Saudi Nursing Interns' Perceptions of Clinical Competence Capstone Project

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Saudi Nursing Interns' Perceptions of Clinical Competence Upon Completion of Preceptorship Experience

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Saudi Nursing Interns' Perceptions of Clinical Competence Upon Completion of Preceptorship Experience

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The purpose of this quantitative cross-sectional descriptive/correlational design research study is to test Benner's (1982) theory "From Novice to Expert" in relation to the impact of preceptorship on the competency of undergraduate nursing interns at King Fahad Medical City (KFMC). This study seeks to determine if preceptors provide the support recommended by Benner (1982) to the undergraduate nurse during their preceptorship program and if these have an impact on undergraduate competency levels. The study will use two reliable validated clinical competence questionnaires based on Benner's (1982) competencies (Shwu & Ching, 2014) and Knowles Adult Learning theory and nursing process (Kim, 2007). Benner's (1982) theoretical framework of novice-to-expert practitioner development will provide the framework for the study. The research question will address the impact of the preceptorship on undergraduate nurse interns' competency levels. A probability sampling technique will be used to recruit undergraduate nursing interns from King Fahad Medical City, Saudi Arabia who will be asked to complete the tool. Probability sampling technique will enable the researcher to make statistical inferences (i.e., generalizations) from the sample being studied to the population of interest and assess how confident the researcher is about such inferences. The researcher used the probability sampling technique to help minimize sampling bias (Creswell, 2011). These interns have completed a five-year full time nursing training educational program including a 12-month foundation year followed by a12-month structured nursing internship program. It is the 12-month internship program that is the focus of this study.

Problem Statement

TOPIC: Capstone Project on Saudi Nursing Interns' Perceptions of Clinical Competence Assignment

King Fahad Medical City (KFMC) is a unique health care system where 95% of the nursing workforce is recruited from outside the country. Nurses of different backgrounds and nationalities are expected to precept graduate nurses. These nurses have their own cultural beliefs and values that are different from those in the Saudi culture (AlMalki & Fitzgerald, 2011). Despite completing four full years of nursing degree programs, 12 months of a structured internship program and opportunities for clinical placement supported by dedicated preceptors, it was noted that nurses who recently graduated from the 12-month long internship program lacked the basic nursing skills to enter into the nursing workforce (KFMC Internship program report, 2013). Educators, nursing leaders and medical teams reported graduate nurses not only struggle with performing basic nursing duties, but also lack the theoretical background to perform them. Many are questioning why these problems exist and why graduate nurses fail to perform basic nursing skills (KFMC Nursing Internship Program, 2013).

According to Mamchur and Myrick, (2003), the transition period from being a student nurse to becoming a staff nurse may lead to increased feelings of anxiety, depression and frustration. These feelings can lead to absenteeism resulting in lower work productivity, job dissatisfaction, burnout and ultimately them leaving the nursing profession, which only further contributes to the nursing shortage.

Nursing graduates have reported feeling disoriented and on the verge of rethinking their choice of nursing as a career. This additional stress may lead to early termination of their first position and the possibility of leaving nursing altogether. Nurse graduates experience a stressful role transition into healthcare organizations, with 30% leaving their first job within 1 year and 57% leaving by 2 years of employment (Aaron, 2011). The nursing education department at King Fahad Medical City recently conducted a basic nursing competency validation with written exams that showed poor performance by the participants. Unless the current situation is reversed, KFMC will risk having graduating nurses that are not capable of providing safe patient care.


There have been significant changes in undergraduate nursing education over the last decade with emphasis on students' experiences and learning in the clinical environment (Bridie & Siobhan, 2010). These changes have come at a time when hospitals are struggling to hire qualified staff nurses while also managing increasing numbers and complexity of patient populations (Lillibridge, 2007). RN's as part of their professional duties are now expected to support nursing student clinical education and assessment in their role as clinical preceptors (Chow & Suen, 2001).

The role of preceptors was developed in the 1970s to facilitate the transition of new nurses to the reality of clinical nursing practice (Omansky, 2010). The role gained popularity and has become the most common method of preparing nursing students for the clinical environment (Bott & Lawlor, 2011). Nursing students and new nurse graduates very often face challenges in transitioning to the professional role due to insufficient experience, limited exposure to clinical skills and patient management; lack of critical thinking skills; and other environmental factors (Chen, Duh, Feng & Huang, 2011; Sandau & Halm, 2010).

Supporting and precepting nursing students and new nurse graduates requires that preceptors act as a role model, mentor and teacher so that the preceptee can successfully integrate nursing theory into nursing practice (Aaron, 2011; Forneris & McAlpine, 2009; Omansky, 2010). Nursing preceptorship programs play an important role in retaining the new generation of nurses engaged to remain at the bedside. In addition, preceptors assist new nursing graduates to demonstrate leadership skills in problem solving, priority setting, decision-making, delegation of responsibility and accountability (Ferguson & Day, 2007). Preceptors facilitate educational activities that promote continued learning and professional growth.

Nursing in Saudi Arabia

The nursing history of Saudi Arabia dates back to the time of Prophet Mohammed, PBUH under the leadership of Rufaida Al Asalmiya when she set up outposts for Muslim armies during the holy wars (Miller-Rosser et al., 2006; Tumulty 2001). Rufaida and her colleagues provided first aid, drinking water and protected the wounded soldiers from getting infections from the desert wind and heat. Ms. Rufaida continued to provide nursing care in peacetime so she could train more women to become nurses and provide health education (Miller-Rosser et al., 2006). Ms. Rifaida is considered the first nurse and the founder of nursing in the Islamic era.

Nursing Education in Saudi Arabia

The Kingdom of Saudi Arabia is a young country with a new nursing profession, which is facing challenges in meeting the health care needs of a growing population. It was not until 1954 that the Kingdom of Saudi Arabia created the Ministry of Health, which was followed by the construction of public hospitals and health care centers. As a result, the development of nursing and nurse training began under the Ministry of Health (MoH) in collaboration with the World Health Organization (WHO).The first formal training for nurses was established at a health institute in Riyadh, known as a Health Institute Program, and was specifically for the training of male nurses only (Tumulty, 2001). The first fifteen male nursing students had only elementary school preparation and completed one year of the nursing training program (Tumulty, 2001). The limited education and training provided by this early program was inadequate in producing qualified nurses. As nursing education in the Kingdom developed, the Ministry mandated that nursing training programs be extended to three years and opened more training programs to increase the number of nurses in the country. The first full Bachelor of Science in Nursing (BSN) program was introduced in 1976 and was followed by the Master of Science in nursing program in 1987. There are currently over fifteen schools offering BSN Programs in the country.

Nursing Workforce

Like many Western and European countries, Saudi Arabia faces a chronic nursing shortage of nurses. The nursing workforce in Saudi Arabia relies heavily on foreign trained nurses who are recruited globally. They account for 70.9% of the total nursing workforce with Saudis comprising only 29.1% (Aboul-Enein 2002; Almali et. al., 2011; Luna 1998; Tumulty 2001). The majority of patients and families speak only Arabic, while most of the health care providers including nurses communicate in English. For many nurses practicing in Saudi Arabia English is not their first language and neither are they competent in Arabic (Simpson et al., 2006). Though the majority of these expatriate nurses are from India and the Philippines, the Kingdom also recruits from North America, the United Kingdom, Australia, South Africa, Malaysia and other Middle East countries (Aboul-Enein 2002; Luna, 1998).

Nursing compared to other professions is a less desirable career and not the career of choice for many in Saudi Arabia. There are many contributing factors to this such as a difficult and risky working environment, limited career opportunities, family commitments and the widespread perception of the role of a nurse as a submissive female hospital worker with a poor public image (Almutairi & McCarthy, 2012; Mansour & Saleh, 2014).The rapid development of the health care system in Saudi Arabia and the changes in the health care needs of the population as a result of the increasing affluent lifestyles demand an increase in the proportion of indigenous nurses who can deliver culturally appropriate high quality patient care and share the Arabic language of their patients (Aldossary & Barriball, 2008). The fact that only 30% of the nursing workforce are nationals meaning that the health… [END OF PREVIEW] . . . READ MORE

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