Date of Award

December 2017

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Teaching and Leadership


Gerald M. Mager


clinical decision making, nurse formation, nurse orientation, nurse preparation, nurse self-concept

Subject Categories




A challenge to health care in the 21st Century is preparing and integrating newly registered nurses (RNs) into the health care system. The most ill and infirm are often the recipients of nursing care provided by new RNs, thus the quality and safety of care may be dependent on these new RNs. Four research questions based on a review of the literature has guided this study. A three-phase sequential explanatory mixed-method approach, using both quantitative and qualitative strategies, was designed to look at nurse self-concept and clinical decision making from the end of the nurse preparation program through the first year of nursing practice. Little is understood regarding the formation of a new RN, particularly how the constructs of nurse self-concept (NSC) and clinical decision making (CDM) are part of formation. Although not one of the research questions, the Conceptual Model of Nurse Formation was found to have a degree of validity in representing the process of nurse formation.

Soon-to-be graduates (n = 168) from five institutions in New York State completed the Nurse Formation Survey (NFS), an instrument developed for Phase One of this study. This instrument included the constructs of NSC and CDM.

In Phase Two 10 individuals were selected and agreed to participate in interviews scheduled over the course of the first year of nursing practice. The interviews focused on nurse self-concept and clinical decision making.

In Phase Three, The NFS was readministered to measure any changes in nurse self-concept and clinical decision making after one year following the first administration. This survey was administered as an electronic survey and resulted in 49 respondents.

The responses in the NFS were analyzed using descriptive statistics, examining NSC and CDM components. These components were also examined in regards to demographics of the respondent group. Pearson’s r was used to study the relationship between NSC and CDM. Interview data were analyzed and 10 individual focused portraits highlighting nurse self-concept and clinical decision making were created. The quantitative and qualitative data were analyzed together to discover the relationship between the survey measures and the lived experiences of the new RNs in understanding nurse formation.

The NSC and CDM scores were clustered at the higher end of the scales and they were positively and moderately correlated. NSC scores did not change over the course of the year; CDM scores declined. Interview data provided multiple ways of viewing nurse self-concept and showed a relationship between nurse self-concept and clinical decision making. There was a difference between NSC and CDM scores and reported nurse self-concept and clinical decision making at the first interview. Based on the interview data over the course of the year nurse self-concept moderated; clinical decision making improved. The role of nurse self-concept and clinical decision making in nurse formation was traced in narrative format.

The study concludes with a discussion of limitations and recommendations for nursing education, nursing practice, and future research.


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