Date of Award


Degree Name

Doctor of Philosophy (College of Nursing)

First Supervisor

Doctor Carol Piercey


The identification of the role and competencies of the graduate nurse in recognising and responding to the deteriorating patient in an acute ward environment: A mixed method study. Patients’ physiological condition can be unstable for prolonged periods before transfer to critical care units. Thus, it is imperative that ward based nurses are able to recognise, respond and initially manage patients with a deteriorating condition. Unfortunately, warning signs of physiological decline are often missed, or ignored by both experienced and newly graduated registered nurses. Complex systems and processes to recognise and respond to clinical deterioration have been developed to try to prevent, or mitigate the risk of this occurrence. These systems and processes have, however, stopped short of allocating roles and specifying the required competencies needed by health care professionals, including newly graduated registered nurses. This study aimed to investigate the key elements of the role undertaken by the graduate registered nurse in recognising and responding to the deteriorating ward patient.

Method: The study employed a partially mixed method explanatory design with four phases. Initially a two part online quantitative questionnaire tool was developed, tested and distributed to over 900 graduate registered nurses. The intent was to firstly explore the role newly graduated nurses in the management of the deteriorating ward patient and the factors impacting on the role. Secondly, itwas aimed at investigating the clinical competencies used and the level of intervention nurses provided. Following analysis of the quantitative data, a qualitative phase utilising focus groups provided further clarification of the graduate nurses’ role, and factors impacting on the role.

Findings: Seventy-nine competencies were identified and utilised by the majority of graduate nurses. The most relevant related to the recognition of deterioration in the ward patient, the assessment and monitoring of vital organ function and the need to call for help. Several factors impacted the graduate nurses role including: the need to gain permission to act; confidence; knowledge; negative emotions; lack of clarity; and ward support. Numerous ways of improving capabilities and performance were suggested. These included; the need for clearly defined competency statements; competency based assessment; organisational role delineation; mentorship; specialised multidisciplinary training; and improvements in undergraduate and post-graduate education.

Conclusion: This study was the first to investigate the role of the graduate registered nurse and the acute care competencies utilised in managing the deteriorating patient from both a quantitative and qualitative perspective. To effectively enable graduates to provide safe, timely management: hierarchical barriers need to be removed, support given for clinical competency standards to be utilised, and specialist education provided.

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Included in

Nursing Commons