Qualitative and Inductive Research on the Workplace Adaptation of New Nurses

QualitativeandInductiveResearch

ontheWorkplaceAdaptationofNew Nurses

新人看護師の職場適応に関する質的帰納的研究

YokoKitajima,YasukoHosoda

北島 洋子

・細田 泰子

Abst

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Thisstudyaimedtoqualitativelyandinductivelyelucidatetheworkplaceadaptationofnew nurses.Semi -structuredinterviewsregardingworkplaceadaptationbehaviorsandstatesofnew nurseswereconductedwith 16nurseswhohadbeenrecruitedasnew graduates,hadcompletedthefirstyearofemployment,andwerein thesecondyearofemploymentatthesamedepartment.Theinterviewswereconductedfrom Augustto Decemberof2013.Workplaceadaptation behaviorsand stateswereanalyzed qualitatively and inductively basedonPiaget’stheoryofadaptation(1948/1978).Forworkplaceadaptationbehaviors,96subcategories,35 categories,and5corecategories— “actstolearnthenecessaryexpertisetoperform duties,”“actsforbuilding new relationships,”“actstofacilitateduties,”“actsrelatedtoself-adjustmenttowork,”and“preparednessto facework”— weregeneratedfrom 269codes.Forworkplaceadaptationstates,53subcategories,14categories, and4corecategories—“senseofbelongingtotheteam,”“nursingpracticeresponses,”“autonomousexecutionof therole,”and“self-efficacyforwork”— weregeneratedfrom 130codes.Itwasclarifiedthatnew nurses incorporate new actions and thinking and change their pre-existing ways ofthinking atnewly joined workplaces.ThisisthoughttobetheassimilationandaccommodationexplainedbyPiaget.Thecontentsof workplace adaptation stateswere similarto LevelIofthe Standard ClinicalLadder(Japanese Nursing Association,2003)anddescribedadaptationstates,whichweregenerallyrequiredinnew nursesandwere alignedwithreality,atanachievablelevel.Theresultsofthisresearchmaybeutilizedasbasicinformation regardingworkplaceadaptationofnew nurses.

Keywords：New nurse,workplaceadaptationbehavior,workplaceadaptationstate,qualitativeandinductive research

１）_{FacultyofHealthSciences,NaragakuenUniversity} ２）_{GraduateSchoolofNursing,OsakaPrefectureUniversity}

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New nursesfacedifficultiesintheirtransitionfrom studentstonurses(Nagai,2009)whilerealityshock (Taniguchietal.,2014)and early resignation (Omorietal.,2012)become issues.Studies on resignation preventionandworkplaceadaptationofnew nurseshavefocusedonapproachestopsychologicalaspectssuch asstress(Kuramasuetal.,2012),methodandcontentstudiesoftrainingfornew employees,interactionof supervising nurseswith new nurses(Yajima,2009),and improvementofsurrounding supportand working environment(Takatani,2010).Sofar,thestudiesonworkplaceadaptationofnew nurseshavenotfocusedon theeffortsofthenew nursesthemselvestoadapttotheworkplace.

Workplaceadaptation ofnew nursestendstobestudied based on acombination ofmultipleconcepts includingrealityshock(Hanaokaetal.,2006)andearlyresignation(Onodaetal.,2012).Amongtheresearchon earlyresignationandrealityshockofnew nurses,manythesesusetheterm “workplaceadaptation,”butfew clearly define thisconcept,and many studiesmeasure workplace adaptation based on a combination of conceptsrelatedtorealityshock,burnout,identity,andjobsatisfaction.

Theconceptsusedinthemeasurementofworkplaceadaptationweregenerallyclassifiedintotwotypes— namely,responsesresultingfrom adaptationandfailureofadaptation.

Responsesthatresultedfrom adaptationwerejobsatisfaction(Wakasaetal.,2011;Sunamietal.,2010;Miwa etal.,2010),continuation ofwork (Tsukamotoetal.,2010),self-esteem (Sunamietal.,2010),organizational socialization(Onodaetal.,2012),andidentityestablishmentasanursingprofessional(Miwaetal.,2010).

Job satisfaction and work continuation are the feelingsofnew nursesto continue theirwork due to adaptationtotheworkplaceandasenseofsatisfactionabouttheirwork.However,theseconceptsdonot reflectadaptationtotheworkplace.Self-esteem canstillbemaintainedevenifnew nursesarenotadaptedto theworkplace.Incontrast,evenifnew nursesareadaptedtotheworkplace,theymayoriginallyhavelow self -esteem duetoindividualcharacteristics.Ogata(2012)positionedorganizationalsocializationasacomponentof organizationaladaptation,anddiscussiononworkplaceadaptationbasedononlyorganizationalsocializationis consideredinsufficient.Identityestablishmentasanursingprofessionalisalsothoughttohaveresultedfrom a new nurse’sacquisitionofasenseofbelongingtotheworkplaceandtherolesaswellasvaluesasanursing professionalaftergettinginvolvedinhumanrelationsattheworkplace.

Responses thatresulted from failure ofadaptation were burnout(Onoda etal.,2012;Wakasa,2011; Tsukamotoetal.,2010;Miwaetal.,2010),realityshock(Hanaokaetal.,2007;Tsukamotoetal.,2010),early resignation(Onodaetal.,2012;Hanaokaetal.,2007;Sunamietal.,2010),desireforresignation(Hanaokaetal., 2007),roleconflict(Hanaokaetal.,2007),andstress(Hanaokaetal.,2007;Nakamuraetal.,2006).

Burnoutreferstothementalandphysicalsymptomsshownwhenexcessiveandcontinuousstressisnot copedwith(Taoetal.,1994).Althoughnew nursesareexposedtostress,consideringtheleveloftheirclinical experience,itisquestionablewhetherthestresscanberegardedascontinuousstressatalevelthatmaycause theburnoutsymptom ofdepersonalization.

Realityshockistheshockthatarisesfrom thefirstencounterofthegapbetweenone’santicipationand dreamsandtheworkdoneatanorganizationortherealityoftheorganization(Kramer,1974).Althoughthe

cause–effectrelationshipbetweenrealityshockandworkplaceadaptationisunclear,ifanew nursefaces shockandcannotadapttohis/herworkplace,realityshockisnottheresultofworkplaceadaptationbutits influencingfactor.Thus,itisnotpossibletomeasureworkplaceadaptationbasedonrealityshock.

Earlyresignationandresignationdesiredonotresultfrom workplaceadaptationbutoccurwhenworkplace adaptationdoesnothappen.Therefore,itisdifficulttodirectlymeasuretheoutcomesofworkplaceadaptation byusingthescaleoftheseconcepts.Althoughroleconflictandstressaretheoutcomesoffailureofworkplace adaptation,theyarealsothefactorsinfluencingtheadaptationprocess.

Yamamoto(2009)measured workplaceadaptation through socialskillsand nursing practiceabilities,but thesearethoughttobeindependentvariablesthatarethefactorsinfluencingworkplaceadaptation.Intermsof otherinfluencefactors,environmentalfactorsincludeatrainingsystem,humansupport(Onodaetal.,2012), patients’gratitudeandrecovery,supportfrom preceptors,rolemodelofseniornurses(Miwaetal.,2010),group counselling(Wasa,2011),humanrelationsattheworkplace(Tsukamotoetal.,2010;Sunamietal.,2010),and mentoring(Sunamietal.,2010).Individualinternalfactorsincludestresscopingstrategies(Onodaetal.,2012), levelofnursingskills(Miwaetal.,2010),personality(Wasa,2011),quantitativeandqualitativeburdensofduties, andphysicalburdens(Sunamietal.,2010).

TheworkplaceadaptabilityscaledevelopedbyFujimotoetal.(2010)didnotclassifyparticipantsbasedon careerstagesandincludedallnursesingeneral.Thus,itisnotapplicableasascaleforthisresearchfocusing onnew nurses.Katsuharaetal.(2004)statedthattherealityshockofnew nursesisinfluencedbythedemand ofbothorganizationalandoccupationalsocialization,andworkplaceadaptationofnew nursesisconsidered differentfrom thatofexperienced nurses.Professionalsocialization isa complex processwith 4 critical attributes:learning,interaction,development,and adaptation (Dinmohammadietal.,2013).To grasp the characteristicsofnew nurses,itisnecessarytoconsidertheunstableelementsofworkplaceadaptationspecific tonew nursesinthecomplexadaptationprocess.

New nursesfacenew experienceseverydayandareoccupiedacclimatingtonew duties.Thisawarenessis restricted to a narrow cognition area,and itisdifficultto broaden new nurses’horizonsto the whole organization and work.Ogata (2012)grasped organizationaladaptation,a conceptsimilar to workplace adaptation,as an integralconcept and measured it through organizationalsocialization,organizational commitment,anddesiretoresign.However,intheresearchareaofnursingscience,workplaceadaptationis morecommonthanorganizationaladaptation,anditismorefrequentlyusedinresearchinvolvingnew nurses. Inaddition,itismoreappropriatetoadoptworkplace,whichisasmallerunitthananorganization,inthis research.

Inpreviousresearchonworkplaceadaptationofnew nurses,therewasmuchliteratureregardingthefactors influencingworkplaceadaptationandhow thesurroundingcouldsupportnew nursesinworkplaceadaptation. However,asexplainedbyTakizawaetal.(1999),adaptationoccursthroughbilateralnegotiationbetweenthe subjectand target.Although the surrounding supportisnecessary,itisalso importantfornew nurses themselves,asthesubject,toworkhardandtakeactionstoadapttotheirworkplace.

differentiatedbetweenadaptationprocessandadaptationstate.Assimilationistheincorporationofexternal realityintotheform basedonone’sactivitiesandthestructuringofitwhileaccommodationistheconstant changing ofone’spre-existing schematosuitnew information whileincorporating new elementsintothe schema.AccordingtoPiaget(1948/1978),organismsaretransformedbytheenvironment,and,thus,whilethe commutationrelationbetweentheenvironmentandorganismsdevelopsinadesirabledirectionforthesurvival oforganisms,adaptationhappens.Intheprocessofworkplaceadaptation,theprecedingrequirementisthe environmentalchangeand thecollapseofbalancein aperson whonewly joined aworkplace.Toachieve balance,thepersonwhonewlyjoinedtheworkplaceincorporatesnew behaviorpatternsandwaysofthinking andadoptstheadaptationbehaviorofchangingbehaviorsandwaysofthinkingfollowingactionsfrom the workplace,whichistheenvironment,and,thus,couldachievetheadaptationstateofstableequilibrium.

Inthisresearch,theprocessofnew nursesachievingequilibrium,whileincorporatingnew waysofthinking and behaviorsatanewly joined workplaceand changing pre-existing waysofthinking and behaviors,is graspedasworkplaceadaptationbehaviorwhiletheequilibrium achievedasaresultoftheprocessisgrasped asworkplaceadaptation state.Thestudy oftheworkplaceadaptation ofnew nursesfrom theaspectsof individuallearning and development,based on Piaget’stheory ofadaptation,isunprecedented and,thus, significant.

２．Obj

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Toqualitativelyandinductivelyclarifytheworkplaceadaptationofnew nurses.

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A new nurseisanursingstaffmemberwhoisemployedathis/herfirstjobafteracquiringthecertificate (MinistryofHealth,LaborandWelfare,2014)andisstillinthefirstyearofemployment.

Workplace adaptation is defined as an individual’s action ofchanging him/herselfand influencing the environmentafterexperiencingthecollapseofinternalandexternalbalanceuponjoininganew workplaceto achieveanew equilibrium aswellastheresultingstableequilibrium betweentheindividualandtheworkplace (Piaget,1948/1978).

４．Met

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Theresearchdesignwasqualitativeandinductive.

The participantswere 16 nursesfrom participating facilitieswho had consented to participate in the research.Theparticipantshadbeenrecruitedasfreshgraduates;hadnopreviousworkingexperience,except part-timejobswhenstudying,orexperienceasassistantnurses;hadcompletedthefirstyearofemployment; and were in the second yearofemploymentatthe same department.The participating facilitieswere extractedthroughconvenientsamplingfrom generalhospitalsintheKinkiarea,hadmorethan200beds,were recognizedbytheJapanCouncilforQualityHealthCare,andhadconsentedtocooperateintheresearch.The researchperiodwasfrom AugusttoDecemberof2013.

The research method was semi-structured interviewing.In accordance with interview guidelines,the participantswererequiredtoreflectontheirfirstyearofemploymentandprovideinformationsuchashow theyadaptedtotheirworkplace,effortsmadetoadapttotheirworkplace,whentheyfelttheyacclimatedto andfitintotheworkplace,andfrom whatsituationtheyacquiredsuchafeeling.

Withtheparticipants’consent,recordedinterview contentsweretranscribed,andthedatawereanalyzed qualitativelyandinductivelywithreferencetocontentanalysisbasedonBerelson’smethodology(Funashima, 2012).Two research questionswere constructed regarding workplace adaptation behaviorand workplace adaptationstatewithreferencetoPiaget(1948/1978),whoclassifiedadaptationprocessandadaptationstate. Contentsthatapplyto00oftheanswer“New nursesadapttotheirworkplaceby00”inresponsetothe question“Whatkindofbehaviordidnew nursesadopttoadapttotheworkplace?”wereextractedasthecodes ofworkplaceadaptationbehavior.Thecodesofworkplaceadaptationstateswereextractedfrom theanswer “New nursesrecognizethestateof00asworkplaceadaptation”inresponsetothequestion“New nurses recognizewhatkindofstateasworkplaceadaptation?”Thecodeswerethencollectedaccordingtosame recordunitgroups,andtheworkofconvertingthem intocategorynamesthatpreciselyexpressedthem was repeated.

ThisresearchwasconducteduponapprovaloftheResearchEthicsCommitteeoftheSchoolofNursing, OsakaPrefectureUniversity(ApplicationNumber25-30).Theparticipantsinthisstudywerenurses,andthe researchcandidateswereintroducedbythesuperiors.Asthenurseswereevaluatedbytheirsuperiors,they mightfeelcertainburdens,suchasinterferenceofprivacy,mentalpressure,andtimerestriction,whiletaking partin the research.Thus,sufficientconsideration isrequired.Therefore,participants’participation was requestedwhileensuringnopowerinterferencefrom higherpositions,andtheirwillingnesstoparticipatewas confirmedthroughmail.A researchscheduleandtimeweresetwhileensuringnointerruptiontothefacilities andtheparticipants’duties,andinterviewswere,uponconsultationwiththefacilities,requestedwhileensuring candidates’freedom toparticipateandprivacyaswellasanenvironmentthatallowedthecandidatestotake theirtime to considerwhetherto participate in the research.In case any participanthad any inquiry, explanation wasgiven politely to ensure understanding.Participantswere explained thatdata would be analyzed anonymously,would notbe used apartfrom for this research,would be stored under strict management,andwouldbedisposedofwhilemaintaininganonymityuponcompletionofthisresearch.

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Among the five facilities extracted through convenientsampling,four consented to participate in the research.Underhospitalfunction classification,there were one advanced treatmenthospital,one regional medicalcaresupporthospital,andtwopublicmedicalfacilities.A totalof20participantswereintroducedby thenurseadministratorofeachfacility.Amongthem,16femaleparticipantsconsentedtoparticipateinthe research,andtheresearchedemploymentperiodwasbetweenoneyearandfivemonthstooneyearandseven monthsafteremployment(Table1).

Forworkplaceadaptationbehaviors,96subcategories,35categories,and5corecategoriesweregenerated from 269 codes (Table 2).For workplace adaptation states,53 subcategories,14 categories,and 4 core categoriesweregeneratedfrom 130codes(Table3).

The“actstolearnthenecessaryexpertisetoperform duties”ofworkplaceadaptationbehaviorscomprised 14categoriesand43subcategoriesthatdemonstratedthebehaviorsofnew nursestoacquiretheknowledge andskillsnecessaryforworkingatthedepartmenttheybelongedto.The“actsforbuildingnew relationships” comprised 7 categories and 20 subcategories thatdemonstrated the behaviors ofnew nurses to build relationshipwithsurroundingpeople,whichisthehumanenvironmentinthenewlyjoinedworkplace.The “actstofacilitateduties”comprised3categoriesand9subcategoriesthatdemonstratedthebehaviorsofnew nursestoperform theirowndailydutiessmoothlyandsteadily.The“actsrelatedtoself-adjustmenttowork” comprised3categoriesand3subcategoriesthatdemonstratedthebehaviorsofnew nursesthemselvesin controlling and preparing their physicalconditions and feelings for work.“Preparedness to face work” comprised7categoriesand20subcategoriesthatdemonstratedthewaysofthinkingandapproachestowards workthatwereincorporatedbynew nurseswhileworking.

Thecorecategory“senseofbelongingtotheteam”ofworkplaceadaptationstatescomprised3categories and11subcategoriesthatdemonstratedthenew nurses’statesoffeelingthattheyhavefitinasamemberof theworkplace.“Nursingpracticeresponses”comprised3categoriesand13subcategoriesthatdemonstrated thenew nurses’statesofrecognizing thegrowth ofaprofessionalselfwhilecarrying outroutinework.

Particip

ant Gender Basic Education Certificate Held Employment Period Department Hospital FunctionClassification A Female 4-year University Nurse & Public_{Health Nurse} 1 year 5 months Department of Internal_Medicine Advanced Treatment_Hospital B Female 4-year University Nurse 1 year 6 months Department of Internal_Medicine Advanced Treatment_Hospital C Female 4-year University Nurse & Public_{Health Nurse} 1 year 6 months Department of Internal_Medicine Advanced Treatment_Hospital D Female 4-year University Nurse & Public_{Health Nurse} 1 year 7 months Surgical Department Advanced Treatment_Hospital E Female 4-year University Nurse & Public_{Health Nurse} 1 year 6 months Surgical Department Regional Medical Care_{Support Hospital} F Female 4-year University Nurse & PublicHealth Nurse &

Midwife 1 year 6 months Maternity Ward

Regional Medical Care Support Hospital G Female 4-year University Nurse & PublicHealth Nurse &

Midwife 1 year 6 months Maternity Ward

Regional Medical Care Support Hospital H Female 4-year University Nurse & PublicHealth Nurse &

Midwife 1 year 6 months Maternity Ward

Regional Medical Care Support Hospital I Female 4-year University Nurse & Public_{Health Nurse} 1 year 6 months Department of Internal_Medicine Public Medical Facility J Female 4-year University Nurse & Public_{Health Nurse} 1 year 6 months Mixture Public Medical Facility K Female Vocational School_{(3-year course)} Nurse 1 year 6 months Department of Internal_Medicine Regional Medical Care_{Support Hospital} L Female Vocational School_{(3-year course)} Nurse 1 year 6 months Surgical Department Regional Medical Care_{Support Hospital} M Female Vocational School_{(3-year course)} Nurse 1 year 6 months Department of Internal_Medicine Public Medical Facility N Female Vocational School_{(3-year course)} Nurse 1 year 6 months Surgical Department Public Medical Facility O Female Junior College (3-_{year course)} Nurse & Public_{Health Nurse} 1 year 5 months Department of Internal_Medicine Public Medical Facility P Female Junior College (3-_{year course)} Nurse 1 year 6 months ICU & CCU Public Medical Facility

“Autonomousexecutionoftherole”comprised5categoriesand18subcategoriesthatdemonstratedthenew nurses’statesofbeingabletoregulateandperform dutiesundertheirchargebythemselves.“Self-efficacyfor work”comprised 3 categoriesand 11 subcategoriesthatdemonstrated the new nurses’statesoffeeling incorporatedintotheworkplaceandbeingabletoproducedesirableoutcomesatwork.

Show passion in front of

seniors Show one's efforts to gain seniors' recognition Listen to various types of team members carefully Explore the human relations among team members

Find opportunities to understand team members' nursing views Accept the diversity of team members

Understand the characters of team members through private opportunities Work hard to build a close relationship with seniors

Talk to seniors at an appropriate time Work hard to build relationship with patients Approach patients

Accept the diversity of clients 

Communicate with doctors Confirm instructions with doctors

Ask seniors for advice about interaction with doctors Actively participate in events apart from duties Take initiative to join the circle of staff

Take initiative to find a good time, and talk to them Take initiative to find topics to talk to them about Join conversations actively

Show consideration for seniors as a new employee Respect the hierarchy among team members Observe team condition before acting

Understand the working methods of team members Act after considering the flow

Set up a daily plan in the morning Consult administrators

Check the meaning of instructions with multiple staff Confirm before acting

Consult seniors

Recognize the need of reporting, and communicate one's own thinking properly Utilize training opportunities

efficiently Utilize training opportunities to refresh oneself Maintain physical condition

for work Relax well and manage health

Emotion control Control emotions by talking with peers, seniors, family, and friends Interact with doctors for

duties' need

Show consideration for seniors

Understand team members' condition before acting Consider action modes efficiently

Report, communicate, and consult

Know the characters of team members

Strive to build relationship with seniors

Build relationship with patients

Acts for building new relationships

Acts to facilitate duties

Acts related to self-adjustment to work Take initiative to join the circle of people at the workplace

Consider getting used to work as a role in the first year

Consider acquiring the ability to carry out duties independently as a role in the first year

Enjoy acquiring knowledge and skills Accept strict advice with a positive mindset Strive to understand the meaning of guidance Tell oneself to enjoy work

Improve to perform better next time

Transform seniors' support to energy, and work hard P

Consider roles in the first year

Face work positively Preparedness to face work

Prepare oneself for the worst and tackle work Depend on evaluations without fear Strive hard to learn all about one's duties

Accept oneself who has failed without running away Never give excuses

Suppress one's emotions, and listen to whatever that is told Reach agreement with one's

mindset Reach agreement with one's inner self on various types of working methods Recognize the sense of responsibility towards patients and complete duties Recognize the sense of responsibility to take charge of hospital rooms Recognize the sense of responsibility towards work

Work towards the goal of acquiring the ability to complete work Strive with the goal of acquiring the ability to act independently Tackle work with resolution

Keep one's own thoughts to oneself

Hold responsibility for one's duties

Tackle work with a goal

Table3.Workplaceadaptationstatesofnewnurses

Able to practice necessary nursing skills in general Understand necessary nursing skills in general

Able to understand the meaning of technical terms and abbreviations Able to roughly predict patients' progress

Able to conduct assessment during sudden change

Able to confirm handling measures and act accordingly during sudden change Able to conduct clinical judgment

Able to report assessment during sudden change Able to build relationship with patients

Able to consider nursing independently and implement accordingly Able to gradually incorporate patients' wish into plans

Able to gradually develop nursing under their charge independently Able to express caregiving thought by oneself

Able to take initiative in asking questions

Able to take initiative in reporting plans thought by oneself Able to practice confirmation and consultation with seniors

Able to precisely report, communicate, and consult regarding necessary items Able to convey one's thinking to seniors and understand seniors' guidance Nursing practice responses 

Autonomous execution of the role Acquiring expertise necessary for duties

Being able to carry out assessments and cope with patients under sudden change

Being able to report, communicate and consult Being able to consider caregiving in the relation with patients and implement accordingly

６．Di

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Workplaceadaptationofnew nurseswasanalyzedqualitativelyandinductively,andtheaspectsofworkplace adaptationbehaviorsandworkplaceadaptationstateswereclarifieddescriptively.Contentsofthisresearch wereclarified descriptively based on interviewswith nursesin theirsecond yearofemployment.Thus,a detailedaccountcouldbegivenoftherealfaceofworkplaceadaptationofnew nursesinroutineworkbased ontheaccountsoftheparticipantsthemselves.

Fivecorecategories— “actstolearnthenecessaryexpertisetoperform duties,”“actsforbuildingnew relationships,”“actstofacilitateduties,”“actsrelatedtoself-adjustmenttowork,”and“preparednesstoface work”—wereextractedforworkplaceadaptationbehaviors.

Humanbehaviorconsistsof4elements:action,thought,feeling,andphysiology(Glasser,1999).Thecore categories“actstolearnthenecessaryexpertisetoperform duties,”“actsforbuildingnew relationships,”and “actstofacilitateduties”ofworkplaceadaptationbehaviorsincludetheelementofactioninhumanbehavior. “Preparednesstofacework”includestheelementofthought— thatis,tochangethewaysofthinkingtoadapt toworkplace— andtheelementsoffeelingandphysiology— thatis,topreparetheirphysicalconditionand feelingsforwork.

Adaptationbehaviorreferstoorganisms’effortstochangeactionmodesandwaysofthinkinginresponseto environmentaldemandsandtheirlearningofnew behaviors(TheReview CommitteeofTechnicalTermsin

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Make duties smooth, and stay together with patients Speed up work

Able to conduct duties smoothly without delay Able to observe the flow of duties and act accordingly Understand the flow of duties

Experience duties in general, and keep them in mind Able to grasp duties overall and set priority Understand the priority of duties

Able to set priority according to one's own pace and act accordingly Able to perform duties and roles well

Able to manage all duties precisely

Able to establish a working method of one's own Able to set up plans and manage time

Losing seniors' protection

Being able to actually feel independence Be independent,  and be left in charge of duties Ability to be independent is recognized

Being able to control physical

condition Being able to control sleep routine

Being able to enjoy interaction with patients and team members Feel a sense of satisfaction with work

Possess the will to work hard Enjoy work

Being able to work with confidence

Possess the resolution to be independent and continue working Being able to actually feel

independence

Being able to hold affirmative emotions about work Self-efficacy for work 

Grasping the flow of duties and conducting them smoothly

Being able to act considering priority 

Being able to perform one's roles at work

Being able to complete work systematically by one's own method

NursingScienceoftheJapanAcademyofNursingScience,2011).“Actsforbuildingnew relationships,”“actsto facilitateduties,”“actsrelatedtoself-adjustmenttowork,”and“preparednesstofacework”aretheactionsof changingpre-existingmethodsuntilnew workingmethodsandwaysofthinkingareincorporatedintooneself while“actstolearnthenecessaryexpertisetoperform duties”isthelearningtoincorporatenew knowledge intooneself.Contentsextractedinthisresearchdescribetheelementsofworkplaceadaptationbehaviorsof new nurses.

Fourcorecategories—“senseofbelongingtotheteam,”“nursingpracticeresponses,”“autonomousexecution oftherole,”and“self-efficacyforwork”—wereextractedforworkplaceadaptationstates.

LevelIoftheStandardClinicalLadderoftheJapaneseNursingAssociation(2003)isdescribedasfollows. Nursingpracticeabilityreferstoanurse’sabilitytocarryoutbasicnursingpractice(basicnursingskills, development ofnursing process,etc.)at the workplace to which he/she belongs.Organizationalrole performance ability refers to the performance ofan insignificant organizationalrole with the lightest responsibilityandlowestdifficultlevel.Itreferstotheabilitytoperform theroleasafollowerorateam memberinanursingteam ortheroleofthepersoninchargeofasimpleroutineasapersoninchargeofa hospitalward.Self-education and research ability referto the ability to discovertopicsforself-education throughguidance.

From thecontentsofthesubcategoriesofworkplaceadaptationstates,theformsofnew nursesgenerally experiencingdutiesatthedepartmenttheybelongedtoundertheguidanceofseniors,gainingtheabilityto implementnecessarynursingskillsingeneralatthedepartment,andbeingabletoberecognizedasamember oftheteam couldbeinferred.TheseformsarehighlysimilartothecontentsofLevelIoftheStandardClinical Ladder,andtheresultsofthisresearchdescribeadaptationstates,whicharegenerallyrequiredinnew nurses andarealignedwithrealityatanachievablelevel.

“Senseofbelonging totheteam,”“nursing practiceresponses,”and “autonomousexecution oftherole” includetheelementsoforganizationalsocialization (Onodaetal.,2012)thatpreviousresearch used asthe indicatorsofworkplaceadaptationwhile“self-efficacyforwork”enhancesself-esteem (Sunamietal.,2010).

Itwasclarified thatnew nursesincorporated new actionsand thinking atnewly joined workplaceand changed pre-existing waysofthinking.Thiscan beexplained through assimilation and accommodation in Piaget’sconceptofadaptation.New nursesadoptthesebehaviorsintheirinteractionwithteam membersin the departmentto which they belong,and thiscan be regarded asthe commutation relation with the environment(Piaget,1948/1978).

Thisresearchhasalimitation.Asitwasconductedthroughinterviewswithnursesintheirsecondyearof employment,onlyadaptationrecognizedbytheparticipantscouldbeclarified,andthefunctionsofassimilation andaccommodationresultingfrom theenvironmentcouldnotbespecified.However,thesubcategoriesof“able torealizethatoneselfisbeinghelpedintheteam,”“recognitionasamemberoftheteam byteam members,” and“losingseniors’protection”showedthatnew nursesthemselvesrecognizedthefunctionsofassimilationand accommodation resulting from theenvironment,and thisdemonstrated thecommutation relation with the environment.

Itisattheworkplacethatnew nurseslearnthroughdailyworkandgrow continuously,andtherecognition thatfocusshould be puton thisaspectisbroadening (Nakahara,2010).Recently,nursing education has theoreticallybeeninfluencedbythetheoryofsituatedlearning.Thisresearch,whichfocusedonworkplace adaptation,issignificant,andtheresultsofthisresearch,whichdescriptivelyclarifiedtheaspectsofworkplace adaptationofnew nurses,arefindingsthatcouldbeutilizedinfuturestudiesonworkplaceadaptation.

７．Concl

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Inthisresearch,workplaceadaptationbehaviors— “actstolearnthenecessaryexpertisetoperform duties,” “actsforbuildingnew relationships,”“actstofacilitateduties,”“actsrelatedtoself-adjustmenttowork,”and “preparednesstofacework”— aswellasworkplaceadaptationstates— “senseofbelongingtotheteam,” “nursingpracticeresponses,”“autonomousexecutionoftherole,”and“self-efficacyforwork”— wereclarified. Theseareusefulfindingsforfuturestudiesonworkplaceadaptationofnew nursesastherealfaceoftheir workplace adaptation in routine work wasdescribed in detailbased on the accountsofthe participants themselves.

Acknowledgements

Wewouldliketoacknowledgetheparticipantsforthisstudy.ThisworkwassupportedbyJSPSKAKENHI GrantNumberJP25463333.

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