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Care and compassion: the experiences of newly qualified staff nurses.

AIMS AND OBJECTIVES
To explore newly qualified staff nurses' perceptions of compassionate care and factors that facilitate and inhibit its delivery.


BACKGROUND
It is known that the transition from student to staff nurse is challenging due to a variety of factors including increased expectations of competence, inadequate staffing levels and eclectic support.


METHODS
A qualitative approach was taken. Data from newly qualified staff nurses (within first year post registration) were collected by focus groups (n=6, total participants=42), using a flexible agenda to guide discussion. Data were analysed to locate codes and themes.


RESULTS
Support for newly qualified staff was eclectic rather than systematic. Participants felt they were 'flung in at the deep end' and 'left to sink or swim'. Some staff were perceived as 'ingrained in the woodwork' and resistant to change of even a minor nature, creating an environment of 'institutionalised negativity'. Clinical supervision was considered a support when available. Compassionate care was a tautology for most participants, that is, care would not be care in the absence of compassion. Compassion as a concept was described frequently with reference to situations in which it was absent. Nursing was 'more than just a job', but an occupation in which 'emotional engagement' is not only desirable but a prerequisite for provision of high-quality care.


CONCLUSION
Findings indicated a tension between 'agency' (the ability of individuals to act) and 'structure' (physical, social, managerial and cultural environments within which care takes place). Supportive environments facilitate provision of compassionate care although individuals remain accountable for their own practice. This study adds depth to existing literature about newly qualified staff nurses, with specific reference to compassionate care.


RELEVANCE TO CLINICAL PRACTICE
Undergraduate nursing programmes should prepare students for the reality of delivering compassionate care despite competing commitments. Managers of care settings should ensure that a formalised supportive framework is in place for registered nurses throughout their first year of practice.