Perceptions and experiences of medical and nursing trainees working and learning in the neonatal intensive care unit

Aims: The neonatal intensive care unit (NICU) is a demanding, emotional environment due to cultural, institutional, and interpersonal factors. This study aims to explore the 'interactions and experiences' of paediatric residents and nurse graduates working and learning within an Australian NICU before and after their first exposure to this environment. Methods: Utilising grounded theory techniques, researchers analysed semistructured open-ended interviews recorded before and after trainees worked six months in the NICU. Coding was completed by an iterative process involving two researchers. Two frameworks were developed with a series of themes and subthemes. Data were sent for member-checking, with responses incorporated into the final analysis. Findings: Six residents and five nurses were recruited with twenty one interviews completed. Three themes emerged from the first framework: 'anticipation and aspiration'. These include 'accepting the challenge', 'protecting their patients whilst being supported', and undergoing 'transformation'. Three themes emerged from the second framework 'evolution through experience', including 'interactions at the interface', 'validation', and 'professional discovery'. These themes can be seen through three different 'lenses' important to the trainees' experiences and learning in the NICU: firstly as a discussion of the learning opportunities and experiences presented in the NICU through the understanding of various learning theories, secondly through the move from 'the ideal to the real', indicating a shift in perceptions from an idealised anticipation to the actual experience, and thirdly, the necessity for, and the stresses of 'boundary crossing' - moving between areas of 'sociocultural difference'. Conclusions: Expectations of working in the NICU were mostly met and positive, but fell short for some. Continuous constructive support and feedback, as well as a stimulating educational environment during transition though the neonatal environment may alleviate these disappointments. The impact of a complex, emotional work environment within a large multidisciplinary institution, on the transition of nurse graduates and paediatric residents who had not previously encountered this environment, cannot be underestimated.