AN ASSESSMENT OF VARIABLES AFFECTING TRAINING TRANSFER AMONG NEW CLINICAL NURSE SPECIALISTS; A CASE STUDY OF UNIVERSITY OF UYO TEACHING HOSPITAL

Chapter One

Introduction

1.1 Background to the Study

Nurses play a pivotal role in healthcare delivery, acting as the frontline caregivers who interact most frequently with patients. They are responsible for a wide range of duties, including monitoring patient health, administering medications, assisting with medical procedures, and providing emotional support to patients and their families (Aiken et al., 2012). For newly qualified nurses, the first year in the workforce is typically marked by a period of adjustment. During this time, they must familiarize themselves with new units, services, and work environments, while simultaneously developing competencies needed for their new roles (Missen et al., 2024). The transition from nursing student to practicing nurse is complex, often presenting challenges that extend beyond basic skills (Duchscher, 2019). One of the most prominent issues reported by new nurses is the disparity between theoretical knowledge gained during academic training and the practical realities encountered in clinical settings (Walker et al., 2015).  To make new nurses adjust to the clinical processes, there is need for training transfer. 

According to Nash, Zack & Nancy (2018) training transfer refers to the effective application of the knowledge, skills, and attitudes learned during training to the workplace.  Traditionally, Blume et al., 2010) highlighted that training transfer is typically categorized into three main areas: learner characteristics, the design and content of training, and the work environment (Grossman & Salas, 2021). While much of the existing literature has focused on the transfer of learning within the workplace, particularly on-the-job training (Burke & Hutchins, 2017), there is limited research on how learning transfer occurs in settings where knowledge is acquired during university and later applied in professional healthcare settings. 

Salmerón (2018) highlights that learning transfer often stems from specific experiences, which in higher education tend to occur long after initial learning has taken place. In the context of healthcare, particularly for clinical nurse specialists (CNS), the ability to transfer training is critical to ensure that they can apply their advanced skills in patient care, leadership, and clinical practice effectively. The training of clinical nurse specialists is comprehensive, focusing on both clinical skills and leadership capabilities (Kaufman, 2019). As CNSs play a pivotal role in improving patient outcomes, it is essential that they transfer the skills learned during training into their practice to ensure the quality of care delivered (Burke & Hutchins, 2007).

According to Holton, Bates & Ruona (2020), regardless of the comprehensive nature of CNS training, many variables can impact the degree to which newly trained specialists transfer their training into clinical practice. One of the specific factor affecting training transfer is the workplace environment, which includes support from supervisors, access to resources, and the overall culture of the institution. For instance, if clinical nurse specialists return to environments that are resistant to change or that do not value continuing education, the likelihood of effective training transfer is reduced. In contrast, Saks & Belcourt (2016) pointed that environments that encourage collaboration and learning are more likely to see successful training transfer. Furthermore, individual characteristics such as motivation, self-efficacy, and prior experience can also affect how well a nurse transfers newly acquired skills to their practice. 

Grossman & Salas (2021) assert that another factor that influences training transfer is the quality of the training itself. This is because training programs that are well-structured, relevant to job responsibilities, and supported by post-training initiatives such as mentorship and ongoing learning are more likely to result in successful skill application. Conversely, Taylor (2019) highlighted that poorly designed training programs that do not consider the specific needs of the learners or the clinical setting may fail to equip clinical nurse specialists with the practical skills they need for their roles. The design of CNS training in Nigeria must, therefore, consider these aspects to ensure effective training transfer. This study will, therefore, assess the variables that affect the transfer of training among new clinical nurse specialists at the University of Uyo Teaching Hospital.

1.2 Statement of the Problem

It is no doubt that in recent times, the gap between training and practice is a persistent issue in many fields, but it is particularly critical in healthcare where ineffective training transfer can lead to substandard patient care. In the case of clinical nurse specialists (CNS), their advanced training positions them to play a key role in improving patient outcomes. Apparently, the healthcare environment in Nigeria, and specifically in teaching hospitals, presents unique challenges. 

Contextually, the University of Uyo Teaching Hospital serves as an essential case study for this assessment due to its position as a leading teaching hospital in Nigeria. As a teaching hospital, it is a training ground for new healthcare professionals, including clinical nurse specialists, who are expected to demonstrate a high level of competence in both clinical and administrative roles (Adamu & Salihu, 2019). Understanding the variables that affect training transfer in this hospital can provide insights into how to improve the overall training process and, by extension, patient care. According to Salas et al (2022), without a thorough understanding of these variables, training programs may fail to achieve their desired outcomes, leading to suboptimal patient care. 

Previous research has indicated that workplace culture, lack of support, and inadequate resources are significant barriers to training transfer in healthcare settings (Burke & Hutchins, 2007).  Studies have also highlighted that individual motivation and self-efficacy play an important role in determining whether training is effectively transferred (Blume et al., 2010). A study by Ogundele & Odoyewu (2020) emphasized that limited resources, high patient-to-staff ratios, and often overwhelming administrative duties can inhibit a nurse’s ability to fully implement the skills they acquire during training). This reality makes it even more critical to assess the specific variables that impact training transfer among new clinical nurse specialists in institutions like teaching hospital.

Despite the crucial role that CNSs are expected to play, there has been limited research into how effectively their training is transferred into clinical practice. This gap in the literature presents a need for further investigation, particularly in the Nigerian healthcare context. More so,  in teaching hospitals like the University of Uyo, where nurses are expected to take on leadership roles in addition to their clinical responsibilities, the stress and demands of the job can reduce motivation and hinder the transfer of skills learned during training. The lack of structured follow-up and ongoing learning opportunities may further exacerbate this problem.  Given the importance of clinical nurse specialists in improving patient outcomes and the limited research on training transfer in Nigerian healthcare settings, this study aims to address this gap by examining the specific factors that inhibit or promote training transfer among new CNSs at the University of Uyo Teaching Hospital.

1.3 Objectives of the Study

To identify the variables that affect training transfer among new clinical nurse specialists at the University of Uyo Teaching Hospital.

To assess the role of workplace environment in facilitating or inhibiting training transfer.

To evaluate the impact of individual characteristics such as motivation and self-efficacy on training transfer.

To offer recommendations for improving the effectiveness of training programs for clinical nurse specialists.

Research Questions

What are the variables affecting training transfer among new clinical nurse specialists at the University of Uyo Teaching Hospital?

How does the workplace environment influence the transfer of training among CNSs?

What individual characteristics affect the ability of new CNSs to transfer their training into practice?

What strategies can be implemented to improve training transfer among clinical nurse specialists?

 Research Hypotheses

Ho1: There is no significant influence of workplace environment on  training transfer among new clinical nurse specialists at the University of Uyo Teaching Hospital.

Ho2: Individual characteristics does not affect the ability of new CNSs to transfer their training into practice in University of Uyo Teaching Hospital.

1.6 Significance of the Study

The practical significance of this study lies in its potential to inform policy and decision-making at the University of Uyo Teaching Hospital and other similar institutions. By identifying the key variables that impact training transfer, hospital administrators can implement strategies to improve the support systems for newly trained clinical nurse specialists. This could lead to better patient outcomes, increased job satisfaction for CNSs, and more efficient healthcare delivery. More so, the study aims to offer recommendations for improving training programs and fostering an environment that promotes continuous learning and effective application of skills.

Additionally, the theoretical significance of the study is grounded in its contribution to the existing body of knowledge on training transfer in healthcare settings. While much research has been conducted on training transfer in high-income countries, there is limited literature on how these variables play out in low-resource environments like Nigeria. This study will fill that gap and provide a foundation for future research on training transfer in similar settings.

1.7 Scope of the Study

The study focuses on the variables affecting training transfer among new clinical nurse specialists. The content of the study includes an assessment of workplace factors, individual characteristics, and training program design as they relate to training transfer. The geographical scope is limited to University of Uyo Teaching Hospital  Uyo, Nigeria, with the target population being clinical nurse specialists who have recently completed their training.

1.8 Limitations of the Study

The limitation of this study is the reliance on self-reported data from participants, which may introduce bias and affect the accuracy of the findings. Additionally, the study is limited to a single teaching hospital, and the results may not be generalizable to other healthcare settings. Another limitation is the potential variability in training quality across different clinical nurse specialists, which may affect the consistency of the findings. Furthermore, external factors such as government policies or economic conditions that could influence the healthcare environment are beyond the control of this study.

1.9 Definition of Terms

Training Transfer: The application of skills, knowledge, and attitudes learned in training to the workplace.

Clinical Nurse Specialist (CNS): An advanced practice nurse with expertise in a specialized area of nursing.

Workplace Environment: The physical and cultural setting in which clinical nurse specialists apply their training.

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