands and pressure which are put upon them’. Kohler et al (2006) agree that demands of university nursing training can lead to stress and produce emotional and intellectual changes in the student. Student nurses face academic stress and burnout along with work placements in the training period which can cause immense pressure on them. Through the transition period to become a newly qualified nurse, they will have stressors of workload, changes, decision making and pressures put on them (Spielberger and Reheiser, 2005). This is a major concern in the United Kingdom for nurses and student nurses (RCN, 2005). Gibbons (2010) defines stress as psychological anguish although he describes that some stress can be positive for nursing students and the newly qualified if they are supported in their learning and workplace which can improve well-being.
Nursing professionals need to consider how university coursework and transition involvements contribute immensely to distress and to eustress and to provide the right support to students and newly qualified nurses. An essential coping method is peer support through studying, learning, and knowledge in the university or workplace (Gibbons, 2010). Waters (2006) states that one-quarter of students do not complete their nursing training at university due to stress and burnout with other students affected during the transition period which then has negative implications for patient care due to staff shortages in the healthcare settings.
Quantitative Critical Appraisal
Quantitative research can be described as producing hard scientific knowledge which involves data collection methods, such as questionnaires, surveys, structured interviews, and observations. Measurements are vital to the phenomena in this method of research (Parahoo, 2014). Suresh, Matthews, and Coyne (2012) researched ‘Stress and stressors in the clinical environment: a comparative study of fourth-year student nurses and newly qualified general nurses in Ireland’.
The Department of Health (2010) states that a newly qualified nurse’s first involvement in the workplace can have an immense impact on their mental health, anxiety and stress levels which can affect their progression and career in nursing. It is presented that nurses and newly-qualified nurses can face several challenges that may lead to stress and physical health decline, due to lack of support, excessive workload and staff shortages (Suresh, Matthews and Coyne, 2012).
The aim of the study is to establish the amount of job-related stress and stressors amongst 4th-year students and newly qualified nurses (Suresh, Matthews and Coyne, 2012). The aim must be clear, trustworthy and credible (Coughlan, Cronin, and Ryan 2007). Polit and Beck (2012) agree that the goal confirms the direction of the research. The aim of this study was clearly demonstrated throughout. The hypothesis for this research study expresses that stress within a clinical work will be higher in newly qualified nurses as in 4th-year student nurses (Suresh, Matthews and Coyne, 2012).
A hypothesis is an account based on information and expertise that must be confirmed or disapproved (Parahoo, 2014). The method used within this study was a survey which is a non- experimental research design that aims to obtain descriptive and correlation data from a large population, this can be used to verify the nature of a problem in which evidence-based practice must be put in place (Holland and Rees,2012). Therefore, this method is suitable to identify that stress is a current and ongoing issue amongst students and newly qualified nurses.
A self-reporting questionnaire containing ‘The Nursing Stress Scale’ was used to collect data in both students and newly qualified nurse groups to quantify and evaluate levels of stress and stressors in the clinical environment (Gray-Toft and Anderson, 1981). A pilot study had been carried out which clarifies reliability. Polit and Beck (2012) state that questionnaires can be biased and may not be reliable and valid however this tool is reliable and valid and has been used with the author’s consent. Lee et al. (2007) concluded that the tool is robust, used since 1986 and has been tested against other scales which is supported by research. French, et al (2000) agree that the stress scale is the most widely used, consistent, reliable and trustworthy.
SPSS computer analysis was used by the researcher which is the most powerful statistical software in the world, therefore their analysis is more reliable and credible (Arkkelin, 2014). Suresh, Matthews, and Coyne (2012) provide clear tables and descriptions of the findings. The association between the variables is strongly presented using correlation which indicates further credibility (Holland and Rees, 2012). Suresh, Matthews, and Coyne (2012) utilized a non-probability convenience sampling which involves using people that are easily accessible, this could be subject to bias (Parahoo, 2014). The sampling included 120 of all the newly qualified nurses and 128 or 4th-year student nurses in 6 hospitals in Dublin, however, the response rate was only 31 of newly qualified nurses (26%) and 40 4th year student nurses (33%). Researchers should be aspiring to aim for at least 60% to achieve less bias and more reliability (Fincham, 2008). Therefore, this study is generated to be less reliable and open to further bias. Inclusion criteria were newly qualified nurses being qualified for 6 months and work within an acute setting. The criteria for 4th-year students were working in an acute ward at the time of data collection with all willing to participate. The criteria used was reasonable to assess the research study.
Ethical approval was gained from the University Research Ethics Committee and granted by the 6 hospitals in Dublin. Ethical principles must be met which include Beneficence, Non-maleficence, Fidelity, Justice, Veracity, and Confidentiality (Parahoo, 2014). This study has complied with these principles to enable them to gain permission to carry out this study, however, there is no mention in the article of informed consent from the participants. The questionnaires remained confidential as they contained no classifying descriptions (Suresh, Matthews and Coyne, 2012).
The main findings of the study proposed that stress is a major issue and a concern the in newly qualified and 4th-year student nurses within the clinical setting. Most of the findings were equal apart from workload and conflict with physicians is higher in the newly qualified nurse (Suresh, Matthews and Coyne, 2012). These findings were measured, compared and concluded. The hypotheses were not proven, as there was no difference in the variables in regards to stress and stressors as found in the data analysis section. Further research was recommended with a larger randomized sample of participants and demographic data, this would prove less bias and more beneficial (Suresh, Matthews and Coyne, 2012).
Strengths of the paper were that the researchers had a transparent aim for their study showing clear data analysis, however, the percentage of participants that responded was not robust. Limitations, as stated by the authors, was the small convenience sample utilized (Holland and Rees, 2010). The results relate to practice as the evidence shows that stress is a major concern and by providing induction, stress management and counseling to newly qualified and student nurses would only benefit them and improve nurse education.