New emergency nurses descriptions of making the transition to a more experienced emergency nurse: An interpretive descriptive study

How do new emergency nurses describe their experiences as they make the transition from being a new to becoming a more experienced emergency nurse? What are the needs of new emergency nurses as they make this transition? In this qualitative study, new emergency nurses were interviewed for the purpose of identifying what is was like to be a new nurse in the emergency department; what were their needs; what health care personnel, educators and administers could do to help them; and their intent to leave. Interpretive description was the research approach utilized in this study. Ethical approval was obtained from the University of British Columbia Behavioural Research Ethics Board and the Fraser Health Clinical Investigation Committee. Using theoretical sampling, eight new emergency nurses, from the lower mainland and Vancouver Island of British Columbia, participated in semistructured, audiotaped interviews. They had three years or less of emergency nursing practice and had completed the core courses of an emergency specialty program. The new emergency nurses felt overwhelmed and unprepared as they started their emergency practice. They encountered inconsistencies and deficiencies in their orientation programs. They encountered factors in the workplace environment that created challenges for them to practice safely and ethically. Workplace challenges included: the nursing shortage; the lack of resources; frustrations with management; the high patient acuity and volume; the challenges of attempting to meet organizational and technical changes; and the expectations of patients and patient's families. Hospital overcrowding created an environment where the nurses experienced occupational stress; mental and physical fatigue plus abuse from patients, patient families and emergency personnel. The participants did not utilized professional services to debrief stressful incidents. They described favourable relationships with emergency physicians and experienced horizontal violence from nursing colleagues. Six of the eight participants anticipated leaving the emergency department or changing their status in a year. They expressed feelings of being frustrated, stressed, overwhelmed and exhausted. The study's findings suggest implications for policy makers, nursing practice and nursing education. Further research is needed to explore the experiences of emergency nurses, the work place environment, the abuse they encounter and strategies to retain them.