NURSE INTERNS' EXPERIENCES OF WORKPLACE VIOLENCE DURING THEIR ENROLMENT IN INTERNSHIP PROGRAMMES: A CONVERGENT MIXED METHODS STUDY

Abstract

Background: Workplace violence (WPV) can negatively affect both nurses and patients. New graduate nurses (known as nurse interns in Saudi Arabia) are vulnerable to WPV because they face challenges adjusting to the work environment. As a result, their turnover is high. The nurse internship programme was designed to ease the transition from education to clinical practice. Nursing students who have finished their Bachelor of Nursing programme proceed to a one-year internship. In Saudi Arabia, the internship programme is mandatory for all new graduate nurses before they commence their role as registered nurses. The intention is to prepare them for the clinical environment. Unfortunately, violence in the workplace is a global problem experienced by healthcare professionals and students. However, interns’ experiences of WPV during their enrolment in internship programmes and the support they receive from these programmes, are inadequately researched. It is currently unknown whether or not these programmes can – and do – support interns who are experiencing WPV. Aim: This study aimed to explore interns’ experiences of WPV during their enrolment in internship programmes and to determine the support provided by these programmes in relation to WPV. Design: A convergent mixed methods design was used, which involved a cross-sectional survey and semi-structured interviews with interns from two Saudi universities. Data collection took place between September 2021 and January 2022. Saudi interns who had completed their bachelor’s degree in nursing from two universities in Saudi Arabia and had enrolled in the internship programme participated in the study and completed the Workplace Violence/Abuse Assessment Questionnaire. They were also invited to participate in a semi-structured interview. The Statistical Package for the Social Sciences (SPSS) (for the survey) and thematic analysis (for the interviews, using NVivo) were used to analyse the data and were then integrated using joint displays. This is a frequently used approach in mixed methods research, which juxtaposes qualitative and quantitative data. Integration of the data occurred in the inference stage. Results: There were 123 responses to the survey, and 20 students participated in the semi-structured interviews. The majority of interns (90.2%) had experienced/witnessed different acts of WPV (physical and verbal). These acts were mostly committed by patients and their families. Moreover, participants reported that senior staff nurses and physicians committed verbal abuse. Only 43.2% of the interns felt supported by managers during the programme. Data from the interviews revealed insights into interns’ vulnerability to WPV, the advantages of the internship programme, the impact of WPV, factors that impede the programme’s support and contribute to WPV, and interns’ needs from the programme and potential solutions. Although the programme eased interns’ transition, it provided insufficient support to those who experienced WPV. Several factors contribute to this situation, including a lack of communication between universities and hospitals, a lack of education sessions regarding WPV, and a lack of support. As a result, interns become disempowered and normalise WPV incidents. Following the joint display integration approach, a conceptual model was developed to capture the factors that impeded this support and led to the interns’ vulnerability to WPV and to their disempowerment. Conclusions: This study has shown that WPV experienced by interns during their transition to practice, combined with inadequate support from the internship programme, is a significant problem. There is a lack of education on how universities prepare students for their transition to clinical practice and a lack of communication between universities and hospitals when delivering the internship programme. Participants reported their needs in relation to the internship programme and from the programme organisers and suggested solutions to improve their working conditions during their transition to practice. The model from this study might help with the redevelopment of the programme and successfully ease interns’ transition to clinical practice, support them during the experience of WPV, and protect them. Universities and clinical environments might consider the model’s components when preparing, implementing, and evaluating internship programmes because it can be a vital part of a successful transition. The results of this study are directly applicable to the Saudi context and provide new knowledge in this context. They may be useful for improving internship programmes internationally and informing educators, policymakers, and programme developers about how to strengthen this programme, considering new graduate nurses’ experience of violence. The study has contributed to knowledge, but it is suggested that more research is needed to investigate the reasons for WPV during the internship programme at a macro level. Further work is also required to test the model developed in this study.