What Are the Elements of Work Readiness of New Graduate Nurses in the New Zealand Context? A Professional Consensus

Background: Preparation for practice as a Registered Nurse (RN) is an age-old concern, and the tension between nursing education and practice has been well described. There is increasing interest in work readiness of new graduate nurses in New Zealand due to a number of factors; the aging population, increased chronic/long-term conditions, health inequities for Māori and Pacific people, increased demand for mental health services, sicker hospital patients with shorter lengths of stay, increased demand for community health services, expanding use of technology and drug therapy, new infections, antibiotic resistance, migration, and the impact of climate change on health. This is the complex and ever-changing context in which new graduate nurses orientate, socialise, and learn to practice as an RN. Aim: To gain consensus across the nursing sector on the elements of work readiness of new graduate nurses in New Zealand and explore the work readiness framework in relation to the Western Institute of Technology Bachelor of Nursing Modern Apprenticeship degree. Methodology: The study used a modified Delphi methodology with a scoping literature review, focus group interviews, and two survey rounds. Participants were presented with 167 items and given YES and NO fixed answers to facilitate convergence to agreement and consensus on work readiness items. Participants were also asked to make judgement on expected levels of performance for each of the work readiness items, using an adapted professional tool. The resulting work readiness framework was explored, and judgements made by a focus group as to whether the work readiness items were ‘taught, practised and assessed’ in the Western Institute of Technology nursing programme. Results: Sixty-seven nurses working in tertiary education, district health boards, primary health care, aged care, community health, and professional bodies participated. Consensus levels were set at 70% and level of agreement was found in 85% of items presented. Four items met a NO consensus. No leadership items reached a YES consensus. The WR framework demonstrates that the highest expectations of WR element performance aligns with the knowledge component (knowledge/knows to), suggesting that NZ nurses view the main purpose of preparing NGNs for beginning professional practice is knowledge for practice acquisition. The lowest scoring component was found in proficiency (accomplished and well-practised) and in over three-quarters of the WR elements NGNs are not expected to be accomplished and well-practised. Ninety-two percent of the work readiness items were judged by the focus group informants to meet each of the criteria of ‘taught, practised and assessed’ in the Western Institute of Technology nursing programme, although the informants agreed that most of the expected levels of performance had been set at a low level; that Western Institute of Technology graduates performed at a higher level. Conclusion: A New Zealand new graduate nurse work readiness framework comprises 143 items with associated expected levels of performance. A transformational nursing degree model, such as the Modern Apprenticeship, can achieve work ready new graduate nurses. A 4th year internship is recommended for the nurse to develop proficiency in the workplace and achieve work readiness. The WR framework proffers an evidence base for articulating a national, curriculum mission, vision, framework, and programme outcomes and the nursing profession needs to re-claim nursing education to ensure a consistent contribution to the wellbeing of the citizens of Aotearoa New Zealand