August 2007 - Volume 1, Issue 4

MAN POWER DESIGN PROGRAM AND WORK REALITY SITUATION OF NURSES

Maryam Nooritajer Ph.D (1) Marbaghi Akram MS (2) (1) Assistant professor of Iran University of medical sciences. Manager department of community health nursing and M.C.H Vali -asr Ave. Rashid yasami St, School of nursing and midwifery. Fax: +98 21 88793805, E-mail:maryamnoorytajer@yahoo.com (2) Faculty member of Iran University of medical sciences. Vali -asr Ave. Rashid yasami St, School of nursing and midwifery. Fax: +98 21 88793805

ABSTRACT Considering that nursing graduates are included in the human force project in our country, the necessity of the investigation is felt. The results of this study would help nursing teachers to prepare students for entrance into clinical field and facing the real work situation and nursing manager to create an appropriate and favorable environment for them. Objective: Assessment Man Power Design Program and situation of the work nurses, Program in tasks such as duties, interactions with the Physicians, coworkers Design: This was a descriptive study in which self report Questionnaires were used As a data gathering tool. Sample: 166 nurses with 2-6 month's experiences of work contributed in this study. Results: many of them (n=161) reported positive experience in interacting with Physicians and other nurses, while some (n=147) said, That they had negative feedbacks. According to their experiences in a real situation 45.2% of the nurses said that they regret to choose nursing as a job, while 43.2% felt loss of motivation to work in hospital and 72% reckoned that educational program prepared them in a low to moderate degree for working in hospital. Conclusion: According to the results it the coworkers whom can have positive effects on new nurses; they should advise, lead and support new coworkers, and not to increase their stress by giving them so many responsibilities. Besides, complete orientation time and providing of a support system is highly recommended.

Keywords: work reality situation, new nurse's experiences, interactions

INTRODUCTION

The new nurses first occupational experience has a critical role in forming their understanding of a nurse role in providing patient care, job satisfaction and creating chance to progress in this field. ( Roberts, Lynn & Jones 2004).Zerwekh & Claborn(2000) state that :As soon As a new comers faces his/her first occupational experience, the role transition process beings.Strater & Decker mention that: Role transition can lead to clinical skill, personal growth,job satisfaction, organizational responsibility, competence, strength and professional socialization if it is done effectively. On the contrary, ineffective role transition could result in decreased self esteem appearance of dependant behaviors, diminished efficacy and finally occupational exhaustion.Kelly & Mathews(2001) also found that new graduates experience different sensations such as anxiety, tension, exhaustion, panic fear etc. In the process of role transition, Zerwekh & clarban (2000) believe that many sensations are experienced during role transition which can affect one`s physical and mental health status.

Ellis & Harthy (2000) express reality shock as another problem for graduates and state that, it occurs when the new comer find that providing favorable care is impossible because of existing limitations in the system. Duchscher (2001) also believes :The paradox between those educations provided to graduates and those observed in real situations cause disillusimment, confusion and hopelessness in these group.

According to those mentioned, it could be concluded that a critical part of the role transition is related to care giving, responsibility and coping with colleagues and real situations.

Considering that nursing graduates are included in the human force project in our country, the necessity of the investigation is felt. The results of this study would help nursing teachers to prepare students for entrance into clinical field and facing the real work situation and nursing manager to create an appropriate and favorable environment for them. The principle goal of this study is to describe early experiences of non conventional nurses in academic hospitals related to universities of Iran, Tehran and Shahid Beheshti, and the special goal of that is to determine nurses experiences in doing their tasks, cooperation with other nurses and clinicians and coping with work situations.

Hulsmeyer (1997) in a survey on role transition problems found that providing care for patients is one of the most important concerns for new graduates in role transition period.Chitty(2001) states that the most important concern for new comers is the adaptation with colleagues and occupational group.

Ellis & Harthy (2000) express reality shock as another problem for graduates and state that, it occurs when the new comer find that providing favorable care is impossible because of existing limitations in the system. Duchscher (2001) also believes :The paradox between those educations provided to graduates and those observed in real situations cause disillusimment, confusion and hopelessness in these group.

This is a descriptive study about non conventional nurse's experiences. The questionnaire was composed of two parts: first, demographic data and second, the experiences of nurses during their occupational period. The questionnaire validity and reliability was determined by content validity and test-retest methods, respectively.

Data collection performed in a 2.5 months duration from 14 August to 27 October 2004.Date analysis was done by SPSS (version 10) software.

The statistical society are composed of nurses graduated with Licentiate degree, Who are passing Human Force Project period in academic hospitals related to 3 medical universities in Tehran and 2 to 6 months of their activities have been passed. 166 subjects were selected and data collection performed by questionnaire designed according to the finding of researchers working on role transition .The questionnaire was composed of two parts : first, demographic data and second, the experiences of nurses during their occupational period.

The findings revealed that of 166 subjects, 143 had encountered one of problems listed in table-1.The results showed that nurses used different ways to overcome their problems including taking information by counseling or asking colleagues (86.3%), using references and text book to increase their fund of knowledge (56.2%) asking help from colleagues (49.7%) participation in reeducating program (9.2%) .Additionally, nurses reported positive results due to increased knowledge by study and asking (74.5%), improved clinical skills (72.5%) and learning new skills from colleagues(68%) more than negative results, significantly (table-2).

95.2% of study units were females, 65.1% of them being single and 31.9% married of whom 4.8% had children . 49.4% of study population were graduated from governmental university and 46.4% from another university, with remaining population from Army and National Bank universities.87.3% were graduated in 2003 . .55.42% worked in internal surgery wards, 26.53% in ICU, CCU and Emergency wards, 14.45% in pediatric and neonatal and 3.6 % in obstetrics and gynecology wards.
33.7% had not passed preliminary period and the remaining speeded a 1 day to 1 month period. 89.7% of subject was in rotation and 24.7% had a history of scholarship activity in this field, 1.8% being worked concurrently in a different hospital.

Results for the third objective of our study, determination of nurses experiences on facing the real job conditions, resulted that most of subjects would decreased their free time when encountered with time insufficiency .(81.3%), furthermore most of nurses (n=136) expressed higher fatigue (81.9%) when encountered with time insufficiency (81.3%), furthermore most of nurses (n=136) expressed higher fatigue (81.9%) . when deal with paradox between academic values and real conditions, most of subjects would join these two entity .(72.9%), the results showed that most cases had been dealt with obligatory unrelated activities (68.7%) and delighted extra time duties.(62%).(table 4).

In the case of nurses experiences for cooperation with other nurses and clinicians, the results revealed that more than half of them(58.4 to 88.6%) had encountered different supportive behaviors from other nurses but the number was lower for clinicians (10.8 to 38%) (Table 3).

The findings also showed that less than half of nurses (25.5 to 48.8%) had faced different annoying behaviors (criticism, conception, reproach from other nurses and even less number (11.4 to 24.1%) by clinicians. In the case of supportive behaviors, the majority of nurses indicated decreased stress and work load (64.6%) and rapid adaptation with work place (62.1%), and in the case of annoying behaviors, most of the subjects mentioned increased tension and stress (63.9%) and loss of interest in the job (52.4%)
the results showed that most cases had been dealt with obligatory unrelated activities (68.7%) and delighted extra time duties (62%). (table 4).

According to our results, 24.7% of nurses had faced expectations without enough training and 30.7% had encountered demands that would be supplied by an experienced nurse. (Table 4)

It seems, therefore, that managers expect inappropriately high capacities from new nurses and this leads to the ignorance of preliminary period and exertion of hard tasks on them. Finding reveals that nurses look at human Force project as a period which causes loss motivation to work in hospital (43.9%), remorse of selecting such a profession (45.2%), feeling of mental exhaustion (42.8%), anxiety and stress about wor k(41.5%).

Hopelessness and disillusion on real situations (39.8%), incompatibility to work in hospital and trend toward leaving the job after the end of the period (32.3%) and decreased physical fitness (31.9%). These results indicate that role transition have occurred ineffectively for them and as mentioned before, ineffective role transition causes lowered self esteem, physical and mental exhaustion, dissatisfaction and occupational determination.

According to the results, most subjects expressed loss of enough staff (91%) and facilities (68.1%) as a preventive factor to provide efficient care for the patients. In a survey conducted by Salehi, Abedi, Alipour, Najafipour and Fatehi (2001) on the difference between clinical cares and academic educations in Isfahan, the participant who had worked mainly for 5 months to 6 years described internal motives as the most effective factor in conjoining these elements. It seems, therefore, that new nurses have more motivation for maintain values and standards at the beginning but it decreases after a while, loss of support and criticism for spending time on patients care could be some causes of this problem. Another problem, most nurses were dealt with, is forcing them to do more than needed duties.(62%).This was mentioned not only by participants but also by two manger of study hospitals. That is due to loss of adequate staff. Indeed, work load is transmitted to non conventional nurses, and leads to engagement of such human forces into hospital activities with out passing preliminary period and Kelky (1996) that colleague supports are related inversely to work stress. Findings in table 5 are in accordance with other researchers.Duchsher (2001) and Derman & Moffit-Wolf (1997) found, in their study, that cooperation with colleagues who treat unfavorably causes stress and anxiety in new graduates. Therefore based on the results in table 5, it could be concluded that inappropriate behaviors of hospital staff particularly nurses and clinicians increase work load and stress and diminish interest in job among new graduates. If intolerable for nurses such a condition forces them to change their working schedules or place to avoid confronting these disturbing staff.

According to the results, nurses had deal more with loss of enough skill to employ equipments (37.3%), forcing a new condition (36.1%) loss of familiarity to routines (33.1%) (table 1). Additionally, based on the results, one third of study units had entered the work without passing, more than one third with only 2 weeks, and the remaining between 14 to 30 days of the preliminary period (36.2 and 30.1%, respectively)/

On the other hand, study population has encountered more disturbing and supportive behaviors from other nurses than clinicians. It could be caused by spending more time in cooperation with nurse fellows. Most nurses (62.1%) linked the fall in tension and stress to supportive behaviors and increased stress to disturbing behaviors. (63.9%) our findings confirm the results of other

According to the results, most of subjects used data acquired by counseling and asking colleagues (86.3%) to overcome new problems. Thus it could be concluded that colleagues are the most important factors for new comers to deal with occupational difficulties .So, one can say that dealing with different problems have resulted more positive experiences for this group (table 2).

Table 1. Frequency distribution of the problem according to the exerted task and sex

P, means significant

Table 2. Frequency distribution of the result from dealing with problems by the nature of result and age.

166 person were investigated from witch 147 person was encountered with inappropriate behavior.