CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
,,PREPARATION
LEVEL OF ASSOCIATE DEGREE NURSE NEOPHYTES:
A SURVEY OF NURSING COMPETENCE EXPECTATIONS HELD
BY NURSING EDUCATORS, HOSPITAL PRECEPTORS,
AND THE NURSE NEOPHYTES THEMSELVES
A project submitted in partial satisfaction of the
requirements for the degree of Master of Science in
Health Administration,
Health Science
by
--
Dorothea Joan Jessop
June, 1980
The graduate project of Dorothea Joan Jessop is approved:
California State University, Northridge
ii
THIS PROJECT IS DEDICATED TO MY PARENTS
WITH GRATITUDE FOR
THEIR HELP, UNDERSTANDING, AND LOVE
iii
TABLE OF CONTENTS
Chapter
1.
2.
Page
INTRODUCTION
1
The Research Problem • •
3
Purpose of the Project
4
Delimitation of Scope
4
Significance of the Project
5
11
REVIEW OF THE LITERATURE
Discrepancy between Nursing Administrators' and Nursing Educators'
Goals and Expectations . . . . . .
.
Inservice Training for Nurse Neophytes .
3.
12
•
24
Summary
25
METHODOLOGY .
27
Design of the Study
27
Subjects .
.
27
Instruments Used .
28
• .
.
Development of Questionnaire
28
Construction
29
Distribution and Returns
32
Treatment of Data Obtained
33
iv
Chapter
4.
Page
FINDINGS
35
Skills Listed
36
Safety, Comfort, and
Personal Hygiene
36
Foods and Fluids
36
Elimination .
.
.
Treatments and Procedures .
55
Diagnostic Activities .
57
Medications .
58
.
Situations Listed
5.
58
CONCLUSIONS, IMPLICATIONS OF THE STUDY
FINDINGS, AND RECOMMENDATIONS . . . .
BIBLIOGRAPHY .
.
B.
c.
61
67
APPENDICES
A.
55
72
Nursing School Questionnaire with
Cover Letter . . . . . . . . ..
73
AA Graduate Questionnaire with Cover
Letter
. . . . . . . . . . . . . .
89
Hospital Preceptor Questionnaire with
Instruction Sheet . . . . . . . . .
101
v
LIST OF TABLES
Table
1.
Page
California Licensing Examination Data,
1973-1977
2.
10
"No" Responses by AA Graduate Nurses and
Nursing School Directors Concerning
Expectations of Neophyte Nurses• Competence in the Listed Nursing Skills,
and Nursing Service Preceptors• Eval37
uation
vi
ABSTRACT
PREPARATION LEVEL OF ASSOCIATE DEGREE NURSE NEOPHYTES:
A SURVEY OF NURSING COMPETENCE EXPECTATIONS HELD
BY NURSING EDUCATORS, HOSPITAL PRECEPTORS,
AND THE NURSE NEOPHYTES THEMSELVES
by
Dorothea Joan Jessop
Master of Science in Health Science
This project focused on the Associate of Arts
degree graduate nurse, whose initial performance in the
hospital has in many cases been found to be a disappointment.
The project represents an attempt to determine, by
means of a survey, the difference in performance expectations between new graduates themselves, directors of
schools of nursing, and hospital preceptors in selected
Southern California counties.
The survey results revealed many discrepancies in
the three groups' goals and expectations.
The question-
naire responses indicated that the A.A. degree neophyte
vii
nurse was expected to function in a leadership role even
though an American Nurses Association position paper
(1965) stated clearly that to assume such a role was not
within the technical nurse's scope of functions.
Further-
more, nursing educators were shown to be in conflict with
nursing service over what is to be taught in order for
neophytes to be able to function effectively in the
reality of nursing practice.
The findings of the study point up an imperative
need for nursing educators and nursing service to maintain
a continual dialogue concerning (a) their expectations
of A.D. degree neophyte nurses,
(b) the A.A. degree
nurses' educational preparation, and (c) the needs of
nursing service.
viii
Chapter 1
INTRODUCTION
Los Angeles County suffers from a severe and
chronic shortage of registered nurses (RNs) .
California
hospitals report multi-million dollar expenditures for
the recruitment of nurses and are distressed over the
rapid turnover of personnel.
Of the 29,184 budgeted
full-time nursing staff positions in the hospitals, 4,204
(14 per cent) have remained unfilled (Mahan and White),
1978).
Temporary staffing agencies are playing an in-
creasing role in supplying personnel.
The average fee
they charge hospitals for an RN per shift exceeds the
average wage the hospitals pay the RN, which in 1978,
was reported in Los Angeles hospitals to be $56.18 plus
$15.55 in benefits.
The average registry fee was $90.89
(nearly 27 per cent higher).
This high cost to hospitals
has reduced their ability to recruit and employ permanent
nursing personnel.
During 1977, hospitals in California spent
$2,184,014 on newspaper advertising to recruit nursing
personnel.
The aggregate costs for turnover and
1
2
recruitment of personnel in California hospitals were
approximately $182,000,000 (Mahan and White, 1978).
The
average recruitment cost per nurse was projected to soon
reach $7,548.
As many as 40 per cent of the hospitals
currently find it necessary to recruit nurses from out
of state.
The numerically inadequate supply of nurses,
however, is not the only problem vexing the hospitals.
Many of the hospitals find that the graduate nurses they
employ are not sufficiently prepared to meet job requirements.
The nursing schools, in turn, protest that their
function is to turn out beginning practitioners, not
accomplished practitioners.
A case in point was the
dispute between the Moore Memorial Hospital
(~I)
in
Pinehurst, North Carolina, and the local community
college which had trained the majority of the nurse's
who were hired by MMH and were found wanting by the
hospital's administrative, medical, and nursing staffs.
The Fayetteville Area Health Education Center was asked
by the employing agency and the educational institution
to help resolve the dispute.
The problem was studied.
As a result of this study, a clinical preceptorship
(a period during which the neophyte nurse works under
constant supervision and guidance of hospital preceptors,
or instructors) was added on to
~he
hospital orientation
3
programs.
Though it was felt that the preceptorship was
a successsful program, it has not solved the basic issues
involved in the discrepancy between the manifested skills
of the current graduates from nursing schools and the
expectations of employing agencies.
The preceptorship
program was only a short-term answer (McGrath and Koewing,
1978).
The Research Problem
This project focused on Associate of Arts (AA)
degree graduate nurses, whose initial performance in the
hospital has in many cases been found to be a disappointment, not only to nursing administrators but also to the
beginning practitioners themselves.
selected for research was:
The question
Why do new AA graduate nurses
encounter great difficulties in "bridging the gap"
between their school experience and their initial work
experience in the actual hospital setting."
This question
was approached by eliciting from the study subjects (categorized into three groups) the following information:
1.
schools:
From the directors of two-year nursing
their expectations concerning the new graduates'
levels of preparation for RN functions.
2.
From the new AA graduates:
their own expec-
tations concerning their competence as neophyte RNs.
4
3.
From the hospital preceptors:
their evalua-
tions of the new graduate nurses' performance.
Purpose of the Project
The primary objective was to contribute data to
the area of research concerned with helping nursing
educators and nursing service administrators in the
development of mutually compatible goals and expectations
relative to the job performance of AA graduate nurses.
Too often hospital nursing departments employing AA
graduates have reason to wonder whether patient needs
are being considered sufficiently and realistically by
those planning and implementing the educational programs.
Many hospital nursing services have become so disillusioned that they hardly expect anymore to find nurses
fully prepared for their job resporisibilities.
This
problem is doubly compounded by the increasing numbers
of graduates from AA programs and the demise of the
Diploma nursing program.
Delimitation of Scope
Geographically, the scope of the survey reported
was limited to three counties in Southern California-Los Angeles, Orange, and Riverside.
One respondent cate-
gory comprised directors of two-year nursing schools in
5
all three counties; the other two categories, new AA
graduates and their hospital preceptors in Los Angeles
County.
The survey was further limited to AA graduates
of two-year nursing programs in California who upon
graduation obtained their RN license and subsequently
employment in one of the hospitals in Los Angeles County.
Graduates who did not pass the state licensing examination were eliminated from the study, since failure to
pass the state licensing examination results in termination of hospital employment.
Quantitatively, the project was limited to the
number of the respondents in, as well as to
the number
of the responses obtained from, each of the three respondent categories participating in the survey.
Significance of the Project
In her sixteen years of administrative nursing
experience, in Utah as well as California, the researcher
has had occasion many times over to observe neophyte
graduate nurses perform in a hospital setting.
New
graduates, generally having limited technical skills and
little or no clinical experience, tend to be uncomfortable in passing medications and to make frequent medication errors.
(One such error, to the researcher's
6
personal knowledge, resulted in the death of a patient.)
Nor are many of the neophyte nurses able to perform
satisfactorily such basic nursing procedures as inserting
Foley catheters and nasogastric tubes, suctioning
patients, and starting and maintaining intravenous
therapy.
In addition to having only limited clinical
skills and experience, the majority of new graduates,
when thrust into positions of supervising a group of subordinate staff members, reveal themselves as totally
unprepared in this area, for communication and leadership
skills are not a part of the basic nursing curriculum.
Though many nurses are hired to function as team leaders,
in which capacity they are required to assume responsibility for a group of patients and a group of subordinate
staff members, many of these nurses have had no more than
one day of experience as team leader during nurses training.
The initial work experience for many neophyte
nurses can thus be almost traumatic.
It has aptly been
referred to as "reality shock" {Kramer, 1974).
In 1965, the American Nurses Association {ANA)
Cornn1ittee on Education presented its first position paper
on education in nursing.
criteria were set forth:
In this paper, the following
7
1. Education for those who work in
nursing shotild take place in institutions
of learning within the general system of
education.
2. Minimum preparation for beginning
professional nursing practice at the
present time should be a baccalaureate
degree education in nursing.
3. Minimum preparation for beginning
technical nursing practice at the present
time should be associate degree education
in nursing.
4. Education for assistants in the
health service occupations should be short,
intensive preservice programs in vocational
education institutions rather than on-thejob training programs.
(pp. 107, 108)
As a result of this position paper, the entire
practice of nursing has changed.
In 1952, there were
two AA degree programs with 25 students (Montag, 1972).
In 1976, the number of programs increased to 642
(Frederickson, 1977), while Diploma programs showed a
proportionate decrease.
It should be noted that of the
sixty AA programs in California, 70 per cent are not
accredited by the ANA.
The Association has clearly
defined technical nurse and professional nurse, but in
reality all nurses, regardless of educational preparation,
are assuming the same responsibilities.
Because of the lack of preparation by the AA
schools, many employing hospitals realize they need to
organize basic nursing programs for new graduates.
Most
8
existing orientation programs were designed for RNs
assumed to have acquired basic nursing knowledge and
skills in the schools.
to be borne out.
This assumption does not appear
Much time and money are being invested
by the hospitals in developing orientation programs
tailored to get the new graduates to the minimum level
at which they can function.
Graduates have come to
expect this type of inservice training and, when seeking
employment, go from hospital to hospital searching for
the best available program.
In view of the nursing
shortage, the hospitals have no alternative but to be
aware of this competitiveness.
The programs are becoming
longer and more costly each year.
The above personal observations are abundantly
substantiated in the literature researched, which reflects
a consensus among health care professionals that the
reasons for the precarious situation described need to
be explored and that the situation must be remedied.
Another factor lending impetus to the project was the
researcher's active involvement in the California Hospital
Association (CHA) sponsored survey, from whose summary
(Mahan and White, 1978) statistical data were quoted
earlier.
The CHA and the Directors of Nursing Council,
Los Angeles Areas (of which the researcher is a member)
highlighted the magnitude of the problem:
the schools
9
of nursing are not producing nurses in adequate numbers,
and there is need to evaluate the high failure rate of
new graduate nurses attempting to take the state board
licensing examinations (see tabulation on following page}
and to find out why the new graduates are not adequately
prepared to function as RNs in the actual hospital
setting.
The findings of the project may be of value to
both two-year nursing schools and hospital nursing
services in their efforts to develop mutually compatible
goals and expectations, that is, in their efforts to
develop closer articulation.
New graduates need to have
a better understanding of their roles in the actual work
setting.
Improvements in school curriculums should
result l.n an increased output of graduates adequately
prepared to pass the state licensing examinations.
A
lower failure rate and more compatible expectation levels
on the part of the schools, the graduates, and the
hospital nursing departments would raise the graduate
nurses' degree of competence and self-confidence.
All
involved would benefit, but most important would be the
ultimate benefit to the patient.
10
Table 1
CALIFORNIA LICENSING EXAMINATION DATA
1973-1977
No. Took Exam in Calif
Year
No. Passed
Month
4069
1735
5804
July
Feb
4241
1189
5430
July
Feb
1211
4230
877
6318
Dec
July
784
3612
1267
5663
Nov
July
Feb
692
3242
689
4623
Oct
July
Feb
1977
6556
3846
1042
1976
6327
2675
9002
1975
3150
4653
2340
10143
1974
2201
3974
2329
8504
1973
2005
3536
1740
7281
RNs currently licensed in California
Licensed and living in Los Angeles County
Licensed in California
Licensed and living in State of California
43,364
182,976
148,009
Source: Board of Registered Nursing, Sacramento,
California 95814.
Chapter 2
REVIEW OF THE LITERATURE
Much information is available on nursing training
generally, and more specifically on the prevailing inadequacy of the two-year nursing program since its inception
in 1952; the discrepancy between the goals and expectations
of nursing administrators and the goals and expectations
of nursing educators; the difference in roles of the three
levels (AA, BS. and Diploma) of nursing graduates; the
inadequate competence level of AA graduates when starting
their career in an actual hospital setting; and the need
for hospital inservice training for nurse neophytes.
It seems appropriate, at this point, to provide
a definition of technical nursing and technical nurse:
Technical nursing is defined as the direct
nursing care of patients with evident health
problems and common recurring nursing problems
in areas of physical comfort and safety,
physiological malfunction, psychological and
social problems and rehabilitation problems.
A technical nurse is an RN with an associate
degree who is licensed for the practice of
nursing and who carries out nursing and other
therapeutic measures with a high degree of
skill, using principles from an ever-expanding
body of science.
It is always done under the
leadership of a professional nurse.
(Metheney,
1974, p. 25)"
11
12
The objective of AA programs, in 1952, was to prepare
the student for the functions of a technical nurse.
This
goal is still the same today.
Discrepancy between Nursing Administrators'
and Nursing Educators' Goals
and Expectations
Although the definition of technical nursing is
specific, numerous studies have shown that Directors of
Nursing make no distinction among neophyte nurses graduating from the three levels of nursing programs.
In 1969,
the American Journal of Nursing reported the results of
a survey of 110 Directors of Nursing.
The objective of
this survey had been to determine whether Directors of
Nursing in their orientation programs, in supervision,
and in their nursing assignments differentiate between
'AA, BS, and Diploma graduates.
Approximately half of
the respondents indicated that they make no distinction.
The other half stated that {1) AA nurses need more prolonged orientation and supervision and more limited work
assignments;
{2) AA nurses cannot accept charge respon-
sibility as soon as other nurses; and {3) they paid AA
graduates a lower salary.
As one director put it:
As a nursing administrator, I think it is
unfortunate that our expectations {my own, too)
of the graduates of the three programs are, in
the real wo.rld of hospitals, the same. At the
same time, however, I have to meet patient care
requirements and have to purchase the services
13
of those available, and use them when they
are available, regardless of their preparation.
(p. 1011)
In another, similar survey, this statement may be
found:
"Data exist which show what appears to be a
general lack of communication between persons preparing
the AA degree nurse and persons using her services"
(Miller, 1974, p. 468).
Of the 94 graduates surveyed by
Miller, 68 had staff positions, 17 began as head nurse
or supervisor, and 9 did private duty and office nursing
when first employed.
Kohnke (1973) determined, by reviewing the
literature and interviewing 15 deans of AA programs and
15 deans of BS programs, that actual curriculum practice
is not in line with that described in the literature.
She suggested that the major reality roadblock lies in
the practice realm.
After education, the graduate can
find only a few places where she can practice as professional or technical nurse.
Channing (1972) found that "no distinction was
being made between the responsibilities and job functions
of nursing practitioners" (p. 52).
Surveying 18 Directors of Nursing, Cicatiello
(1974) concluded that what the schools teach and what the
faculties perceive about technical programs differs from
what the literature on nursing education states.
He feels
14
that a consensus should be reached among educators about
the philosophy of technical education.
According to Cantor (1974), it is not clear
to many of those who employ graduates from AA degree
programs what the mission of such programs is in the minds
of those who plan and implement the programs, and many
wonder to what extent the needs of the patient are considered in the planning.
Cantor emphasizes that the goals
and requirements of each nursing program must be carefully
identified.
Nursing educators are in a position to influ-
ence the quality of nursing care given patients by students
after graduation, yet they, the educators, are rarely, if
ever, called upon to assume responsibility for the quality
of patient care given by these graduates as neophyte
nurses.
Many educators evaluate student achievement in
relation to objectives of their own rather than in relation
to the service requirements iri actual employment settings
and situations.
Nurses' performance failures are fre-
quently attributed to failure on the part of the nursing
supervisor to make use of the skills with which the
graduate is equipped.
Educators have the opportunity to
develop highly relevant programs if they are willing to
be guided by existing service needs and are realistic in
their assessment and use of the capabilities of their
particular educational system.·
Associate degreeprograms
15
can perhaps best serve society by providing practitioners
who are able to move quickly into the practice setting.
Allen (1974) similarly identifies the problem.
The proper use of AA degree graduates by nursing service,
Allen says, continues to be a major concern of nurse
educators and nursing service directors.
Too often these
graduates are put in management and leadership positions.
She feels that nursing personnel need to be assigned
according to responsibilities inherent in meeting the
needs of patients, and not according to the educational
labels attached to the nursing practitioners.
McClure (1976) found that AA degree nurses were
being utilized in the same kinds of roles as professional
nurses (BS)--as supervisor, head nurse, and faculty member.
When asked specific questions regarding the kind of nursing care given patients, BS and AA degree
grad~ates
interviewed held similar expectations regarding their
respective roles; they perceived no differences in the
ways they believed they should be functioning.
Compounding this situation are the facts
that graduates of technical programs are
eligible for the same licensure as the professional and, equally as important, demand the
same wages. Thus, patients' needs, academic
curriculums, licensure laws, and salary scales
all militate against development of a distinctive technical practice.
(Fagin, McClure, and
·Schlotfeldt, 1976, pi 102)
16
Johnson (1966) holds that if both professional
and technical nurses are required for direct service to
patients, clear distinctions as to their respective competence must be made as rapidly as possible, so that each
group may be recruited, educated, and utilized efficiently,
and economically.
Nursing educators have not provided
nursing service administrators with precise information
as to the potential competence of their graduates.
fore, expectations of all graduates are the same.
ThereCom-
petency in the technical nurse is expected, wanted,
utilized, and rewarded in nursing service.
Improvements
are needed in educational preparation and some changes in
nursing service organization would facilitate an even
fuller utilization of competencies.
The study most closely related to the present
project is a Master's thesis by Campagna (1977), who in
her study attempted to identify the performance skill
expectations held by AA nurse neophytes and to determine
whether or not these expectations were generally consistent with the expectations held by nursing service and
nursing educators.
Campagna restricted her study to 138
students enrolled in a two-year program in one and the
same school.
She utilized the same questionnaire that
was used in the present project.
Campagna's study differs,
however, from the present one in that in Campagna's study
the results obtained are compared to those of a national
17
survey, while in the present project the results obtained
from the three respondent categories (directors of twoyear nursing schools, new AA graduates, and hospital preceptors) are compared to one another.
The national survey with the results of which
Campagna compared her own study results was conducted in
1972 (unpublished).
The Children's Hospital at Los
Angeles in 1971 developed the questionnaire for this survey, and later participated in it (information on the
national survey, development of questionnaire, and the
Children's Hospital's participation in the national survey
was obtained in interviews with Beatty, 1979).
The pur-
pose of the national survey, as its title, "Mutual Expectations for the Neophyte Staff Nurse--A Cooperative Effort
of Nursing Education and Service, .. indicates was to determine mutual expectations for neophytes, on a national
and regional basis.
Letters of introduction were mailed
to all 1970 National League for Nurses accredited schools
of nursing in the United States, approximately 1,300, and
to approximately 2,000 hospitals (including Veterans Administration) in the United States that are American Hospital accredited.
Personnel from 645 schools of nursing
and 826 hospitals agreed to complete neophyte expectation
questionnaires.
Questionnaires from 571 hospitals and 420 schools
were returned in time to be included in the analysis.
A
18
total number of 3,965 responses were returned.
Unfortu-
nately, 543 respondents were eliminated from the analysis
because they erroneously classified themselves as school
personnel when in fact they were hospital staff.
The
institutions involved were associated with diploma programs.
Therefore, the total number of respondents
included in the analysis was 3,422, comprised of 1,023
school respondents and 2,399 hospital respondents.
The results show that the expectations instructors
and service personnel stated they had for neophyte staff
nurses were very similar.
Although slight differences
emerged, the similarity held true both nationally and
regionally.
When compared in detail, however, it was
noted that the instructor respondents had higher expectations of neophytes than service personnel.
Another noteworthy finding was that there seems
to be some disparity in what people believe and what is
actually expected of neophytes, especially of associate
degree neophytes.
Although these neophytes were educated
to be "technical" nurses, most respondents stated they
did not expect many technical skills of them.
Yet,
respondents with associate degree backgrounds expected
more of associate degree neophytes than did other respondents.
Diploma neophytes were more often expected to
perform technical skills, .while baccalaureate degree
19
neophytes were more often expected to perform skills
involving knowledge and judgment.
It was concluded from the survey findings that
in view of the closeness of the expectations of nursing
education and service, it is clear that other factors
besides expectations are responsible for the dissatisfaction of neophytes and some of the staff who work with
them.
Staff utilization influences the functions neo-
phytes are expected to perform, while the neophytes'
perceptions of their roles in turn influence their performance.
Brandt, Hastie, and Schumann (1967) conducted a
three-phase investigation into the relationships between
achievement of nursing students during their enrollment
in the school, their success on the state board licensing
examination, and their job performance following graduation.
The graduates considered themselves as capable
as, or more capable than, graduates from other programs
and were viewed as such by their supervisors.
In the
area of decision making, however, they saw themselves
as much more capable than their supervisors saw them.
Montag (1972} evaluated AA degree nurses' ability
to pass the licensing examination and to perform satisfactorily in the clinical setting.
The conclusions
reached by Montag may be summed up as follows:
(1) AA
20
degree nurses are able to carry out the functions ordinarily associated with the registered nurse; and (2) the
programs continue to attract students.
According to
Montag, each type of nursing program needs to be based
on a clear statement of objectives, and a differentiation
needs to be made between the professional and technical
practitioner.
She further suggested the advisability of
having separate licensing examinations for the two types
of practitioner.
Nelson (1978) discussed a survey she had undertaken concerning AA, BS and Diploma degree nursing program
graduates; perceptions of their respective technical,
communicative, and administrative skill levels, and also
their supervisors' perceptions.
Differences were found
among the graduates' perceptions as well as among the
supervisors' perceptions of the graduates; competency in
the various required nursing skills.
Nelson cited several studies the results of which
point up the need for better professional nursing training.
Among the cited sources are Voight (1972) :
"Students and
graduates of 'associate degree nursing programs in selected
community colleges in Michigan were found to have serious
deficiencies in accordance with their preparation" (Nelson,
p. 122); Ables (1969):
"Eighty-three per cent of the
graduates of four associate degree nursing programs in
21
Texas performed equally as well as, or somewhat better
than, graduates of diploma and baccalaureate programs.
Insufficient practical, on-the-job experience during
basic programs wap the reason. given for most areas in
which the Associate degree graduate felt unprepared to
perform her duties" iibid.); and Wescoe (1972): " • . . the
gaps between service expectations and education goals .
[are] considerable, so great, in fact, that . . . the
differences [are] insoluble unless significant changes
!occur] in both the nursing service and the education
groups"
(ibid.).
One of the major problems identified by Nelson
was the lack of agreement among nurses on the differentiation between the levels of nursing practice of the
graduates from the three types of educational program
(AA, BS, and Diploma).
This lack of differentiation in
turn has led to confusion in both education programs and
employing agencies.
Nelson concluded that since nursing graduates
and supervisors perceived differences in the degree of
the graduates' competency, schools of nursing and agencies
that employ beginning practitioners should cooperate in
developing realistic mutually compatible expectations of
the various levels of graduates' competencies; and, since
the public and the nursing profession expect nursing
graduates to be skilled practitioners, the nursing schools
22
should continue to strive to raise the students' preparation level, and agencies that employ beginning practitioners should assume the responsibility for extending
the educational process.
Kaiser (1975) did a comparison study of students
in practical nursing programs and associate degree nursing
programs (1) to determine the differences and similarities
in selected characteristics of beginning students in the
two programs,
(2) to provide selected information on the
students, and (3) to consider the implications of the
findings for nursing educators and the feasibility of
future study.
The study results show that there were
many more similarities than differences in the characteristics selected for comparison.
Meleis and Farrell (1974) did a study to deter-,
mine whether graduates of different programs (AA, BS, and
Diploma) provide a different quality of nursing care.
The study sample comprised 188 students from six schools.
These students were tested for intellectual characteristics, leadership, research orientation, and sociopsychological factors.
Students of all programs rated alike on
intellectual characteristics and on the consideration
aspects of leadership and self-esteem.
The BS graduates
ratedhigher in the area of communication than the AA and
Diploma graduates, and also higher on the structure ·and
autonomy factors of leadership.
Diploma graduates
23
placed the highest value, and the BS graduates the lowest,
on research.
Gray et al.
(1977) sought to determine whether
graduates of the technical and professional programs at
the University of Vermont School of Nursing performed
differently in specific nursing care situations.
A random
sample was taken for two consecutive years of seniors
graduating from the two types of program.
The faculty
developed a tool consisting of open-ended, short essay
questions based on clinical situations.
Each question
was coded as Being Expected of All Nurses, Being Expected
of only Technically Prepared Nurses, or Being Expected
of Only Professionally Prepared Nurses.
Differences
emerged in the areas of technical skills, teaching,
leadership, giving support to the patient and family,
interviewing for assessment purposes, actions ·in structural situations, and actions following observations.
The technical nurses showed concern for meeting patients'
immediate health needs and anticipated ways to avoid or
handle expected immediate or later problems related to
the primary problem.
Although the professional nurses
expressed the same concerns, they stated, in addition,
that they would initiate nonprescribed nursing actions,
would ask questions to ascertain from the patient possible
24
causes for presenting problems, and would anticipate longterm needs of the patient and/or family.
These needs were
not necessarily related directly to the primary problem
and their identification reflected the nurse's breadth of
knowledge.
Moreover, the professional group's responses
reflected leadership concerns as opposed to the management
concerns reflected in the technical group's responses.
The findings of this study substantiate theoretical
descriptions of the differences between technically and
professionally prepared nurses and suggest implications
for the preparation and utilization of these two types of
practitioner and for the evaluation of their practice.
Inservice Training for Nurse Neophytes
Burrell (1977) describes how St. Raphael Hospital
in New Haven, Connecticut attempted to
determi~e
the best
way to help new graduates assume the responsibilities of
staff nurses.
A pilot internship program was developed
toward this end.
Performance requirements were based on
the staff nurse job description and divided into three
levels:
technical, perceptual and interviewing skills;
leadership, patient and family teaching; and crisis intervention.
All study subjects lacked experience in cathe-
terization, colostomy care, ·administration of enemas,
25
IV therapy, nasogastric suctioning, hypothermia, cardiac
monitoring, and the use of special equipment such as
Hemovacs and chest tubes.
By the end of eight weeks,
seven of the ten interns were satisfactorily performing
the most common technical skills.
Conferences were re-
quired to help the subjects learn about specific illnesses
and master the steps of the nursing process, and interviewing techniques.
Six interns required five weeks
before they could pass medications satisfactorily.
Six months was required for orientation.
Four
of the ten subjects were not hired because they were not
adequately prepared for leadership responsibilities.
According to Kase (1976}, an estimated amount of
$226 million was spent for inservice and orientation of
RNs in 1973-1974 employed by the 5,865 acute care community hospitals in the United States.
Summary
Overall, the literature reviewed in the preceding
pages supports the premise that nurses graduating from AA
programs are not prepared to assume their responsibilities
in the hospital setting and that hospitals are spending
phenomenal amounts of money to bring neophyte nurses to
a level where they can function.
26
The literature, futhermore, recognizes that a
minimal amount of dialogue is occurring between nursing
service and nursing educators and that expectations of
new graduates vary greatly.
It is also recognized that,
due to the prevailing shortage of nurses, nursing service
is utilizing all RNs, regardless of training, in the same
capacity.
Chapter 3
METHODOLOGY
This chapter deals with the methodological aspects
of the project.
headings:
These are set forth under the following
(1) Design of the Study;
(2) Subject;
(3) Instrument Used; and (4) Treatment of Data Obtained.
Design of the Study
An exploratory survey design was utilized to
examine the research problem, which focused on the question why AA graduate nurses encounter great difficulties
in "bridging the gap" between their school experience and
their. initial work experience in the actual hospital setting.
The approach to the problem entailed the eliciting
of information from the study subjects concerning their
expectations and evaluation of the neophyte nurses' levels
of preparation for their functions.
Subjects
The study subjects fell into three categories:
1.
Directors of the twenty-two two-year schools
of nursing in Los Angeles County, Orange County, and
Riverside County (N
=
13) .
27
28
2.
Newly graduated (AA) RNs hired in hospitals
in Los Angeles County between June l, 1978 and
September 30, 1978 (N = 95).
3.
Preceptors in hospitals in Los Angeles County
that employed newly graduated RNs between June l, 1978
and September 30, 1978 (N
=
95).
The total number of participants in the project,
as can be seen, was 203.
Instrument Used
It seemed that the instrument most suitable for
the present project would be a questionnaire.
Since a
national survey entitled "Mutual Expectations for the
Neophyte Staff Nurse--A Cooperative Effort of Nursing
Education and Service," conducted in 1972 (see Review of
Literature, pp. 18-20) focused on questions
rela~ed
to
the question under study in the present project, the
questionnaire used in that survey was examined.
It was
found to meet the purposes of the present project, and
therefore was used.
Development of Questionnaire
The questionnaire was developed at Children's
Hospital at Los Angeles as part of a project funded by a
National Institute of Health Special Project Grant,
Number 5 DlONU 00587-02 (Beatty, 1979).
Selected nursing
29
educators from the Los Angeles college system and selected
nursing service personnel of Children's Hospital were
called together to form a panel for the purpose of working
out a questionnaire which was to determine in what way
nursing educators' and nursing service personnel's expectations of neophyte staff nurses' competency differed.
For validation, the drafted questionnaire was distributed
among senior student nurses in their last quarter, and
interviews were held with head nurses.
The questionnaire,
refined according to the findings, until the judge panel
reached full agreement, was then used in the abovementioned national survey, in which the Children's
Hospital at Los Angeles participated.
Construction
The instrument contains 102 items, the first 66
comprising a list of motor skills pertaining to nursing
procedures, and the remaining 36 items being situational
questions involving theory application.
The questionnaires distributed to the three categories of study subjects are not identical, yet similar
(see copies in Appendices A, B, C).
They differ in the
following manner:
1.
The school director respondents were asked
about their expectations concerning the new graduate's
competency level in performing the
l~isted
skills· and in
30
handling the listed expectations, the expectations to
be in conformance with the curriculum content and school
objectives.
2.
The AA graduate respondents were asked to
self-assess their preparation level in the areas of the
listed skills and listed situations at the time they
entered their first hospital employment.
3.
The hospital preceptors were asked to eval-
uate the AA graduate neophyte RNs' competency in the
listed skills as evidenced during the first six weeks
of employment or during the inservice orientation
period.
The hospital preceptor questionnaire does not
include the situational questions, for prior to the
time the hospital preceptors had filled in the questionnaire, they had had little opportunity to observe the
new graduates in the listed types of situations.
Further differences may be noted in the response
format:
School director and new-graduate questionnaires
(see Appendixes A and B);
Two response options:
"Yes" and "No."
Next to
each item under the "yes," a "1"; under the "No," a "2."
Respondents were asked to indicate their response by
placing a circle around the "1" or the "2," depending
on whether their answer was "Yes" or "No."
31
To the new-graduate questionnaire, a respondent
information sheet was added, eliciting information concerning (1) type of nursing program attended,
state, and country of graduation,
(2) year,
(3) additional work
experience in nursing prior to receiving the RN degree,
i.e., as nursing assistant, licensed vocational nurse,
or technician;
(5)
(4) dates of previous employment; and
setting of previous employment, i.e., acute hospital,
extended care facility, specialty.
Hospital-preceptor questionnaires (see Appendix C):
Three main response columns;
independently;
(n/a) .
(1) Can function
(2) demonstration, and (3) Non-applicable
Two subcolumns in Column 2:
Satisfactory and
further training.
Each question was accompanied by a covering
letter, differing somewhat according to the category of
respondent.
Covering letter accompanying school-director and
new-graduate questionnaires (see Appendices A and B) :
Purpose of the project; explanation of questionnaire; description of completion procedure.
Covering letter accompanying hospital-preceptor
questionnaire (see Appendix C):
Instruction sheet, including definition of "new
graduate" as used within the context of the investigation,
32
and explanation of the administrative procedures.
(There
was no need to set forth the purpose of the project,
since all the directors of nursing of the participating
hospitals were actively involved in the investigation.)
Distribution and Returns
Distribution procedures also differed according
to respondent category.
A copy of the school-director questionnaire,
with covering letter, was mailed to each of the twentytwo two-year schools of nursing in Los Angeles, Orange,
and Riverside Counties.
The directors were asked to
return the completed questionnaires to the program chairman of the Directors of Nursing Council, Los Angeles Area,
by May 15, 1978.
One copy of the new-graduate questionnqire and
one copy of the hospital-preceptor
questionna~re,
with
respective covering letter, were given to each member of
the Directors of Nursing Council, Los Angeles Area.
The
directors were asked to xerox one copy of the new-graduate
questionnaire and one copy of the hospital-preceptor
questionnaire for each new graduate RN hired between
June 1, 1978 and September 30, 1978, then to handdistribute these questionnaires to the new graduates and
their preceptors (that is, to either the head nurse or
33
inservice instructor), and upon completion to return
the questionnaires by mail to the researcher.
Of the twenty-two questionnaires sent to the
twenty-two two-year schools of nursing in Los Angeles,
Orange, and Riverside Counties, thirteen were returned.
Of an indeterminate number of new-graduate and
hospital-preceptor questionnaires sent out, 190 were
returned.
The total number of returned questionnaires
was thus 203.
Treatment of Data Obtained
The questionnaire responses obtained from the
three categories of respondents are presented side by
side for a comparative overview (see Table 2, p. 3£ ff.).
Tabulation was by frequency of "No" answers.
Arrangement
and abbreviations used are explained below:
The first column lists the questionnaire items.
Columns 2-5 refer to the new-graduate responses; column 6
refers to the school educator responses; and columns 7-10,
to the nursing service (preceptor) responses.
The new-graduate responses were broken down as
follows:
Column 2 NA Exp (previous experience as nursing
assistant)
Column 3 LVN Exp (previous experience as
licensed vocational nurse)
Column 4 No Exp
{no previous experience in
the field of nu~sing)
34
Column 5 Total
(the total of columns 2, 3,
and 4)
Responses of school educators were given one
column only:
Column 6 School (directors of participating
two-year nursing schools)
The comments of the hospital preceptors were
broken down as follows:
Column 7 Sat Ind (satisfactory functioning
independently)
Column 8 F.T.
(further training required)
Column 9 N.A.
(not applicable, i.e., skills
not performed in unit where
respondent was working)
Column 10 No Ans (no answer given)
These data were then analyzed, tabulated and
interpreted.
Chapter 4
FINDINGS
As Table 2 (p.
3~
ff.) shows, 64 of the 95 new AA
graduate RNs who returned a questionnaire stated they had
had previous experience as nursing assistant; 13, they
had had previous experience as licensed vocational nurse;
and 18, they had had no experience in nursing prior to
attending nursing school.
As was stated earlier (Chapter 3, Methodology),
the skill areas to which "No" answers were recorded by
25 percent or more of the respondents (i.e., by 23 or
more new graduate respondents and 3 or more school
directors of nursing) may be taken to be problem areas.
The preceptor responses may not be as valid as
basis for conclusions as would be desirable, for as can
be seen from the table, numerous questions were left unanswered.
The data were included, however, for purposes
of comparison.
35
36
Skills Listed (refer to Table 2)
Safety, Comfort, and Personal Hygiene
All groups of subjects, i.e., new AA graduates,
nursing school directors, and nursing service preceptors
were consistent in their responses to the questions pertaining to Safety, Comfort, and Personal Hygiene.
No
skill in these areas was considered to cause problems.
It is interesting to note, however, that five preceptors
stated they felt that the new graduates under their preceptorship still needed further training in such basic
areas as giving or assisting with a bath, and eight
preceptors indicated that further training was needed in
providing range of motion exercises to the patient.
Foods and Fluids
Sixty-four of the new graduates (67.3 percent)
stated they were not able to start intravenous infusions.
This response was consistent with the school directors'
responses, 12 of the 13 directors indicating that this
skill was not expected of the new graduates and that 26
(27.2 percent) needed further training.
This finding
reveals a large discrepancy between the students' and
their preceptors' perceptions of the students' competence
level, 49 (51 percent) of the preceptors statipg that
Table 2
"NO" RESPONSES BY AA GRADUATE NURSES AND NURSING SCHOOL DIRECTORS CONCERNING
EXPECTATIONS OF NEOPHYTE NURSES' COMPETENCE IN THE LISTED NURSING SKILLS,
AND NURSING SERVICE PRECEPTORS' EVALUATION
Questions
New Graduates
LVN Exp No Exp
(13)
(18)
- - - - - · -
NA Exp
( 6 4)
Total
( 9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
Safety, Comfort
& Pers. Hygiene
1. Use of safety
measures
0
0
2
2
0
94
2. Observe & enforce safety &
fire reg.
1
0
1
2
1
90
3
1
3. Use aseptic
technique
2
0
1
3
0
92
2
1
4 . Isolation
technique
0
0
0
0
0
94
1
5. Give or assist
with bath
0
0
0
0
0
88
5
2
6. Assist with
pers. hygiene
0
0
0
0
0
92
2
1
7. Give skin care
0
0
0
0
0
88
2
4
1
1
1
w
-....]
Table 2 (Continued)
Questions
NA Exp
( 64)
8. Position in
correct body
alignment
New Graduates
LVN Exp No Exp
(18)
(13)
Total
(9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
0
0
0
0
0
91
2
1
9. Use supportive
& comfort
0
devices
0
1
1
0
78
4
1
1
10. Range of
, ·motion
1
0
0
1
0
71
8
4
11
11. Assist to
become ambulatory
0
0
0
0
0
85
4
2
4
7
8
5
1
1
0
1
1
0
0
4
2
1
0
1
11
11
7
1
1
0
0
0
0
0
28
25
30
79
81
3
3
3
4
4
59
61
54
12
8
5
6
8
2
1
5
0
4
9
1
52
18
13
12
45
11
8
64
12
49
26
15
5
3
3
2
8
0
70
15
0
0
Foods and Fluids
l.a.
b.
c.
d.
e.
Infant
Toddler
Child
Adult
Geriatric
2.Tube feedings
3.Start IV's
4.Hang, regulate
& discont.
'XV'S
.
w
00
Table 2 (Continued)
Questions
NA Exp
{64)
5. Observe, measure, & record
·intake & out0
put
New Graduates
LVN Exp No Exp
(18)
(13)
Total
(9 5)
Nursing Service Preceptors'
Evaluation
School
Directors Sat Ind F.T. N.A. No Ans
(13)
0
0
0
0
93
2
0
0
0
0
0
0
0
92
0
2
1
2. Prepare & give
0
enemas etc.
0
1
1
0
78
10
2
5
3. Remove fecal
impactions
13
0
7
20
3
41
17
17
20
3
1
5
9
2
63
14
6
12
20
6
15
41
2
38
29
9
18
2. Maintain drainage tubing with
suction
a. Chest tubes 21
0
12
32
2
28
21
18
24
Elimination
1. Assist with
elimination
4. Insert uri-
nary cath.
Treatments &
Procedures
1. Insert nasogastric
tubes
w
1.0
•)
Table 2 (Continued)
·Questions
NA Exp
(64)
New Graduates
LVN Exp No Exp
(18)
(13)
Total
(95)
Nursing Service Preceptors'
Evaluation
School
Directors Sat Ind F.T. N.A. No Ans
(13)
2
0
6
8
1
61
13
7
14
18
1
13
32
2
29
24
18
24
3. Irrigate and
instill solut:i.ons into
20
tubings
1
10
31
1
38
22
12
23
4. Irrigate and
instill solutions, openings
(e.g. douche,
wounds)
5
1
6
12
1
40
20
11
24
5. Assist to rum,
cough, & deep
breathe
0
0
0
0
0
88
2
2
3
physician with
procedures
30
6
13
49
3
53
30
3
9
7. Remove sutures
& skin clips 42
10
13
65
10
11
17.
57
11
8. Prepare for &
administer IT
48
procedures
11
17
66
6
8
21
63
4
b. N/G tubes
c. Gastrostomy
6. Set up & assist
9.
(Eliminated)
,:::,.
0
Table 2 (Continued)
Questions
NA Exp
(6 4)
New Graduates
LVN Exp No Exp
(13)
(18)
Total
(9 5)
Nursing Service Preceptors'
Evaluation
School
Directors Sat Ind F.T. N.A. No Ans
(13)
10. Care for
tracheosto my
8
0
7
15
1
44
18
10
23
21
3
9
33
3
30
28
14
23
11. Set up & operate o equip2
ment
7
4
7
18
1
75
14
1
5
12. Give mouth
to mouth
resusc.
4
1
2
7
0
56
11
10
9
a. Suction
b. Remove,
clean, &
replace
inner
cannula
13. Assemble ortho
equipment
a. Beds &
frames
b. Traction
14. Operate ortho
beds & frames
/
37
36
9
9
15
16
51
61
9
9
14
10
24
28
39
39
17
18
27
7
11
45
1
16
28
22
29
..,.
1--'
Table 2 (Continued)
Questions
NA Exp
( 64)
15. Maintain
patients in
traction
New Graduates
LVN Exp No Exp
(13)
.(18)
Total
(95)
Nursing Service Preceptors-,
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
8
1
2
11
0
38
12
24
21
3
0
2
5
0
44
8
16
27
14
17
11
23
2
0
0
3
7
10
7
9
23
27
18
35
2
0
1
1
32
42
27
17
15
10
16
23
18
20
25
26
30
23
27
28
1. Take TPR & BP
0
0
0
0
0
93
0
2
0
2. Determine CVP
31
5
11
47
3
27
23
37
9
3. Set up & operate EKG
equipment
47
8
15
70
10
18
26
42•
9
4. Recog. &
report EKG abnormalities
39
5
12
56
4
17
44
31
3
16. Apply
bandages
a. Ace
b .. Scultetous
c. Pressure
d. Slings
e. Splints
Diasnostic Activities
~
N
Table 2 (Continued)
Questions
NA Exp
( 6 4)
5. Apply & read
skin tests
6. Obtain
specimens
for culture
New Graduates
LVN Exp No Exp
(18) .
(13)
Total
(9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T.
N.A. No Ans
(13)
35
10
9
54
8
17
25
48
5
9
1
6
16
0
75
9
7
4
0
2
0
0
0
0
0
2
0
0
90
88
3
3
1
2
1
2
6
1
1
5
12
17
0
1
65
6
9
8
2
7
19
20
0
0
0
0
0
0
0
2
0
0
0
0
94
85
91
1
6
3
0
1
0
0
4
1
0
5
7
5
0
7
13
4
1
49
40
18
0
4
2
6
84
42
27
70
7
21
21
21
0
13
22
1
4
19
25
3
7. Test urine for:
a. Sugar
b. Acetone
c. Specific
Gravity
d. pH
10
60
Medications
1. Prepare & administer
medications
0
Oral
2
Rectal
IM
0
Subcutaneous
1
·e. Intradermal 37
f. Inhaled
·20
g. I. v.
9
a.
b.
c.
d.
"""
w
Table 2 (Continued)
Questions
NA Exp
(64)
·h.· Eye, nose, &
ear drops
0
i. Topical
1
New Graduates
LVN Exp No Exp
(18)
(13)
Total
(95)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
0
0
3
0
3
1
1
1
1. Have present &
operational at
the bedside a
suction machine
& trach care tray
upon Susan's return
4
,to her room
0
4
8
0
2. Recog. that she
is admitted to
her room after
2
surgery
0
0
2
0
3. Wait until Susan
is quiet before
rechecking her
pulse rate which
is 180 while
2
crying
0
0
2
0
76
8
81
4
4
6
6
5
Situation 1
Susan, age 2, has
just returned from
OR room with new
trach.
I
~
~
Table 2 (Continued)
Questions
NA Exp
( 6 4)
4. Notice secretion
bubbling in the
trach. upon
entering Susan's
room
4
New Graduates
LVN Exp No Exp
(13)
0
(18)
( 9 5)
6
2
5. Organize care
to ensure Susan
remains in an environment of increased oxygen &
hUmidity as much
as possible
3
0
6. Suction Susan's
trach. after noticing her to be.unusually restless,
even though no
gurgling sound
is heard
11
2
7. Notice Susan
staring at door
in her mother's
absence
4
1
Total
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
0
5
0
7
20
2
2
7
1
2
~
Ul
Table 2 (Continued)
Questions
NA Exp
(64)
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
8. Provide a con-
stant means by
which Susan can
initiate communication
7
0
0
7
1
9. Organize
Susan's activities so that a
familiar routine
similar to home
is established 3
0
1
4
1
Situation 2
Karl, age 15, is
hospitalized as a
newly diagnosed
diabetic
1. Introduce yourself
to Karl when he is
admitted, orient
him to other teen0
age patients
0
0
0
0
2. Recog. steps to
be taken upon
noting an acetone
.t>0)
Table 2 (Continued)
Questions
3.
4.
5.
6.
NA Exp
(64)
odor while assisting Karl with his
oral hygiene
5
Sit down &
listen with
interest when
Karl complains
bitterly that he
can't eat anything
that he likes
anymore
0
Encourage Karl to
carry out his care
independently, as
he 1.s able to
accept new responsibllities
0
Show Karl how to
give his insulin
and test his
urine
1
Delay giving Karl
a scheduled dose of
insulin when he
remarks that his
New Graduates
LVN Exp No Exp
(13)
(18")
Total
(95)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
0
4
9
0
0
0
0
0
0
0
0
1
1
0
2
0
~
-...]
Table 2 (C6ntiriuedy
Questions
NA Exp
( 64)
lips are numb &
his hands perspiring
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 95)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
11
0
3
14
0
7. Use examples with
which Karl is familiar in teaching
him about his illness .& medical
Fegime
0
0
1
1
1
8. Refrain from
scolding Karl for
sneaking food,
rather express
understanding of
his feelings & discuss possible adaptive behaviors
1
0
0
1
0
9. Arrange to lunch
with Karl & his
parents in a
restaurant outside the hospital
for the purpose of
aiding in the selection of Karl's
diet
27
4
10
41
2
>f::o
00
Table 2 (Continued)
Questions
NA Exp
( 6 4)
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 95)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Irid F.T. N.A. No Ans
(13)
Situation 3
Mr. Thomas, age 42, has
been in the Coronary
Care Unit for one week
with a myocardial infarction
1. Ensure that activity & noise levels
remain low in
Mr. Thomas' room 0
0
0
0
0
2. Refrain from statements such as
11
You'll be up and
about in no time"
when Mr. Thomas
asks whether he
is going to be
well again
0
0
0
0
1
3. Notice Mr. Thomas,
who is supposed to
be7on bedrest,
attempting to get
out of bed
0
0
0
0
0
,:::..
~
Table 2 (Continued)
Questions
NA Exp
(6 4)
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
4. Say something
like "It must
be frustrating
to be stuck in
bed" when Mr·.
Thomas makes sarcastic remarks 4
0
1
5
1
5. Observe that
though Mr. Thomas
has been lying
quietly in bed,
his posture is
rigid & his expression tense
3
0
0
3
1
6. Elevate the head
of his bed & initiate oxygen
therapy immediately when Mr.
Thomas complains
of dyspnea
2
0
1
3
0
7. Observe that Mr.
Thomas has not
questioned the
doctor regarding
U1
0
Table 2 (Continued)
Questions
NA Exp
( 64)
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
his illness even
though he has expressed concern
to the nurse
3
0
. 2
5
2
8. Provide opportunity for Mr. &
Mrs. Thomas to
talk in relative privacy
0
0
0
0
1
3
9
1
9. Have Vitamin K
on hand as a pre· cautionary meas.
while Mr. Thomas
is receiving anticoagulants
6
0
'
Situation 4
The beginning staff
nurse is working
7am to 3pm & is
assigned as team
leader
"
1. Assign patients
& tasks taking
into account the
V1
f-'
Table 2 (Continued)
Questions
NA Exp
(6 4)
abilities of
each team
. member
22
2. Review assigned
patients' diagnoses & care
with each team
member at beginning & as necessary during
4
each shift
3. Listen & change·
assignments
accordingly when
a patient complains bitterly
about "his
5
nurse"
4 • Plan her activ. .it.i,.es so that
she will be
available to
assist team
3
members
New Graduates
LVN Exp No Exp
(13)
(18)
Total
( 9 5)
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
1
5
28
2
2
8
1
1
2
8
2
1
3
7
1
3
U1
!'V
Jable 2 (Continued)
Questions
NA Exp
( 64)
New Graduates
LVN Exp No Exp
(13)
(19)
Total
(95)
Nursing Service Preceptors'
Evaluation
School
Directors Sat Ind F.T. N.A. No Ans
. (13)
5. Set an example
& give suggestions while
, as·sisting each
team member in
giving care
3
6. Discuss problem
& attempt a
satisfactory
solution when
tw_o team members
.appear sharp with
each other
9
7 .. Comment at a
.team conference
one the success
.of a team member's
suggestion & have
this member enter
the suggestion on
patient's care
plan
2
8 .. Assist personnel
with problem solving in patient
care situations 3
0
3
6
0
0
1
10
4
0
0
2
1
0
1
4
2
U1
w
Table 2 (Continued)
Questions
NA Exp
( 6 4)
9.
Reassign team
members to
accomplish
tasks by
priorities
when a team
member leaves
ill
4
New Graduates
LVN Exp No Exp
(13)
1
(19)
4
Total
( 95)
9
Nursing Service Preceptors'
School
Evaluation
Directors Sat Ind F.T. N.A. No Ans
(13)
2
lJ1
"""
55
the new graduates were able to start intravenous
infusions.
Another discrepancy was found to exist in the
respondents' perceptions of the students' ability to
administer tube feedings.
Nine of the responding
graduates admitted to a need for further training, while
1 percent of the responding preceptors felt that further
training was needed; on the other hand, the preceptors
indicated that 52 (54.7 percent) of the AA graduates
were competent enough to perform tube feedings.
Twelve
preceptors did not answer the question, and in thirteen
cases the question was not applicable, which may be taken
to mean that this particular procedure was not performed
in the area in which the graduate was working.
Again,
a discrepancy was found between graduates' and the
preceptors' perceptions.
Elimination
No major problem areas were identified in this
skill category.
However, again many of the questions
remained unanswered by the preceptors.
Treatments and Procedures
In these two skill categories, the following
skill areas were identified by the responding·graduates
as areas in which they felt they could not function
56
independently (the numbering follows that used in the
questionnaire) :
1.
Inserting nasogastric tubes
2.
Checking and maintaining drainage tubing
with suction used
a.
Chest tubes
c.
Gastrostomy
3.
Irrigate and instill solutions into tubings
(e.g., colostomy, drains)
6.
Set up and assist physician with procedures
(e.g., examinations, cut downs, LPs)
7.
Remove sutures and skin clips
8.
Prepare for and administer inhalation
therapy procedures
10.
Care for tracheostomy
b.
13.
Remove, clean and replace inner cannula
Assemble orthopedic equipment
a.
Beds and frames
b.
Traction
14.
Operate orthopedic beds and frames
16.
Apply bandages
b.
Sculteto.ns
c.
Pressure
e.
Splints
Out of the 14 skill areas identified by the
graduates as areas in which th€y could not function
57
independently, only 5 were identified by the school
directors as skills they would not expect their graduates to be able to perform.
These were:
6.
Set up and assist the physician with procedures
7.
Remove sutures and skin clips
8.
Prepare for and administer inhalation
therapy procedures
13.
Assemble ortho equipment
a.
Beds and frames
b.
Traction
The preceptors identified eight of the skills in which
according to their perception the new graduate nurses
required further training.
However, because of the
large number of items to which no answer was received,
it is difficult to determine the validity of the data.
From these results it is evident that the new
graduates participating in the survey did not feel as
prepared to perform these functions as the educators
believed they should be.
Diagnostic Activities
Four areas in this skill category were cited
by the graduates and preceptors alike in which they
thought further training was required:
58
2.
Determine central venous pressure
3.
Set up and operate EKG equipment
4.
Recognize and report abnormalities recorded
on monitores, scopes, EKG strips
5.
Apply and read skin tests
In each of these skills, more than 25 percent of
the responding school directors indiated that these
skills were not expected of the new graduate.
All three
categories of respondents were in agreement.
Medications
The graduates identified two items--administration of intradermal and inhaled medications--as skills
in which they required further training.
The school
director respondents stated the graduates should not be
expected to know how to administer intradermal and intravenous medications.
The number of receptors
~tating
they
thought further training was required in the two areas
did not exceed 25 percent.
This finding is in sharp
contradiction to the findings reported in the literature
and also to this researcher's own experience.
Situations Listed (refer to Table 2, p. 37)
Out of the 36 situations listed, the graduates
indicated only two in which
function independently.
~hey
felt they could not
59
Situation 2, No. 9
Arrange to lunch with Karl and his parents
in a restaurant outside the hospital for
the purpose of aiding in the selection of
Karl's diet.
Situation 4, No. 1
Assign patients and tasks taking into account
the abilities of each team member.
The school directors identified Situation 2,
Nos. 9 (see above) and 6:
"Discuss the problem and
attempt a satisfactory solution when two team members
appear sharp with each other" as situations in which
they expected the new graduates could not function
independently.
Preceptor responses were not solicited to the
situation items.
The results of the survey further have shown
that those graduates who have had previous experience
in nursing as LVN appeared to be more confident and
able to function more independently than those with
previous experience as nursing assistant or those with
no experience in nursing prior to attending nursing
school.
Those with previous nursing assistant experience
had the second highest degree of confidence, while those
with no experience in nursing prior to attending nursing
··school had the most difficulty adjusting to their new
roles.
60
The discrepancies between what the school
directors expected their graduates to be able to do and
what the graduates themselves stated they feel confident
they can do appear to cause a major problem in our educational system.
The goals of the teachers are being
met, but not those of the students or the employing
hospitals.
Chapter 5
CONCLUSIONS, IMPLICATIONS OF THE STUDY
FINDINGS, AND RECOMMENDATIONS
The survey results have revealed many discrepancies in the goals and expectations of the AA graduates,
the schools of nursing directors, and the hospital
preceptors participating in the study.
The literature
reviewed has suggested that the potential for role conflict increases when the expectations of the individuals
involved are divergent or inconsistent.
The greater
the discrepancy in expectations, the greater the conflict.
Although the American Nurses Association (ANA)
position paper (1965) has stated that the technical
nurse is not responsible for functioning in a leadership
role, neophytes nevertheless are being taught and
expected to function in a leadership capacity.
Because
of the shortage of nurses, nursing educators find themselves in conflict with nursing service over what is
supposed to and what must be taught in order for neophytes to be able to function effectively in the reality
of nursing pr.actice.
As long as AA graduate. nurses are
61
62
required to take the same state board examination as
the BS graduate nurses and as long as they all are paid
the same salaries and expected to perform the same
functions, the existing problems will not be resolved .
II
. patients' needs, academic curriculums;
li~ensure
laws, and salary scales all militate against development
of a distinctive technical practice"
(Fagin et al., 1976,
p. 102).
Recognition of levels of practice through
separate state board examinations and subsequent state
licensure may require schools to direct more attention
toward teaching two distinct levels of practice.
If
nursing is ever to substantiate the need for levels
of practice, clear evidence must be obtained that two
products exist, and educating institutions must be
required to produce two levels of beginning practitioners.
Role conflict and dissatisfaction were cited by
Kramer (1974) as the major cause of the exodus of neophytes from nursing.
As discussed in the review of the
literature, educational preparation and utilization of
nurses are not closely related.
In view of the many conflict-producing differences in the expectations of neophyte nurses, nursing
service, and nurse educators that the study results have
63
revealed, it is imperative that nursing service and
nursing educators maintain a continual dialogue regarding
expectations and needs of service and educational preparation.
As a result of this survey, just such a dialogue
has already been implemented between the Directors of
Nursing and the Directors of the Associate Degree programs in California.
The findings of this study have implications for
nursing service and for the revision of the previously
cited ANA position paper on the technical nurse.
Although this paper was written in 1965, the concepts
expressed therein have never been implemented.
According to Beerup and Good (1979}, ANA will
propose in 1985, with a view to upgrading the nursing
profession, that the BS degree in nursing be made the
minimal entry level requirement for professional nurse
licensure and the AA degree in nursing be made the
minimal entry level requirement for technical nurse
licensure.
For a successful implementation of this
proposal it would be necessary that (1} articulation
agreements are made between the AA degree, BS degree,
and diploma programs;
(2} the percentage of BS degree
nurses and the percentage of new graduates from BS
programs are significantly larger than is presently the
case; and (3} a sufficient number of realistic, accessible programs are established to make it feasible for
64
the practicing RN to earn a degree.
Had ANA chosen co-
operation and articulation as the means of implementing
its 1965 position paper, all three of the above goals may
be realistic today.
Nursing service must also be willing to accept and
implement the role of the technical nurse.
The nurses
in nursing service and those in nursing education must
collaborate, defining the needs that exist in the patient
care delivery system and reaching agreement on reasonable
and consistent expectations of the neophytes based on
these needs.
These expectations should be utilized to
develop inservice programs consistent with the neophytes'
needs and their educational preparation.
Such inservice
programs would reduce frustration and confusion over the
needless duplication in the instruction of knowledges
and skills the neophytes already possess.
As a result,
funds could be more efficiently employed and clinical expertise utilized for instruction so that it more fully
meets the needs of both the neophytes and the institution.
A further recommendation to ANA would be to redefine the role of the technical nurse.
Results of the
present study have shown that the participating AA degree
graduates expect to perform not only basic and functional
nursing skills but also leadership skills.
Fagin (1976)
found that, when asked specific questions regarding
65
patient care, both baccalaureate and associate degree
graduates reported similar expectations regarding their
own roles; no differences were found in the ways they
believed they should be functioning.
During the past fourteen years, there has been
a rapid growth in medical technology resulting in a new
era of nursing practice, yet ANA has not revised or
clarified the role of the technical nurse.
The needs
of the public and the role of the nurse have changed,
but ANA's position has not.
The leaders in nursing must
correct this lag, or risk (1) seeking a further fragmentation of nursing care;
(2) witnessing a further exodus
of new graduates from nursing practice;
(3) impeding
the preparation and utilization of the AA degree graduate; and (4) losing their place in the determination
of the nurse's role and functions to those who will
take action, whether or not it is to the profession's
liking.
It is also recommended that the National League
for Nursing begin to accredit more of the two-year programs in order to provide input to curriculum development
and standards of performance.
Finally, it is strongly recommended that ANA
conduct a study similar to the one here presented, but
on a national_level.
Because the present study was
66
confined to the Los Angeles area, statistics should be
obtained on the magnitude of the discussed problems on
a national level.
Replication of the present study on a national
level, with subjects including, in addition to AA graduate nurses, diploma nurses and BS graduates, would
allow an intercomparison of the three levels of programs
and the graduates' competence levels.
BIBLIOGRAPHY
67
68
BIBLIOGRAPHY
Allen, Virginia 0.
"Associate-Degree Graduates:
Generalists or Specialists?" Journal of Nursing Education 13 (April 1974): 4-7.
ANA Committee on Education.
"American Nurses' Association
First Position Paper on Education for Nursing."
American Journal of Nursing 65 (December 1965) :
106-111.
Beatty, Audrey, Director of Nursing Services, Project
Staff Member, Children's Hospital at Los Angeles.
Personal interviews, October, 1979.
Beerup, Claudia, and Arnold Good.
"The ANA's 'Hidden
Agenda 1 for 1985." R.N. Magazine 42 (November 1979):
71-78.
Brandt, Edna M., Bettimae Hastie, and Delores Schumann.
11
Comparison of On-the-Job Performance of Graduates
with School of Nursing Objectives ... Nursing Research
16 (Winter 1967): 50-60.
11
, and Bettimae Metheny.
Relationship between
----::Mc:-e-asures of Student and Graduate Performance. 11
Nursing Research 17 (May-June 1968): 242-246.
11
Btillough, Bonnie.
You Can't Get There from Here: Articulation in Nursing Education ... The Journal of Nursing
Education ll (November 1972): 4-9.
Burrell, Barbara, Elizabeth Lally, and Barbara Wiklinski.
11
lnternships for A.D. Graduates ... American Journal
of Nursing 77 (January 1977): 114-116.
11
Campagna, Kathleen Ann.
Performance Expectations of
Associate Degree Nurse Neophytes ... Master's Thesis,
University of California, Los Angeles, 1977.
Cantor, Marjorie M.
"Associate Deg-ree Education for
What? 11 Journal of Nursing Education 13 (April
1974): 26-31.
11
Channing, Rose M.
The Associate Degree Nurse in the
Health Care Delivery System--Now and in the
69
Eighties." Associate-Degree Education--Current
Issues. New York: National League for Nursing,
1972. Publication Number 23-1464; pp. 52-60.
Cicatiello, Julian.
"Expectations of the AssociateDegree Graduate." Journal of Nursing Education 13
(April 1974): 22-25.
Coordinating Council for Higher Education.
"Progress
Report on Nursing Education in California," July 1,
1968.
DeChow, Georgeen.
"Issues in Associate-Degree Education
in Nursing." Journal of Nursing Education 13
(April 1974): 2-3.
"Do Beginning Jobs for Beginning Graduates Differ?"
American Journal of Nursing 69 (May 1969):
1009-1011.
Fagin, Claire, Margaret Mclure, and Rozella Schlotfeldt.
"Can We Bring Order out of the Chaos of Nursing
Education?" American Journal of Nursing 76
(January 1976): 98-107.
Franklin, Doris R.
"Selective and Nonselective Admissions
Criteria in Junior College Nursing Programs." New
York: National League for Nursing, 1975. Publication Number 23-1561; League Exchange Number 104.
Frederickson, Kerrile, and Gloria G. Mayer.
"ProblemSolving Skills: What Effect Does Education Have?"
American Journal of Nursing 77 (July 1977):
1167-1169.
Gray, Judith E., Barbara L. s. Murray, et al.
"Do Graduates of Technical and Professional Nursing Programs
Differ in Practice?" Nursing Research 26 (SeptemberOctober 1977): 368-373.
"Diploma versus Degree Nurses: Are They
Hover, Julie.
Alike?" Nursing OUtlook 23 (November 1975): 684687.
Johnson, Dorothy.
"Competence in Practice: Technical
and Professional." Nursing Outlook 14 (October
1966): 30-33.
70
Kaiser, Joan E.
"A Comparison of Students in Practical
Nursing Programs and in Associate Degree Nursing
Programs." New York: National League for Nursing,
1975. Publication Number 23-1592; League Exchange
Number 109.
Kase, Suzanne H., and Betty Swenson.
"Costs of Hospital
Sponsored Orientations and Inservice Education for
Registered Nurses." Bethesday, Md.:
u.s. Dept. of
HEW, Nov. 1976. DHEW Publication Number (HRA) 77-25.
Kohnke, Mary.
"Do Nursing Educators Practice What Is
Preached?" American Journal of Nursing 73
(September 1973): 1571-1575.
"Literature versus Practice in Nursing Education." Ph.D. Dissertation, Teachers' College,
Columbia University, New York, 1972.
Kramer, Marlene. Reality Shock: Why Nurses Leave Nursing. St. Louis: C. 0. Mosby & Co., 1974.
Lande, Sylvia.
"A National Survey of Associate Degree
Nursing Programs. New York: National League for
Nursing, 1967. Dept. of A.D. Programs, Publication
Number 23-1348.
McGrath, Barbara Jo, and J. Robert Koewing.
"Clinical
Preceptorship." The Journal of Nursing Administration
3 (March 1978): 12-18.
Mahan, Paul B., and Charles H. White.
"A Study-of the
Recruitment of Registered Nurses by California Hospitals and Nursing Homes." California Hospital Association, Division of Research and Development,
August 1978.
Matheney, Ruth U.
"Technical Nursing Practice." Associate
Degree Education for Nursing--Current Issues. New
York: National League for Nursing, 1974. Publication Number 23-1539; pp. 19-25.
Meleis, Afaf S., and Kathleen M. Farrell.
"Operation
Concern: A Study of Senior Nursing Students in
Three Nursing Programs." Nursing Research 23 (Nov.Dec . 19 7 4 ) : 4 6 1-4 6 8 .
71
Miller, Michael H.
"Work Roles for the Associate Degree
Graduate." American Journal of Nursing 7 4 (March
1974): 468-470.
Montag, Mildred L.
"Evaluation of Graduates of Associate
Degree Nursing Programs." New York: Teachers
College Press, 1972.
"NLN Nursing Data Book." Statistical Information on Nursing Education and Newly Licensed Nurses. New York:
National League for Nursing, Division of Research,
1978. Publicaton Number 19-1751.
Nelson, Lois F.
"Competence of Nursing Graduates in
Technical, Communicative, and Administrative Skills."
Nursing Research 27 (March-April 1978): 121-125.
Sparks, Colleen, and Bonnie Bullough. "Baccalaureate vs.
Associate Degree Nurses: The Care-Cure Dichotomy."
Nursing Outlook 23 (November 1975): 688-692.
Waters, ve·rle H., Shirley s. Chater, et al.
"Technical
and Professional Nursing: An Exploratory Study."
Nursing Research 21 (March-April 1972): 124-131.
Weiss, Sandra J., and Ellen Ramsey.
"An Interagency
Internship: A Key to Transitional Adaptation."
The Journal of Nursing Administration 7 (October
1977): 36-42.
APPENDICES
72
APPENDIX A
NURSING SCHOOL QUESTIONNAIRE WITH COVER LETTER
73
74
April 20, 1978
Dear Colleague:
The members of the Directors of Nursing Council - Los Angeles Area,
are greatly concerned about the current rate of attrition of the
newly graduated staff nurse experiencing his/her first employment
in a hospital setting. We are asking for your assistance in
resolving this problem. Your cooperation in completing this questionnaire will help us to answer this question.
WHAT SHOULD BE EXPECTED OF THE NEWLY GRADUATED STAFF NURSE IN
HER/HIS FIRST POSITION?
Although the role may vary from one hospital to another, the nurses
in each employing institution have expectations of what the beginning staff nurse should know and be able to do. We recognize that
these expectations may or may not be realistic. Your assistance
in.helping us to identify discrepancies in any expectations that
we may hold would be greatly appreciated.
The questionnaire consists of two parts--a list of tasks to survey
expectations of manual skills and some situations to elicit expectations in the areas of knowledge and judgment.
In answering, there are no right or wrong answers to the questions.
Your answer should not be what "ideally" you would like her/him to
be able to do but what you consider to be "acceptable" performance
by a beginning staff nurse graduated from your program.
PLEASE ANSWER ONLY FOR YOUR PROGRAM.
We are anxious to have this information prior to hiring new graduates this summer and would appreciate the questionnaire being
returned by May 15, 1978.
75
Thank you for your assistance.
Audrey Beatty
Program Chairman
Directors of Nursing Council - LA Area
76
PLEASE INDICATE WHETHER YOU EXPECT BEGINNING STAFF NURSES TO ACCURATELY AND INDEPENDENTLY PERFORM THE FOLLOWING SKILLS IN HER FIRST
EMPLOYMENT BY PLACING A CIRCLE AROUND THE NUMBER {1) FOR "YES" OR
(2) FOR "NO" UNDER EACH OF THE THREE EDUCATIONAL PROGRAMS. SINCE
NO ATTEMPT HAS BEEN MADE TO LIST ALL SKILLS, FEEL FREE TO ADD ANY
THAT YOU BELIEVE SHOULD DEFINITELY BE INCLUDED.
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
Explain and use safety
measures (e.g., restraints,
side-rails) in caring for
patients
1
2
1
2
1
2
Observe and enforce safety
and fire regulations
(e.g.; spilled water, no
smoking signs)
1
2
1
2
1
2
1
2
1
2
1
2
Prevent transferring pathogens
between patients (e.g., wash
hands, change gowns)
1
2
1
2
1
2
Give or assist patients to
take baths
1
2
1
2
1
2
Assist patients with personal
hygiene (e.g., hair, nails,
skin, teeth)
1
2
1
2
1
2
Give skin care to bedridden
patients (e.g., in casts,
restraints coma)
1
2
1
2
1
2
Safety, Comfort, and
Personal Hygiene
1.
2.
3. · Carry out aseptic technique
when using sterile supplies
(e.g., syringes, dressings)
4.
5.
6.
7.
77
8.
9.
10.
11.
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
Turn and position patients in
correct body alignment
1
2
1
2
1
2
Use supportive and comfort
devices (e.g. , bed cradles,
footboards)
1
2
1
2
1
2
Assist patients in range
of motion exercises
1
2
1
2
1
2
Assist patients to become
ambulatory (e.g. , dangle,
get out of bed)
1
2
1
2
1
2
Foods and Fluids
l.
Assist patient to eat
a.
Infant
1
2
1
2
1
2
b.
Toddler
1
2
1
2
1
2
c.
Child
1
2
1
2
1
2
d.
Adult
1
2
1
2
1
2
e.
Geriatric patient
1
2
1
2
1
2
Administer tube feedings
(e.g. , nasogastric, gavage,
gastrostomy)
1
2
1
2
1
2
3.
Start intr¥ivenous infusion
1
2
1
2
1
2
4.
Hang, regulate, and discontinue
intravenous fluids
1
2
1
2
1
2
Observe, measure, and record
food and fluid intake and
output (include drainage
bottles)
2
1
2
1
. 2
2.
5.
1
78
Diploma
School
Graduate
Baccalaureate
Graduate
YES
NO
YES
Assist patients with natural
elimination (bedpan, urinal)
1
2
1
2
1
2
Prepare and give enemas and
Harris flushes
1
2
1
2
1
2
3.
Remove fecal impactions
1
2
1
2
1
2
4.
Insert urinary catheters
1
2
1
2
1
2
5.
Irrigate urinary catheters
1
2
1
2
1
2
1
2
1
2
1
2
NO
Associate
Degree
Graduate
YES
NO
Elimination
1.
2.
Treatments and Procedures
1.
Insert nasogastric tubes
2.
Check and maintain drainage
tubing with suction
3.
4.
5.
6.
a.
Chest tubes
1
2
1
2
1
2
b.
N/G tubes
1
2
1
2
1
2
c.
Gastrostomy
1
2
1
1
2
Irrigate and instill solutions
into tubings (e.g., colostomy,
drains
1
2
1
2
1
2
Irrigate and instill solutions
directly into body openings
(e.g., douche, wounds)
1
2
1
2
1
Assist patients to turn,
cough, and deep breathe
1
2
1
2
1
2
Set up for and assist
physician with procedures
(e.g., examinations, cut
downs , L. P • ' s )
1
2
1
2
1
2
79
Diploma
School
Graduate
Ba.ccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
7.
Remove sutures and skin clips
1
2
1
2
1
2
8.
Prepare equipment and
administer inhalation
therapy
1
2
1
2
1
2
Assist patients with
postural drainage
1
2
1
2
1
2
9.
10.
11.
12.
13.
Care for tracheostomy
a.
Suction
1
2
1
2
1
2
b.
Remove, clean, and replace inner cannula
1
2
1
2
1
2
Set up and operate commonly
used 02 equipment (e.g. ' nasal
catheters, masks, tents,
croupettes)
1
2
1
2
1
2
Give mouth-to-mouth
resuscitation
1
2
1
2
1
2
Assemble commonly used
orthopedic equipment
a.
Beds and frames
1
2
1
2
1
2
b.
Traction
1
2
1
2
1
2
1
2
1
2
1
2
14.
Operate commonly used orthopedic beds and frames
15.
Maintain patients in
traction
16.
Apply bandages
a.
Ace
1
2
1
2
1
2
b.
Scultetous
1
2
1
2
1
2
c.
Pressure
1
2
1
2
1
2
80
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
YES
NO
YES
NO
NO
d.
Slings
1
2
1
2
l
2
e.
Splints
l
2
l
2
l
2
Diagnostic Activities
l.
Take TPR and BP
1
2
l
2
l
2
2.
Determine central
venous pressure
l
2
l
2
l
2
Set up and operate
EKG equipment
l
2
l
l
2
Recognize and report abnormalities recorded on
monitors, scopes, EKG strips
l
2
l
2
l
2
5.
Apply and read skin tests
l
2
l
2
l
2
6.
Obtain nose, throat, stool,
urine~ and wound specimens
l
2
l
2
l
2
3.
4.
7.
Test urine for:
a.
Sugar
l
2
l
2·
l
2
b.
Acetone
l
2
l
2
l
2
c.
Specific Gravity
l
2
l
2
l
2
d.
pH
l
2
1
2
1
2
Medications
l.
Prepare and administer
medications
a.
Oral
l
2
l
2
l
2
b.
Rectal
1
2
1
2
1
2
c.
IM
1
2
1
2
l
2
81
Diploma
Schoo
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
d.
Subcutaneous
1
2
1
2
1
2
e.
Intradermal
1
2
1
2
1
2
f.
Inhaled
1
2
1
2
1
2
g.
I.V.
1
2
1
2
1
2
h.
Eye, nose, and ear drops
1
2
1
2
1
2
i.
Topical
1
2
1
2
1
2
PLEASE USE THIS SPACE TO ADD ANY SKILLS WHICH YOU BELIEVE SHOULD
BE INCLUDED.
82
THE FOLLOWING SITUATIONS HAVE BEEN DEVELOPED TO IDENTIFY EXPECTATIONS
OF THE NEWLY GRADUATED STAFF NURSE IN HER FIRST EMPLOYMENT IN THE
AREAS OF KNOWLEDGE AND JUDGMENT. PLEASE INDICATE YOUR EXPECTATIONS
BY PLACING A CIRCLE AROUND THE NUMBER (1) FOR "YES" OR (2) FOR "NO"
UNDER EACH OF THE THREE EDUCATIONAL PROGRAMS.
Situation
Susan, age 2, has just returned from the operating room with a new
tracheostomy.
Diploma
School
Graduate
2.
3.
4.
5.
6.
Associate
Degree
Graduate
YES
NO
YES
NO
YES
Have present and operational
at the bedside a suction
machine and tracheostomy care
tray upon Susan's return to
her room
1
2
1
2
1
2
Recognize that Susan's arms
are not restrained as she is
admitted to her room after
surgery
1
2
1
2
1
2
Wait until Susan is quiet
before rechecking her pulse
rate which is 180 while crying
1
2
1
2
1
2
Notice secretions bubbling in
the tracheostomy upon entering Susan's room
1
2
1
2
1
2
Organize care to insure
Susan remains in an environment of increased oxygen and
humidity as much as possible
1
2
1
2
1
2
Suction Susan's tracheostomy
after noticing her to be unusually restless, even though
no gurgling sound is heard
1
2
1
2
1
2
DO YOU EXPECT THE BEGINNING
STAFF NURSE TO:
1.
Baccalaureate
Graduate
NO
83
7.
8.
9.
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
YES
Notice Susan staring at the
door in her mother's absence
l
2
l
2
l
2
Provide a constant means by
which Susan can initiate
communication
l
2
l
2
l
2
Organize Susan's activities
so that a familiar routine
similar to home is
established
l
2
l
2
l
2
NO
NO
Situation
Karl, age 15, is hospitalized as a newly diagnosed diabetic.
DO YOU EXPECT THE BEGINNING STAFF
NURSE TO:
l.
2.
3.
4.
5.
Introduce herself to Karl when
he is·admitted, orient him to
the ward, and introduce him to
other teen-age patients
l
2
l
2
l
2
Recognize steps to be taken
upon noting an acetone odor
while assisting Karl with
his oral hygiene
l
2
l
2
l
2
Sit down
interest
bitterly
anything
more
l
2
l
2
l
2
Encourage Karl to carry
out his care independently,
as he is able to accept new
responsibilities
l
2
l
2
l
2
Show Karl how to give his insulin and test his urine
l
2
l
2
l
2
and listen with
when Karl complains
that he can't eat
that he likes any-
84
6.
7.
8.
9.
Diploma
School
Graduate
Bacca
laureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
Delay giving Karl a
scheduled dose of insulin
when he remarks that his
lips are numb and his hands
perspiring
1
2
1
2
1
2
Use examples with which Karl
is familiar in teaching him
about his illness and medical
regime
1
2
1
2
1
2
Refrain from scolding Karl for
sneaking food, rather express
understanding of his feelings
and discuss possible adaptive
behaviors
1
2
1
2
1
2
Arrange to lunch with Karl and
his parents in a restaurant
outside the hospital for the
purpose of aiding in the
selection of Karl's diet
1
2
1
2
1
2
Situation
Mr. Thomas, age 42, has been in the Coronary Unit
for one week with a myocardial infarction.
DO YOU EXPECT THE BEGINNING STAFF
NURSE TO:
1.
2.
Insure that the activity and
noise·levels remain low in
Mr. Thomas' room
1
2
1
2
1
2
Refrain from statements such as
"you'll be up and about in no
time" when Mr. Thomas asks
whether he is ever going to
be well again
1
2
1
2
1
2
85
3.
4.
5.
6.
7.
Diploma
School
Graduate
Baccalaureate
Graduate
YES
NO
YES
NO
YES
NO
1
2
1
2
1
2
Say something like "it must
be very frustrating to be stuck
in bed," when Mr. Thomas makes
sarcastic remarks
1
2
1
2
1
2
Observe that though Mr. Thomas
has been lying quietly in bed,
his posture is rigid and his
expression tense
1
2
1
2
1
2
Elevate the head of his bed and
initiate oxygen therapy immediately when Mr. Thomas complains of dyspnea
1
2
1
2
1
2
Observe that Mr. Thomas has
not questioned the doctor
regarding his illness even
though he has expressed concern to the nurse
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
Notice Mr. Thomas, who is
supposed to be on bedrest,
attempting to get out of bed
8. ·Provide opportunities for Mr.
and Mrs. Thomas to talk in
relative privacy
9.
Have Vitamin K on hand as a
precautionary measure while
Mr. Thomas is receiving anticoagulants
Associate
Degree
Graduate
86
Situation
The beginning staff nurse is working 7 a.m. to 3 p.m. and is
assigned as team leader.
Diploma
School
Graduate
Baccalaureate
Graduate
YES
NO
Assign patients and tasks
taking into account the
abilities of each team member
1
2
1
2
1
2
Review assigned patients'
diagnoses and care with each
team member at the beginning
and as necessary during each
shift
1
2
1
2
1
2
Listen and change assignments
accordingly when a patient
complains bitterly about "his
nurse"
1
2
1
2
1
2
Plan her activities so that
she will be available to
assist team members
1
2
1
2
1
2
Set an example and give suggestions while assisting each team
member in giving care
1
2
1
2
1
2
Discuss the problem and attempt
a satisfactory solution when
two team members appear sharp
with each other
1
2
1
2
1
2
Comment at a team conference on
the success of a team member's
suggestion and have this member
enter the suggestion on the
patient's care plan
1
2
1
2
1
2
YES
NO
Associate
Degree
Graduate
YES
NO
DO YOU EXPECT THE BEGINNING STAFF
NURSE TO:
1.
2.
3.
4.
5.
6.
7.
87
8.
9.
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
YES
NO
YES
NO
YES
NO
Assist personnel with problem
solving in patient care
situations
1
2
1
2
1
2
Reassign team members to
accomplish tasks by priorities when a team member
leaves ill
1
2
1
2
1
2
Now that you have indicated whether you expect beginning staff nurses
to be able to perform some specific skills independently. PLEASE
INDICATE WHETHER YOU EXPECT ANY DIFFERENCE IN PERFORMANCE OF THE THREE
TYPES OF NEW GRADUATES BY CIRCLING THE APPROPRIATE NUMBERS.
"1"
Expected to do independently.
"2"
Expected to do with assistance.
"3"
Not expected to do at all.
Situation
The. beginnign staff nurse is working 7 a.m. to 3 p.m. and is assigned
as team leader.
Diploma
School
Graduate
Baccalaureate
Graduate
Associate
Degree
Graduate
DO YOU EXPECT THE BEGINNING STAFF
NURSE TO:
1.
2.
Assign patients and tasks
taking into account the abilities of each team member
1
2
3
1
2
3
1
2
3
Review assigned patients'
diagnoses and care with each
team member at the beginning
and as necessary during
each shift
2
3
1
2
3
1
2
3
1
88
Diploma
School
Graduate
3.
4.
5.
6.
7.
8.
9.
Baccalaureate
Graduate
Associate
Degree
Graduate
Listen and change assignments
accordingly when a patient
complains bitterly about
"her nurse"
1
2
3
1
2
3
1
2
3
Plan her activities so
that she will be available
to assist team members
1
2
3
1
2
3
1
2
3
Set an example and give
suggestions while assisting
each team member in giving
care
1
2
3
1
2
3
1
2
3
Discuss the problem and
attempt a satisfactory solution when two team members
appear sharp with each
other
1
2
3
1
2
3
1
2
3
Comment at a team conference
on the success of a team
member's suggestion and have
this member enter the suggestion on the patient's care
p;J._an
1
2
3
1
2
3
1
2
3
Assist personnel with problem
solving in patient care situations
1
2
3
1
2
3
1
2
3
Reassign team members to
accomplish tasks by priorities when a team member
leaves ill
2
3
1
2
3
1
2
3
1
APPENDIX B
AA GRADUATE QUESTIONNAIRE WITH COVER LETTER
89
90
Dear Graduate:
Your cooperation in completing this questionnaire will help us to
answer the question:
WHAT SHOULD BE EXPECTED OF THE NEWLY GRADUATED STAFF NURSE IN HER
FIRST POSITION?
Although your roles may vary from one hospital to another, the
nurses in each employing institution have expectations of what the
beginning staff nurse should know and be able to do. These expectations may be clearly identified by some, but are frequently an
informal nonverbalized gauge by which the neophyte is evaluated.
This gauge is applied to all beginning staff nurses from all three
types of nursing education programs.
The questionnaire consists of three parts--a list of tasks to
survey manual skills; some situations to look at areas of knowledge and judgment; and a few demographic questions about the
respondent to facilitate analysis of the findings.
In answering, THERE ARE NO RIGHT OR WRONG ANSWERS to the questions.
Please give an honest appraisal of what you believe you are able
to do at this point in your nursing career. Try to ignore variations in hospitals as to policies and procedures--these will be
learned during your orientation. Your answers should reflect a
self-evaluation of your present abilities.
Thank you for your assistance. The time and effort you spent is
greatly appreciated and will contribute toward more realistic
expectations for beginning staff nurses.
Director of Nursing Council
Los Angeles Area
91
Self-Assessment Inventory
PLEASE INDICATE WHETHER YOU CAN PERFORM THESE SKILLS INDEPENDENTLY
OR NOT BY PLACING A CIRCLE AROUND THE NUMBER (1) FOR "YES" OR (2)
FOR "NO. II
YES
NO
Explain and use safety measures (e.g., restraints,
side rails) in caring for patients
1
2
Observe and enforce safety and fire regulations
(e.g., spilled water, no smoking signs)
1
2
Carry out aseptic technique when using sterile
supplies (e.g., syringes, dressings)
1
2
Prevent transferring pathogens between patients
(e.g., wash hands, change gowns)
1
2
5.
Give or assist_patients to take baths
1
2
6.
Assist patients with personal hygiene (e.g., hair,
nails, skin, teeth)
1
2
Give skin care to bedridden patients (e.g., in
casts, restraints, coma)
1
2
Turn and position patients in correct body
alignment
1
2
Use supportive and comfort devices (e.g., bed
cradles, footboards)
1
2
10.
Assist patients in range of motion exercises
1
2
11.
Assist patients to become ambulatory (e.g., dangle,
get out of bed)
1
2
Safety, Comfort, and Personal Hygiene
1.
2.
3.
4.
7.
8.
9.
92
YES
NO
Foods and Fluids
1.
Assist patient to eat
a.
Infant
1
2
b.
Toddler
1
2
c.
Child
1
2
d.
Adult
1
2
e.
Geriatric patient
1
2
Administer tube feedings (e.g., nasogastric,
gavage, gastrostomy)
1
2
3.
Start intravenous infusion
1
2
4.
Hang, regulate and discontinue intravenous
fluids
1
2
Observe, measure, and record food and fluid
intake and output (include drainage bottles)
1
2
Assist patients with natural elimination
(bedpan, urinal)
1
2
2.
Prepare and give enemas and Harris flushes
1
2
3.
Remove fecal impactions
1
2
4.
Insert urinary catheters
1
2
5.
Irrigate urinary catheters
1
2
1
2
2.
5.
Elimination
1.
Treatments and Procedures
1.
Insert nasogastric tubes
2.
Check and maintain drainage tubing with suction
a.
Chest tubes
1
2
b.
N/G tubes
1
2
93
YES
NO
1
2
Irrigate and instill solutions into tubings
(e.g., colostomy drains)
1
2
Irrigate and instill solutions directly into
body openings (e.g., douche, wounds)
1
2
5.
Assist patients to turn, cough, and deep breathe
1
2
6.
Set up for and assist physician with procedures
(e.g., examinations, cut downs, L.P.'s
1
2
7.
Remove sutures and skin clips
1
2
8.
Prepare equipment and administer inhalation
therapy
1
2
Assist patients with postural drainage
1
2
c.
3.
4.
9.
10.
Gastrostomy
Care for tracheostomy
a.
Suction
1
2
b.
Remove, clean, and replace inner cannula
1
2
Set up and operate common used 02 equipment
(e.g., nasal catheters, masks, tents, croupettes)
1
2
12.
Give mouth-to-mouth resuscitation
1
2
13.
Assemble commonly used orthopedic equipment
11.
a.
Beds and frames
1
2
b.
Traction
1
2
14.
Operate commonly used orthopedic beds and frames
1
2
15.
Maintain patients in traction
1
2
16.
Apply bandages
a.
Ace
1
2
b.
Scultetous
1
2
c.
Pressure
1
2
94
YES
NO
d.
Slings
1
2
e.
Splints
1
2
Diagnostic Activities
l.
Take TPR and BP
1
2
2.
Determine central venous pressure
1
2
3.
Set up and operate EKG equipment
1
2
4.
Recognize and report abnormalities recorded
on monitors, scopes, EKG strips
1
2
5.
Apply and read skin tests
1
2
6.
Obtain nose, throat, stool, urine, and wound
specimens
1
2
7.
Test urine for:
a.
Sugar
1
2
b.
Acetone
1
2
c.
Specific Gravity
1
2
d.
pH
1
2
Medications
l.
Prepare and administer medications
a.
Oral
1
2
b.
Rectal
1
2
c.
IM
1
2
d.
Subcutaneous
1
2
e.
Intradermal
1
2
f.
Inhaled
1
2
g.
I . v.
1
2
95
YES
NO
h.
Eye, nose, and ear drops
1
2
i.
Topical
1
2
PLEASE USE THIS SPACE TO ADD ANY SKILLS WHICH YOU BELIEVE SHOULD BE
INCLUDED.
96
THE FOLLOWING SITUATIONS HAVE BEEN DEVELOPED TO IDENTIFY ABILITY
IN THE AREAS OF KNOWLEDGE AND JUDGMENT.
PLEASE INDICATE WHETHER YOU CAN PERFORM THESE SKILLS INDEPENDENTLY
OR NOT BY PLACING A CIRCLE AROUND THE NUMBER ( 1) FOR "YES" OR { 2)
FOR "NO. "
THE SITUATIONS SERVE ONLY AS A FRAME OF REFERENCE.
PLEASE INFER YOUR ABILITIES FROM SIMILAR SITUATIONS.
Situation
Susan, age 2, has just returned from the operating room with a new
tracheostomy.
GIVEN THIS SITUATION, COULD YOU PERFORM THESE ACTIVITIES INDEPENDENTLY?
1.
2.
3.
YES
NO
Have present and operational at the bedside a
suction machine and tracheostomy care tray upon
Susan's return to her room
1
2
Recognize that Susan's arms are not restrained
as she is admitted to her room after surgery
1
2
Wait until Susan is quiet before rechecking her
pulse rate which is 180 while crying
1
2
1
2
Organize care to insure Susan remains in an
environment of increased oxygen and humidity
as much as possible
1
2
Suction Susan's tracheostomy after noticing her
to be unusually restless, even though no gurgling
sound is heard
1
2
Notice Susan staring at the door in her mother's
absence
1
2
Provide a constant means by which Susan can
initiate communication
1
2
Organize Susan's activities so that a familiar
routine similar to home is established
1
2
4 •. Notice secretions bubbling in the tracheostomy
upon entering Susan's room
5.
6.
7.
8.
9.
97
Situation
Karl, age 15, is hospitalized as a newly diagnosed diabetic.
GIVEN THIS SITUATION, COULD YOU PERFORM THESE ACTIVITIES INDEPENDENTLY?
1.
2.
3.
4.
5.
6.
7.
8.
9.
YES
NO
Introduce yourself to Karl when he is admitted,
orient him to the ward, and introduce him to
other teen-age patients
1
2
Recognize steps to be taken upon noting an acetone
odor while assisting Karl with his oral hygiene
1
2
Sit down and listen with interest when Karl cornplains bitterly that he can't eat anything that
he likes anymore
1
2
Encourage Karl to carry out his care independently,
as he is able to accept new responsibilities
1
2
Show Karl how to give his insulin and test
his urine
1
2
Delay giving Karl a scheduled dose of insulin
when he remarks that his lips are numb and his
hands perspiring
1
2
Use examples with which Karl is familiar in teaching him about his illness and medical regime
1
2
Refrain from scolding Karl for sneaking food, rather
express understanding of his feelings and discuss
possible adaptive behaviors
1
2
Arrange to lunch with Karl and his parents in a
restaurant outside the hospital for the purpose
of aiding in the selection of Karl' s diet
1
2
98
Situation
Mr. Thomas, age 42, has been in the Coronary Care Unit for one week
with a myocardial infarction.
GIVEN THIS SITUATION, COULD YOU PERFORM THESE ACTIVITIES INDEPENDENTLY?
1.
2.
3.
4.
5.
6.
7.
8.
9·.
YES
NO
Insure that the activity and noise levels remain
low in Mr. Thomas' room
1
2
Refrain from statements such as "you'll be up and
about in no time" when Mr. Thomas asks whether
he is ever going to be well again
1
2
Notice Mr. Thomas, who is supposed to be on bedrest, attempting to get out of bed
1
2
Say something like "it must be very frustrating to
be stuck in bed," when Mr. Thomas makes sarcastic
remarks
1
2
Observe that though Mr. Thomas has been lying
quietly in bed, his posture is rigid and his
expression tense
1
2
Elevate the head of his bed and initiate oxygen
therapy immediately when Mr. Thomas complains
of dyspnea
1
2
Observe that Mr. Thomas has not questioned the doctor
regarding his illness even though he has expressed
concern to the nurse
1
2
Provide opportunities for Mr. and Mrs. Thomas to
talk in relative privacy
1
2
Have Vitamin K on hand as a precautionary measure
while Mr. Thomas is receiving anticoagulants
1
2
99
Situation
The beginning staff nurse is working 7 a.m. to 3 p.m. and is assigned
as team leader.
GIVEN THIS SITUATION, COULD YOU PERFORM THESE ACTIVITIES INDEPENDENTLY?
1.
2.
3.
4.
5.
6.
7.
8.
9.
YES
NO
Assign patients and tasks taking into account the
abilities of each team member
1
2
Review assigned patients' diagnoses and care with
each team member at the beginning and as necessary
during each shift
1
2
Listen and change assignments accordingly when a
patient complains bitterly about "his nurse"
1
2
Plan her activities so that she will be available
to assist team members
1
2
Set an example and give suggestions while assisting
each team member in giving care
1
2
Discuss the problem and attempt a satisfactory
solution when two team members appear sharp with
each other
1
2
Comment at a team conference on the success of a
team member's suggestion and have this member
enter the suggestion on the patient's care plan
1
2
Assist personnel with problem solving in patient
care situations
1
2
Reassign team members to accomplish tasks by
priorities when a team member leaves ill
1
2
100
RESPONDENT INFORMATION SHEET
1.
Nursing program attended
(please circle one)
Assoc. Degree
2.
Graduation
Date
Diploma
Bac.
State
Country
3.
Additional work experience in
nursing (please circle one)
YES
4.
If yes, what capacity
(please circle one)
NA
NO
LVN
TECH
OTHER (please explain)
5.
Dates of employment
6.
Setting
(please circle one)
Acute general
Specialty
Extended Care
OTHER (please explain)
Thank you.
----
APPENDIX C
HOSPITAL PRECEPTOR QUESTIONNAIRE WITH INSTRUCTION SHEET
101
102
INSTRUCTION SHEET:
1.
For the purpose of this study, the new graduate is
defined as having an interim permit or license,
and the current position is the first post-graduation
employment.
2.
You are being supplied with one copy of each questionnaire.
Please duplicate as many as you need.
3.
Assign an identifying number to each new graduate who
is participating in the study.
Place that number in
the upper right-hand corner of the NEW GRADUATE
ORIENTATION CHECK LTST and of the SELF-ASSESSMENT
These numbers must coincide.
INVENTORY.
4.
Have each new graduate complete the SELF-ASSESSMENT
INVENTORY on the first day of employment.
5.
Keep the above on file until the NEW GRADUATE
ORIENTATION CHECK LIST iS completed.
6.
Have the person orienting the new graduate complete
the NEW GRADUATE ORIENTATION CHECK LIST within six
weeks.
7.
Indicate with N/A any procedure inappropriate for your
hospital.
8 . . Include only those graduates hired prior to September 30, 1978.
9.
Upon completion staple the two
return to:
forms together and
Joan Jessop
7539 Denrock Avenue
Los Angeles, California 90045
NEW GRADUATE ORIENTATION CHECK LIST
Record #
NAME:
----------------
------------------------------------
NAME OF SCHOOL:
---------------------------
SCHOOL OF NURSING
Diploma
AA
Bachelor
{Circle)
DATE=------------~--------------------Please indicate in the appropriate column what your experience with the following procedures are.
Can Function
Independently
1.
Explain and use safety measure
{e.g., restraints, siderails) in caring
for patient
2.
Observe and enforce safety and fire regulations {e.g., spilled water, no smoking signs)
3.
Carry out aseptic technique when using
sterile supplies {e.g., syringes, dr€ssings)
4.
Prevent transferring pathogens between
patients {e.g., wash hands, change gowns)
5.
Give or assist patients to take baths
Sat.
Further
Training
N/A
Signature
1--'
0
w
Can Function
Independently
6.
Assist patients with personal _hygiene
(e.g., hair, nails, skin, teeth)
7.
Give skin care to bedridden patients
(e.g., in casts, restraints, coma)
8.
Turn and position patients in correct
body alignment
9.
Use supportive and comfort devices
(e.g., bed cradles, footboards)
10.
Assist patients in range of motion exercises
11.
Assist patients to become ambulatory
·(e.g., dangle, get out of bed)
Demonstration
Further
Sat.
Training
N/A
Signature
Body and Fluids
1.
Assist patients to eat
a. Infant
b. Toddler
c. Child
--d. Adult
e. Geriatric patient
2.
Administer tube feedings (e.g., nasagastric, gavage, gastrostomy)
3.
Start intravenous infusion
I-'
0
~
Can Function
Independently
4.
Hang, regulate, and discontinue intravenous
fluids
5.
Observe, measure, and record food and fluid
intake and output (include drainage bottles)
Demonstration
Further
Sat.
Training
N/A
Signature
Elimination
1.
Assist patients with natural elimination
(bedpan, urinal)
2 • . Prepare and give enemas and Harris.flushes
3.
Remove fecal impactions
4.
Insert urinary catheters
Irrigate urinary catheters
Treatments and Procedures
1. -Insert nasogastric tubes
2.
·3.
Check and maintain drainage tubing with
suction
a. Chest tubes
b. N/G tubes
c. Gastrostomy
-Irrigate and instill solutions into tubings
(e.g., colostomy, drains)
1-'
0
t.n
Can Function
Independently
4.
Irrigate and instill solutions into body
openings (i.e., douche, wounds)
5.
Assist patients to turn, cough and deep
breathe
6.
Set up for and assist physicians with procedures (e.g., examinations, cut downs,
Demonstration
Further
Training
Sat.
N/A
Signature
L.P.'s.)
7.
Remove sutures and skin clips
8.
Prepare equipment and administer inhalation
therapy
9.
Assist patients with postural drainage
10.
11.
Care for tracheostomy
a. Suction
b. Remove, clean and replace inner cannula
Set up and oper-ate commonly used 02 equip(e.g., nasal catheters, masks,
tents, croupettes)
~ent
12.
Give mouth-to-mouth resuscitation
13.
Assemble commonly used orthopedic equipment
f-'
0
0'1
Can Function
Independently
13.
Assemble commonly used orthopedic equipment
a. Beds and frames
b. Traction
14.
Operate commonly used orthopedic beds
and frames
15.
Maintain patients in traction
16.
Apply bandages
a. Ace
b. Scultetous
c. Pressure
d. Slinss
e. Splints
Demonstration
Further
Sat.
Training
N/A
Signature
Diasnostic Activities
1.
Take TPR and BP
2.
Determine central venous pressure
3.
Set up and operate EKG equipment
4.
Recognize and report abnormalities recorded
on monitors, scopes, EKG strips
5.
Apply and read skin tests
6.
Obtain nose, throat, stool, urine
and wound specimens
I-'
0
-...]
Can Function
Independently
7.
Demonstration
Further
Sat.
Training
N/A
Signature
Test urine for:
a. Sugar
b. Acetone
c. Specific Gravity
d.
pH
Medications
1.
Prepare and administer medications
b.
a.
Oral
Rectal
c.
=I~M~-----------------------------------------------------------------------------------------------
d.
e.
f.
Subcutaneous
Intradermal
Inhaled
g.
I.V.
h.
i.
Eye, nose and ear drops
Topical
f-'
0
co