The experiences of new graduate nurses caring for the deteriorating patient in rural areas: An integrative review

Background: With an ageing population and an increase in chronic conditions, nurses are increasingly providing care for patients with complex healthcare needs who are at risk of deterioration. Although care for the deteriorating patient is expected of nurses, newly graduated registered nurses, being those in their first year of practice since graduation, often feel ill-equipped and unprepared to provide this care and it is unclear as to how working in rural areas may impact the management of care provision.

Aim: The aim of this review was to identity and explore the literature focused on the experiences of new graduate nurses caring for the deteriorating patient in rural practice areas.

Methods: An integrative review methodology was selected with the aim to review and provide a more comprehensive understanding of New Graduate Registered Nurses (NGRNs) caring for the deteriorating patient by exploring the empirical literature. Literature reviewed was drawn from Australia, the USA, Ireland, Canada, and Sweden. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to present the findings. Literature was critically appraised against the Critical Appraisal Skills Program qualitative studies checklist. Thematic analysis was undertaken to identify relevant themes.

Findings: Three major themes were identified within the literature; “preparedness for caring for the deteriorating patient,” “experiencing the deteriorating patient,” and “new graduate support for safe patient care.”

Discussion: NGRNs experience stress and anxiety around situations involving the deteriorating patient and are unprepared to manage these. In rural areas NGRNs have additional stressors including increased responsibilities with requirements of everyday care needs and additionally emergent situations, however, the experience of new graduate nurses managing such emergent situations such as deteriorating patients is unknown.

Conclusion: No specific studies were found on NGRNs caring for the deteriorating patient in rural areas.Further research is needed to explore the experiences of the newly graduated nurse caring for the deteriorating patient with the added complexities of the rural environment so that appropriate education, orientation, ongoing development and support to ensure safe patient care can be provided.