Refining nursing practice through workplace learning: A grounded theory

AIMS AND OBJECTIVES: To examine how experienced registered nurses in direct patient care learn within the constantly changing contemporary healthcare environment. The key objectives were to examine educational interactions amongst workplace, nurse and nursing practice, with a focus on the influence of context. BACKGROUND: Registered nurses must maintain competence throughout their careers. The related ongoing learning is triggered by external demands and nurses' internal motivation. Experienced nurses, poised to retire, have worked through the recent tumultuous changes in health care and therefore provide insight into how they sustained excellent patient care. DESIGN: The methodology for this study was a grounded theory informed by symbolic interactionism. EQUATOR guidelines for qualitative research (COREQ) applied. METHODS: Data collection entailed semi-structured interviews with experienced nurses across diverse settings and participant observation on two acute care units. Analysis of data was conducted using three-level coding, constant comparison, theoretical sampling and extensive memoing. RESULTS: Refining nursing practice begins during nursing education and early employment. Getting grounded involves establishing key capabilities, specifically becoming self-aware, setting high standards, cultivating healthy apprehension and seeing the whole patient picture. Three catalysts for workplace learning are mentor-guides, workplace camaraderie and a highly functional workplace team. Refining nursing practice includes both formal and informal learning; however, significant nursing expertise is developed through puzzling and enquiring, an iterative process of learning while nursing. CONCLUSIONS: Facilitating the development of capabilities for nurses' workplace learning during nursing education and early work experiences contributes to excellent patient care. Healthcare organisations need to value and support the unique contributions of mentor-guides in the clinical setting and promote individuals' development of expertise by nurturing camaraderie and developing highly functional workplace teams. RELEVANCE TO CLINICAL PRACTICE: Attending to the processes and catalysts for nurses' workplace learning will contribute to excellent patient care.