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The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two‐phased approach included individual semi‐structured interviews, followed by focus group discussions with students. Participants included 53 pre‐registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students. [ABSTRACT FROM AUTHOR]

There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under‐explored, especially in the Australian context. This two‐phased qualitative study used Interpretive Description to explore 53 pre‐registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up. [ABSTRACT FROM AUTHOR]

Aim To investigate the nature and timing of support available to new graduate nurses within a rural transition to practice programme. Background For new graduates in rural practice successful transition is complicated by the unique role of the rural nurse, staff ratios and resources within rural environments. Little is known about the support needs of graduates working in rural health services, or who is best placed to provide support during their transition. Method This was a qualitative case study, using individual interviews with new graduate nurses at 3, 6 and 9 months milestones during a 12-month rural transition to practice programme plus interviews with experienced rural nurses who were employed in rural health agencies where the new graduate nurses were employed. Results Graduates in rural health services rely on nurse unit managers and nurse managers for feedback, support and debriefing, provision of emotional support, advocacy, openness, encouragement and protection from organisational requests and demands during the transition to rural nursing practice. Conclusions Nurse managers play an important role in rural health services in the provision of support for new graduate nurses. Implications for nursing management As clinical leaders rural nurse managers and nurse unit managers, have an important role in facilitating the successful entry and retention of new graduate nurses into the rural nursing workforce. [ABSTRACT FROM AUTHOR]

Aims and objectives To present the findings from the experienced rural nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. Background There are specific and unique aspects of rural nursing practice that influence the nature and timing of support for new graduate nurses that have not been explored or acknowledged as influencing the new graduate nurses' experience of transition. Specifically, the difficulties and challenges that experienced rural nurses face in providing effective and timely support for new graduate nurses who are making the transition to rural nursing practice is yet to be explored. Design Using a qualitative case study framework, this study specifically aimed to investigate and describe the nature and timing of support required during the transition to nursing practice that is specific for the rural context and capacity. Methods Individual in-depth interviews were conducted with 16 experienced rural nurses who, at the time of the study, worked with new graduate nurses in the rural practice environment. Results The findings from this study showed that the provision of timely on-ward support for new graduates making the transition to rural nursing practice is affected and influenced by the skill mix and staffing allocation within the rural environment. As well, there is a lack of awareness by rural nurses of how to meet the on-ward support needs of new graduate nurses. Conclusions This study has identified the specific and unique aspects of the rural nurse's role and responsibilities for which the new graduate nurse requires incremental learning and intensive clinical support. Relevance to clinical practice The findings can be used by rural health services and experienced rural registered nurses to assist in implementing adequate and timely support for new graduate nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this paper is to present the findings from the new graduate nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. Background Evidence indicates that workload, skill mix and organizational pressures are still of concern for new nursing graduates within the Australian context and internationally. Many graduates are expected by employers to have high levels of independence, well developed problem solving abilities and be able to assume management and leadership responsibilities early in their graduate year. Design An exploratory, descriptive, qualitative case study design was utilised to determine the particular support needs over time that would assist with a safe transition to the rural nursing workforce. The aims of the study were to: (1) Explore the new graduate nurses' perceptions and experience of the nature and timing of support throughout their Transition to Practice Program in a rural setting; (2) Identify the functional elements of rural graduate nurse transition programs and develop guidelines that will assist in the design of Transition to Practice Programs that match the rural context and capacity. Methods A purposive sample of 15 new graduate nurses who had commenced a 12 month Transition to Practice Program within a rural health facility from northern New South Wales, Australia, participated in this study. In-depth individual interviews with the new graduate nurses were conducted at time intervals of three to four months, six to seven months and 10 to 11 months. Results One of the key findings of this study is that as the new graduate nurse making the transition to professional rural nursing practice moves along the transition continuum, there are particular and unique aspects of the rural nurse's role and responsibilities for which the new graduate nurse will require specific learning support during their transition. Conclusions When the new graduate moves from the role of the student to the less familiar role of professional practitioner, it is important that a rural Transition to Practice Program offers an incrementally staged workload and responsibilities that recognises the graduate's beginning nurse status. Relevance to clinical practice The study contributes new knowledge to the discussion of issues concerning support mechanisms for new graduate nurses as they make the transition to rural nursing practice. [ABSTRACT FROM AUTHOR]