Design, sample and setting

This was a qualitative descriptive evaluation using a focus group and interviews. The project began in April 2022 and was concluded in March 2023. All nursing students, nursing associates and newly registered nurses working in clinical settings at a specialist cancer centre were eligible to take part (n=32). Purposive sampling via email was used to approach and recruit the sample. The project team (the authors of this article) defined a newly registered nurse or nursing associate as having been registered for two years or less.

The specialist cancer centre referred to in this evaluation is located across two sites in south east England and provides cancer services including diagnostics, surgery, chemotherapy, radiotherapy, outpatient services, critical and acute care, and symptom management and support.

Data collection and analysis

Data collection took place between May and August 2022.

Eight nursing students took part in a semi-structured focus group with a schedule of questions including ‘What motivated you to work in a cancer placement?’ and ‘Tell me about your experiences on a cancer placement so far?’ The focus group was led by one of the authors (EH) and supported by another author (GO). A total of 19 newly registered nurses or nursing associates took part in semi-structured individual interviews via their choice of means – either telephone, a digital platform or face-to-face. The interview schedule included questions about the participants’ perceptions of cancer care such as ‘What motivated you to apply for a job in cancer care?’ and ‘What has been good about your experience as a newly registered nurse in oncology so far?’ The interviews were conducted by two of the authors (either EH or GO) and lasted between 20 minutes and 46 minutes (average 29 minutes). There was no established relationship between the members of the project team and the participants before the focus group and interviews.

Data from the focus group and interviews were digitally recorded and transcribed verbatim. The transcriptions were thematically analysed manually, which was aided by reflexive notes (Braun and Clarke 2012, 2022). This approach involved two members of the project team (EH and GO) generating initial codes from the transcripts, then reaching coding consensus, agreeing categories and inductively developing broader themes. To ensure the reliability of the final themes, these were checked against the participants’ initial responses and the data were peer reviewed by other members of the project team (Lincoln and Guba 1985).

Ethical considerations

Ethical approval was sought for the project from the local clinical committee for research and it was approved as a service evaluation. The project team also presented the service evaluation to the local specialist cancer centre patient experience group. Written information was sent to the eligible participants and written consent was obtained before any interviews then later confirmed verbally. Participant confidentiality and anonymity were assured and maintained throughout the project, and all the data were securely stored.

Navigating the nursing student experience

Motivation to work in oncology

Nursing student and newly registered nurse participants described various factors that influenced their decision to work in cancer care. Personal factors – such as the experience of observing their own family members living with cancer or also having worked in the specialty – were a significant influence for participants, with one stating:

‘I always wanted to work in cancer. Mum was a cancer nurse. She’s one of those nurses who just loves being patient-facing and just absolutely adores her job.’ (Newly registered nurse 1)

Participants also expressed how positive experiences on a clinical placement in cancer care could be motivating. For example, observing high clinical standards and professional role models offered a template for the participants to emulate. One of them commented:

‘I did my very first placement at the [specialist cancer centre], on ward X and I knew that I was going back there. That was my first placement… I was just amazed with everything really. I saw nurses doing PICC [peripherally inserted central catheter] line insertion and I thought “Wow, I didn’t know nurses could do this”.’ (Newly registered nurse 19)

The specialist cancer centre was seen as a desirable place to work by participants, particularly with its reputation for leading research and education and for offering a supportive environment for learning:

‘I think just the general organisation of the hospital, the support that’s available to the patients and to staff, was a lot more of a supportive environment than maybe some of the other placements I’ve had.’ (Newly registered nurse 4)

‘There were a lot of people that were really keen to do their training [at the specialist cancer centre], so to have that opportunity… it was special, almost. Not many people can say they’ve done their training there.’ (Newly registered nurse 13)

Transition to staff nurse

Once newly registered nurses were appointed to their first nursing post, they underwent the transition from nursing student to registered nurse. In this service evaluation, most of the participants described being given clear directions in their first staff nurse role and a timetable for learning clinical skills. The role of the practice educator was considered important in providing one-to-one support with a non-judgemental attitude, as was the support and encouragement of colleagues on the ward. For example, one participant commented:

‘I felt supported by [the practice educator] a lot, in the way that I wanted to feel supported. She wasn’t patronising, she didn’t make me feel stupid, and, yeah, she helped me.’ (Newly registered nurse 9)

Some participants experienced a feeling of being overwhelmed in their first staff nurse role, particularly if they had missed out on clinical opportunities as part of their nurse training due to the COVID-19 pandemic. In addition, where participants had been on clinical placement at the specialist cancer centre as a nursing student, this was viewed as an advantage over being completely new to the centre:

‘I was a student at the [specialist cancer centre] for quite a few of my placements, so this is where I did most of my training and I felt more comfortable, as a newly qualified nurse, starting in an area that I’m familiar with.’ (Newly registered nurse 10)

‘There is a massive gap from qualifying and starting your first role. The gap is huge because you are not accountable as a student, and you can just “pull the student card” as and when… I am seeing a lot of students who have trained here, they know the lay of the land. I have to learn it.’ (Newly registered nurse 5)

Some participants expressed particular anxiety around being asked to undertake specialist tasks such as systemic anticancer therapy (SACT) delivery and felt that this responsibility had been given to them too soon. One of them stated:

‘I thought, I’ve not been in here a year and have only been doing [intravenous infusions] for six months. I’m still figuring out. I obviously know what I’m doing, but there’s loads of things I need to learn that are the basics. Should I really be giving chemotherapy to a patient just yet? I’m not really sure.’ (Newly registered nurse 2)

The preceptorship programme provided an opportunity for participants to access peer support. However, attendance at preceptorship sessions could be affected by short staffing, and many of the participants did not have positive views about self-directed learning. For example, one participant stated:

‘We’re being made to make a poster to advertise for a preceptorship champion thing and we have to reference and then present it and I’m just like, “I don’t want to be doing that in my own time”.’ (Newly registered nurse 6)

Regarding the personal qualities required when transitioning from a student to registered nurse role, many participants acknowledged their lack of confidence when they first started in post, but reflected on how their confidence had grown and how they were motivated by pride that their role had real value. Some participants who described themselves as ‘shy’, ‘nervous’ or ‘sensitive’ had questioned their suitability for nursing and could become particularly stressed when confronted with the unexpected, such as a move to another clinical area to cover staff shortages. One participant commented:

‘It’s just losing the familiarness of the ward, it just throws you off a bit when you’re put into a different ward.’ (Newly registered nurse 10)

An organisational culture that featured positive feedback on performance, alongside support through listening and receiving empathy from other staff members, was important in developing participants’ confidence, as was a culture of framing mistakes as opportunities for reflection. As one participant observed:

‘There have been [errors which needed to be recorded on the risk management system] Datix. Even when scenarios like that have occurred, I know that I’m not being told off or penalised. It is a learning thing and a safety thing, and so even when I’ve made errors, I never felt I was receiving a telling-off.’ (Newly registered nurse 13)

Looking ahead

Most of the newly registered nurses had considered their future career roles. Most of these roles were in oncology, with the most popular being clinical nurse specialist; however, participants were aware of other roles, including in airway management, tissue viability, haematology, transplant and palliative care. Other roles mentioned as potential career options were in education or as advanced nurse practitioners, although few participants aspired to be senior ward managers. Several participants intended to continue working at the specialist cancer centre because they felt there were more opportunities available than in other areas, and that the centre focused on innovation and research. One of them stated:

‘I just like the feel of the [specialist cancer centre] actually and, if I’m honest it’s somewhere there is money, if that makes sense. There’s always research going on, you know?’ (Newly registered nurse 7)

Some participants discussed being given the opportunity to practice management roles by taking charge of a clinical area at the weekend, with senior support. In the short term, several participants were looking to the next stage of their career by furthering their oncology knowledge and applying for band 6 positions, with one of them commenting:

‘Yes with the staffing on the ward at the moment there’s definitely a lot of vacancies, so I think as soon as I can, I’d love to do my module and get my band 6. In the next year I’ll look into starting it.’ (Newly registered nurse 6)

Limitations

One potential limitation of this evaluation is that 26 of the 27 participants identified as female – although this is representative of the nursing profession, where around 90% are women (Buchan and Catton 2020). Additionally, this was a unique sample since the participants’ experiences were directly affected by the COVID-19 pandemic, and therefore may not have been representative of the experiences of other nurses. Only one nursing associate was recruited to this service evaluation, so further work is necessary to explore these professionals’ experiences and perceptions.