New graduate nurse transitioning: Necessary or nice?

Echoes of silence

Communication is an integral part of nursing practice-with patients and their relatives, other nurses and members of the healthcare team, and ancillary staff. Through interaction with the 'other', language and silence creates and recreates social realities. Acceptance, rejection or modification of social realities depends on what is expressed and by whom. Narratives that are offered can tell of some experiences and not others. Some nurses choose to be silent while others are silenced. In nursing situations recognising and allowing silence to speak is a challenging but uniquely personal experience that embraces reflection in and on experiences, practice and self as a person and a professional. If enabled and truly heard, silence can speak more loudly than the hubbub of daily practice, allowing us to collectively question and challenge inherent assumptions and biases as professionals, and as a profession. Through a microcosm of Newly Graduated Nurses' lived experiences of nursing situations and expressions of silence individuals' discomfort and private efforts to ascribe meaning to experiences are reflected on. Returning to silence is to return to a constant process of professional transformation that can enable ways of knowing and being that can reform our profession from within and enable us to cast off shackles that bind us to a shameful cultural underbelly.

The mediating effect of job embeddedness on the nursing work environment and transition shock among new nurses: A cross-sectional study

AIMS

This study aims to investigate the status of transition shock and test the mediating effect of job embeddedness on the nursing work environment and transition shock among new nurses.

BACKGROUND

Transition shock, primarily experienced during the first two years of employment, manifests itself as an unsettling or discordant experience among new nurses, which is caused by the gap between theoretical learning and clinical practice.

DESIGN

This is a cross-sectional survey study, following the STROBE guidelines.

METHODS

A cross-sectional study was conducted among 435 new nurses from November to December 2022 in Hunan Province, China. The participants were recruited to complete a sociodemographic information questionnaire and rank 3 standardized scales of transition shock (Cronbach's alpha = 0.918), job embeddedness (Cronbach's alpha = 0.890) and nursing work environment (Cronbach's alpha = 0.946). Then, the data were analysed by SPSS 26.0 and mediation testing was performed using Hayes' PROCESS macro (Model 4). A p value of < 0.05 was deemed statistically significant.

RESULTS

The mean score with standard deviation of the transition shock scale in new nurses was 88.86 (22.50). The place of origin, working months and weekly working hours were the significant sociodemographic factors that affected the transition shock score in new nurses. Transition shock was found to be negatively related to both job embeddedness (r = -0.468, p < 0.001) and nursing work environment (r = -0.416, p < 0.001), while job embeddedness mediated the relationship between transition shock and nursing work environment (R2 = 0.262, F = 30.455, p < 0.001).

CONCLUSIONS

New nurses from rural areas and with longer weekly working hours are more prone to transition shock. Those with 6-12 months of employment experience more pronounced transition shock than those with less than 6 months. In addition, the nursing work environment can not only directly influence transition shock for new nurses but also indirectly influence it through job embeddedness. These findings provide a basis for hospitals to develop strategies to effectively address transition shock in new nurses and ultimately solve the nursing shortage issue.

Understanding the mechanism of safety attitude mitigates the turnover intention novice nurses via the person-centred method: A theory-driven, deductive cross-sectional study

AIM

Examine profiles of safety attitudes among novices and explore whether profiles moderate the occupational identity-turnover pathway.

BACKGROUND

Novice nurses face unique challenges in adopting positive safety attitudes, which influence outcomes like turnover. However, past research found only average levels of safety attitudes among novices, ignoring possible heterogeneity. Exploring whether meaningful subgroups exist based on safety perspectives and factors shaping them can provide insights to improve safety attitudes and retention.

DESIGN

This study was designed as a cross-sectional investigation.

METHODS

Data were collected through the distribution of questionnaires. Descriptive statistics were first conducted, followed by latent profile analysis. We then carried out univariate analysis and ordinal multinomial regression to explore the factors shaping the different profiles. Finally, we examine the moderating effect of nurses' safety attitudes with different latent profiles on the relationship between professional identification and turnover intention.

RESULTS

A total of 816 novice nurses were included. Three profiles were identified: high, moderate and low safety attitudes - higher attitudes were associated with lower turnover intention. Interest in nursing, health status, identity and turnover predicted profile membership. Moderate profile had a stronger buffering effect on the identity-turnover link versus high profile.

CONCLUSION

Multiple safety attitude profiles exist among novice nurses. Certain factors like interest in nursing and occupational identity are associated with more positive safety profiles. Targeting these factors could potentially improve safety attitudes and reduce turnover among novice nurses. The moderating effects suggest that tailored interventions matching specific subgroups may maximize impact.

IMPACT

Assessing subgroup attitudes enables tailored training for novices' specific needs, nurturing continuous improvement. Supporting early career development and role identity may strengthen retention intentions.

Experienced career perspectives of nursing students and their supervisors in learning departments: a qualitative study

BACKGROUND

Due to the nursing shortage, positive work environments are needed to retain (student) nurses. More and attractive internships for students need to be ensured. In order to provide more internship places learning departments were developed, which are characterized by a buddy system and supervisors who coaches at least two students during a shift. Gaining knowledge about career perspectives and job satisfaction is essential within the context of learning departments, as both will contribute to quality and safety of care and will support lifelong learning. The current study aimed to investigate how nurses and nursing students working and learning in learning departments experience preconditions for career opportunities.

METHODS

Using a generic qualitative approach, semi-structured interviews were conducted through videocalls between March and April 2021 in the Netherlands. Inductive qualitative analysis based on 'The Data Analysis Spiral' was used.

RESULTS

Career perspective is explored among six students and seven nurses. Five main themes were generated for both nurses and students; (1) personal goals; (2) skills and self-efficacy; (3) mentoring; (4) job satisfaction; and (5) career perspectives. Within the five main themes, subcategories were developed from 198 codes related to career opportunities. Results show career perspective is experienced differently. For students, the requirements to experience career perspective seem largely existing, as learning departments fits with personal goals, increases self-efficacy and provide coaching mentoring. Students felt learning departments contributed positively to becoming more skilled in working independently and collaborating with fellow students. This resulted in students feeling well prepared for the future. Nurses' career perspectives varied from wanting more personal development to experiencing opportunities due to having great colleagues, a challenging patient category, satisfaction from sharing knowledge and a decreasing physical workload. Nurses who had affinity with coaching students experience more career perspective on learning departments.

CONCLUSION

Interviews provided in-depth insights. Interviews gave in-depth insight into the elements of learning departments that contribute to career perspectives of (student)nurses. The results can be used by nursing supervisors, teachers and policymakers to optimize nurses' work environment, to eliminate leave intentions and improve quality of patientcare. The results should be taken into consideration when coaching students, developing manuals and implementing or optimizing learning departments. Future research is recommended to investigate which tools/interventions are effective for nurses and other healthcare professionals to support career guidance.

The mediating effect of clinical teaching behavior on transition shock and career identity among new nurses: A cross-sectional study

BACKGROUND

New nurse attrition is a worldwide problem. Because of the gap between theory and practice in their work, new nurses may experience transition shock, which can have a negative impact on their career identity. Clinical teaching behavior is an important component in reducing the impact of new nurse transition, stabilizing the hospital nursing workforce, and cultivating high-quality nursing talents.

OBJECTIVES

Based on the New Nurse Transition Model, to explore the mediating role of clinical teaching behavior in the relationship between transition shock and career identity in the new nurse population of Gansu Province.

DESIGN

A cross-sectional study.

SETTING

Seventeen hospitals in Gansu province of China.

PARTICIPANTS

A total of 1684 new nurses (1590 female and 94 male) were recruited from seventeen hospitals in Gansu province.

METHODS

Three questionnaires include: The Clinical Teaching Behavior Inventory (CTBI-23), the Transition shock of Newly Graduated Nurses Scale (TSNGNS), and the Nurse's Career Identity Scale (NCIS). Structural equation modeling was used to deal with the relationships among clinical teaching behavior, transition shock, and career identity.

RESULTS

Transition shock was found to be negatively related to both career identity and clinical teaching behavior, with clinical teaching behavior mediates the relationship between transition shock and career identity.

CONCLUSIONS

The clinical teaching behavior of the teaching staff plays a role in mediating the relationship between new nurses' sense of career identity and transition shock. Accordingly, the teaching behavior of clinical teaching should be improved and the quality of clinical teaching behavior should be improved to increase the career identity of new nurses and reduce the turnover rate of new nurses.

New Graduate Nurses’ Incivility Experiences: The Roles of Workplace Empowerment, Nursing Leadership and Areas of Worklife

Aims

To determine what extent are workplace empowerment, New Graduate Nurses’ (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences?

Background

NGNs’ perceptions of nursing leaderships’ control over workload contribute to coworker incivility experiences were tested. The relationship between workplace empowerment, authentic leadership, and areas of work life (workload control and fair resource allocation) to coworker incivility experiences were examined.

Design

Secondary analysis of Starting Out, national survey, Time 1 dataset. Select factors of workplace empowerment, authentic leadership, areas of worklife, trust in management and NGNs’ co- worker incivility experiences were situated within an ecological approach. Multiple linear regression was used to test whether a negative relationship of workplace empowerment, areas of worklife and authentic leadership to NGNs co-worker incivility experiences and important new findings were discovered.

Results

First, NGNs’ perceptions of workplace empowerment predict coworker incivility experiences when controlling for authentic leadership and trust in management. Second, NGNs’ perceptions of areas of worklife predict coworker incivility experiences when controlling for authentic leadership, trust in management, and workplace empowerment. Third, NGNs’ perceptions of authentic leadership do not predict coworker incivility experiences when controlling for workplace empowerment and trust in management. Finally, NGNs’ perceptions of authentic leadership do predict coworker incivility experiences when trust in management and workplace empowerment are not controlled.

Conclusions

NGNs’ perceptions of authentic leadership would benefit from workplace empowerment of the nurse leader in workplace environments to mitigate coworker incivility experiences.

A review: Developing an ecological model approach to co-worker incivility experiences of new graduate nurses

AIM

To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co-worker incivility experiences of new graduate nurses.

DESIGN

Key concepts related to new graduate nurses' incivility experience informed the research question building on the findings of our first author's integrative review. Second, relevant theories and concepts were identified by conducting a literature review. Third, the themes build on prior theories and factors to propose a hypothetical model.

DATA SOURCES

(2016-2019) CINAHL, OVID, PSYCINFO, PUBMED, EBSCO, ERIC, SCOPUS, Cochrane Library; PROQUEST and Google Scholar.

REVIEW METHODS

(a) Constructs identified in an IR (Blackstock et al., 2018) guided a literature review on predictive variables linked to new graduate nurse's co-worker incivility experiences; (b) an ecological approach was explored; and (c) we demonstrate how multidimensional organizational factors related to incivility experiences of new graduate nurses can be situated in an ecological model.

RESULTS

Structural and organizational factors, and nurse leaders influencing new graduate nurses' experiences are situated in an ecological model. Placing new graduate nurses' co-worker incivility experiences in the microsystem and close to the mesosystem (nurse supervisor) and exosystem (workplace empowerment) of our ecological model provides new insights into their incivility experiences and informs future research.

CONCLUSION

The ecological approach and operational definition of incivility help to clarify incivility behaviours as not merely individual behaviours observed by others needing corrective cognitive behaviours, nor support in a graduate transition program, but rather a symptom of work environment factors contributing to multidimensional work environments of new graduate nurses' and influence incivility behaviours.

IMPACT

New graduate nurse co-worker incivility research could measure change across time and across system domains informed by this ecological approach and can shape new ways of thinking about how to prevent and mitigate incivility.

Are human resource practices the key to managing job burnout in New Zealand nurses? Testing a path model

AIM

To explore if human resource practices are the key to manage job burnout in nurses.

OBJECTIVE

To determine if human resource practices provide more meaningful work to nurses, subsequently leading to enhanced work-life balance and lower job burnout (emotional exhaustion and cynicism).

BACKGROUND

Job burnout is a global phenomenon, particularly relevant in the nursing profession due to pressures within the health sector. Job burnout is also a result of nurses not balancing work with their life roles and maintaining meaning in one's work. High-performance systems are tools that hospital human resource departments can use to increase core employee factors that ultimately reduce the risk of job burnout.

METHODS

Using cross-sectional data from 114 New Zealand nurses, we tested a path model to distinguish whether human resource practices can influence job burnout, with meaningful work and work-life balance mediating. The data were analysed using structural equation modelling and indirect effects for mediating. This research adhered to the STROBE Statement.

RESULTS

Human resource practices are positively related to meaningful work and work-life balance, and meaningful work was positively related to work-life balance and negatively related to cynicism. Finally, work-life balance is negatively related to emotional exhaustion and cynicism.

CONCLUSIONS

Given the influence of human resource practices on job burnout is fully mediated by meaningful work and work-life balance, indicating that managing job burnout is best understood via human resource practices enhancing nurses meaning from work and role balance, which subsequently reduces job burnout.

RELEVANCE TO CLINICAL PRACTICE

Human resource practices can enhance work factors, such as meaningful work and work-life balance, that can enable nurses to have reduced job burnout. This will help prevent cynicism, exhaustion and will therefore prevent absenteeism, enhance performance and overall aid long-term employment benefitting not only patients but hospitals.

Correlates of career satisfaction in internationally educated nurses: A cross-sectional survey-based study

BACKGROUND

More and more high-income countries hire internationally educated nurses as part of their workforce. While the factors that push and pull internationally educated nurses to migrate and influence their workforce integration have been widely reported in the literature, little is known about internationally educated nurses' career development and whether they are satisfied with their nursing career in Canada.

OBJECTIVE

This study aims to identify the main correlates of internationally educated nurses' career satisfaction.

METHODS

A cross-sectional analysis of data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses, was conducted. Measures of career satisfaction included individual, job and career characteristics as well as organizational-related and integration process factors. Non-parametric Mann-Whitney U and Spearman rank correlation tests were used to examine the association of the various factors with career satisfaction.

RESULTS

Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on sociodemographic characteristics, organizational setting, and geographic location. Older and more experienced internationally educated nurses tended to be more satisfied with their career than their younger or less experienced colleagues were. Furthermore, male were inclined to be less satisfied than their female counterparts, and having children tended to make all three groups (men, women and overall) more satisfied. The higher the level of education prior to immigrating the lower the career satisfaction. Internationally educated nurses who identified as White or Asian had the highest level of career satisfaction, whereas those who identified as Black tended to be the least satisfied. Career satisfaction was the highest among those who live in the Prairie Provinces (Alberta, Saskatchewan and Manitoba), and Ontario, the lowest in the Atlantic Provinces (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador). As for organizational characteristics, full-time nurses were more satisfied than those working part-time or with occasional employment. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career.

CONCLUSION

Our findings highlight the need for organizations to ensure a healthy work environment for internationally educated nurses, free of discrimination, where they can attain their career goals. Tweetable abstract: More and more countries rely on internationally educated nurses to ease their nursing shortages. This study aims to identify the main correlates of internationally educated nurses' career satisfaction, using non-parametric Mann-Whitney U and Spearman rank correlation tests on data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses. Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on the internationally educated nurses' sociodemographic characteristics, organizational settings and geographic location. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career. Our findings highlight the need for organizations to ensure environment free of discrimination, where internationally educated nurses can attain their career goals.

Identifying, describing, and assessing interventions that support new graduate nurse transition into critical care nursing practice: a systematic review protocol

BACKGROUND

Given a persistent nursing shortage in Canada and a decline in new nurses entering the profession, new graduate nurses (NGNs) are being hired into positions historically reserved for more experienced staff. Critical care settings, which are areas of specialty nursing practice, are now routinely hiring NGNs in many hospitals. While evidence on NGN transition into critical care is emerging, best practices around training and support for these nurses are limited internationally, and non-existent within the Canadian context. Therefore, the aim of this systematic review is to identify, describe, and assess the effectiveness of interventions that support NGN transition into critical care clinical practice settings.

METHODS

This is a systematic review of interventions using the Joanna Briggs Institute Methodology. Data sources will include MEDLINE, CINAHL, PsychINFO, Education Source, and Nursing and Allied Health electronic databases. Two independent reviewers will screen titles and abstracts using predetermined inclusion criteria. A consensus meeting will be held with a third reviewer to resolve conflicts when necessary. Full texts will also be screened by two independent reviewers and with conflicts resolved by consensus. Data will be extracted using a standardized extraction form. We will assess the quality of all included studies using Joanna Briggs Institute quality assessment tools. Data describing interventions will be reported narratively and a meta-analysis will be conducted to determine effectiveness, if appropriate.

DISCUSSION

This systematic review will identify interventions that support NGN transition into critical care nursing practice. The findings of this study will provide a foundation for developing strategies to support NGN transition into these areas of specialty nursing practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020147962.

Transition shock and job satisfaction changes among newly graduated nurses in their first year of work: A prospective longitudinal study

AIMS

To identify the changes in transition shock and job satisfaction among newly graduated nurses during their first year and examine the factors affecting these changes.

BACKGROUND

Newly graduated nurses' high turnover is related to transition shock and job satisfaction. However, insufficient information exists on changes in these variables among such nurses.

METHODS

A prospective longitudinal design was used. Participants were nurses newly graduated from nursing schools and working in hospitals in South Korea. There were 312, 195 and 120 participants at 4, 8 and 12 months, respectively.

RESULTS

Transition shock and job satisfaction decreased as working period increased; transition shock was lower, and job satisfaction was higher in positive work environments. Linear mixed models revealed work environment was the only factor significantly related to transition shock and job satisfaction changes.

CONCLUSION

The nurses' transition shock and job satisfaction varied as per working period and work environment, which were the most important factors of these changes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can be aware of transition shock and job satisfaction changes, assess their severity and implement solutions in their hospitals. Thus, retention strategies should differ according to the changing needs of nurses at different stages of their career.

Reasons why Dutch novice nurses leave nursing: A qualitative approach

Shortages in the nursing profession are increasing. It is, therefore, imperative to understand why novice nurses are leaving the profession. This qualitative study explores Dutch novice nurses' motives for leaving the profession. Individual semi-structured interviews were held with seventeen former novice nurses who had decided to leave nursing within two years after graduation. Data was collected and analysed following the principles of Thematic Analysis, leading to six themes; 1) Lack of challenge; ambitious to progress further in management or research roles. 2) Lack of passion; no feeling of passion for patient care. 3) Lack of perceived competence; not feeling "up to the challenge". 4) Lack of job satisfaction due to heavy workload; work-life imbalance and inability to deliver high-quality care. 5) Lack of work capacity due to non-work-related health conditions; unmet requirements for job or work environment adjustment. 6) Lack of feeling of belonging; suffering from a negative attitude of colleagues to one another. To prevent novice nurse professional turnover, measures such as capacity building, supervisor support and a tailored personal development plan could be taken. To make novice nurses feel safe and reassured, support from colleagues and supervisors is important. Such measures require thoughtful implementation and evaluation.

The Role of Medical Specialization on Posttraumatic Symptoms in Pediatric Nurses

PURPOSE

Comparison of medical specialization of repeated exposure to secondary trauma and Post-Traumatic Stress Disorder (PTSD) symptoms in pediatric nurses was examined.

DESIGN AND METHODS

The PTSD Checklist-Civilian Version (PCL-C) was administered to 182 nurses over their first year on the job at a pediatric hospital (three time-points: baseline, 3 month follow-up, and 1 year follow-up). Demographic characteristics (age groups, gender, education, and race) and previous healthcare experience on whether nurses met criteria for no, partial, or full PTSD across all three time-points was examined. Differences in unit assignment on total PTSD symptoms and symptoms of each criterion of PTSD (re-experiencing, avoidance, and arousal) were also examined.

RESULTS

No significant differences of both demographic characteristics and previous healthcare experience were found on these PTSD categories. However, both ICU and Hematology/Oncology units were more at risk for developing partial and full PTSD, respectively compared to other units. Nurses in the rehabilitation units had significantly higher re-experiencing, avoidance, and arousal symptoms than those assigned to medical/surgical and intensive care units.

CONCLUSIONS

Results demonstrate a need for hospitals to assess why nurses from certain units are reporting more PTSD symptoms and screen for PTSD symptoms and other mental health concerns throughout their career.

PRACTICE IMPLICATIONS

Being aware of which units may be more at-risk should inform unit-specific prevention and intervention programs to decrease negative outcomes, including burnout, compassion fatigue, and job dissatisfaction.

New Graduate Nurses' Perceptions of Patient Safety: Describing and Comparing Responses With Experienced Nurses

BACKGROUND

A significant proportion of the acute health system workforce is composed of new graduate nurses, yet there is a limited understanding of patient safety perceptions among new graduate nurses and how they compare with nurses who have more experience.

METHOD

This study used a descriptive approach to complete secondary analysis on two sources of data containing new graduate nurses' (n = 1,613) and experienced nurses' (n = 64,906) responses to the Hospital Survey on Patient Safety Culture.

RESULTS

New graduate nurses had a more positive perception of safety culture than more experienced nurses. The greatest differences were observed in perceptions of how nurse managers respond to mistakes. Similarities in perceptions were observed on items associated with communication.

CONCLUSION

Educational systems and transitional programs must prepare new graduate nurses for patient care. There is an opportunity for academic and practice partners to collaborate on programs that facilitate the transition of new graduate nurses to the workforce. [J Contin Educ Nurs. 2020;51(7):309-315.].

New Graduate Orientation Evaluation: Are There Any Best Practices Out There?: A Scoping Review

Efficient, cost-effective, and safe orientations with clear expectations are necessary for new graduates in their transition from student to practicing nurse. In the current nursing shortage, healthcare needs to invest more in retaining new graduates. Orientation can be a factor in decisions to leave. This scoping review revealed that strong evidence is lacking regarding best practices during orientation for evaluating new graduate nurses' readiness to practice on their own. More resources, research, and tools are needed.

Final clinical practicum, transition experience and turnover intentions among newly graduated nurses: A cross sectional study

BACKGROUND

The shortage of nurses is a global issue, and turnover rates are especially high for newly graduated nurses. The transition from student to nurse is often described as challenging, and the final clinical practicum before graduation is suggested to be important in preparing graduating students for the transition. However, little is known about the actual relationships between the final clinical practicum, transition and turnover intentions.

OBJECTIVES

To examine whether the final clinical practicum experience is associated with the transition experience and turnover intentions of newly graduated nurses, and whether the transition experience mediates the potential relationship between the practicum and turnover intentions.

DESIGN

Cross-sectional survey study.

SETTINGS

The study was carried out in Finland (October-December 2018).

PARTICIPANTS

Registered nurses graduated within the past two years (n = 712).

METHODS

A new survey instrument with five subscales was developed for measuring the final clinical practicum experience. Transition experience was measured on four scales that demonstrated the emotional, physical, socio-developmental and intellectual domains of the transition: Psychological distress, sleep quality, role conflict/ambiguity, perception of transition and educational preparation. Turnover intentions from job and profession were asked about with two questions. Structural equation modelling was used to explore the associations between the variables. The models were adjusted for multiple potential confounders.

RESULTS

Final clinical practicum experience was associated with all domains of the transition experience and turnover intentions. The association between the practicum and turnover intentions was partly mediated by the emotional (psychological distress) and socio-developmental (role conflict and ambiguity) domains of the transition.

CONCLUSIONS

Our findings provide new evidence about the associations between the specific final clinical practicum dimensions and turnover intentions and the specific mechanisms linking this association. These results highlight the importance of final clinical practicums and suggest targets for improving nurses' transition processes during their first years in practice.

"I felt a sense of belonging somewhere". Supporting graduates' job transitions with WhatsApp groups

BACKGROUND

Nurse graduates' transition into the world of work is a very challenging phase of professional development. This research examined the affordances of using moderated WhatsApp groups to support nurse graduates in this phase.

APPROACH AND METHODS

Study participants, newly graduated nurses (n = 72) from South Africa, were assigned to two WhatsApp groups. The groups were facilitated by moderators during the 12-week intervention. The intervention was based on a curriculum that incorporated topics related to professional immersion that emerged from a priori needs assessment. Twelve individual interviews were carried out and analysed together with the written conversations from the WhatsApp chats using content analysis as part of an interpretive paradigm.

RESULTS

Three central affordances emerged in the analysis: (1) Instructional: joint learning and cooperative problem solving in-situ; (2) Social: co-constructing proximity and providing motivational and socio-emotional support; (3) Professional: scaffolding job immersion in becoming and being a nurse. Through re-connecting relatable social ties (former students) and tapping into a medium that afforded intimacy, immediacy and high levels of ownership, the intervention offered spatially, socio-culturally and often emotionally 'dislocated' graduates a provisional space to belong to.

CONCLUSIONS

The feasibility and dynamics of supporting graduates in marginalised and remote areas with a facilitated, peer-mediated and WhatsApp-based transition support group are shown; practical recommendations and challenges are discussed.

Effective orientation programs for new graduate nurses: A systematic review

OBJECTIVE

To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings.

METHOD

A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008-2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program.

RESULTS

A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization.

CONCLUSION

Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.

A narrative study of newly graduated registered Swedish nurses' establishment in the profession and the portrayal of a healthcare organisation

PURPOSE

The purpose of this paper is to investigate how the participants talk about their experiences as newly graduated nurses, managers and nursing colleagues in the context of "newcomers' establishment in the profession" and to identify how they portray the healthcare organisation in their narratives.

DESIGN/METHODOLOGY/APPROACH

A narrative approach is used to reveal and illustrate three perspectives on the topic "new-comers' establishment". In total, 14 interviews are conducted with 4 managers, 4 nursing colleagues and 6 newly graduated registered nurses. The focus of this study is how a healthcare organisation embraces and retains newly graduated registered nurses and how this is perceived.

FINDINGS

The newcomers' establishment is facilitated by an orientation programme and an orientation period, individual support provided by managers and colleagues, and the creation of trust to boost confidence in nursing situations. The organisation is portrayed as struggling with high workloads, nursing shortages, high levels of responsibility and showing concern and an interest in the newcomer. The parties criticise the university for not teaching the most basic knowledge, thereby revealing the existence of a theory-practice gap.

ORIGINALITY/VALUE

The research shows how building trust amongst the organisation's members is essential for creating a satisfying workplace and the retention of newly graduated registered nurses. Empirical descriptions of newly graduated nurses, managers and nursing colleagues experiences of "newcomers establishment" are rare, which is why the description of such "establishment" in this research increases the value of the paper.

Predictors of new graduate nurses' health over the first 4 years of practice

AIM

To examine predictors of Canadian new graduate nurses' health outcomes over 1 year.

DESIGN

A time-lagged mail survey was conducted.

METHOD

New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012-March 2013 (Time 1) and May-July 2014 (Time 2). Multiple linear regression (mental and overall health) and logistic regression (post-traumatic stress disorder risk) analyses were conducted to assess the impact of Time 1 predictors on Time 2 health outcomes.

RESULTS

Both situational and personal factors were significantly related to mental and overall health and post-traumatic stress disorder risk. Regression analysis identified that cynicism was a significant predictor of all three health outcomes, while occupational coping self-efficacy explained unique variance in mental health and work-life interference explained unique variance in post-traumatic stress disorder risk.

Impact of Interplaying and Compounding Factors in the Novice Nurse Journey: A Basic Qualitative Research Study

Purpose

This study explores the impact of interplaying and often compounding factors and the resulting ability to thrive as a novice nurse. Novice nurse attrition rates continue to be high, compounding concerns of an impending nursing shortage. There is currently a lack of research that seeks to understand how the interplay of contextual factors impacts novice nurses’ ability to manage the stressors endemic in the field.

Design

The study was performed using a Basic Qualitative Research approach. Eight western Canadian novice nurses underwent multiple iterative interviews to explore the impact of interplaying contextual factors. Findings: While participant experiences and contexts vary, common patterns of interplay among factors were clear. The interplay between previous life experience factors and the workplace context has a significant impact on the perception and management of workplace stimuli. Those with more developmental assets, garnered through life experience, are less likely to experience workplace stimuli as stressful, reducing their risk of emotional exhaustion and improving their ability to thrive. Implications for nursing: Understanding how interplay impacts the ability to thrive versus survive informs new graduate transition support efforts and enables an ability to articulate the compounding nature of common novice nurse stressors.

Clinical supervision and ward orientation predict new graduate nurses' intention to work in critical care: Findings from a prospective observational study

INTRODUCTION

Clinical supervision and transitional support programs are important in supporting the successful transition and retention of new graduate nurses and their intention to work in specialty settings. However, little is known about which elements of support programs influence this intention. This study aimed to examine new graduate nurses' perceptions of clinical supervision and the practice environment, and how these influenced their intention to stay in critical and non-critical care areas following their transitional support program.

METHODS

Between May 2012 and August 2013, new graduate nurses (n = 87) were surveyed towards the end of their 12-month transitional support program. In addition to demographic and ward details, participants completed the Manchester Clinical Supervision Scale (MCSS) and the Practice Environment Scale Australia (PES-AUS). The 'Intention to Stay in a Clinical Specialty' survey was used to measure new graduate nurses' intention to remain working in their current ward or unit.

RESULTS

Predictors of new graduate nurses' intention to stay in their current ward/unit were not having to practise beyond personal clinical capability (AOR: 4.215, 95% CI: 1.099-16.167) and working in a critical care specialty (AOR: 6.530, 95% CI: 1.911-22.314). Further analysis of those nurses who indicated an intention to remain in critical care revealed that high satisfaction with clinical supervision (AOR: 3.861, 95% CI: 1.320-11.293) and high satisfaction with unit orientation (AOR: 3.629, 95% CI: 1.236-10.659) were significant predictors.

CONCLUSION

While this study identified that new graduates who worked within their scope of practice were more likely to report their intention to remain in their current ward, new graduates assigned to critical care were six times more likely to indicate their intention to remain than new graduates in other wards/units. Ensuring new graduate nurses assigned to critical care areas receive good unit orientation and clinical supervision increases their intention to remain in this setting.

The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety: An Integrative Review

Stronger evidence on the value of new graduate nurse transition programs is needed to justify the cost and warrant expansion of these programs to more health systems. The aim of this integrative review was to critically analyze published research on the relationship between new graduate nurse transition programs and patient safety outcomes. Limited evidence was found on actual safety improvement; rather, transition programs have predominately measured the development of competency as a process outcome variable for improving patient safety. A systems model is proposed to guide future research examining structure, process, and outcome variables, linking transition programs with patient outcomes.

THRIVEable work environments: A study of interplaying factors that enable novice nurses to thrive

AIM

The purpose of this study was to gain an understanding of the impact of the interplay between workplace and developmental factors that enable and disable thriving within the first year of nursing practice.

BACKGROUND

While much is known about the high attrition rates among new graduate nurses, little research has explored the impact of interplay between workplace stressors and developmental assets.

METHOD

Through a basic qualitative study, eight novice nurses underwent three in-depth interviews.

RESULTS

The interplay between workplace factors and development factors such as congruence and self-compassion had a significant impact on the participants' ability to effectively manage workplace stimuli.

CONCLUSION

Those lacking developmentally were more likely to perceive workplace stimuli as threatening, which had a significant impact on the ability to self-actualize as a novice nurse. Therefore, the role of interplay is significant in determining why some merely survive versus those who thrive, despite similar work environments.

IMPLICATIONS FOR NURSING MANAGEMENT

A greater understanding of the impact of the role of interplay will inform transition programs by enabling nurse leaders to cater to the unique needs of new graduates as they step over the threshold of professional practice.

Perception of ethical climate and turnover intention among nursing staff: does organizational cynicism mediate?

Purpose

The purpose of this paper is to explore the mediating effect of organizational cynicism between the relationship of perception of ethical climate and turnover intention among nurses working in public sector hospitals.

Design/methodology/approach

A quantitative approach was utilized and 870 questionnaires were distributed to collect data from nursing staff working in Punjab region of Pakistan by using non-probability multistage sampling technique. A total of 711 questionnaires were returned out of which 668 questionnaires were scrutinized. Additionally, confirmatory factor analysis and structural equation modeling were applied to analyze the data.

Findings

The results revealed a full mediating effect of organizational cynicism between the relationship of perception of ethical climate and turnover intention.

Research limitations/implications

The current study has adopted a multistage non-probability sampling technique to collect data because the management of hospitals restricted researcher access to personal information about the nurses. Therefore, at the first stage, the researcher used convenience sampling and at the second stage, the researcher utilized quota sampling to collect the data. Moreover, the findings of the current study are based on cross-sectional data because of the limited time and resources.

Practical implications

The current study fosters the ongoing debate in organizational studies related to cynicism and it is noteworthy for the nursing managers to understand the significant factors which directly or indirectly affect the nursing attitude.

Originality/value

The current study explored the mediating role of organizational cynicism between perception of ethical climate and turnover intention in nursing profession to fill the research gap.

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review

BACKGROUND

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments.

METHODS

The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers.

RESULTS

A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes.

CONCLUSIONS

The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.

Impact of resilience and job involvement on turnover intention of new graduate nurses using structural equation modeling

AIMS

Nurses' turnover intention is not just a result of their maladjustment to the field; it is an organizational issue. This study aimed to construct a structural model to verify the effects of new graduate nurses' work environment satisfaction, emotional labor, and burnout on their turnover intention, with consideration of resilience and job involvement, and to test the adequacy of the developed model.

METHODS

A cross-sectional study and a structural equation modelling approach were used. A nationwide survey was conducted of 371 new nurses who were working in hospitals for ≤18 months between July and October, 2014.

RESULTS

The final model accounted for 40% of the variance in turnover intention. Emotional labor and burnout had a significant positive direct effect and an indirect effect on nurses' turnover intention. Resilience had a positive direct effect on job involvement. Job involvement had a negative direct effect on turnover intention. Resilience and job involvement mediated the effect of work environment satisfaction, emotional labor, and burnout on turnover intention.

CONCLUSION

It is important to strengthen new graduate nurses' resilience in order to increase their job involvement and to reduce their turnover intention.

Orientation Process for Newly Credentialed Athletic Trainers in the Transition to Practice

CONTEXT

  Orientation is an important part of socialization and transition to practice, yet the orientation process for newly credentialed athletic trainers (ATs) is unknown.

OBJECTIVE

  To determine how newly credentialed ATs are oriented to their roles.

DESIGN

  Cross-sectional study.

SETTING

  Online survey.

PATIENTS OR OTHER PARTICIPANTS

  Three hundred thirty-two of 1835 newly credentialed ATs (18%) certified and employed between January and September of 2013 completed the survey (129 men, 203 women; age = 23.58 ± 2.54 years).

DATA COLLECTION AND ANALYSIS

  The survey consisted of demographic information (eg, employment setting, job title) and 2 sections: (1) orientation tactics and (2) usefulness of orientation tactics. For the first section, participants identified if various orientation tactics were included in their orientations (eg, policies and procedures review). For the second section, participants identified how useful each orientation tactic was on a Likert scale (1 = not useful, 4 = very useful). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis tests were used to determine differences between demographic characteristics and orientation tactics. A Bonferroni correction accounted for multiple comparisons. A panel of experts established the content validity of the survey. The Cronbach α was used to establish internal consistency (α = 0.802) Results:  The most common orientation tactics were meeting with supervisors (n = 276, 82.9%) and staff members (eg, coaches; n = 266, 79.9%) and learning responsibilities (n = 254, 76.2%). The least common orientation tactics were simulation of the emergency action plan (n = 66, 19.8%) and preceptor development (n = 71, 21.3%); however, preceptor development was not applicable to many participants. The most useful orientation tactics were simulating the emergency action plan (3.45/4.0) and meeting with staff members (3.44/4.0). Participants who felt their orientation prepared them for their roles were exposed to more tactics during orientation (Mann-Whitney U = 17 212, P < .001).

CONCLUSIONS

  Many tactics were used to orient newly credentialed ATs to their roles, but orientations varied based on the practice setting.

Experiences of new graduate nurses working in a neonatal intensive care setting: a systematic review protocol of qualitative evidence

REVIEW QUESTION/OBJECTIVE

The overall objective of this systematic review is to identify, critically appraise and synthesize the experiences of new graduate nurses in the neonatal intensive care unit (NICU). The specific review question is: what are the experiences of new graduate nurses working in a NICU setting?

Factors associated with final year nursing students' desire to work in the primary health care setting: Findings from a national cross-sectional survey

BACKGROUND

Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs.

OBJECTIVES

This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care.

DESIGN

A cross-sectional survey design comprising a quantitative online survey.

SETTING

14 Australian universities from all states/territories, both rural and urban.

PARTICIPANTS

530 final-year nursing students.

METHODS

Binary logistic regression identifying factors contributing to desire to work in primary health care.

RESULTS

The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support.

CONCLUSIONS

Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care.

Professional Socialization of Iranian BSN Students: A Grounded Theory Study

Introduction: Professional socialization is a critical aspect of nursing students’ development, which begins with entry into the nursing program and continues when their professional practice begins. The aim of this study was to explore the socialization of Iranian BSN students in the nursing profession.

Methods: An exploratory qualitative approach utilizing Straussian version of the grounded theory (1998) method was used. Individual in-depth semi-structured interviews were undertaken with 14 participants chosen from two large nursing schools in an urban area through purposive and theoretical sampling. The data were analyzed, using the constant comparative method.

Results: Five main categories and eleven subcategories emerged and integrated around one core category. Professional metamorphosis as the core variable was a complex and interrelated process (consisting of three stages: dependence, disintegration, and integration) with dynamic, ongoing, and personal features influenced by professional and extra-professional context. The students assumed a passive role in the initial of their studies. However, during the last year of the educational program, they gradually involved actively in dealing with own personal and professional issues.

Conclusion: This study introduced "professional metamorphosis of BSN students" as a substantive grounded theory in the socio-cultural context of the health care system in Iran. During this process, students move from outsider personal position to insider professional position. The nurse educators and administrators may develop effective educational interventions to promote professional socialization of students with an understanding of the promoting and driving forces influencing socialization.

Transition experiences, intrapersonal resources, and job retention of new graduate nurses from accelerated and traditional nursing programs: A cross-sectional comparative study

BACKGROUND

With increasing numbers of new graduate nurses from accelerated nursing programs entering the workforce, it is important to understand their transition experiences, as they may differ from those of traditional graduates.

OBJECTIVES

The aim of this study was to describe and compare the intrapersonal resources, transition experiences, and retention outcomes of these two groups.

DESIGN

A descriptive cross-sectional comparison study was conducted.

PARTICIPANTS

A random sample of 3655 registered nurses with <3years of nursing experience were invited to participate from across Canada; 1020 responded (27.9%). The final sample included 230 nurses from accelerated programs and 768 from four-year programs (total n=998).

METHODS

Following ethics approval, participants were mailed a questionnaire to their home address. One month later non-responders were sent a reminder letter, followed by a second questionnaire one month later (January to March, 2013). Descriptive statistics were conducted using SPSS. Group differences were assessed using independent samples t-tests for continuous variables and χ² tests for categorical variables.

RESULTS

Overall, there were few significant differences between new graduate nurses from accelerated and traditional programs. Nurses in both groups had high levels of intrapersonal resources, positive transition experiences, were satisfied with their jobs and their choice of nursing as a career, and their intentions to leave were low.

CONCLUSIONS

All new graduate nurses need to have a strong educational preparation and transition support, regardless of their age and previous work and career experiences.

Becoming an Air Force Nurse: The Experience of Transition A New Perspective of a Known Phenomenon

PROBLEM

Transitions in nursing have consistently been described as complex and stressful. While the literature is replete with studies investigating role transitions in civilian healthcare settings, there is no known research that explores the role transition of experienced nurses who move from civilian to military nursing practice. Using nurses in the U.S. Air Force as an exemplar, this study serves as a starting point to understand the transition process and challenges likely encountered by nurses new to the military. The outcomes of this study could influence future efforts to recruit and retain qualified nurses.

METHODS

A hermeneutic, phenomenologic approach was used to explore and describe the lived experience of transition from civilian staff nurse to Air Force staff nurse.

FINDINGS

The results indicated that new Air Force nurses encounter challenges related to a lack of knowledge and role preparedness, which led to feelings of stress and frustration. Support from peers, mentors, and managers helped the new Air Force nurses bridge the gap in knowledge and successfully integrate into the military culture.

IMPLICATIONS

Efforts to reduce the perceived lack of knowledge through improvements to the Commissioned Officer Training program and the clinical orientation period are recommended.

New graduate nurses' experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support

BACKGROUND

Given the increasing complexity of acute care settings, high patient acuity and demanding workloads, new graduate nurses continue to require greater levels of support to manage rising patient clinical care needs. Little is known about how change in new graduate nurses' satisfaction with clinical supervision and the practice environment impacts on their transitioning experience and expectations during first year of practice. This study aimed to examine change in new graduate nurses' perceptions over the 12-month Transitional Support Program, and identify how organizational factors and elements of clinical supervision influenced their experiences.

METHODS

Using a convergent mixed methods design, a prospective survey with open-ended questions was administered to new graduate nurses' working in a tertiary level teaching hospital in Sydney, Australia. Nurses were surveyed at baseline (8-10 weeks) and follow-up (10-12 months) between May 2012 and August 2013. Two standardised instruments: the Manchester Clinical Supervision Scale (MCSS-26) and the Practice Environment Scale Australia (PES-AUS) were used. In addition to socio-demographic data, single -item measures were used to rate new graduate nurses' confidence, clinical capability and support received. Participants were also able to provide open-ended comments explaining their responses. Free-text responses to the open-ended questions were initially reviewed for emergent themes, then coded as either positive or negative aspects of these preliminary themes. Descriptive and inferential statistics were used to analyse the quantitative data and the qualitative data was analysed using conventional content analysis (CCA). The study was approved by the relevant Human Research Ethics Committees.

RESULTS

Eighty seven new graduate nurses completed the follow-up surveys, representing a 76% response rate. The median age was 23 years (Range: 20 to 53). No change was seen in new graduate nurses' satisfaction with clinical supervision (mean MCSS-26 scores: 73.2 versus 72.2, p = 0.503), satisfaction with the clinical practice environment (mean PES-AUS scores: 112.4 versus 110.7, p = 0.298), overall satisfaction with the transitional support program (mean: 7.6 versus 7.8, p = 0.337), satisfaction with the number of study days received, orientation days received (mean: 6.4 versus 6.6, p = 0.541), unit orientation (mean: 4.4 versus 4.8, p = 0.081), confidence levels (mean: 3.6 versus 3.5, p = 0.933) and not practising beyond personal clinical capability (mean: 3.9 versus 4.0, p = 0.629). Negative responses to the open-ended questions were associated with increasing workload, mismatch in the level of support against clinical demands and expectations. Emergent themes from qualitative data included i) orientation and Transitional Support Program as a foundation for success; and ii) developing clinical competence.

CONCLUSIONS

While transitional support programs are helpful in supporting new graduate nurses in their first year of practice, there are unmet needs for clinical, social and emotional support. Understanding new graduate nurses' experiences and their unmet needs during their first year of practice will enable nurse managers, educators and nurses to better support new graduate nurses' and promote confidence and competence to practice within their scope.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice

AIM

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles.

BACKGROUND

Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services.

METHOD

A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces.

RESULTS

New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads.

CONCLUSIONS

The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Exploring the relationship of horizontal violence, organizational cynicism and turnover intention in the context of social exchange theory

Purpose

The purpose of this paper is to explore the relationship of horizontal violence, organizational cynicism and turnover intention in the nursing profession.

Design/methodology/approach

A quantitative approach was utilized and 870 questionnaires were distributed to collect data from nursing staff working in Punjab region of Pakistan by using non-probability multistage sampling technique. A total of 711 questionnaires were returned, out of which, 668 questionnaires were scrutinized. Additionally, confirmatory factor analysis and structural equation modeling were applied to analyze the data.

Findings

The results revealed an insignificant mediating effect of organizational cynicism between the relationship of horizontal violence and turnover intention.

Research limitations/implications

The current study has adopted a multistage non-probability sampling technique to collect data because the management of hospitals restricted researcher access to personal information about the nurses. Therefore, at the first stage, the researcher used convenience sampling and at the second stage, the researcher utilized quota sampling to collect the data. Moreover, the findings of the current study are based on cross-sectional data because of the limited time and resources.

Practical implications

The current study fosters the ongoing debate in organizational studies related to cynicism, and it is noteworthy for the nursing managers to understand the significant factors which directly or indirectly affect the nursing attitude.

Originality/value

The current study explored the mediating role of organizational cynicism between horizontal violence and turnover intention to fill the research gap.

Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

CONTEXT

Research is limited on the transition to practice of newly credentialed athletic trainers (ATs). Understanding this transition could provide insight to assist employers and professional programs in developing initiatives to enhance the transition.

OBJECTIVE

To explore newly credentialed ATs' experiences and feelings during their transition from student to autonomous practitioner.

DESIGN

Qualitative study.

SETTING

Individual phone interviews.

PATIENTS OR OTHER PARTICIPANTS

Thirty-four ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 23.8 ± 2.1 years; work settings were collegiate, secondary school, clinic, and other). Data saturation guided the number of participants.

DATA COLLECTION AND ANALYSIS

Participants were interviewed via phone using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed through phenomenologic reduction, with data coded for common themes and subthemes. Credibility was established via member checks, peer review, and intercoder reliability.

RESULTS

The 3 themes that emerged from the data were (1) transition to practice preparation, (2) orientation, and (3) mentoring. Transition to practice was rarely discussed during professional preparation, but information on the organization and administration or capstone course (eg, insurance, documentation) assisted participants in their transition. Participants felt that preceptors influenced their transition by providing or hindering the number and quality of patient encounters. Participants from larger collegiate settings reported more formal orientation methods (eg, review policies, procedures manual), whereas those in secondary school, clinic/hospital, and smaller collegiate settings reported informal orientation methods (eg, independent review of policies and procedures, tours). Some participants were assigned a formal mentor, and others engaged in peer mentoring.

CONCLUSIONS

Employers could enhance the transition to practice by providing formal orientation and mentorship. Professional programs could prepare students for the transition by discussing how to find support and mentoring and by involving preceptors who provide students with opportunities to give patient care.

Graduate-Assistant Athletic Trainers' Perceptions of the Supervisor's Role in Professional Socialization: Part II

CONTEXT

Many new athletic trainers (ATs) obtain graduate-assistant (GA) positions to gain more experience and professional development while being mentored by a veteran AT; however, GA ATs' perceptions of the supervisor's role in professional development are unknown.

OBJECTIVE

To explore the supervisor's role in the professional development of GAs in the collegiate setting.

DESIGN

Qualitative study.

SETTING

Phone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 19 collegiate GAs (15 women, 4 men; average age = 23 ± 0.15 years; National Collegiate Athletic Association Division I = 13, II = 3, III = 2; National Association of Intercollegiate Athletics = 2; postprofessional athletic training program = 5).

DATA COLLECTION AND ANALYSIS

Data were collected via phone interviews and transcribed verbatim. Interviews were conducted until data saturation occurred. Data were analyzed through phenomenologic reduction. Trustworthiness was established via member checks and peer review.

RESULTS

Three themes emerged: (1) GAs' expectations of supervisors, (2) professional development, and (3) mentoring and support. Participants expected their supervisors to provide mentorship, support, and feedback to help them improve their athletic training skills, but they also realized supervisors were busy with patient care responsibilities. Most participants felt their supervisors were available, but others believed their supervisors were too busy to provide support and feedback. Participants felt their supervisors provided professional development by teaching them new skills and socializing them into the profession. Furthermore, they thought their supervisors provided mentorship professionally, personally, and clinically. Supervisors supported the participants by standing behind them in clinical decisions and having open-door policies.

CONCLUSIONS

The graduate assistantship allows new ATs to gain experience while pursuing professional development, mentorship, and support from a supervisor. The extent of development is highly dependent on the supervisor, but most supervisors mentor GAs. When looking for graduate assistantships, future GAs should seek positions in which supervisors actively provide mentoring and professional development.