Moore, Linda Weaver PhD, RN, CNS, CNL; Kelly, Cynthia W. PhD, RN, CCP, CNL; Schmidt, Susan PhD, RN, CNS, COHN-S, CNL; Miller, Margaret EdD, RN, CNS; Reynolds, Marie MSN, RN, CNL
Maintaining a highly qualified nursing workforce is a continual goal of nurse administrators. Achieving this goal is an increasingly daunting task considering projections from the US Bureau of Labor Statistics.1 Analysts suggest that more than 1 million new and replacement nurses will be needed by 2016. Considering these projections, innovative approaches must be used to attract more individuals to nursing. One approach that brings new recruits to nursing is second-degree, also called accelerated, nursing programs. These educational programs are designed for individuals with degrees in other fields who desire a career in nursing. Second-degree programs, both at the baccalaureate and master's level, have flourished in the past 2 decades.2 Because of the proliferation of these programs, more individuals who have selected nursing as a second career are graduating and being employed. These individuals with a "reservoir of talent waiting to be tapped"3 can provide a solution to help resolve the future shortage.
Second-Degree Student Attributes
Although the empirical literature on second-degree nursing programs and their graduates is sparse,4 some scholars have noted attributes of these graduates that may be valuable to administrators. When compared with traditional graduates, second-degree individuals bring multiple life experiences and are highly self-motivated5; have greater confidence, self-awareness, and maturity4,6; have thoroughly researched nursing as a career and envisioned a career trajectory7; and have greater critical-thinking skills.8 A survey of employers of accelerated graduates reported that these individuals showed a high level of maturity through problem-solving skills and were proficient with communication.9 Employers also reported that they like to employ second-degree graduates because of their maturity, their strong clinical skills, and their ability to be quick studies on the job. Employers viewed these individuals as having successful track records and possessing an understanding of the work world that traditional graduates often lack.2 Employers acknowledge that these individuals bring a wealth of knowledge and experience to the profession.10
Scholars suggest that second-degree graduates are committed to the profession. Second-degree individuals' retention in the workforce is better than the norm11 and they are more likely to indicate plans to stay indefinitely in their work setting than traditional graduates.12
No studies were uncovered that explored the perceptions of second-degree master's graduates regarding their transition to the workforce. To continue to recruit these individuals and use them at their full potential, nurse administrators must better understand these individuals and their strengths.
Data Collection and Participants
Institutional review board approval was granted for a descriptive, qualitative study. Semistructured researcher-participant interviews were conducted through a 10-month period. Interview questions were developed by the researchers based upon a review of the literature, input from administrators, and the researchers' experience with second-degree graduates. Questions were designed to elicit information that would be useful to administrators and educators. Data presented in this article are derived from the administratively focused questions. Before each interview, informed consent was obtained. Interviews were conducted in 3 rounds: immediately after graduation, 3 months after employment, and 6 months after employment. Based on when the researchers believed the participants could provide thick, rich answers, the researchers selected at the outset what questions would be asked in which round of interviews. The principal investigator conducted all interviews. Each interview lasted 45 to 60 minutes. Interviews were tape recorded and transcribed. Transcriptions were verified for accuracy.
Second-degree prelicensure graduates of a master's program in the Midwest participated. Graduates were in the clinical nurse leader track. Immediately after graduation, graduates were invited to participate. After agreeing to be involved, to protect confidentiality, each participant was assigned an identification number. Only research team members had access to a locked file that contained the master list that connected the participant to the code number.
The entire cohort, 14 graduates, agreed to participate in the first round of interviews, 13 participated in the second round, and 12 continued to the third round. Two participants withdrew from the study because of personal reasons. Participants were aged 24 to 38 years (mean [SD], 28.71 [4.20] years). Of the 14 participants, 13 (93%) were European-American women and 1 was African American (7%). Additional demographic information is noted in Table 1.
Content analysis of transcripts from each interview was conducted independently by each research team member at the end of every round of interviews. The team consisted of 4 researchers, 2 with extensive qualitative research experience, and 1 research assistant. Independently, and then as a group, the researchers categorized data according to interview questions using constant comparison. Key thoughts and phrases, pulled from each category for each participant, were analyzed for common themes. The researchers agreed upon all themes. Data were analyzed in this manner at the completion of each round of interviews.
Rigor was enhanced when data were gathered through repeated interviews conducted by the same researcher, over time. Data were analyzed independently by each researcher and then agreement was reached among team members regarding the common themes. Findings were linked directly back to the data through an audit trail. Finally, several participants verified that findings were representative of their experiences.
The results highlight second-degree prelicensure master's graduates' views regarding their transition. For each interview question, the most common themes are presented along with the number and percentage of participants whose descriptions and thoughts fit in that theme. All themes, including the less common ones, are found in Table 2. Many times, participants' answers, because of their rich detail, contained multiple themes; thus, the percentages for each question are often greater than 100%.
First Nursing Position Determinants
During the first round of interviews, participants were asked to share the major determinants for selecting their first nursing position. Fourteen participants (100%) selected places of employment that they believed offered opportunities for growth. Such institutions were perceived as "progressive" and on the "cutting edge." One participant commented, "There's so much research being done and being brought onto the unit…I really like being on the new and up and coming." Other participants commented, "I saw more opportunities for me there" and "I wanted some room to grow, where there'd be room for me to do various things."
When selecting where to work, 10 (71%) of the participants gravitated to familiar institutions, where they had completed a clinical rotation as a student and had established connections with the staff. One participant noted, "I made a lot of contacts within that hospital…so that is ultimately why I chose to stay there." Another commented, "Since I had done my role transition there, I knew the administrative team. I had built a nice rapport…I knew this is where I wanted to start off."
Positive attitudes of nurses and positive unit environment were also important for 9 participants (64%). "The reason I chose that unit was the people…they seemed so happy working there…I thought that was a good sign." Another participant stated, "I felt very comfortable there. It is a very different environment than some of the other hospitals. I think that it tends to be more friendly, more community. People say 'hi' to you and they hold the door for you a little more than in other places."
Participants were asked during round 1 (14 participants) and round 2 (13 participants) what they believed to be their biggest strengths. The same 2 strengths emerged in both interviews, the ability to establish relationships with people (round 1, 11 participants, 79%; round 2, 7 participants, 54%) and being a strong critical thinker and problem solver (round 1, 8 participants, 57%; round 2, 9 participants, 69%). Multiple comments revealed their skill with establishing relationships. They spoke of communicating well with and developing connections with others, getting along with and being inclusive of others, being a good listener, and empathizing. Participants' comments included, "I get along with most people," "I'm pretty open, pretty easy to talk to," and "I really like working with people so that has helped with my relationships."
Participants perceived that they were strong critical thinkers with problem-solving skills, as evidenced in the following comments: "I like to ask lots of questions, I like to understand why things work the way they do" and "…being able to look at why something happens the way it does." Other similar comments included, "[I] try to figure out how the pieces of the puzzle fit together" and "let's solve this issue."
During all 3 rounds of interviews, participants were asked to address major concerns regarding transitioning into practice. During round 1, 12 of 14 participants (86%) expressed concerns that are often voiced by novice nurses: fear of making mistakes, hurting someone, or missing something. One participant stated, "I know I'm going to have some times where I make mistakes. I just hope those mistakes are small." Another commented, "I think my biggest concern is that I'm going to mess up. I don't want to make anyone's condition worse than it is." Other novice nurse concerns expressed included fear of being on their own, fear of the unknown, not knowing how to care for diverse types of patients, fitting in with staff, and handling codes. Fewer novice nurse concerns were voiced in the second (7/13 participants; 54%) and third (3/12 participants; 25%) rounds.
During round 1 of interviews, 9 of 14 participants (64%) were concerned about how their master's education and second-degree status would be received in the workforce by experienced nurses. They were concerned that they would face unfair labels, judgments, and expectations. Several spoke of the "stigma" attached to being a master's-prepared, novice nurse. One participant noted, "They [nurses] might feel against us because we've only done it [schooling] for 2 years and we've got our master's already. I mean we've already felt that stigma…some of the nurses [during our clinical rotations] would say, 'how can you already have your master's, when you didn't get your bachelors degree in nursing, how is that possible?'" As a result, some of the participants were reticent to let experienced nurses know their degree status. "I do have a fear of letting people know that I have a master's degree, I want to just blend in…" Other concerns related to having their master's degree included that others would assume they wanted management positions, feel intimidated, and assume they knew something just because they had advanced degrees. During the second round of interviews, 7 of 13 participants (54%) voiced similar concerns, whereas in the third round, only 2 of 12 participants (17%) voiced that concern.
During round 3, the participants were asked what they believed enhanced their transition. Eight of 12 participants (67%) identified factors from within the work setting. Residency or intern programs were helpful, as noted in this comment, "I think the internship that I did helped a lot. Just to see things. I learn by practicing, by seeing." The importance of well-matched preceptors is also evident in this statement, "My first preceptor…we were just on totally different pages…. My second preceptor was amazing. She was awesome…we totally clicked." Another participant noted that familiarity with the setting enhanced transition, "…the good thing for me…was that I had done clinical there so that helped because I was familiar and I already knew the computer system and things like that."
Relationship With Nurses and the Team
Participants were asked to comment on their relationship with other nurses and the interdisciplinary care team during the second and third round of interviews. During rounds 2 and 3, respectively, 7 of 13 participants (54%) and 7 of 12 participants (58%) described their relationship with other nurses in a positive manner without reservations. Comments such as "They were very welcoming," "They have confidence in me," "They opened the door for me to ask questions," "They keep an eye out for me," and "I have made some good friendships" support their perceptions of positive relations. Although the remainder of participants viewed their relations with other nurses to be positive overall, some had reservations. Participants spoke of experienced nurses forming "cliques," being "intimidating," and "questioning" their degree.
When questioned in rounds 2 and 3 about their relations with interdisciplinary health team members, 100% of participants in both rounds perceived these relations to be overwhelmingly positive. There were no qualifying comments or hints of negativity. Comments regarding relations with the team included the following: "Respect for what I have to say," "Everybody brings their expertise," "Supportive and always helpful," "They respect my education," and "We learn from each other."
Advice to Nurse Administrators
During round 3, participants were asked what advice they would give to nurse administrators hiring second-degree graduates. All participants suggested that administrators determine the graduate's previous field of study and career experience and use that knowledge to benefit patient care and the nursing unit. One participant stated, "Find out what they know and what it is that they have in their heads…use it…I mean you have these people who are second-degree people…use them, pump them for all they are worth." Another noted the importance of listening to second-degree graduates when she stated, "Listen to their ideas. They're going to have more exposure…they might be able to really help…respect that other area and find ways to incorporate it into that unit…use one person for multiple things."
This study highlights important points for nurse administrators employing second-degree master's graduates. All participants selected their first position based on their perception that the setting fostered growth. Administrators hoping to recruit these graduates must provide opportunities within their institutions that foster the growth desired. Opportunities to hone their bedside skills and opportunities beyond the bedside such as career ladders, journal clubs, institutional committees, and research teams are ways these graduates could continue to develop and be challenged.
More than 70% of participants were drawn to institutions where they had previous exposure, generally during a student clinical rotation. This finding highlights the importance of student clinical experiences serving as a springboard to a pool of future recruits. Administrators in concert with faculty should strive to ensure that clinical rotations provide excellent learning opportunities. Time spent working with faculty to arrange rotations that meet these students' needs is often time well spent.
Most participants (64%) noted that the overall "mood" of the work environment was a major determinant in their selection of employment. As students, they "size up" a unit, making judgments if they should consider future employment there. Administrators must work with the staff to ensure that they understand the importance of positive attitudes and positive nurse-to-nurse relationships. A positive work environment is the responsibility of every healthcare team member, but a major responsibility for healthy work settings rests with nurse administrators who must role model positive behaviors.
Employing nurses who understand the art and science of nursing is important. One finding suggests that second-degree graduates have strengths that enhance their understanding of both. Participants viewed themselves as being skilled in establishing relationships, a component of the art of nursing, and being strong critical thinkers, a needed component of the science of nursing. Because nursing is relational work, no administrator can deny the importance of hiring nurses who can relate well with others. This is an interesting finding considering that previous studies indicate that second-degree individuals often come to nursing for reasons other than relating to people, reasons such as financial stability and multiple employment opportunities.13,14 Finding that these graduates perceive the establishment of relationships as one of their strengths is important for administrators who may be questioning whether these individuals are coming to nursing for "stability" versus viewing nursing as a "good fit." Participants perceived themselves as strong critical thinkers and problem solvers. Although this was the participants' perception, other studies support this view.8,9 Considering the complexities that exist in the current healthcare system, nurse administrators must continually strive to employ nurses with strong problem-solving and critical-thinking skills.
Perhaps, one of the most interesting findings was that despite their advanced level of education, their maturity, and their past work experiences, these graduates had many of the same concerns that traditional graduates experience while transitioning. Early in the transition process, 86% of participants voiced concerns often expressed by novice nurses, such as a fear of making mistakes or missing something. This finding underscores the importance of not assuming that age, maturity, and educational level initially equate with clinical expertise. Administrators must remember that second-degree prelicensure graduates require mentoring, guidance, supervision, and encouragement, similar to any novice nurse. Although these graduates have a broad knowledge base, clinical expertise develops over time. The findings also indicate that although novice nurse concerns are paramount initially, those concerns diminish fairly quickly with these graduates (round 2, 54%; round 3, 25%). As suggested in the literature, these individuals are "quick studies."2 This suggests to administrators that despite the fact these individuals begin as clinical novices, they quickly move to be strong, confident, reliable members of the nursing team.
Nurse administrators understand the importance of a cohesive team. Studies note the link between good nurse-to-nurse relationships and job satisfaction15 and prevention of burnout.16,17 Administrators should be encouraged noting that participants in this study viewed themselves as team players. All perceived that they had good relations with the interdisciplinary care team and overall saw themselves as having good interactions with experienced nurses. It is interesting to note that although 100% of the participants saw their relations with members of the team as positive, they were reserved in their thoughts regarding interactions with experienced nurses. Finding seasoned nurses "intimidating" and having difficulty breaking into "cliques" is of concern. As noted previously, nurse administrators must be vigilant to the overall tone of the nursing units, ensuring that nurturing care environments exist not only for the patients but also for new graduates.
Finally, the participants urged nurse administrators to question these newly employed second-degree graduates regarding their previous work experience and educational backgrounds and provide avenues for these backgrounds to be used as assets for the betterment of patient care and the nursing unit. Several participants noted that administrators never asked questions regarding previous work experience or education. Administrators must capitalize on assets when hiring these individuals. Patient care issues are multifaceted and complicated, requiring a broad knowledge base to resolve. Business, psychology, religion, and journalism backgrounds may all prove helpful in looking at patient care issues from a different perspective. One participant stated, "don't be skeptical" but instead use this untapped resource to its full potential.
When interpreting findings from this study, certain limitations should be considered. Participants for this study were graduates of one nursing program. These graduates were from one graduate cohort. Perhaps, graduates from other schools of nursing have differing views regarding their transition-to-practice experience. Another limitation of the study is that graduates were not interviewed at the 1-year timeframe when the graduates' descriptions of the transition process might have been even more detailed.
This study provides insight into the transition-to-practice experience of second-degree prelicensure master's graduates. Findings can assist administrators in understanding these graduates and how to best use their assets. Second-degree graduates are indeed a reservoir of talent that administrators should continue to tap without reservation to further enhance patient care delivery in the future.
© 2010 Lippincott Williams & Wilkins, Inc.