Identifying patterns of occupational stress trajectories among newly graduated nurses: A longitudinal study

Comparison of the Achieved and Expected Competence Level of New Graduate Nurses: Two Cross-Sectional Studies

AIM

To explore and compare the self-perceived competence level of new graduate nurses with the expected competence level that nurse managers believe new graduate nurses should have in general.

DESIGN

Two cross-sectional empirical studies.

METHODS

Two independent cross-sectional studies were carried out in 12 tertiary hospitals in September 2020 and November 2021, respectively. Participants were 1017 new graduate nurses with less than 2 years of work experience and 306 nurse managers who completed an online survey.

RESULTS

The score of self-perceived nursing competence of new graduate nurses was 74.77 ± 14.35, and the expectation of nurse managers was 74.21 ± 15.04. The values of 18 items were significantly different between the two of them (p < 0.05), and there were only three items showed higher expectations of nurse managers than the self-rated values of new graduate nurses. Results of latent profile analysis revealed that this cohort of new graduate nurses could be divided into three subgroups, named risky competent (11.1%), medium competent (46.0%) and advanced competent (42.9%). When comparing, the nurse managers' expected competence level was between the value of 'medium competent' group and 'advanced competent' group.

CONCLUSIONS

Our study adopted a dual perspective comparison of nurse managers and new graduate nurses, which broke through the limitations of the previous single perspective study of new graduate nurses' nursing competence.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study highlights the importance of the consistency in new graduate nurses' nursing competence from the perspectives of new graduate nurses and nurse managers.

IMPACT

This study showed a generally good match of actual nursing competence level of new graduate nurses and the expected level from nurse managers. While there was significant individual heterogeneity in the competence score of new graduate nurses, three subgroups were identified through the individual-centred analysis of latent profile analysis. Therefore, Nurse managers need to systematically adjust the standardized training programs and teaching methods for new graduate nurses according to the population characteristics and take precise interventions to improve nursing competence of new graduate nurses.

REPORTING METHOD

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Job preferences among traditional Chinese medicine clinical graduates in China: a discrete choice experiment

BACKGROUND

Primary-level Traditional Chinese Medicine (TCM) healthcare institutions are currently facing a severe shortage of TCM professionals, highlighting the urgent need to explore the job preferences of TCM clinical graduates. This study aimed to investigate the stated job preferences of TCM clinical graduates when seeking employment.

METHODS

A discrete choice experiment (DCE) was conducted to assess the employment preferences of TCM clinical graduates from 16 TCM universities across China. The job attributes examined included the monthly income, work location, hospital tier, job stability (position tenure), work intensity, opportunities for mentorship under renowned practitioners, and career advancement prospects. A mixed logit model was employed to obtain the main effects model. Based on the results of the main effects model, analyses of relative importance and willingness to pay (WTP) were conducted. Additionally, heterogeneity analysis and scenario simulation analysis were performed.

RESULTS

A total of 2,402 valid questionnaires were included in the primary DCE analysis. Monthly income was the most important factor (RIS = 52.58%). Among non-economic factors, participants expressed the strongest willingness to reduce workload, being willing to forgo 2,367.5 yuan in monthly income to transition from high to low work intensity. Other significant factors included formal establishment (RIS = 11.32%), mentorship opportunities (RIS = 7.44%), and hospital level (RIS = 4.63%), with job location being the least important (RIS = 3.44%). Subgroup analysis showed that male graduates were more willing than female graduates to forgo formal establishment for mentorship opportunities. Graduates from the eastern region valued lower work intensity and formal establishment more than those from the central and western regions. Postgraduates were more likely than undergraduates to give up monthly income for jobs in higher-tier cities. Scenario analysis revealed that graduates had a 43.0% probability of choosing third-tier cities under baseline conditions. Comprehensive improvements (e.g., higher income and formal establishment) increased this probability to 84.8%, rising to 87.3% with better promotion opportunities.

CONCLUSION

This study demonstrates that the monthly income has the most significant impact on employment preferences. The work intensity and mentorship opportunities also play crucial roles, with the influence of the work intensity surpassing those of other non-economic factors. In contrast, the hospital tier and work location have a relatively smaller impact on graduates' preferences. In addition, a combination of certain non-economic measures can enhance students' willingness to choose hospitals in third-tier cities. Based on these findings, it is recommended that recruitment and career development strategies focus on the salary, work intensity, and mentorship opportunities, while providing stable job positions and favorable work environments, so as to meet the primary needs of TCM clinical graduates. A novel contribution of this study is its identification of the significant influence of mentorship opportunities, which are one of the distinctive features of TCM, on the employment choices of TCM graduates, filling a gap in the existing research. Future studies should integrate online questionnaires with offline interviews to gain deeper insights into the decision-making processes of graduates in real-world work environments.

Developmental trajectories of professional preparedness among senior nursing students during clinical placement: A longitudinal study

BACKGROUND

Newly graduated nurses' lack of professional competence is associated with inadequate preparation during their clinical placement as nursing students. Clinical placement is a critical stage in the development of nursing students' professional preparedness. However, research on the trajectory of nursing students' professional preparedness during clinical placement has not yielded findings with the same specificity.

OBJECTIVES

The aim of this study is to estimate differences in professional preparedness levels at different clinical placement stages, to identify distinct patterns of professional preparedness trajectories during clinical placement, and to evaluate predictors of these trajectory group memberships.

DESIGN

A quantitative longitudinal study.

SETTINGS

Participants were recruited on a voluntary basis using convenience sampling at a tertiary hospital in Nanning, China.

PARTICIPANTS

224 senior nursing students were initially invited to participate in the study. A total of 178 nursing students successfully completed the follow-up assessments at baseline, as well as at 1 month, 4 months, and 8 months into their clinical placement.

METHODS

Participants completed four online surveys, during which their professional preparedness level was measured using the Perceived Professional Preparedness questionnaire for senior nursing students. Professional preparedness scores at different time points were compared using one-way repeated measures ANOVA and latent growth model. Group-based trajectory model was applied to identify professional preparedness trajectories. Multiple logistic regression was adopted to determine the predictors of trajectory group memberships.

RESULTS

The entire sample of Senior nursing students experienced a significant increase in professional preparedness during clinical placement. The best-fitting group-based trajectory model delineated three distinct trajectories: low-slowly increase trajectory (27.53 % of sample), moderate-rapidly increase trajectory (47.19 % of sample) and a high-stably increase trajectory (25.28 % of sample). Male, good and excellent academic performance, and very high degree of professional interest are the predictors of the moderate-rapidly increase trajectory. While male, good and excellent academic performance, high and very high degree of professional interest and participating in medical-related part-time employment are the predictors of the high-stable increase trajectory.

CONCLUSIONS

Senior nursing students exhibit different levels of professional preparedness throughout their clinical placement. Simultaneously, three different trajectories were identified among the sample of nursing students. Therefore, in future research, greater attention should be directed towards the professional preparedness levels of nursing students with different trajectories, and early identification and targeted interventions should be prioritized.

Stress in novice nurses in new work environments: a systematic review

Background

Inexperienced nursing care can compromise the quality of care and the well-being of patients. The aim of this study was to assess the main sources of stress encountered by nurses and novice nurses in a setting not previously experienced.

Methods

A systematic review was conducted following the PRISMA format in Pubmed, Scopus, Web of Science, and CINAHL electronic databases in March 2024. A total of 395 studies were identified, of which 16 met the inclusion criteria. Selection was made on the basis of topic relevance and methodological quality, assessed using the critical tools of the Joanna Briggs Institute (JBI).

Results

A total of 16 studies were included in this review. Of the 16 selected, 10 were cross-sectional studies, 3 were cohort studies, 2 were qualitative, and 1 was a systematic review. The studies revealed that the main stressors for novice nurses included time management, workload, and interpersonal relationships. The results underline that organizational factors, such as lack of support and high work demands, play a key role in generating stress.

Conclusion

Identifying and addressing the key challenges faced by novice nurses, such as workload, adjustment to the environment, professional expectations, and interpersonal relationships, is crucial to sustain their professional engagement and ensure the quality of health care. This understanding is essential for creating efficient policies and practices that enhance the occupational well-being and stability of nurses in the workforce.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024520651, CRD42024520651.

Development and implementation of a self-directed violence prevention training program for correctional behavioral health providers: a clinical trial study protocol

BACKGROUND

Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills.

METHODS

This pilot trial is a type 3 hybrid implementation-effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50-100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points.

DISCUSSION

The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.

Job preferences of master of public health students in China: a discrete choice experiment

BACKGROUND

The shortage of public health personnel and the uneven distribution between urban and rural areas are thorny issues in China. Master of public health (MPH) is an integral part of public health human resources in the future, and it is of far-reaching significance to discuss their work preferences. The present study wants to investigate the job preference of MPH, understand the relative importance of different job attributes, and then put forward targeted incentive measures.

METHODS

Discrete choice experiment (DCE) was used to evaluate the job preference of MPHs in two medical colleges in Liaoning Province. Attributes include employment location, bianzhi, working environment, career development prospects, work value and monthly income. Thirty-six choice sets were developed using a fractional factorial design. Mixed logit models were used to analysis the DCE data.

RESULTS

The final sample comprised 327 MPHs. All the attributes and levels included in the study are statistically significant. Monthly income is the most important factor for MPHs. For non-economic factors, they value career development prospects most, followed by the employment location. Respondents' preferences are heterogeneous and influenced by individual characteristics. Subgroup analysis showed that respondents from different family backgrounds have different job preferences. Policy simulation suggested that respondents were most sensitive to a salary increase, and the combination of several non-economic factors can also achieve the same effect.

CONCLUSIONS

Economic factors and non-economic factors significantly affect the job preference of MPHs. To alleviate the shortage and uneven distribution of public health personnel, more effective policy intervention should comprehensively consider the incentive measures of the work itself and pay attention to the individual characteristics and family backgrounds of the target object.

"Discovering shine through feedback seeking"---feedback seeking among new graduate nurses: a qualitative study

BACKGROUND

Feedback is critical to improving practitioners' clinical practice and professional growth. Although they are still considered junior practitioners, their feedback-seeking experiences have yet to be investigated. This study aimed to understand the fundamental thoughts and experiences of new graduate nurses regarding feedback-seeking and to identify the main factors that influence their feedback-seeking behaviors.

METHODS

Conducting a descriptive phenomenological study, semi-structured in-depth interviews with newly graduated nurses from four hospitals in Zhejiang Province, China, face-to-face or via video call in the hospital conference room through purposive and snowball sampling. Interview data were evaluated using Colaizzi's 7-step phenomenological data analysis. The COREQ checklist was followed.

RESULTS

A total of 15 new graduate nurses were interviewed as a sample, and 13 categories emerged from our data. They were categorized into four central elements: (1) perceptions and attitudes, (2) drivers, (3) dilemmas and needs, and (4) transformation and growth.

CONCLUSIONS

This study found that new graduate nurses have various needs but face dilemmas in the feedback-seeking process. Nursing managers should be proficient at providing positive leadership, collaborating with clinical mentors to foster an atmosphere where new graduate nurses may obtain honest, transparent, and fair feedback, and exercising caution when providing negative feedback.

How do new midwives' early workforce experiences influence their career plans? An integrative review of the literature

AIM

To explore how the early workforce experiences of new midwives influence their career plans.

BACKGROUND

Each year, thousands of new midwives graduate from entry-to-practice midwifery courses, gain professional registration, and enter the workforce. Despite this, the world continues to face a shortage of midwives. The first five years of clinical practice, commonly referred to as the early career period, can be highly stressful for new midwives, contributing to early attrition from the profession. Supporting the transition from midwifery student to registered midwife is vital if we are to grow the workforce. Whilst the early career experiences of new midwives have been more broadly explored; little is currently understood about how these can influence their career plans.

METHODS

Following Whittemore and Knafl's (2005) five-stage process, an integrative review was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the criteria for inclusion. Thematic analysis was undertaken to organise and present the findings.

FINDINGS

Thematic analysis, guided by the review question led to the identification of three overarching themes: 'the need for support', 'sustaining health and wellbeing', and 'being able to provide safe and effective midwifery care'.

CONCLUSION

Very little research to date has specifically explored how the early career experiences of new midwives influence their career plans, particularly within the Australian context. Further research is required to better understand how the early workforce experiences of new midwives can either strengthen their commitment to the profession or contribute to the decision to leave midwifery prematurely. This knowledge would provide a basis for the development of appropriate strategies to minimise early attrition from the midwifery profession and promote career longevity.

Trajectories of Perceived Stress among Students in Transition to College: Mindset Antecedents and Adjustment Outcomes

There is growing evidence of a clear association between students' perceived stress and their adjustment to life at college. However, the predictors and implications of distinct changing patterns of perceived stress during the transition to college life are less clear. To address these research gaps, the current study aims to identify distinct patterns of perceived stress trajectories among 582 Chinese first-year college students (M_age = 18.11, SD_age = 0.65; 69.40% female) across the first 6 months upon enrollment. Three distinct profiles of perceived stress trajectories, i.e., low-stable (15.63%), middle-decreasing (69.07%), and high-decreasing (15.29%), were identified. Moreover, individuals who followed the low-stable trajectory showed better distal outcomes (specifically, higher levels of well-being and academic adjustment) 8 months after enrollment than those who followed the other two trajectories. Furthermore, two types of positive mindset (a growth mindset of intelligence and a stress-is-enhancing mindset) contributed to differences in perceived stress trajectory, either independently or jointly. These findings highlight the significance of identifying different patterns of perceived stress among students during the transition to college, as well as the protective roles of both a stress mindset and a mindset of intelligence.

Mediating effects of psychological capital on the relationship between workplace violence and professional identity among nurses working in Chinese public psychiatric hospitals: a cross-sectional study

OBJECTIVE

To examine the relationship between workplace violence (WPV) and professional identity among Chinese psychiatric nurses and the mediating effects of psychological capital (PsyCap) from this association.

SETTING

Seven public tertiary psychiatric hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 952 psychiatric nurses were recruited for this study. Registered nurses who have been engaged in psychiatric nursing for more than 1 year were eligible as participants in this investigation.

OUTCOME MEASURES

Questionnaires consisting of the Workplace Violence Scale, the Occupational Identity Scale, the Psychological Capital Questionnaire and a demographic data sheet were used to collect participant information. We used hierarchical multiple regression and asymptotic and resampling strategies to examine the mediating role of PsyCap in the relationship between WPV and professional identity.

RESULTS

WPV was negatively associated with professional identity after controlling for demographic factors (β=-0.353; p<0.001). PsyCap mediated the relationship between WPV and professional identity, according to the mediation analysis (a×b=-0.150, bias-corrected and accelerated 95% CI (BCa 95% CI) (-0.185 to -0.115); p<0.001). In addition, two dimensions of PsyCap: hope (a×b=-0.075, BCa 95% CI (-0.104 to -0.049); p<0.001) and resilience (a×b=-0.064, BCa 95% CI (-0.090 to -0.039); p<0.001) mediated the association between WPV and professional identity. For professional identity, hope, resilience and PsyCap mediation accounted for 21.6%, 18.1% and 42.4%, respectively.

CONCLUSIONS

Based on these findings, PsyCap could partially mediate the relationship between WPV and professional identity. Therefore, hospital administrators should implement measures to prevent and reduce WPV and provide nurses with skills training programmes to improve the PsyCap such as hope and resilience.

Transitioning to Independent Nursing Practice during COVID-19: A Mixed Methods Study

The COVID-19 pandemic presented challenges to onboard and support new graduate nurses (NGNs). This study sought to explore the perceptions of nurses entering clinical practice during the COVID-19 pandemic. Using mixed methods, we investigated the experiences of NGNs entering the field during the pandemic and how a nurse residency program (NRP) adapted to meet their needs. Newly graduated nurses entering practice in November 2019 described their transition through nurse experience surveys and focus group discussions. Results from the quantitative data reported on compassion satisfaction, burnout, and exposure to secondary traumatic stress. The qualitative data mirrored these findings with the discovery of the following five themes: transitioning through an NRP, impact to nursing care, value of coworkers, coping, and professional growth. These findings illustrate the need to better support future practice transitions in times of disruption and change.

Association between circadian rhythm and sleep quality among nursing interns: A latent profile and moderation analysis

Background

Disturbances in circadian rhythms are common among night-shift workers and result in poor sleep quality. Nevertheless, the heterogeneity of circadian rhythms and their relationship with sleep quality is less explored in nursing interns. Therefore, we aimed to identify the latent subtypes of circadian rhythm, explore their relationship with sleep quality, and evaluate their moderating role between perceived stress and sleep quality in nursing interns.

Materials and methods

In all, 452 nursing interns were recruited between October 2020 and January 2021 from Be Resilient to Nursing Career (BRNC), which is a multicenter, prospective cohort of a career growth program for nursing students. They were assessed using the 10-item Chinese Perceived Stress Scale, Circadian Type Inventory, and Pittsburgh Sleep Quality Index. Latent profile analysis and moderation analysis were performed.

Results

Overall, 72.3% of the nursing interns reported poor sleep quality. We identified three latent subtypes of circadian rhythms, namely, Vigorousness (40.1%), Inadaptability (18.6%), and Flexibility (41.1%). Females (OR = 1.97, 95% Cl: 1.01-3.83, P = 0.047) with normal body mass index (OR = 1.62, 95% CI: 0.95-2.76, P = 0.078) were prone to Flexibility. Circadian rhythm types significantly moderated the association between perceived stress and sleep quality (P < 0.05).

Conclusion

Nursing interns suffer from poor sleep. There exists heterogeneity of circadian rhythm subtypes in nursing interns, and attention should be paid to those with Inadaptability type. The association between perceived stress and sleep quality is significantly moderated by circadian rhythm subtypes.

Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance

Despite the high prevalence of nurses’ turnover and the turnover intention of new nurses, there are insufficient studies examining turnover intention at the time when job orientation is completed and independent nursing commences. Thus, this study examined turnover intention levels and identified the factors affecting turnover intention of new Generation Z nurses, focusing on job stress and sleep disturbance, at the eighth week after completing job orientation. This was a cross-sectional descriptive correlational study. Using a convenient sampling method, 133 new nurses were recruited. Data were collected using a structured questionnaire consisting of demographic and occupational characteristics, job stress, sleep disturbance, and turnover intention. Descriptive statistics were computed to describe the sample and interest variables. Logistic regression analysis was performed to examine the association of job stress and sleep disturbance with turnover intention. Most nurses were women (91.7%) and approximately two-thirds worked in the surgical ward (n = 61, 45.9%). Turnover intention was 12.8%, average job stress was 40.11 ± 90.7, and average sleep disturbance was 42.39 ± 15.27. New graduate nurses’ turnover intention was associated with job stress (OR = 1.07, 95% CI = 1.02–1.12) and sleep disturbance (OR = 1.19, 95% CI = 1.05–1.35), and this model explained 47.7% of the variance. Study findings determine that job stress and sleep disturbance were significant predictors of turnover intention in new nurses at the eighth week after joining the hospital. Therefore, nursing administrators should focus on new nurses’ job stress and sleep disturbance, and provide them with timely assessment and management to reduce turnover intention.

Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey

BACKGROUND

Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China.

METHODS

A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children's education opportunities, working environment, career promotion speed and bianzhi (formally established post).

RESULTS

A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed).

CONCLUSION

Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.

Examining the dimensionality, reliability, and invariance of the Chinese version of the Resilience Scale-14: A multicenter cross-sectional survey in Chinese junior nurses

BACKGROUND

This study aimed to present the psychometric properties (dimensionality, reliability, and invariance) of the Chinese 14-Item Resilience Scale (RS-14) within Chinese register nurses (RNs) with less than 3 years work experiences. And we aimed to compare the fit of a unidimensional model and a bifactor model.

MATERIALS AND METHODS

This multicenter cross-sectional survey was conducted from August to September in 2019. A total of 7,231 registered nurses from 90 hospitals were recruited. Data was anonymously obtained through online questionnaires. Both reliability and validity of Chinese RS-14 were assessed. The confirmatory factor analyses (CFA) were used to compare the fit of two different factor structures of the RS-14 (unidimensional model vs. a bifactor model). Moreover, multigroup CFA (MGCFA) were applied to evaluate the measurement invariance (MI) across sociodemographic parameters (gender, educational level, marital status, and et al.).

DESIGN

Cross-sectional quantitative analyses.

RESULTS

Our study confirmed that the bifactor model presented the best fit within Chinese nurses (CFI = 0.924, TLI = 0.909, RMSEA = 0.095, SRMR = 0.043), and found strong factorial invariance across gender, marital status, and status of receiving standardized training. The reliability of RS-14 was high with a Cronbach's alpha coefficient of 0.939. Moreover, RS-14 was positively correlated with the social support and was negatively correlated with workplace bullying.

CONCLUSION

This is the first study to explore the latent factor structure for the RS-14 among Chinese RNs and evaluated MI across a series of sociodemographic variables. Based on our findings, the Chinese version RS-14 is both valid and reliable.

"SURVIVAL" intervention program effects on student nurses' transition to staff nurses: A quasi-experimental study

OBJECTIVE

The purpose of this study is to explore the effects of the "SURVIVAL" intervention program on the nursing competencies, work self-efficacy, occupational stress and retention rate for students who recently graduated from the two-year baccalaureate nursing program.

BACKGROUND

The role transition for students who have recently graduated is a dynamic process, which is associated with stress and challenges. It was also a vital stage for successfully adapting to a nursing career to overcome the reality shock and become competent.

DESIGN

A prospective, longitudinal, quasi-experimental design was used to examine the effects of the SURVIVAL intervention on 72 participants in the control group and 38 participants in the experimental group.

METHODS

The SURVIVAL intervention included an internship program, the adjustment of the college curriculum, career mentorship and peer support. The outcomes, including nursing competencies, work self-efficacy, occupational stress and the retention rate, were evaluated prior to the participants started working and one, three, six and 12 months after they started working.

RESULTS

Compared with the participants in the control group, those in the experimental group performed significantly better with regard to general clinical nursing skills, basic biomedical science, ethics, overall assessment, work self-efficacy and lower occupational stress.

CONCLUSIONS

The "SURVIVAL" intervention program for career transition, jointly developed through a partnership between academia and practice, improved some of the nursing competencies and work self-efficacy of the newly graduated nurses and also reduced their occupational stress.

Effects of an Adaptive Education Program on the Learning, Mental Health and Work Intentions of New Graduate Nurses

Health care workers are at a higher risk of psychological distress than ordinary people. Stress affects physical and mental health, and can even produce an intention to leave. The current training for new graduate nurses (NGNs) during this transitional period mostly focuses on the cultivation of professional ability, with less attention to mental health or emotional feelings, and thus there are insufficient structured support strategies. As such, this study explores the effects of intervention through an appropriate education program on the learning, mental health and work intentions of new recruits during the transition period. A pre-test and post-test for a single group was designed for new nursing staff in a large teaching hospital in northern Taiwan. The test period was from May 2017 to December 2018, and a total of 293 cases were accepted. A three-month adaptive education program was provided and evaluated in terms of: care for learning, care for health, improving professional ability, and individualized guidance on satisfaction, mental health disturbance and work intention. The new graduate nurses who received gentle care and counseling showed a downward trend in their BSRS-5 scores and statistical differences over time (p < 0.001). The higher the BSRS-5 score, the easier it is for new graduate nurses in acute and intensive care units. There is a tendency for turnover leave (p = 0.03). After the intervention of the overall plan, the turnover rate of new graduate nurses within three months was 12.6%, and the one-year retention rate was 87.9%. The adaptive education program uses multiple support strategies to improve learning and professional abilities, to reduce psychological emotions, and thereby to increase retention. Today will face new medical challenges; the education programs will become more important across clinical care settings, and it will be important to rigorously validate their performance in helping NGNs.

Association of work environment and resilience with transition shock in newly licensed nurses: A cross-sectional study

AIMS AND OBJECTIVES

To examine transition shock in newly licensed nurses and the association of work environment and resilience with nurses' transition shock.

BACKGROUND

Although work environment is related to transition shock in newly licensed nurses, little is known about the factors of nursing work environment associated with transition shock. Furthermore, resilience is known to help nurses positively face workplace challenges; however, there is little evidence on the associations between resilience and transition shock in new nurses.

DESIGN

A cross-sectional, descriptive study.

METHODS

Data from 163 new nurses with <12 months of work experience in the current hospital since graduation were analysed. Participants' characteristics, work environment, nurse resilience and transition shock were self-reported. Multivariable linear regressions were performed in three steps (following the STROBE checklist).

RESULTS

The highest mean score of transition shock was obtained for the item 'I perceive the limitations of my professional knowledge in nursing care'. In the regression analysis adjusted for all variables, two factors of work environment-'nurse staffing and resource adequacy' and 'collegial nurse-physician relationships'-were associated with transition shock. Meanwhile, resilience was not related to transition shock.

CONCLUSIONS

The gap between newly licensed nurses' theoretical and practical knowledge continues to exist. Adequate nurse staffing and a positive relationship with physicians, rather than nurse resilience, were more likely to associate with new nurses' transition shock.

RELEVANCE TO CLINICAL PRACTICE

Hospitals need to provide ward-based simulations and case-based learning methods to enhance nurses' transition to professional practice. For nurses' transition, hospitals should make efforts to provide adequate nurse staffing and resources. Furthermore, hospitals should provide communication opportunities to build a positive collaborative culture between nurses and physicians. Unit nurse managers need to assess newly licensed nurses' perception of nurse-physician professional relationship and create an atmosphere of respect and understanding for each other.

The Moderating Effect of Nursing Practice Environment on the Relationship between Clinical Nurses' Sleep Quality and Wellness

This study examined the moderating effect of nursing practice environment on the relationship between clinical nurses’ sleep quality and wellness. The wellness of clinical nurses is a direct outcome of individual-level health behaviors and organizational environmental factors. This study was a cross-sectional analysis. Participants were clinical nurses recruited using convenience sampling. The Nurse Practice Environment Scale, Wellness Index, and Pittsburgh Sleep Quality Index, Korean version (PSQI-K) were used. Data collected from 1874 nurses were analyzed using descriptive statistics and hierarchical multiple regression analyses. A total of 95.3% of the participants were women, and the mean age was 28.8 years. Further, 42.4% of the participants had a nursing career of 5 years or longer. The mean score for nursing practice environment was 2.24 and the mean PSQI-K score was 9.39. Nurses with less than 1 year of experience reported lower wellness scores. The wellness scores decreased with poorer sleep quality, and a more positive evaluation of the nursing practice environment predicted higher levels of wellness. Nursing practice environment had a moderating effect on the negative association of nurses’ poor sleep quality with their wellness. Regarding management, individual strategies for nurses’ well-being and organizational improvement policies may improve the nursing work environment.