Relationship between Nurse Interns' Satisfaction Regarding Internship Program and Clinical Competence

Transcription

1 Med. J. Cairo Univ., Vol. 81, No. 2, March: , Relationship between Nurse Interns' Satisfaction Regarding Internship Program and Clinical Competence SANA A. AL-MAHMOUD, D.N.Sc.* ; SHEREEN R. DORGHAM, D.N.Sc.** and MAHASEN I. ABD EL-MEGEED, D.N.Sc.* The Department of Nursing Administration, Faculty of Nursing, Tanta University** and ill-dammam University, K.S.A.* Abstract Successful internship programs should be those in which teaching and learning are provided to help the new graduate nurse make the transition from novice to advanced beginner who can demonstrate acceptable performance and cope in real situations. The present study aimed to assess the relationship between nurse interns' clinical competence and their satisfaction regarding internship program at King Fand Hospital of the University (KFHU) in Kingdom of Saudi Arabia. Fifty eight respondents participated in the study. The data of the study was collected using two separate instruments developed by the researchers, first one assessed clinical competence contains two parts and the second assess satisfaction levels among nurse interns. After obtaining the subjects' consents, the researchers distributed the questionnaires on studied tool I on hospital preceptors to assess the interns' clinical competence, they filled the questionnaire while were working in their work settings. And assessed interns' satisfaction regarding internship program by using tool II, once before the end of internship training year. Filling the questionnaire consumed about minutes for each tool, the data collected during internship training year. This study cancelled the relationship between nurse interns' clinical competence and their satisfaction regarding internship program. Highest mean score for interpersonal and communication skills, followed by managerial, while knowledge and psychomotor skills s have the lowest mean scores. The study recommended that; Further research focused on nurse internship satisfaction for hospital and College preceptors. Moreover, further research to study the relationship between internship program and new graduates' retention. Key Words: Competence Satisfaction. Introduction DEVELOPING competent and confident new graduate nurses who remain with their hospitals is a major challenge. Nurse shortage is a worldwide problem while high stress from new environment and low competence may be contributors for high Correspondence to: Dr. Shereen R. Dorgham, The Department of Nursing Administration, Faculty of Nursing, Tanta University turnover of new graduates [1,2]. Although the enrollment in baccalaureate programs in nursing continues to increase, the increase is not enough to solve the nursing shortage. Unless there is significant progress in expanding the size of the future nursing workforce, realizing the goals of health care reform will be difficult. The decreased supply of and increased demand for nurses is a recipe for another even more intense nursing shortage in the coming years [3,4]. Consequently, organizations have responded by competitively increasing the recruitment of new graduate nurses in their hiring pools. However, these new graduates fill vacancies, hiring new graduate nurses also generates problems. The high turnover of newly graduated nurses is emerging as one of the problems that hospitals need to address [2,5,6]. In fact, many new nurses expressed satisfaction with their role and recognized opportunities for personal growth and development. Others enjoyed the responsibility of working as a nurse. Inadequate staffing, pace of work and feeling unprepared for the responsibility of the role have been found to be dissatisfying to newly graduated nurses while achieving patient care goals and receiving recognition were satisfying [7-11]. Nursing literature reported that poor training, a lack of support systems, and the stress related to the intense working situation and high patient acuity are the main reasons nurses are leaving during their first year after graduation [11-13]. Furthermore, a high turnover and an influx of new Operational definitions: *New graduates: Are student nurses who successfully accomplished four years of undergraduate nursing program. 151

2 152 Relationship between Nurse Interns' Satisfaction graduates have led to a higher proportion of inexperienced nurses in direct patient care, which may not only be traumatic for the new professional nurse but may also threaten patient safety [14,15]. Nursing students entering the clinical area can be characterized as novices because their knowledge is limited, they tend to be rather inflexible, and they are inexperienced in actual clinical situations. Successful internship programs should be those in which teaching and learning are provided to help the new graduate nurse make the transition from novice to advanced beginner who can demonstrate acceptable performance and cope in real situations [16-18]. Moreover, the readiness of new graduates to function as registered nurses (RNs) continues to be in question. Therefore, the need to assure an ongoing supply of competent RNs who are prepared to practice in acute care seftings and who will remain in those settings requires a change in how new graduate nurses are transitioned into professional nurses [19-22,23]. Despite the assessment of nursing students' clinical competence being at the core of evaluations during their nursing education, there are no clear definitions of such competence for nurse educators to use. In previous studies, the concept of clinical competence was considered an integration of cognitive, emotional, and functional aspects of the quality that needs to be instilled in nursing professionals. Initially, such a perspective led to the definition of clinical competence as one's ability to carry out given tasks by effectively using one's lmowledge and skills [12]. But with the expansion of the scope of nurses' responsibilities, more integrative as well as comprehensive definitions have been developed [24,25]. In other words, recent definitions of clinical competence include the tactful integration and execution of one's context-specific nursing lmowledge and skills based on one's ethics, values, and proper maintenance of therapeutic relationships. Furthermore, such definitions increasingly require that nurses demonstrate an ability to provide quality care for patients from a wide variety of cultural backgrounds, and to collaborate with other nurses and staff across divisions [26]. Many nursing colleges rely on internship programs to train novice registered nurses into the ranks of critical care. This practice places additional demand on already exhausted resources. Bayfront Medical Center's Emergency Department (St Petersburg, FL) is feeling the full weight of this demand and is committed to providing a wellstructured, evidence-based solution. Our solution is the creation of the Novice Registered Nurse Internship Program [25,26]. Hence, preceptorship or internship periods represent an exciting time for students, but it is clear that these also present major challenges for students on many levels. These include the need to acquire and regularly demonstrate communication and clinical skills, including history taking, examinations, providing patient information, and performing practical procedures. Therefore, developing a befter understanding and performing practical procedures [26]. A regulatory perspective described that, the ultimate goal of transition programs is to increase competence of new nurses and consequently augment the quality and safety of healthcare provided to all patients. Currently, there is no national standard for transitioning new nurses into practice following graduation from a nursing program, and very few states have regulations for the development of nurses during the first year of practice [24]. Complicating the issue is that many organizations have a limited or varied orientation structure for new graduate nurses, making the transition to practice very difficult. Faced with reality shock, low job satisfaction, as well as confidence and competence issues, many new graduates leave the profession within the first two years. Therefore, internships are now considered essential for demonstrating work experience to potential employees and can significantly increase new graduate nurses chances of getting hired for a full-time job after graduation to overcome nursing shortage. Moreover internships provide students a taste of the working world, and let them become familiar with a potential job sector. As more universities stress the importance of internships the market is becoming more competitive [271. Multiple studies have demonstrated the various aspects of reality shock and lack of confidence that new graduate nurses experience during those crucial first months in the workforce. Some authors estimated it takes at least 1 year for a person to master a job because the health care culture emphasizes specialization, technology, and perfectionist standards [27-29]. However, the research on the effects of this program is limited by small-size studies and the experiences of single institutions. There are few systematic literature reviews focusing on internship programs for newly graduate nurses. The purpose of this study is to assess the relationship between nurse interns' satisfaction regarding internship program and clinical competence, moreover identify the key elements which may be contributing to interns' satisfaction regarding internship program.

3 Sana A. Al-Mahmoud, et al The Aim of the Study: The aim of this study was to assess the relationship between nurse interns' satisfaction regarding internship program and clinical competence. Research questions: Two research's questions were asked about: What was the relation between demographic data of nurse interns and their clinical competences? Is there a relationship between interns' satisfaction regarding internship program and clinical competence? Material and Methods Design: Descriptive correlation research design was utilized for this study. Setting: This study was conducted at king Fand Hospital of the university (KFHU), in the following departments; Medical, Surgical, Pediatric, Obegynecology, Orthopedics, Burn, Haemodialysis, Emergency, Intensive Care Units (Medical Intensive Care Unit, Surgical Intensive Care Unit, Pediatric Intensive Care Unit, Neonatal Intensive Care Unit). Sample: Nurse interns who are graduated from College of Nursing, University of Dammam through the academic year (2011/2012) and who are training at king Fand Hospital of the university (KFHU), available nurse interns [58]. Head nurses as preceptors [15] worked in the above mentioned departments and units who were responsible for the evaluation of interns. Inclusion Criteria: Graduates from College of Nursing, University of Dammam academic year 2011/2012, who successfully completed program within four years. Nurse interns who finished internship training year in August, Exclusion Criteria: Nurse interns from different academic year and different University. Nurse interns who didn't finished internship training year, until August, Tools: Two tools in this study were developed by the researchers after review of related literatures [19,24]. Both tools used once at the end of the internship training program. Tool I: Assess clinical competence contains two parts; demographic data & clinical competence s; knowledge [14], Interpersonal & communication skills [13], Psychomotor [21] & Managerial competence [4]. Each item is rated on a 4- point scale ranging from 0 (No experience ), 1 (Need review & supervision), 2 (Competent with resource available), 3 (=Competent to perform independently & safety), & 4 (Expert, able to act as resource to others) & NA not applicable (skill which did not applied in the training area, and should be excluded). Tool IL Assess satisfaction levels among nurse interns. It is rating scale of [25] items, Each item is rated on a 3-point scale ranging from 1 (Disagree) to 3 (Agree) and [7] open questions. Ethical considerations: The research was approved by an ethical committee of the university. The data was collected after the approval of permission from the hospital responsible authorities. Prior to the data collection, informed consents of all nurse interns and preceptors were obtained. The nurse interns and preceptors were informed about the purpose of the research study. Tools were developed after reviewing the related recent scientific literature and used by the researchers to collect data once at the end of internship training program. A pilot study was carried out on 10 nurses from the previously mentioned setting to assess the applicability and test/retest reliability and excluded from the main study's sample. Data collection: The researchers distributed tool I on hospital preceptors to assess the interns' clinical competence, they filled the questionnaire while were working in their work settings. And assessed interns' satisfaction regarding internship program by using tool II, by collecting them in basement auditorium at King Fand University Hospital once before the end of internship training year. Distribution of questiormaire was conducted by researchers. Filling the questionnaire consumed about minutes for each tool, data was collected within two month since Jun 2012 to August Statistical analysis: After completing the data collection, data was coded, verified, and transferred into a special form to be suitable for computer feeding using SPSS (Statistical Package for Social Science) version Descriptive measures include means and standard deviations for quantitative variables. Analysis of collected data was done through the use of several statistical tests as: Student t-test that is used to test the association between two variables and ANOVA used to test the association between three or more variables. Spearman's rho is used to measure correlation. Significant level is set at

4 154 Relationship between Nurse Interns' Satisfaction p<0.05. Kendall's tau and Spearman's rho were used for test re-test reliability of values were >0.8 in almost all cases. For internal consistency reliability were used Cronbach's coefficients alpha >0.90. Scale Content Validity Index S-CVI was over 0.9. Results Table (1) shows distribution of studied respondents according to their demographic characteristics. High percent (63.7%) of nurse interns were in the age 23 years, their age was ranged from years with mean age value 23±6.72. More than fifty percent 51.7% of them were single, 43.1% were resident in Al-Qateef and 24.1% from Khober. The majority (43.1%) of nurse interns had GPA 3.5, the mean GPA of the studied interns was 3.67±0.44 with range Table (1): Distribution of studied respondents according to their socio-demographic characteristics. Demographic Characteristics No. Age: Age GPA: Mean=23 years SD=0. 69 Range (22-25 years) GPA Mean=3. 67 SD=0. 44 Rang ( ) Marital status: Single Married Residence: Khober Danunam Al-Qateef Further Fig. (1) presents mean scores for clinical competence s among studied respondents. It demonstrates that the highest mean score is 69.05±18.08 for interpersonal and communication skills, followed by 65.10±22.91 for managerial, while knowledge and psychomotor skills s have the lowest mean scores (53.69±13.88 & 52.20±22.69) respectively. Moreover, mean score for their total clinical competence is 59.62± Mean scores for clinical competence s Knowledge Interpersonl Psycho- Managerial Total & motor D competence communication scale Fig. (1): Clinical competence s among studied respondents. Table (2) shows correlation of clinical competence s. The table illustrated that there were a highly statistically significant correlations between four clinical competence s p< Table (2): Correlation of clinical competence s. Competence s subscale Knowledge Interpersonal communication Psychomotor Managerial Interpersonal and conununication Psycho-.motor Managerial Total r (p) r (p) r (p) r (p) ** ** * Table (3) shows nurse interns' satisfaction toward internship training program. It can be noticed that the highest percent 81% of studied respondents agreed that" they know internship objectives, followed by 74.1% for "they have increased their level of knowledge", 72.4% that "they follow internship policies, and 69% of them agreed that internship program provided them with the opportunity to strengthen the communication & language skills. On the other hand, an equal percentage 34.5% of studied respondents agreed that "the internship increase their feeling of care & concern from the staff of college, When they need an advice, they can communicate easily with the college internship staff, & the internship program provided them with the opportunity to strengthen the problem solving skills", while the lowest percent 32.8% of them agreed that the orientation program cover basic & general information about the internship year.

5 Sana A. Al-Mahmoud, et al 155 Table (3): Nurse Interns' satisfaction toward internship training program. Satisfaction Items Agree - Freq. % Neutral Freq. % Disagree Freq. % 1- I Know internship objectives I Know internship Policies I follow internship policies Internship policies are congruent with the hospital policies I know methods of evaluation The internship is line with my field of my study I receive mentoring from my college I have increased my level of knowledge I am able to make a positive contribution to the needs of the organization I have increased my level of cross-cultural understanding as a result of internship The internship increase my recruitment chance The internship increase my feeling of being connected to people in the organization The orientation program cover basic & general information about the internship year I have a chance to apply clinical decision making The internship increase my feeling of care & concern from the staff of college The internship increased my job satisfaction, confidence & reduced stress When you need an advice, you can conununicate easily with the college internship staff The internship program provided you with the opportunity to strengthen the organizational skills The internship program provided you with the opportunity to strengthen the interpersonal skills The internship program provided you with the opportunity to strengthen the networking skills The internship program provided you with the opportunity to strengthen the communication & language skills. 22- The internship program provided you with the opportunity to strengthen the delegation skills The internship program provided you with the opportunity to strengthen the time management skills The internship program provided you with the opportunity to strengthen the decision making skills The internship program provided you with the opportunity to strengthen the problem solving skills Total Satisfaction. Mean SD Median IQ ± Moreover, 63.8% of them rated neutral for the item of "internship program provided them with the opportunity to strengthen the problem solving skills", as well as, more than fifty percent of the studied respondents were neutral for the following items; "The internship increase my feeling of care and concern from the staff of college", "The college internship staff', "The internship program" "I receive mentoring from my college", "Internship policies are congruent with the hospital policies, When you need an advice", "you can communicate easily with provided you with the opportunity to strengthen the decision making skills" (56.9, 55.2, 55.2, 51.7, 51.7) respectively. Total mean score satisfaction was 74.45± Table (4) presents correlation of clinical competence s with nurse interns' satisfaction regarding internship training program. It highlights that no statistically significant correlations are documented between total clinical competence s, as well as each with studied respondents' satisfaction (p>0.05). Table (4): Correlation of clinical competence s with nurse interns' satisfaction regarding internship training program. Clinical competence Knowledge Interpersonal & Psychomotor Managerial Total clinical s communication competence s Satisfaction Scales

6 156 Relationship between Nurse Interns' Satisfaction Table (5A) shows relationship between clinical competence s and demographic characteristics of studied nurse interns. Table illustrates that there are no statistical significant relationships between studied respondents' demographic characteristics (age, and GPA) and their clinical competence s (p>0.05). Table (5B) shows relationship between clinical competence s and demographic charac- teristics (region and marital status) of studied nurse interns. Table illustrates that there are no statistical significant difference between means of different clinical competence s and various regions for studied respondents'. As well as, no statistical significant differences were existed between mean scores of different clinical competence s and respondents' marital status, (either married or single). Table (5A): Relationship between clinical competence s and demographic characteristics (age and GPA) of studied nurse interns. Clinical competence s Demographic characteristics Knowledge Interpersonal and communication Psychomotor Managerial Total clinical competence Age GPA Table (5B): Relationship between clinical competence s and demographic characteristics (region and marital status) of studied nurse interns. Demographic characteristics Knowledge Clinical competence s Interpersonal and communication Psychomotor Managerial Total clinical competence Region Marital status Table (6) presents relationship between studied respondents' satisfaction and demographic characteristics. It can be noticed that no statistical significant relationships are existed between studied respondents' demographic characteristics and their satisfaction regarding internship training program (p>0.05). Table (6): Relationship between studied respondents' satisfaction and demographic characteristics. Demographic characteristics Total satisfaction Age GPA Region Marital Status Discussion The present study assessed relationship between nurse interns' clinical competence and satisfaction with internship training program in KSA at King Fahad Hospital of the University 58 respondents participated in the study. The results provided the most complete available information about level of clinical competence among nurse interns and their satisfaction regarding internship training program. Internships are now considered essential for demonstrating work experience to potential employees and provide support to new graduates by offering opportunities for growth and autonomy, leading to active participation as team members. Moreover, internships provide students a taste of the working world, and let them become familiar with a potential job sector. Evaluation criteria include satisfaction for interns based on program objectives.

7 Sana A. Al-Mahmoud, et al 157 Competency assessment is always outcome oriented; the goal is to evaluate performance for the effective application of lmowledge and skill in the practice setting. Competency assessment techniques address psychomotor, cognitive, and affective domains. Competencies can be generic to clinical practice in any setting, specific to a clinical specialty, basic or advanced [19,20]. The result of the present study showed that, interpersonal and communication and managerial skills recorded the highest mean score among studied respondents. This result can be attributed to that they were concerned with this aspect of clinical competence because they understood through their college study that it was the key to the other aspects of clinical competence. This means that, through communication skills they could be communicated with patients and families as; "Prepares patient/family for procedures by explaining the process and reasons before occurrence," "Explains to patient/family varied treatment options" and "Requests consultation when needed". As well as, they interacted and communicated with other health care personnel for the continuity of care. Furthermore, it is important for health care personnel to understand the doubts, fears and the anxieties of the patients who come to them for treatment. This empathy is possible only if there is proper communication. These findings are supported with "RNs Association of British Columbia" [30] which stated that the new graduates possess the communication lmowledge and skills to engage in partnerships and collaborative relationships with clients and members of various health disciplines. In addition, they possess knowledge and beginning level skills in therapeutic communication, negotiation, conflict management, advising and leadership. In this respect, literature suggested that clinical competence in health professions is an outcome of the curriculum and must include the integration of scientific knowledge with communication skills [31,32]. In addition, results of the current study revealed that, knowledge and psychomotor skills had the lowest mean score. These results supported by "Wheelahan" [33] who mentioned that a student may come from a university with a skill taught on "principle" which, if performed differently to the "procedure manual" of the specific clinical environment, could cause the student to be failed. In addition, wealmess in clinical judgment, ineffective delegation, response to emergencies, inability to recognize abnormal labor other diagnostics, and performance of psychomotor skills have been documented in multiple studies [34-37]. These results are consistent with "Oermann and Garvin" [38] who stated that applying knowledge that was learned in school to patient care is one of the greatest challenges faced by new graduates. As well as, in the area of critical care,"cavanaugh and Huse" [39] described the difficulty nurses experience when attempting to transfer classroom lmowledge to the bedside. "Owens et al.," [40] asserted that the work place environment challenges the new nurse to perform competently and proficiently in a short period of time. In this respect, several tudies [35,36,40-44] stated that employers express concerns about the readiness of new nurses to assume the role of the professional nurse in clinical practice. These concerns are based on the complaints voiced by the colleagues of the new RNs and center around the following areas; (a) a lack of lmowledge of appropriate delegation, (b) inability to perform physical assessment or interpret lab data, poor prioritization and time management skills, (c) ineffective response to emergencies or the (d) ability to determine that an emergency exists; and (e) critical thinking However, these findings are in contradictory with "Children's National Medical Center for Doctors and Health Care Professional" [45] which reported that the internship program provides the novice nurse with the knowledge base and skill set needed to transition to competence in clinical nursing practice. The program bridges the gap between undergraduate education and "Real-life" professional nursing practice. Moreover, "Graham et al.," [46] and "Heslop, McIntyre and Ives" [47] concluded that new nurses also possess a strong theory-base for practice, but are aware of their limited clinical experiences. In contrary with the result of the current study, regarding managerial skills the research of "Keller, Meekins and Summers" [48] at the University of Pittsburgh Medical Center, found only 43% of the nurses surveyed felt that the new registered nurses were able to practice safely. Their concerns include the ability of new graduates to solve conflict, problem solving, use critical thinking, delegate, and interact with physicians. It can be noticed that, there were highly statistical significant correlations among four s of clinical competence. These results are in accor-

8 158 Relationship between Nurse Interns' Satisfaction dance with the fact that competence is a generic quality referring to a person's overall capacity and competency refers to specific capabilities such as leadership, which are made up of knowledge, attitudes and skills. Moreover, the results of this study revealed that no statistical significant correlations are documented between total clinical competence s, as well as each with studied respondents' satisfaction. These findings are contradicting with "Tzeng" [49] who proved that nurses' satisfaction with their own nursing competencies is a key predictor to overall satisfaction with job performance These findings are unexpected, because, as mentioned and discussed by several studies [38,50,51] reported that new nurses were often stressed by what they felt was a lack of skills to perform in the professional nurse role. These skills such as time management, inability to take a full patient load, medication management; physician interaction, new situations and procedures. Regarding transition period,"delaney" [52] research on transition has shown that newly graduated nurses feel anxious overwhelmed, insecure, and puzzled by a discormection between what they learned in nursing school and real-world nursing. A variety of strategies and interventions to improve the transition process has been reported in the international literature. These range from formal approaches such as orientation programs, graduate programs, externship program, residency programs, and nurse internships. The findings also indicated that studied respondents recorded that internship program have increased their level of knowledge, and provided them with the opportunity to strengthen the communication and language skills, also, time management, organization, and interpersonal skills. These findings are expected and could be attributed to that, the goals of the internship programs are to provide an opportunity to consolidate clinical nursing lmowledge in new areas of practice and to provide an opportunity to demonstrate understanding and competence in technical skills and procedures related to the specialty in which they are practicing. The program also allows for the application of sound clinical judgment and critical thinking throughout the nursing process in the management of patient care. The development of time management and delegation skills are another important goals. These results are contradict with concerns voiced by seasoned nurses related to new graduates were the intangible: Lack of commitment to the profession, lack of confidence in professional skills, an inability to handle stress, poor problem solving skills, and subpar organizational and teamwork skills [35-37]. On the other hand, the results of the present study showed that, high percent (63.8%) of the studied respondents rated neutral for the item of "internship program provided them with the opportunity to strengthen the problem solving skills", as well as, more than fifty percent of the studied respondents were neutral for the following items; "The internship increase my feeling of care and concern from the staff of college", "I receive mentoring from my college", "Internship policies are congruent with the hospital policies, When you need an advice", "You can communicate easily with the college internship staff', "The internship program provided you with the opportunity to strengthen the decision making skills". In accordance with these results "Krugman, Bretchneider, Horn, Krsek, Moutafis and Smith" [53] proved that many new nurses perceive that they lack adequate clinical preparation, have not enough support from preceptors and educators, and feel a low level of confidence in their ability to deliver care independently. At the same time, "Pine and Tart 2007" [54] found that clinical judgment, decision making, leadership, professional commitment, and a lack of evidence based practice in new graduate nurses. In this respect, "Vermont Nurses Internship Project" [VNIP] [55] reported that the preceptor guide the new nurse resident through the day-to -day residency experience. The role of the preceptor is to teach, support, evaluate, advocate and protect the new resident. "Santucci" [42] emphasized the role of the preceptor in socialization, performance, professionalism, and job satisfaction for new nurse resident. The fmdings also indicated studied respondents' satisfaction regards overall internship training program. These findings are supported by several studies [56-60] who administered some type of questionnaire or survey to obtain information regarding the satisfaction levels of new nurses who participated in a nurse internship, they revealed that nurse internships increased satisfaction in graduate nurses. Satisfaction included either satisfaction in the internship program itself or satisfaction in their job.

9 Sana A. Al-Mahmoud, et al 159 Concerning the relationship between sociodemographic characteristics of studied respondents and their clinical competencies and internship satisfaction the findings of the present study demonstrated that there were no statistical significant relationships between studied respondents' demographic characteristics (age, GPA, region and marital status) neither their clinical competence s nor their satisfaction regarding internship training program. These findings could might be related to the fact that all the studied respondents had closed or the same age. These results are contradict with "Greene's survey" [61] who found that nurses under age 32 showed that life/work balance was ranked as the number one source of job dissatisfaction. Furthermore, "Newhouse et al.," [62] claimed that nurse internship study didn't give description of demographics, while, the studies of "Salt et al.," [60] and "Rhe'aume et al.," [63] only reported age and gender. Conclusion: The transition from nursing student to practicing nurse is a fragile time where new nurses quickly become discouraged. Finding ways to support and mentor these nurses through internships helps with retention and satisfaction. The present study didn't prove that there is a relationship between interns' satisfaction regarding internship program and clinical competence. It demonstrated that the highest mean scores among studied respondents were for interpersonal and communication skills, followed by managerial, while knowledge and psychomotor skills s had the lowest mean scores among them. Moreover, findings of the study illustrated that there were a highly statistically significant correlations between four clinical competence s. The majority of the studied respondents were satisfied regarding overall internship training program. On the other hand, no statistically significant correlations were documented between total clinical competence s, as well as each with studied respondents' satisfaction. Recommendations: Further research focused on nurse internship satisfaction for hospital and College preceptors. Moreover, further research to study the relationship between internship program and new graduates'retention. College educators should emphasize the importance of skills' lab. And simulation to enhance students'psychomotor skills. Hospital educators should be encouraged to aftend seminars and/or symposiums that focus on transitioning the graduate nurse to professional nursing practice. It is also the responsibility of College educators to ensure that nurses who serve as preceptors/mentors are properly prepared for that responsibility. College educators should redesign educational approaches to support the role transition of new graduate nurses. Offering preceptor training classes and even certifying these preceptors prior to allowing them to precept would be beneficial to both the preceptor and the preceptee. Information and research findings on the topic of nurse interns' satisfaction and competence must be disseminated to administrative leadership of universities, college of nursing and organizations training nurse interns and employing nurses. References 1- ULRIC B., ASHLOCKCH C.H., KROZEK C., AFRICA L.M., EARLY S. and CARMAN M.L.: Improving retention, confidence and competence of new graduate nurses: Results from a 10-years longitudinal database. Nursing Economics. Nov. Dece., 28 (6): , BEECROFT P.C., KUNZMAN L., TAYLOR S., DEVE- NIS E. and GUZEK F.: Bridging the gap between school and workplace: Developing a new graduate nurse curriculum. Journal of Nursing Administration, 34 (7/8): , PARK M. and JONES C.B.: Aretention strategy for newly graduated nurses. Journal for Nurses in Staff Development, 26 (4): , ALTIER M.E. and KRESK C.A.: Effects of 1-year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development. 22 (2): 70-7, American Association of Colleges of Nursing. Nursing shortage. Retrieved. August (9). edu/medical/facts heetsnursingshortage. htm, BUERHAUS P., AUERBACH D. and STAIGER D.: The recent surge in nurse employment: Causes and implictions. Health Affairs (Web exclusive), w Retrieved fromwww. healthstaff.org/ documents/ surgeinnurseemployment. pdf, AMOS D.: An evaluation of staff nurse role transition. Nursing Standard, 16 (3): 36-41, DELANEY C.: Walking a fine line: Graduate nurses transition experiences during orientation. Journal of Nursing Education, 42 (10): , HODGES H.F., KEELEY A.C. and TROYAN P.J.: Professional resilience in baccalaureate-prepared acute care nurses: first steps. Nursing Education Perspectives, 29 (2): 80-89, JACKSON C.: The experience of a good day: A phenomenological study to explain a good day as experienced by

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