Samples and Sample Size

Phase 1: University Teaching Hospital Interviews

The study sample for the semi-structured interviews was purposive and identified by snowballing. The samples and sample size were the following:

• Five nurse managers who were involved in an orientation programme for recently registered nurses or who were familiar with the issues related to recently qualified nurses

Part 2: Japan • 10 ward managers in ITUs/HDUs/CCUs/ICUs at the study sites where recently

qualified nurses were working.

• 15 recently qualified nurses registered for 24 months or less who had graduated from the university working in ITUs/HDUs/CCUs/ICUs at the study sites.

The recruitment of recently qualified nurses was limited to graduates from university as the Scottish recently qualified nurses were all university graduates. The sample size for interviews in Japan was decided based on the sample size for the Scottish study.

As noted (4.4.4), in this study, RQNs were defined as nurses registered for 24 months or less. In addition, RQNs were defined to include RNs with various length of experience as hospitals only employ newly graduate nurses once a year, usually in April.

Phase 2: University Teaching Hospital Questionnaire

The sample for the questionnaire was purposive and obtained via convenience sampling to meet the inclusion criteria as follows:

• Registered nurses in ITUs/HDUs/ICUs/CCUs working with recently qualified nurses in one of the study sites

The exclusion criteria were the following:

• Bank nurses

• Registered nurses on sick leave or maternity leave.

The sample size of this phase was set at 200, the same as Part 1 after consideration of potential nurse numbers, the timeframe and manageability of data given that this was a cross cultural, two country study. Even though an over-sampling strategy was used in Part 1, it was not applied in Part 2 because the researcher was able to estimate the number of registered nurses who met the inclusion criteria for the questionnaire according to her previous working experience at one of the study sites. The questionnaire response rate with Japanese nurses was expected to be around more than 80 per cent according to similar questionnaire studies in Japan (Suzuki et al., 2006; Kanai-Pak et al., 2008). In addition by the time the researcher decided the sample size, she knew the response rate for the

Part 2: Japan questionnaire in Part 1 (n=118). Thus, 80 per cent of 200 potential participants was 160, which would allow the researcher to conduct statistical analysis.

4.5.6 Identification and Recruitment Process

The recruitment period was from 15/05/20010-31/08/2010.

After gaining research approval, the researcher identified and recruited potential participants for the study. Each step is described in the following paragraphs.

Phase 1: Identification and Recruitment Process: Ward

After having gained research approval from the Director of Nursing at each hospital, initial contact was made with six ward managers through Directors of Nursing Education and they asked the ward manager’s permission to conduct a study in their clinical area. They were asked for their support in terms of recruiting staff nurses. A recruitment pack was sent via email and also handed by the Director of Nursing Education to each ward manager. At this point, all six ward managers agreed to participate in the study. This study was conducted in four ICUs/ITUs/HDUs/CCUs located in the two different university teaching hospitals.

The researcher asked the ward manager at the meeting for the followings:

• Their help to identify and distribute the interview recruitment package to recently qualified nurses on the ward.

• Their help to distribute the questionnaire to all registered nurses on their ward.

• Their agreement to participate in the study by being interviewed.

Phase 1: Identification and Recruitment Process for Nurse Managers Interviews

Initially, the Directors of Nursing (n=2) at each study site agreed with the interview when the researcher asked them their permission to conduct this study. They identified an additional four nurse managers at their hospital to be approached for interview. After the identification of potential participants, initial contact was made with these four nurse managers via a letter with a Study Protocol, PIS (Appendix XXX), Interview Guide

Part 2: Japan (Appendix XXXIII), and Consent Form (Appendix XXXV). The Director of Nursing Education distributed the interview recruitment package. All targeted nurse managers agreed to be interviewed. In addition, a Japanese academic who the researcher had informal interview with prior to this study identified one potential participant from the Japanese Nursing Association (JNA) and one RN person from the government. Even though Part 1 did not recruit anyone from the Royal Collage of Nursing, equivalent to the JNA, the researcher decided to recruit him as one of the potential participants. The researcher considered that including him as a potential participant expanded the variety of data within the Japanese healthcare system where hospital structure and the role of nurse managers are slightly different from Scotland. A nurse manager from the JNA was contacted initially via a letter with study protocol, PIS, interview guide, and consent form and agreed. A potential participant from the government was also included. She was the leader of the project in nursing workforce planning in the Japanese government. The researcher had an interview with nurse manager working for the Scottish governmental project in Part1, Phase 2. The researcher considered her to be in the equivalent position as a participant in Scotland. Initial contact was made as the same way as other potential participants and an interview was agreed.

Phase 2: Identification Process for Ward Managers Interviews

Ward managers (n=6) on study wards were identified by the Director of Nursing Education at each hospital. Interview recruitment packages including the PIS, Interview Guide, and Consent Form were given to the ward managers during the process of recruiting the study wards. Six managers agreed to be interviewed.

Phase1: Identification Process for Recently Qualified Nurse Interviews

Ward managers and the Director of Nursing Education at one hospital identified the recently qualified nurses who met the inclusion criteria. A total of 18 recently qualified nurses who met the inclusion criteria were identified from the two participating hospitals.

Phase 2: Identification Process for Questionnaire

Ward managers from the two hospitals and the Director of Nursing Education from one hospital site identified all registered nurses (n=180) on their wards (n=4) for the purpose of the questionnaire distribution.

Part 2: Japan

Phase 2: Recruitment Process for Ward Managers Interviews and Questionnaire

Four ward managers and 18 recently qualified nurses who met the inclusion criteria were invited to the study in the following way.

1. The study protocol, PIS, questionnaire, interview guide, and consent form were given to the ward manager at the initial contact via email and/or by hand.

2. After gaining their permission and agreement, a meeting was organized at each nurse manager’s office to discuss the steps the researcher would take to conduct her study on their ward and the support the researcher needed from the ward manager. There was no meeting with one ward manager because she was extremely busy during the researcher’s visit to the study site. Thus a meeting was organised with the Director of Nursing Education at that study site to discuss the project.

3. During the meeting, all potential participants were identified by the Director of Nursing Education and ward managers for interviews and questionnaires. The ward managers or the researcher distributed questionnaire recruitment packages and interview recruitment packages to potential participants (nurse managers, recently qualified nurses and RNs) individually.

4. The researcher put the potential participant’s name when available on an envelope and distributed individually during the staff meeting.

5. Publicizing the study to the nurses was undertaken in the following ways; the researcher visited the ward several times with permission and gave a small talk to the nurses about this study and/or the researcher attended the staff meeting. If available, written notes were put in the communication book which all nurses looked at during their shift.

The following table shows each step taken in order to gain the maximum response from all potential participants (Table 4-3).

Part 2: Japan Table 4-3: Steps to Maximize the Response Rate

Study Site

H I J K

Putting individual names on the recruitment packages (questionnaire and interview packages) Ward Manager declined Only interview package Distribution of the recruitment package

individually face to face by ward manager

Distributing the recruitment package individually face to face by the researcher

Researcher giving a small talk about this study to nurses on the ward

Attended staff meeting

Writing notes in the communication book

Researcher sends reminder letter to the each ward before the return date of the questionnaire

Researcher sends reminder letter before the due day for the interview

When the researcher was distributing the interview recruitment package at one study ward, two recently qualified nurses were no longer working on that study ward. Thus a total of 16 recently qualified nurses were recruited.

Two ward managers declined to put names on envelopes because it made it difficult for them to distribute the questionnaire to the nurses.

The reminder letter was not sent to each potential participant for the questionnaire. The researcher discussed with three nurse managers and nurses with recent working experience at the study sites. They advised that it was not culturally acceptable behaviour to send each potential participant a reminder letter. Thus the researcher decided to send the reminder letter to the ward and asked the ward manger to put it in the communication book so that everyone could look at it and this was done.

Part 2: Japan

4.5.7 Data Collection Tools

Interview Schedule

There were two different interview schedules; one for nurse managers including ward managers (Appendix XXXIII); and one for recently qualified nurses (Appendix XXXIV). These interviews were initially developed in English for Part 1 (Appendix XII and Appendix XIII) and then translated to Japanese (4.5.1). At this point, several questions were omitted from translation because the contents were not appropriate for Japanese interviewees (e.g. asking about ‘FS’ or ‘ECCFs’). Additionally, several original questions from the English interview schedule were combined or amended to make it easier to follow for Japanese interviewees. Thus the numbers of interview questions in some schedules were different from the Scottish interview schedule. After translating the original documents to Japanese, back-translation was applied to these documents. The content of back-translate interview guides were discussed with the supervisor and the researcher made some amendments according to the discussion.

The interview schedule for nurse managers including ward managers was composed of two parts. The first part consisted of five questions (Q1-Q5) (similar to Q1-6, see Appendix XII) to probe their perceptions, opinions, concerns and issues related to government policies and legislative changes regarding nursing workforce planning. After these questions, the second part focused on their perceptions and opinions about the most recent legislative changes in the ‘Nurse Provision Act’ and ‘Public Health Nurses, Midwives and Nurses Act’ in 2009. Seven questions were asked in total. The first two questions (Q6-Q7) were about their expectations and perception of legislative change on ‘Nurse Provision Act’ and ‘Public Health Nurses, Midwives and Nurses Act’ in 2009 (similar to Scottish interview Q7-8, see Appendix XII). The next question (Q8) aimed to probe the outcome and changes due to these legislative changes on the ward and recently qualified nurses (similar to Scottish interview Q9-10, see Appendix XII). The following questions (Q10- Q11) were about their unique programmes at their hospitals and any concerns and issues (similar to Scottish interview Q11 and Q13, see Appendix XII) and the following question (Q11) asked about possible different approaches to the issues related to recently qualified nurses.

The interview schedule for recently qualified nurses was composed of two parts. The first part probed their experiences of being a recently qualified nurse (Q1-Q5) (similar to

Part 2: Japan Scottish interview Q1-5, see Appendix XIII) while the second part was aimed at their experience of the orientation programme at the hospital and support (Q6-Q9) (similar to Scottish interview Q6-15, see Appendix XIII). The last questions were about their concerns or recommendations for other recently qualified nurses.

Construction of the Questionnaire

The Japanese version of the questionnaire was developed based on the English version of the questionnaire.

The Japanese version examined the impact of government policies related to recently qualified nurses; on the nursing workforce at local level with critical care nurses and to provide a general view of the nursing practice environment in Japan. The questionnaire included the same component as the Scottish version of the questionnaire, including participant demographics and three further sections: in relation to change to their work place; in relation to experiences as a recently qualified nurse; and in relation to their working environment.

The original (Scottish) version of the questionnaire was translated into Japanese by the researcher and then back translated by bilinguals. After checking the contents of the questionnaire with the supervisor, the researcher also asked some native Japanese speakers who had some nursing background to feedback on the content and the wording of the questionnaire. In this way the validity of Japanese content of the questionnaire was established. In this section, only the differences from Scottish arm are described.

The first part of the questionnaire was about demographic data. The answers for the educational background were originally added to the English version as the Japanese nursing education system is different from Scottish one.

In Section 1, perceptions of workplace change were measured by using the POWCS (Perception of Workplace Change Schedule) (see 3.8.1.) The last question asking about their involvement in the ECCFs and FS programmes or project targeted at recently qualified nurses was omitted as there is no such a programme in Japan.

Section 2 was designed only for recently qualified nurses to complete. In this section, experiences of being recently qualified were explored. Several questions asking about their

Part 2: Japan involvement in and their satisfaction with ‘FS’, ‘ECCFs’ were omitted from the Japanese version of the questionnaire.

Section 3 was designed for all registered nurses to complete. In this section, their perceptions of the hospital nursing practice environment were measured. There are Japanese studies used the NWI-R (Nursing Work Index Revised) (Kanai-Pak, 2007; Kanai- Pak et al., 2008). Thus the translation of the PES-NWI was done based on the Japanese version of NWI-R used in the previous studies (Kanai-Pak, 2007; Kanai-Pak et al., 2008) because PES-NWI was originally developed from NWI (Kramer and Hafner, 1989)and NWI-R (Aiken and Patrician, 2000)was revised version of NWI. Back-translation was therefore not necessary. However, the wording of the questionnaire from the Japanese version of NWI-PES was compared with the original version and discussed with the bilinguals who did the back-translation for other research documents. In particular the word and content was compared and discussed where the researcher made changes in the questionnaire for the Scottish arm. The researcher decided to use the phrase from Japanese version of NWI-R rather the phrase from the Scottish questionnaire for this part. For example, ‘Adequate support services allow me to spend time with my patients’ was used where it was rephrased in Scottish questionnaire to ‘Our hospital believes that it is important for me to spend time with my patients’.