Abstract
Background
The impact of the COVID-19 pandemic has brought about major changes throughout nursing education. Most clinical practicum has been substituted by skills laboratories, simulation laboratories, virtual simulation or written assignments. Nursing students who have experienced this change in practicum have fears about their future role as new graduate nurses. However, to date, no studies have been conducted exploring how their fears work when they become new graduate nurses.
Objectives
To investigate the status of nursing practicum at nursing universities before and during the COVID-19 pandemic, and to explore the relationship between difficulties in nursing tasks, work readiness, reality shock, and organizational socialization among new graduate nurses with nursing practicum experience during this pandemic.
Design
Descriptive comparative research design.
Participants
178 new graduate nurses with a clinical experience from 1 month to less than 12 months and graduating from nursing universities in 2021, the 3rd grade in 2020 and the 4th grade in 2021.
Methods
Cross-sectional study via a self-administered online questionnaire measuring difficulties in nursing tasks, work readiness, reality shock, and organizational socialization. Data were analyzed by descriptive statistics, independent t-tests, Pearson correlation.
Results
New graduate nurses were divided into 72 in the Clinical/Clinical group and 106 in the Clinical/Substitute group. There was a significant difference in the difficulties in nursing tasks (t = −2.342, p = .020), but there were no significant differences in work readiness, reality shock, and organizational socialization between the two groups.
Conclusions
Efforts in the clinical field to increase the adaptation of new graduate nurses could prevent problems that may arise due to the restrictions and absence of clinical practicum. Discussions should be continued to develop and implement efficient nursing practicum education that not only can reduce the gap between nursing education and nursing practice, but also respond appropriately to any pandemic situation.
Keywords: COVID-19, Nursing education, Nursing students, Socialization
1. Introduction
On March 11, 2020, the World Health Organization (WHO) declared a global pandemic of Coronavirus disease-2019 (COVID-19) (World Health Organization, 2020). Within Korea, the Government announced a national action plan to prevent the spread of COVID-19 and implemented intensive social distancing policies (Ministry of Health and Welfare, 2020). In accordance with the Ministry of Education's academic management guidelines, all educational institutions postponed the start of the 2020 academic year and conducted the semester with all sessions delivered in online mode (Ministry of Education, 2020). The response to this pandemic was not limited to Korea, but was a global trend. Nursing schools have transitioned to distance learning (Weston and Zauche, 2021). The shift to distance learning posed many challenges for teachers and students, with these challenges being more prominent in nursing education, which requires more than a certain number of hours of nursing practicum but also skills based workshops (Wallace et al., 2021).
Nursing is a practical discipline based on theoretical knowledge. Nursing students must develop the ability to deal with potential and actual problems through nursing practicum experiences (Song and Kim, 2013). Within most nursing universities in Korea, theory classes are held in the first and second years, and nursing practicum is added from the third year. Therefore, third and four-grade nursing students must complete both theory classes and nursing practicum during the semester. One of the nursing practicums takes place in different nursing fields outside of university, within various healthcare institutions including hospitals and public health clinics, which are referred to as clinical practicum.
However, due to the spread of COVID-19, most institutions were unable to provide clinical practicum sites for safety reasons, and many of the clinical practicums were substituted by non-face-to-face online learning (Bang et al., 2021; Kang, 2020). The International Nursing Association of Clinical Simulation and Learning (INACSL) and the Society for Simulation in Healthcare (SSH) officially stated their support for the use of virtual simulation as a replacement for clinical hours for nursing students during the COVID-19 crisis (Foronda and Armstrong, 2020). These cause a sharp decrease in the opportunities for nursing students to experience clinical field prior to graduation, which may be related to maladjustment of new graduate nurses.
Substitute practicum included ‘skills laboratories’, ‘simulation laboratories’ using models or mannequins, ‘virtual simulation’ in an online environment, and ‘written assignments’ (Lim, 2021; Sim, 2021). Among substitute practicum, virtual simulation enables students to experience patient care similar to the real world (Kang, 2020). Virtual simulation is a type of simulation that injects humans in a central role by exercising motor control skills, decisions skills, or communication skills in a virtual reality similar to reality (Hancock et al., 2008). It has positive effects on critical thinking (Lim and Yeom, 2020), problem-solving ability (Ha and Lee, 2021), clinical performance (Yoon et al., 2021). The results from a meta-narrative review showed comparable student engagement, educational outcomes, and student proficiency with both simulation and clinical practicum, even when a percentage of clinical hours is replaced with simulation (Roberts et al., 2019). Therefore, virtual simulation has been suggested as a teaching-learning strategy that can substitute for clinical practicum.
There is a long-running debate about the value of simulation versus practical experience (Badowski et al., 2021; Ma and Nickerson, 2006). Despite the advantages of simulation, one reason for the ongoing debate is that nursing students who have experienced simulation instead of practical experience fear their future role as nurses (Lim, 2021; Suliman et al., 2021). However, to date, no studies have been conducted exploring how these fears translate to the practice environment when they become new graduate nurses.
1.1. Background
The significant nursing shortage is an ongoing global issue and a threat to the delivery of quality healthcare (Kaihlanen et al., 2020). In 2030, it is expected that there will be a shortage of at least 160,000 nurses in Korea (Korea Institute for Health and Social Affairs, 2015). As a way to address this issue, the enrollment quota for nursing universities has been steadily increasing, and as a result, the number of graduate nurses increased by about 100,000, from 13,065 in 2013 to 23,362 in 2022 (Korea Health Personnel Licensing Examination Institute, 2022). Nevertheless, the shortage of nurses in Korea remains unresolved. The main reason for this problem is the resignation of nurses. In 2020, the average resignation rate of Korean nurses is 14.5 %, and that of new graduate nurses with less than one year of working experience is 34.1 %, which is remarkably higher than the average one. Of the 23,064 newly employed nurses in 2020, 10,999 nurses (47.7 %) resigned within one year of employment, and the main reason for resignation was maladaptation (Korean Hospital Nurses Association, 2022). It can be confirmed that the core problem of the Korean nursing workforce is not the absolute shortage of nurses, but due to nurses leaving the profession.
Resignation of new graduate nurses not only provides the individual nurse with an experience of fatal frustration, but also causes a major setback in the demand and supply of registered nurses (Yoon, 2002). Specific measures to increase the retention of nurses should begin with resolving the ‘maladaptation’ identified as the main reason for the resignation of new graduate nurses. In the process of adapting to clinical settings, most new graduate nurses experience reality shock due to the gap between the knowledge or skills learned at university and the expected roles in hospitals (Caliskan and Ergun, 2012). At this time, new graduate nurses with low work readiness have difficulties in applying what they learned in school to practice (Leong and Crossman, 2015), and experience pressure and interpersonal problems due to poor work performance (Gardiner and Sheen, 2016; Sin and Kim, 2017). These difficulties lead to reality shock accompanied by excessive anxiety, fear of interpersonal relationships, rejection and degradation, hostility, anger, and fatigue (Kramer, 1974). Reality shock lengthens the clinical adaptation process (Duchscher, 2009). Clinical adaptation refers to the learning process of values, performance capabilities and expected behaviors required to perform roles as an organizational member, and social knowledge within the organization (Van Maanen and Schein, 1979). In other words, the organizational socialization of nurses means adaptation to the clinical field. It is difficult for new graduate nurses to adapt to the new organizational environment due to inexperienced knowledge and skills, role conflicts on job performance, and complex interpersonal relationships. Therefore, a systematic curriculum that can alleviate reality shock and promote organizational socialization is required from nursing universities by increasing the work readiness of nursing students.
However, due to the COVID-19 pandemic, most of the theory classes were changed to online lectures, and clinical practicum, which is a mandatory course for nursing students, has been mostly substituted by skills laboratories, simulation laboratories, virtual simulation, or written assignments (Ha and Lee, 2021; You and Cho, 2021). This means that nursing students lose important opportunities such as reducing fear of clinical field and gaining confidence as future nurses by providing nursing process to actual patients. Changes in nursing education imply that there is a possibility of negatively affecting the clinical adaptation of new graduate nurses. Accordingly, previous studies have been conducted with nursing students who experienced a sudden transition to online practicum (Kang, 2020; Lim, 2021; Wallace et al., 2021) or to confirm the effectiveness of online practicum (Bang et al., 2021; Kang, 2020). All of these were conducted for nursing students who had just experienced substitute practicum during the pandemic. Now that nursing students who participated in substitute practicum at the time of the COVID-19 pandemic have become new graduate nurses, it is necessary to identify their degree of clinical field adaptation.
1.2. Research aims
This study aimed to investigate the status of nursing practicum at Korean nursing universities before and during the COVID-19 pandemic, and to explore the relationship between difficulties in nursing tasks, work readiness, reality shock, and organizational socialization among new graduate nurses with nursing practicum experience during this pandemic.
2. Methods
2.1. Research design
We used a descriptive comparative research design to explore the work readiness, reality shock, and organizational socialization of new graduate nurses according to the type of nursing practicum.
2.2. Research participants
Participants were new graduate nurses with a clinical experience from 1 month to less than 12 months and independently provide direct nursing care at hospitals. Among new graduate nurses graduating from nursing universities in 2021, only nurses who were in the 3rd grade in 2020 (before the COVID-19 pandemic) and the 4th grade in 2021 (during the COVID-19 pandemic) were included using the convenience sampling. A sample size of 140 participants (70 participants per condition) was calculated through G*Power 3.1 by applying differences between two independent means with an effect size of 0.5, power of 0.9, and significance level of 0.05.
2.3. Instruments
We used a self-reported questionnaire consisting of two sections. The first section asked about demographic characteristics and nursing practicum related characteristics. Demographic characteristics included sex, age, hospital type and location, working department, university location, and the clinical experience. The characteristics related to nursing practicum included questions about the practicum types, satisfaction, usefulness in performing nursing tasks, and the proportion of clinical practicum according to grade. The second section consisted of four tools that measure difficulties in nursing tasks, work readiness, reality shock, and organizational socialization. Permission to use each of the instruments was obtained from its developers (Lee et al., 2021; Sin et al., 2014; Sohn et al., 2008).
2.3.1. Difficulties in nursing tasks
The question, “Please indicate the degree of difficulties in nursing tasks that you felt as a new graduate nurse due to the lack of clinical practicum” was answered using the Visual Analog Scale (VAS) developed by researchers. The VAS consists of a 10 cm line with two end points representing 0 (no difficult) and 10 (extremely difficult).
2.3.2. Work readiness
Work readiness was defined as “the degree to which graduates possess the characteristics and attributes that prepare them for success in the workplace” (Walker et al., 2015). This was measured using the Korean version (Lee et al., 2021) of the Work Readiness Scale for Graduate Nurses (Walker et al., 2015), which consists of 46 items in four subdomains: work competence, social intelligence, organizational acumen, and personal work characteristics. Each item was measured on a 10-point Likert scale (1 = completely disagree to 10 = completely agree). A higher score indicated a higher level of work readiness. Cronbach's alpha was equally 0.95 in both the Korean version scale and this study.
2.3.3. Reality shock
Reality shock was defined as “the total social, physical, and emotional response of a person to the unexpected, unwanted, or undesired, and in the most severe degree, to the intolerable. It is the startling discovery and reaction to the discovery that school-bred values conflict with work-world values” (Kramer, 1974). This was measured by using the Korean version (Sin et al., 2014) of the Environmental Reality Shock Instrument Issues and Concerns (Kramer et al., 2013). The scale consists of 22 items and each item was answered on a 4-point Likert scale (1 = no worry at all to 4 = extremely worried). A higher score indicated a higher level of reality shock. Cronbach's alpha was equally 0.89 in both the Korean version scale and this study.
2.3.4. Organizational socialization
Organizational socialization was defined as “the process by which an individual comes to appreciate the values, abilities, expected behaviors, and social knowledge essential for assuming an organizational role and for participating as an organizational member” (Louis, 1980). This was measured using the instrument developed by Sohn et al. (2008). The scale consists of 39 items and the items were scored on a 5-point Likert scale (1 = not at all to 5 = very much). A higher score indicated a higher level of organizational socialization. Cronbach's alpha in the original scale and this study were 0.97 and 0.88, respectively.
2.4. Data collection
Data collection was conducted from October 21, 2021 to April 5, 2022. Recruitment documents were posted in nurses' rest areas including a direct link to the survey website. We also posted it in three online communities for nurses. Only participants who voluntarily agreed to participate signed the online consent form, and completed the online questionnaire.
A total of 186 new graduate nurses participated, and 178 participants were finally included in the analysis, excluding 8 participants who did not meet the inclusion criteria. In order to categorize nursing practicum experience during the COVID-19 pandemic, 72 nurses were assigned to the Clinical/Clinical group (CC group) and 106 nurses were assigned to the Clinical/Substitute group (CS group) based on the 40 % of clinical practicum rate for each year.
2.5. Statistical analysis
Data were analyzed by descriptive statistics, independent t-tests, Pearson correlation, and Cronbach's alpha coefficient using SPSS version 20.0.
2.6. Ethical considerations
The study was approved by the Institutional Review Board of the researcher's university (No. ewha-202111-0031-02).
3. Results
3.1. Descriptive characteristics
As shown in Table 1 , 92.1 % of participants were female and 98.9 % of those in their 20s, with an average age of 24.7 years. 78.1 % were working in tertiary hospitals, and all participants belonged to various departments in the following proportions: medical ward (26.4 %), surgical ward (23.0 %), intensive care unit (16.9 %), and integrated nursing care service ward (12.4 %). While most of them were working in hospitals located in Seoul (78.1 %) and Gyeonggi-do (20.8 %), the nursing universities they graduated from were distributed in all 13 cities and provinces. More than half the participants had 4 to 9 months of clinical experience (68.6 %) and the average tenure was confirmed to be 7.4 months.
Table 1.
Descriptive characteristics (N = 178).
| Characteristics | Categories | n (%) | M ± SD |
|---|---|---|---|
| Sex | Male | 14 (7.9) | |
| Female | 164 (92.1) | ||
| Age (years) | 23–29 | 179 (98.9) | 24.74 ± 1.66 |
| 30–39 | 2 (1.1) | ||
| Type of hospital | Tertiary hospital | 139 (78.1) | |
| Secondary hospital | 39 (21.9) | ||
| Working department | Integrated nursing care service warda | 22 (12.4) | |
| Medical ward | 47 (26.4) | ||
| Surgical ward | 41 (23.0) | ||
| Mother-child ward | 4 (2.2) | ||
| Emergency room | 10 (5.6) | ||
| Intensive care unit | 30 (16.9) | ||
| Operation room | 17 (9.6) | ||
| Othersb | 7 (3.9) | ||
| Location of hospital | Seoul | 139 (78.1) | |
| Incheon | 1 (0.6) | ||
| Gyeonggi-do (province) | 37 (20.8) | ||
| Gyeongsang-do (province) | 1 (0.6) | ||
| Location of university | Seoul | 55 (30.9) | |
| Incheon | 7 (3.9) | ||
| Daejeon | 11 (6.2) | ||
| Busan | 5 (2.8) | ||
| Ulsan | 6 (3.4) | ||
| Daegu | 6 (3.4) | ||
| Gwangju | 7 (3.9) | ||
| Gyeonggi-do (province) | 21 (11.8) | ||
| Gangwon-do (province) | 3 (1.7) | ||
| Chungcheong-do (province) | 14 (7.9) | ||
| Jeolla-do (province) | 20 (11.2) | ||
| Gyeongsang-do (province) | 17 (9.5) | ||
| Jeju-do (province) | 6 (3.4) | ||
| Clinical experience (months) | 1–3 | 12 (6.7) | 7.35 ± 2.68 |
| 4–6 | 56 (31.5) | ||
| 7–9 | 66 (37.1) | ||
| 10–12 | 44 (24.7) |
Department that provides comprehensive 24-hr inpatient care systems operated by professionally trained nurses.
Psychiatric ward (2), oriental medicine ward (3), nonresponse (2).
3.2. Nursing practicum related characteristics
Table 2 presents nursing practicum conducted in third-grade (before COVID-19 pandemic) was followed by clinical practicum (35.0 %), skills laboratories (25.9 %), simulation laboratories (23.8 %), virtual simulation (9.4 %), and written assignments (5.9 %). In the case of fourth-grade (after COVID-19 pandemic), skills laboratories (23.4 %), clinical practicum (21.1 %), simulation laboratories (20.4 %), virtual simulation (19.6 %), and written assignments (15.5 %) were ranked in the order. When comparing the clinical practicum of fourth-grade nursing students with third-grade, the substitute practicum rate increased as the clinical practicum decreased. When duplicate responses were allowed, the total number of responses to third and fourth-grade practicum was 509 and 607, respectively, indicating that fourth-grade practicum curriculum consisted of more diverse types of practical education. As for the satisfaction by types of substitute practicum, the average satisfaction in simulation laboratories was the highest with 2.86 ± 0.64, and that of written assignments was the lowest with 2.24 ± 0.75.
Table 2.
Type of nursing practicum education (N = 178).
| Practicum | 3rd grade (before pandemic) |
4th grade (after pandemic) |
Satisfaction |
||||
|---|---|---|---|---|---|---|---|
| n (%) | Case % | n (%) | Case % | M ± SD | Min/Max | ||
| Clinical | Clinical Practicum | 178 (35.0) | 100.0 | 128 (21.1) | 71.9 | ||
| Substitute | Skills Laboratories | 132 (25.9) | 74.2 | 142 (23.4) | 79.8 | 2.74 ± 0.64 | 1/4 |
| Simulation Laboratories | 121 (23.8) | 68.0 | 124 (20.4) | 69.7 | 2.86 ± 0.64 | 1/4 | |
| Virtual Simulation | 48 (9.4) | 27.0 | 119 (19.6) | 66.9 | 2.59 ± 0.59 | 1/4 | |
| Written Assignments | 30 (5.9) | 16.9 | 94 (15.5) | 52.8 | 2.24 ± 0.75 | 1/4 | |
| Totala | 509 (100.0) | 286.0 | 607 (100.0) | 341.0 | |||
Allow duplicate responses.
As a result of ranking of usefulness in performing nursing tasks in clinical practice (Table 3), the priorities were shown in the order of clinical practicum, simulation laboratories, skills laboratories, and written assignments. The fact that 84.2 % of participants chose clinical practicum as their top priority indicates that clinical practicum is considerably useful for clinical nursing practice.
Table 3.
Usefulness in performing nursing tasks in clinical practice (N = 178).
| Practicum | 1st |
2nd |
3rd |
4th |
5th |
Total |
|
|---|---|---|---|---|---|---|---|
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
| Clinical | Clinical practicum | 144 (84.2) | 12 (7.0) | 11 (6.4) | 4 (2.3) | 0 (0.0) | 171 (100.0) |
| Substitute | Skills laboratories | 9 (5.4) | 65 (38.9) | 72 (43.1) | 19 (11.4) | 2 (1.2) | 167 (100.0) |
| Simulation laboratories | 19 (11.2) | 82 (48.5) | 56 (33.1) | 10 (5.9) | 2 (1.2) | 169 (100.0) | |
| Virtual simulation | 4 (2.6) | 12 (7.9) | 20 (13.2) | 97 (63.8) | 19 (12.5) | 152 (100.0) | |
| Written assignments | 2 (1.4) | 0 (3.4) | 5 (13.8) | 20 (13.8) | 118 (81.4) | 145 (100.0) | |
Table 4 shows the percentage of clinical practicum by grade, namely the rate of clinical practicum before and after COVID-19 pandemic. Third-grade clinical practicum conducted before the pandemic accounted for 80–89 % of the total nursing practicum in most cases (27 %), and the lowest clinical practicum rate was at least 40 %. However, the clinical practicum rate decreased after the COVID-19 pandemic. In the case of fourth-grade, the number of participants with 0 % of clinical practicum was 40, accounting for the largest proportion (22.5 %) of the total.
Table 4.
Percentage of clinical practicum in nursing practicum education (N = 178).
| Clinical practicum (%)a | 3rd grade |
4th grade |
|---|---|---|
| n (%) | n (%) | |
| 0 | 0 (0.0) | 40 (22.5) |
| 1–9 | 0 (0.0) | 4 (2.2) |
| 10–19 | 0 (0.0) | 11 (6.2) |
| 20–29 | 0 (0.0) | 27 (15.2) |
| 30–39 | 0 (0.0) | 24 (13.5) |
| 40–49 | 13 (7.3) | 11 (6.2) |
| 50–59 | 30 (16.8) | 31 (17.4) |
| 60–69 | 32 (18.0) | 9 (5.1) |
| 70–79 | 33 (18.5) | 10 (5.6) |
| 80–89 | 48 (27.0) | 4 (2.2) |
| 90–99 | 14 (7.9) | 5 (2.8) |
| 100 | 8 (4.5) | 2 (1.1) |
| Total | 178 (100.0) | 178 (100.0) |
| Min/Max | 40/100 | 0/100 |
Clinical Practicum / (Clinical Practicum + Skills Laboratories + Simulation Laboratories + Virtual Simulation + Written Assignments) ∗ 100.
As shown in Table 4, 40 % was the lowest rate of clinical practicum before COVID-19 pandemic. Therefore, Table 5 shows the prominent type of nursing practicum education by grade based on the 40 % clinical practicum rate. In third and fourth-grade practicum curriculum, 72 participants (40.4 %) had a clinical practicum rate of 40 % or more. On the other hand, as the rate of substitute practicum increased due to the pandemic, 106 participants (59.6 %) were found to have less than 40 % of the fourth-grade clinical practicum rate after COVID-19 pandemic.
Table 5.
Labeled nursing practicum education according to the rate of clinical practicum (N = 178).
| 3rd grade | 4th grade | n (%) |
|---|---|---|
| Clinical practicuma | Clinical practicum | 72 (40.4) |
| Clinical practicum | Substitute practicumb | 106 (59.6) |
| Total | 178 (100.0) | |
When the proportion of clinical practicum is 40 %, or more than 40 %.
When the proportion of clinical practicum is less than 40 %.
3.3. Comparison by group according to the type of nursing practicum
There was a significant difference in the degree of difficulties in nursing tasks between the two groups classified by Table 5. Table 6 presents the average score of the CC group was 4.64, which was significantly lower than 5.37 of the CS group (t = −2.342, p = .020), indicating that the CC group had lower difficulties in performing nursing tasks. On the other hand, there were no statistically significant differences in work readiness, reality shock, and organizational socialization between the two groups.
Table 6.
Differences in difficulties in nursing tasks, work readiness, reality shock, and organizational socialization according to labeled nursing practicum education (N = 178).
| Type | n | M ± SD | t | p | |
|---|---|---|---|---|---|
| Difficulties in nursing tasks |
CCa group | 72 | 4.64 ± 2.09 | −2.342 | .020⁎ |
| CSb group | 106 | 5.37 ± 2.00 | |||
| Total | 178 | 5.07 ± 2.01 | |||
| Work readiness | CC group | 72 | 6.01 ± 1.04 | 0.294 | .769 |
| CS group | 106 | 5.96 ± 0.97 | |||
| Total | 178 | 5.98 ± 1.00 | |||
| Reality shock | CC group | 72 | 2.32 ± 0.48 | −0.377 | .707 |
| CS group | 106 | 2.35 ± 0.49 | |||
| Total | 178 | 2.34 ± 0.49 | |||
| Organizational socialization | CC group | 72 | 2.86 ± 0.38 | 0.214 | .831 |
| CS group | 106 | 2.85 ± 0.43 | |||
| Total | 178 | 2.85 ± 0.41 |
p < .05.
Clinical/Clinical.
Clinical/Substitute.
In the CC group, as presented in Table 7 , the higher work readiness, the lower reality shock (r = −0.369, p < .01) and the higher organizational socialization (r = 0.606, p < .01). The higher reality shock, the lower organizational socialization (r = −0.615, p < .01). In the CS group, the higher work readiness, the lower reality shock (r = −0.519, p < .01) and the higher organizational socialization (r = 0.628, p < .01). The higher reality shock, the lower organizational socialization (r = −0.655, p < .01). Therefore, the direction of the correlation between the variables that were significant in both groups were the same, but the degree of correlation was confirmed that the CS group was stronger than the CC group. There was no significant difference in the correlation between difficulties in nursing tasks and other variables in both groups.
Table 7.
Correlations between main variables according to labeled nursing practicum education (N = 178).
| Type | Variables | Difficulties in nursing tasks |
Work readiness | Reality shock |
|---|---|---|---|---|
| CCa group (N1 = 72) |
Work readiness | 0.067 | ||
| Reality shock | 0.165 | −0.369⁎⁎ | ||
| Organizational socialization |
−0.078 | 0.606⁎⁎ | −0.615⁎⁎ | |
| CSb group (N2 = 106) |
Work readiness | 0.015 | ||
| Reality shock | 0.185 | −0.519⁎⁎ | ||
| Organizational socialization |
−0.061 | 0.628⁎⁎ | −0.655⁎⁎ |
p < .01.
Clinical/Clinical.
Clinical/Substitute.
4. Discussion
Before and after the COVID-19 pandemic, the types of nursing practicum can be divided into clinical practicum and substitute practicum. As opportunities for clinical practicum decreased due to the pandemic, various types of substitute practicum, among them, the increase in virtual simulation and written assignments was found to be remarkable.
Virtual simulation is in the spotlight as an alternative practicum method for clinical practicum as it can compensate for the shortcomings of the existing simulation methods, that is, it requires a separate space for simulator installation, time and cost for management, and the limitation of the number of students available at a time (Frick et al., 2014). However, in the results of this study, satisfaction with virtual simulation and usefulness in performing nursing tasks in actual clinical practice were relatively lower than those of other types of nursing practicum. This suggests that virtual simulation is not yet ready to substitute for clinical practicum in the COVID-19 pandemic situation. Written assignments were given the lowest score in satisfaction and usefulness. Based on the experience of new graduate nurses who received substitute practicum in the context of the COVID-19 pandemic, further research is needed to analyze shortcomings, and explore development plans of virtual simulation and written assignments.
From the results obtained, in 2020, after the pandemic, the case where the clinical practicum rate was less than 40 % was about 60 %, accounting for more than half of the cases. In addition, about a quarter of the respondents said they had never experienced clinical practicum, indicating that substitute practicum prevailed in Korean nursing universities after the pandemic. These results serve as empirical evidence to show that the following backgrounds had a great influence on nursing education, especially practical education: significant increase in non-face-to-face teaching, requests from hospitals to suspend clinical practicum for reasons of infectious disease prevention and safety of patients and students, and students' fear of being infected with COVID-19 during clinical practicum (Kang, 2020; Lim, 2021).
Bang et al. (2021) investigated the percentage of clinical practicum substituted by online or school practicum in 2020. As a result, 43.1 % of the respondents answered that the substitute practicum rate was 41–60 %, and 10.2 % of the respondents answered that it was 81 % or more. Comparing this with the substitute practicum rate identified in this study, our result was higher than that of the Bang et al. (2021). A study by Bang et al. (2021) was conducted at four national nursing universities in Korea. Most national universities have their own university hospitals, and in this case, it is relatively easy to secure places for clinical practicum. Therefore, it can be inferred that the substitute practicum rate presented in the study of Bang et al. (2021) was lower than that of this study due to the presence of their own hospitals.
As a result of comparing difficulties in nursing tasks, work readiness, reality shock, and organizational socialization between the CC and CS group, the difficulties in nursing tasks was significantly lower in the group with a high rate of clinical practicum. This means that the difficulties in performing nursing tasks felt by new graduate nurses differed according to the rate of clinical practicum. Nursing universities should carefully review the current curriculum for substitute practicum and specific discussion should be introduced as soon as possible for better development and operation of the curriculum. In Korea, practicum hours are stipulated by an accrediting body, Korean Accreditation Board of Nursing Education. Prior to COVID-19 pandemic, the institution has increased the accreditation rate for simulation practicum, which can substitute for clinical practicum, from 10 % to 12 % of the total clinical practicum hours (Korean Accreditation Board of Nursing Education, 2017). After this pandemic, as a large proportion of clinical practicum is being substituted with other types of practicum including simulation, there is an urgent need to discuss the ratio of clinical practicum in nursing curriculum.
It is noteworthy that there were no significant differences in work readiness, reality shock, and organizational socialization between the two groups. These results could be due to the effect of education provided to new graduate nurses in the clinical field. As the resignation rate of new graduate nurses continues to increase, the Government announced ‘Improvement Plan of Nursing Work Environment and Labor Conditions’ including the placement of nurses in charge of training for new graduate nurses and guarantee of a three-month training period (Korean Ministry of Health and Welfare, 2019). The Korea Nurses Association (2019) has distributed ‘New Graduate Nurses’ Education Management System Guidelines' to each hospital. Based on this guideline, Song et al. (2020) found that a project to support nurses in charge of training had a positive effect on new graduate nurses' adaptation to the new organizational environment. Practical adaptation support programs (Kwon et al., 2021) and mentoring programs (Park and Lee, 2018) have been developed and are being used in clinical field. Various efforts to enhance the field adaptation of new graduate nurses are thought to have compensated for possible problems caused by the substitution of clinical practicum.
Regarding the limitations of this study, most of the new graduate nurses who participated in this study worked at tertiary general hospitals in Seoul and Gyeonggi-do. Therefore, it is difficult to generalize the analysis results to all new graduate nurses, and careful interpretation and caution are required. Despite these limitations, this study has great significance in that, for the first time in Korea, a new graduate nurse, who received practical training during the COVID-19 pandemic and is currently working in a clinical setting, was selected as the research participant. Through this study, it can be used as a useful data for developing substitute practicum education to increase field adaptation of new graduate nurses by confirming how the effect of substitute practicum was manifested when working as a new graduate nurse in the clinical setting.
5. Conclusion
The impact of the COVID-19 pandemic has brought about major changes throughout nursing education. There were many changes in practical education due to restrictions on clinical practicum. The new graduate nurses who participated in this study were divided into the CC group and CS group according to the rate of clinical practicum before and during the pandemic. As a result of this study, there were no significant differences in work readiness, reality shock, and organizational socialization between the two groups. These results show that efforts, especially in clinical fields, to increase the field adaptation of new graduate nurses. However, only the difficulties in nursing tasks showed a significant difference. Difficulties in nursing tasks reported in the CS group, which had a clinical practicum rate of less than 40 %, was significantly higher than that of the CC group with more than 40 %. This suggests that discussions should be continued to develop and implement efficient nursing practicum education that not only can reduce the gap between nursing education and nursing practice, but also respond appropriately to any pandemic situation.
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1A2C2006359).
CRediT authorship contribution statement
Younhee Kang: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Writing – review & editing, Supervision, Project administration, Funding acquisition. Hyeyoung Hwang: Conceptualization, Methodology, Software, Formal analysis, Investigation, Resources, Data curation, Writing – original draft, Project administration.
Declaration of competing interest
The authors declare that they have no conflict of interest.
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