Date of Award

Spring 1999

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)


Educational Policy and Leadership

First Advisor

Bogenschild, Erika G.

Second Advisor

Olson, Jane

Third Advisor

Bardwell, Rebecca


For more than twenty years I have been challenged by the need to prepare nursing graduates for the reality of clinical practice in an acute care setting. Accurate clinical judgment by registered nurses is critical to effective patient outcomes. I have experienced and examined this phenomena from the perspective of staff nurse, preceptor, staff development educator, clinical specialist, faculty, and manager. The problem is perhaps even more acute as we enter the new millennium and the ever increasing competitive demands on health care organizations to manage clinical resources effectively. No one is likely to dispute the need to facilitate the transition of the new graduate nurse from the relative security and ideal practice of the university, to the reality of managing a caseload of patients in the fast paced multidisciplinary environment of the acute care setting. The faculty are no longer present to provide direction and feedback to the novice nurse. The nursing manager of the department is accountable to provide an acceptable level of competent professional nurses. The need to provide an effective clinical orientation for the new graduate in a cost effective manner is part of the nurse manager's practice. The nursing literature was devoid of research based approaches to clinical orientation. Many acute care settings assign the new nursing graduate to a more experienced staff nurse who serves as a preceptor or mentor. The criteria to select the nursing preceptor had not been examined and may not have been given much thought relative to the responsibility placed on another staff nurse with little or no preparation to assume this role. The curricula and instructional methodology that most effectively prepare the staff nurse for the preceptor role had also not been studied. Nursing faculty strive to teach students to think critically in preparation for a clinical discipline that demands the ability to think critically under conditions where the patient and/or environment are often more complex than the reality presented in the classroom. The literature is clear that one needs to have knowledge in a content area in order to critically reflect on an issue and develop expertise. Experts, regardless of discipline, seem able to accurately perceive a new situation by clustering or patterning data in a manner that allows them to make an appropriate decision. Dewey noted that effective teachers know how to facilitate a situation so that learning occurs. Cognitive-field psychologists postulate that the learner is in constant dynamic interaction with the environment. The challenge for those involved in the education or development of new nurses is to create the environment that is most conducive to the development of clinical expertise in the novice practitioner. The intent of this research is to offer new knowledge relative to the orientation of the new graduate nurse in the acute care setting.



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