The Evaluation of Graduate Nurses' Performance Gaps in Blood Administration

Abstract

New nurse graduates are expected to help relieve the current and pending massive nursing shortage anticipated in the nursing field (Goode, Reid Ponte, & Sullivan Havens, 2016). However, there is a discrepancy between evaluations of new graduate readiness and the expectation to provide competent complex care. Ninety percent of undergraduate nursing education leaders feel new graduate nurses are prepared to practice, yet 90% of hospital nurse administrators disagree. When graduate nurses participating in nurse residency programs perform self-assessments on procedural readiness, emergency management and blood product administration/transfusion are frequently in the top three skills/procedures they feel uncomfortable performing independently. Yet little is published regarding specifics within the procedure that lead to a gap in readiness to practice. In this study, an exploratory mixed methods action research approach was taken to evaluate graduate nurses’ performance gaps in blood administration procedures. Graduate nurses participating in a nurse residency program (n = 143) completed online surveys questioning their experiences and comfort with blood administration. Questions asked graduate nurses about nursing school blood administration training, stated comfort with performance, and experiences surrounding blood administration. Open- ended questions were used to identify common themes for more educational opportunities and the graduate nurses’ previous experience. Expert nurses were interviewed to gather organizational and department- specific blood administration processes relative to the patient care. Expert nurses (n=8) were asked about organizational orientation and performance practices in blood administration. Qualitative analysis of the interview themes was used to complete a preliminary procedural assessment. We then conducted consensus building to determine the underlying competencies needed for each procedural step (i.e., basic knowledge, psychomotor skill, and/or critical decision making) and the essentiality of each step for safe blood administration. Results indicated that graduate nurses had a mean comfort level with blood administration of 3.1 out of a 5-point Likert scale, near the “Undecided” anchor at 3.0. “Comfort” correlated positively with perceived Level of Difficulty in three of five subtasks: Starting a Transfusion, Assessment, and Documentation. “Comfort” correlated positively with self-perceived Learning Achievement for the subtasks “Starting Transfusion” and “Documentation.”. Survey results revealed no statistically significant relationship with “Comfort” and “Recent Semesters” or “More Semesters” of learning; Learning Difficulty with understanding “Purpose” or “Risks”; or self-perceived Learning Achievement in understanding “Purpose,”, “Risks,”, or “Assessment.”. OfIn those participants with previous experience prior to licensure (80%, n = 114), most participants were Nursing Assistants in acute care (48%, n = 55) and Nursing Assistants in nonacute care (18%, n = 21) – patient care areas which require significant amounts of hands-on patient care. However, one-way between-groups ANOVA comparing the effect of previous experience on “Comfort” showed no statistical significance at the p < .05 level [F(2, 111) = 1.109, p = .333]. When comparing graduate nurse survey responses and nurse expert interview themes, only two commonalities were emphasized within blood administration: skills within starting a transfusion and assessment of the patient receiving a blood transfusion. This study explored and found specific factors and curriculum training characteristics consistent with graduate nurses’ level of comfort with blood administration. The study also provided a 6-Phase Blood Administration Task List to be used in future competency-based assessment and education.