A literature review: graduate nurses' preparedness for recognising and responding to the deteriorating patient


Correspondence: Lindy King, Senior Lecturer and Associate Dean, School of Nursing & Midfiwery, Flinders University GPO Box 2100, Adelaide, SA 5001, Australia. Telephone: +61 08 8201 3344.

E-mail: lindy.king@flinders.edu.au


Aims and objectives

To explore the research literature that provided data on factors that influence new graduate nurse's preparedness for recognition and response to patient deterioration in the acute care setting.


Nurses have a significant role in recognising subtle signs of patient deterioration and responding appropriately to prevent adverse events and improve patient outcomes. This pivotal position has often fallen to the new graduate who must be prepared to make high-consequence decisions in relation to a suspected decline in their patient's condition.

Design and methods

An integrative review was undertaken. A comprehensive literature search was conducted using online databases, reference lists of key articles and expert advice. Multiple keyword combinations were used. All relevant studies were subsequently appraised for rigour and quality. Seventeen primary research studies drawn from novice and experienced registered nurse experiences emerged as relevant to the review.


Thematic analysis of the studies provided six major themes related to the aim of the review. Emergent themes were as follows: clinical staff support, lack of nurse experience, overwhelming workload, holistic patient assessment, past experiences and lack of available resources.


This review highlighted the importance of positive staff support and subsequent confidence building. Graduates then felt able to present effective assessments and less fearful of reprimand when escalating an intervention call. The need for further research to investigate graduate nurses' experiences of recognising and responding to the deteriorating patient emerged.

Relevance to clinical practice

Realistic workloads and access to supportive experienced staff would allow graduates time to focus on grouping clinical information to understand the ‘total picture’ of the patient. Results indicated undergraduate and hospital in-service education programmes needed to offer the opportunity to practice reasoning. Complex clinical situations involving patient deterioration through simulation and clinical placement opportunities appeared most useful.