Role transition from student nurse to staff nurse: Facilitating the transition period

Factors associated with practice readiness among newly qualified nurses in their first two years of practice

BACKGROUND

Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession.

OBJECTIVES

To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession.

DESIGN

A cross-sectional study.

SETTINGS AND PARTICIPANTS

A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore.

METHODS

Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice.

RESULTS

More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03).

CONCLUSIONS

It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.

Trajectories of Wok Adjustment and Influencing Factors Among Newly Registered Nurses

PURPOSE

This study explored the work adjustment trajectory and its predictors and characteristics among newly registered nurses.

METHODS

A total of 245 newly registered nurses working in a university hospital provided general baseline characteristics and completed a work adjustment questionnaire along with self-report measures of clinical competency, psychological capital, preceptor exchange, social support, and role conflict when they started working independently (baseline) and at 7 and 12 months after employment. Data were collected from July 2020 to August 2022. The collected data were subjected to a group-based trajectory model, χ2 test, F test, one-way ANOVA, and multiple logistic regression using SAS 9.4, and SPSS 25.0.

RESULTS

Group-based trajectory modeling classified three newly registered nurse groups: nurses with a high work adjustment level in all subscales from the beginning of employment (early adjustment group, 16.1%), nurses with a moderate level of adjustment from beginning to end (standard adjustment group, 60.6%), and nurses with a low level of work adjustment from early to mid-term, rising later (delayed adjustment group, 23.3%). Higher hope, optimism, and emotional support predicted early and standard adjustments.

CONCLUSIONS

Based on the trajectory characteristics, newly registered nurses need to improve their work adjustment. The early and standard adjustment groups should continuously monitor their levels of work adjustment while monitoring their hopes, optimism, and emotional support. In particular, the delayed adjustment group required customized educational programs and strengthened peer support.

Senior nurses' expectations and support of new graduate nurses' adjustment in hospitals: A qualitative descriptive study

Aim

This study aimed to identify senior nurses' expectations and support of new graduate nurses' adjustment to their work environment.

Background

New graduate nurses have difficulties in adjusting to their work environment because they are not well prepared for clinical nursing practice upon graduation. Hospitals support their adjustment to their work environment through residency/transition programs. Although such support exists, new graduate nurses are expected to learn the expected behavior and attitude themselves. Thus, identifying senior nurses' expectations and support of new graduate nurses' adjustment may facilitate smooth adjustment to the work environment.

Design

This was a qualitative descriptive study.

Methods

Fourteen nurses who teach new graduate nurses in Japanese hospitals were interviewed face-to-face individually. The data were analyzed using qualitative inductive content analysis, which was coded and sorted to identify categories.

Results

Regarding senior nurses' expectations of new graduate nurses' adjustment, six categories emerged: trying to fit in with people in their ward, behaving by following the unspoken rules of their ward, having attitudes compatible with learning, addressing their situations using their initiative, showing a willingness to learn, and obtaining necessary information by themselves. Senior nurses' support of new graduate nurses' adjustment consisted of four categories: watching over and speaking to them, trying to create a good working environment, encouraging them to have attitudes compatible with learning, and teaching them how to learn.

Conclusions

Senior nurses need to understand and express what they expect from new graduate nurses at the stage of hospital adjustment. If senior nurses understand their expectations for adjustment, they can help new graduate nurses effectively. Furthermore, understanding the expectations of senior nurses may facilitate new graduate nurses' adjustment. These findings may contribute to good working relationships between senior and new graduate nurses.

Effect of Repeated Multipatient Simulations on Professional Readiness Among Senior Nursing Students

BACKGROUND

Senior nursing students are expected to be ready in terms of professional decisions and practices as soon as possible after graduation. Quality and Safety Education for Nurses (QSEN) is a framework to prepare nursing students for practice in the health care system.

PURPOSE

This study aimed to explore the effect of repeated exposure to multipatient simulations on senior nursing students' pregraduation transition views, QSEN knowledge level and self-competency, professional readiness, and postgraduation transition shock.

METHODS

A randomized controlled trial of intervention and control groups with pretest, posttest, and a follow-up was conducted with 78 senior nursing students at a private, accredited, nursing program in Istanbul, Turkey.

RESULTS

There was a statistically significant improvement in the intervention group between the pretest and the posttest for self-confidence ( P < .01), QSEN knowledge level ( P < .01), and professional readiness ( P < .01). The QSEN knowledge level ( P < .01) and professional competency ( P < .05) of the intervention group were higher than those of the control group.

CONCLUSION

These results suggest that multipatient simulations may be an effective strategy to better prepare students for the health care system's demands.

Reflective Transition Practice Model: The New Graduate Registered Nurse

Reflection is a strategy that may enhance transition into practice for the new graduate registered nurse (NGRN). If introduced in the early stages of practice, reflection can be used as a tool to continuously evaluate and improve practice. A theory synthesis of Meleis' transition theory and Schon's reflective practice model was developed to support reflection as a tool for new nurses transitioning into the role of professional nurses. Reflection has the potential to improve the NGRNs' perception of their role, decrease feelings of disconnectedness, and improve patterns of response.

Role transition from education to practice and its impact on the career futures of Omani nurses

AIM

The aim of this study was to examine new Omani graduate nurses' role transition from education to practice. We also sought to describe factors that may affect the effective transition of new Omani graduates to their professional nurse role.

BACKGROUND

There is a substantial literature on the process of transition from graduation to being a professional nurse in countries across the globe; however, little is known about new Omani graduate nurses' role transition from education to practice.

DESIGN

This study had a descriptive cross-sectional design.

METHODS

Data were collected from nurses who at the time of the study had been working for at least 3 months but not longer than 2 years. Role transition was assessed with the Comfort and Confidence subscale of the Casey-Fink Graduate Nurse Experience Survey (Casey et al., 2004). The survey consists of a 24-items that are rated on a 4-point Likert scale. We conducted a multivariate regression analysis to assess the factors that influence nurses' role transition. These factors included participants' demographic information, employment orientation durations, preceptorship duration and length of time before employment.

RESULTS

The total sample consisted of 405 nurses working in 13 hospitals in Oman. Most (68.89%) had worked as a nurse for less than 6 months. The average internship and orientation durations were approximately 6 months (SD = 1.58) and 2 weeks (SD = 1.79), respectively. The number of preceptors assigned to new graduate nurses ranged from none to four. The average score on the Comfort and Confidence subscale was 2.96 (SD = 0.38). Results from the regression analysis demonstrated that age (β = 0.029, SE = 0.012, p = .021), waiting time before employment (β = -0.035, SE = 0.013, p = .007) and employment orientation duration (β = -0.007, SE = 0.003, p = .018) were statistically significant factors influencing role transition experience among newly joined nurses.

CONCLUSION

The results suggest that appropriate intervention strategies at the national level are needed to enhance the transition of nursing school graduates to their professional role. Strategies directed toward shortening the waiting time before employment and improving the internship experience are examples of priority-level tactics that can enhance Omani nursing graduates' transition to their professional role.

International Postgraduate Study in the United Kingdom: An Exploration of Nursing Students

BACKGROUND

This study explored the experiences of international postgraduate nursing students from the Gulf Cooperation Council region as they transitioned from home to a university in the United Kingdom and then again as they reintegrated to work and life at home after completing their studies.

METHOD

This research was grounded in Schlossberg's transition theory. A two-phased qualitative approach was followed, and semistructured interviews were conducted.

RESULTS

Analysis of qualitative data revealed the following themes: the presence of social integration, retransition, and readjustment.

CONCLUSION

International students faced challenges as they adapted socially and academically to living in another country and also on their return home. The mechanisms students use to negotiate and make sense of the transition process suggest a need for universities to consider increasing preparation and orientation of students, supporting host and international student friendships, and ensuring students are equipped to reintegrate to their careers and cultures on their return home. [J Nurs Educ. 2023;62(3):125-132.].

New Nurses' Perceptions on Transition to Practice: A Thematic Analysis

BACKGROUND

New nurses' transition to the workforce is often described as challenging and stressful. Concerns over this transition to practice are well documented, with the hypothesis that transition experiences influence the retention of new nurses in the workforce and profession.

METHODS

In a cross-sectional survey (N = 217) to assess new nurse transition in the province of Ontario, Canada, an open-ended item was included to solicit specific examples of the transition experience. The comments underwent thematic analysis to identify the facilitators and barriers of transition to practice for new nurses.

RESULTS

Comments were provided by 196 respondents. Three facilitator themes (supportive teams; feeling accepted, confident, and prepared; new graduate guarantee) and four barrier themes (feeling unprepared; discouraging realities and unsupportive cultures; lacking confidence/feeling unsure; false hope) to new nurse transition emerged.

CONCLUSIONS

Concerns of nursing shortages are heightened in the current COVID-19 pandemic, reinforcing the priority of retaining new nurses in the workforce. The reported themes offer insight into the contribution of a supportive work environment to new nurses' transition. The recommendations focus on aspects of supportive environments and educational strategies, including final practicums, to assist nursing students' development of self-efficacy and preparation for the workplace.

"Jumping into the COVID-19 arena": The professional transition into clinical practice of new graduate nurses in Italy at time of COVID-19

AIMS AND OBJECTIVES

To evaluate the impact of the professional transition of new graduate nurses during the COVID-19 pandemic.

BACKGROUND

The transition from the role of student to the professional role can be challenging for new graduate nurses for the acquisition of higher autonomy and responsibility. The COVID-19 pandemic impacted the quality of the professional transition.

DESIGN

This was a cross-sectional observational study following the Strengthening and Reporting of Observational Studies in Epidemiology checklist.

METHODS

One hundred and two nurses who graduated in three consecutive sessions (November 2019-pre-pandemic, March 2020-pandemic outbreak, and November 2020-2nd wave) in a north Italian university located in the most affected Italian region by the COVID-19 pandemic, completed an online survey assessing well-being, risk of burnout, resilience, perceived stigma, strengths and limitations and quality of the professional transition. The study was performed between March and May 2021.

RESULTS

81.4% of participants described the professional transition as worse than expected, and new graduate nurses who worked in COVID-19 settings reported a more difficult transition to professional life. No differences emerged in burnout, mental well-being and perceived stigma between new graduate nurses who worked in COVID-19 settings and those who did not. Similarly, no differences emerged amongst the three graduated cohort sessions. The most commonly mentioned challenges faced during the transition were organisational aspects, suddenly acquired autonomy and lack of suitable coaching.

CONCLUSION

New graduate nurses reported a challenging academic-professional transition, in particular, those who worked in COVID-19 settings. The mid- and long-term impact of experiencing an academic-professional transition in COVID-19 settings should be assessed and monitored.

RELEVANCE TO CLINICAL PRACTICE

The professional transition of new graduate students should be adequately planned and monitored, new graduates should be assisted to develop realistic expectations about the transition, and an adequate coaching period should be guaranteed all the more during health emergencies.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study

Background

During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education.

Methods

A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions.

Results

The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained.

Conclusions

Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01002-0.

Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study

PURPOSE

Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa.

METHOD

The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally.

RESULTS

The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2).

CONCLUSIONS

This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.

Positive consequences of the hidden curriculum in undergraduate nursing education: An integrative review

Background:

Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.

Materials and Methods:

A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.

Results:

Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.

Conclusions:

Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

The best of both worlds - entering the nursing profession with support of a transition programme

BACKGROUND

Transition into clinical practice for newly graduated nurses is a difficult time, with high stress levels defined by a demanding period of personal and professional acclimatisation. Transitions are complicated and multi-dimensional, and to understand this process, it is crucial to identify the factors that facilitate or stand in the way of a healthy transition.

AIM

The phenomenological study aimed to describe newly graduated nurses' expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme, including education, supervision, and critical reflection with peers.

METHOD

The study was based on seven group interviews with newly graduated nurses. The interviews utilised open-ended and follow-up questions and were carried out as a dialogue to enable reflection on the phenomenon of interest. This was explored and illuminated using the reflective lifeworld research approach, based on phenomenological epistemology.

FINDINGS

"Expectations of transition into the nursing profession via the Clinical Nursing Introduction Programme" is signified by an oscillating movement between uncertainty, security, challenge, and growth on the threshold of a new identity. The phenomenon is constituted by the courage to grow, responsibility and fear, belonging and vulnerability, and support and challenge.

CONCLUSION

Transitioning into the nursing profession via the Clinical Nursing Introduction Programme means having the best of both worlds. Newly graduated nurses have the opportunity to receive education and structured support at the same time as they work independently in clinical practice.

The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study

BACKGROUND

The use of information systems takes up a significant amount of nurses' daily working time. Increased use of the systems requires nurses to have adequate competence in nursing informatics and is known to be a potential source of stress. However, little is known about the role of nursing informatics competence and stress related to information systems (SRIS) in the well-being of nurses. Moreover, the potential impact of nurses' career stage on this matter is unknown. This study examined whether SRIS and nursing informatics competence are associated with stress and psychological distress in newly graduated nurses (NGNs) and experienced nurses.

METHODS

A cross-sectional study was conducted in Finland between October and December 2018. The participants were NGNs (n = 712) with less than two years of work experience and experienced nurses (n = 1226) with more than two years of work experience. The associations of nursing informatics and SRIS with nurses' stress and psychological distress were analyzed with linear regression analysis. Analyses were conducted separately for NGNs and experienced nurses. Models were adjusted for age, gender, and work environment.

RESULTS

SRIS was associated with stress / psychological distress for both NGNs (β = 0.26 p < 0.001 / β = 0.22 p < 0.001) and experienced nurses (β = 0.21 p < 0.001/ β = 0.12 p < 0.001). Higher nursing informatics competence was associated with lower stress (β = 0.20 p < 0.001) and psychological distress (β = 0.16 p < 0.001) in NGNs, but not among experienced nurses.

CONCLUSIONS

SRIS appears to be an equal source of stress and distress for nurses who are starting their careers and for more experienced nurses, who are also likely to be more experienced users of information systems. However, informatics competence played a more important role among NGNs and a lack of adequate competence seems to add to the strain that is already known to be high in the early stages of a career. It would be important for educational institutions to invest in nursing informatics so that new nurses entering the workforce have sufficient skills to work in increasingly digital health care.

From registered nurse to nursing student - Exploring registered nurses' transition to nursing student during a post-registration children's nurse programme: A qualitative descriptive research study

BACKGROUND

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006.

OBJECTIVES

The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition.

DESIGN

A qualitative descriptive research design was used.

SETTING

The study was carried out in a large teaching children's hospital in Dublin, Ireland.

PARTICIPANTS

A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student.

METHODS

Face-to-face, semi-structured, conversation-style interviews were conducted.

RESULTS

Four main themes were identified from the data: 'Feelings related to returning to student status', 'Supports throughout the transition', 'Differences between disciplines' and 'Knowing your place'. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor.

CONCLUSIONS

The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship.

Supporting the transition from nursing student to newly qualified children's nurse

BACKGROUND

The transition from nursing student to newly qualified nurse is known to be challenging but research on the transition to children's nurse is limited.

AIM

To examine the experience of primary and secondary transitions among newly qualified children's nurses and to identify effective support strategies for this staff group.

METHOD

The study was supported by a literature review and conducted in a children's hospital in Ireland in 2017. A descriptive survey methodology was used. Data were collected using a validated survey tool. The purposive sample encompassed 81 nurses who had qualified as children's nurses from 2011 onwards.

FINDINGS

The transition to children's nurse was found to be a complex but generally positive experience and to require robust support. Transition lasted beyond the first year of practice and the transition experience was similar for all participants, irrespective of whether they had undergone primary or secondary transition. Preceptorship, transition and orientation programmes were reported to be beneficial support strategies.

CONCLUSION

Challenges are to be expected during transition and effective support strategies for new children's nurses are needed, as is further research in this area.

Proceed With Caution: Integrating Newly Graduated Nurses Into an Emergency Department

Virtually, no published research is available on the relationship between employing newly graduated nurses (NGNs) in the emergency department (ED) and the advancing of nursing practice and the optimization of patient care outcomes. Traditionally, nurses hired into these practice areas have required advanced skills in clinical assessment and experience with a variety of situations that were assumed to offer them a framework by which they could recognize and respond to potentially life-threatening changes in a patient's status. This qualitative study explored the issues of integrating NGNs into the ED. Findings clearly established the challenges to integrating NGNs into this practice context. The intersection of variables included a low level of clinical predictability accompanied by high acuity; an increased level of practitioner autonomy combined with high levels of risk when applying decision making to patient outcomes; and the potential for devolution of professional identity in the face of highly intense, morally conflicted, and socially nuanced care situations.

International nursing students' and international nursing graduates' experiences of transition to the nursing workforce: A systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to identify and synthesise existing evidence on the experiences of international nursing students' and international nursing graduates' transition to the host country's nursing workforce.

BACKGROUND

International students' experiences of transition to the host country has been extensively explored by researchers. International students experience unique challenges related to communication and language, socialisation, finance, and temporary student visa. One under-researched area is the experiences of transition for international nursing students and international nursing graduates. This systematic review examined the existing evidence on international nursing students' and international nursing graduates' experiences of transition to the host country's nursing workforce.

INCLUSION CRITERIA

This review considered published and unpublished studies-qualitative, quantitative, mixed methods, evidence syntheses, and grey literature-that included international nursing students enrolled in an undergraduate nursing programme outside their home country and international nursing graduates, either employed or not yet employed in nursing and within their first year of completing an undergraduate nursing programme outside their home country.

METHODS

A three-step search strategy was utilised in this review. The search strategy aimed to find published and unpublished literature in English from January 2000 to April 2020. The databases searched were Ovid Medline, Scopus, Emcare, ERIC, PsycINFO, ProQuest Central, ProQuest Dissertations and Theses Global, JBI Evidence-based Practice Database, and ScienceDirect. Two reviewers independently screened the titles/abstracts and full texts of studies for inclusion and appraised the methodological quality of the included studies. Findings and accompanying illustrations were extracted by one reviewer, assigned a level of credibility, and checked by the others. Results were analysed using JBI's approach to qualitative meta-aggregation.

RESULTS

This review included three qualitative papers published between 2011 and 2018. All included studies were appraised as of moderate quality. Sixty-five study findings and nineteen categories were aggregated into the following six synthesised findings: international nursing graduates developed confidence and satisfaction through challenges; personal challenges; clinical challenges; discrimination and justice; academic barriers to success; and what international nursing students liked and wanted.

CONCLUSION

The synthesised findings revealed ongoing anxiety, lack of preparedness and role uncertainty that was experienced by international nursing students and international nursing graduates as they transition to the host country's nursing workforce. They expressed the need for information about professional role expectations, guidance, and support to transition. University transition programmes and services could provide support to address the workforce transition challenges faced by international nursing students and international nursing graduates.

TWEETABLE ABSTRACT

Systematic review shows international nursing students and international nursing graduates experience anxiety, limited preparedness and role uncertainty when transitioning to the host country's nursing workforce.

Components of the nursing role as perceived by first-year nursing students

BACKGROUND

Identifying and acquiring the nursing role is key to the development of nurses' professional identity. Understanding nursing students' perceptions in this regard will enable nursing educators to choose teaching strategies that lead to positive development of their students' professional identity.

OBJECTIVES

To describe how nursing students perceive the different components of the nursing role at the beginning of the nursing degree.

DESIGN

Cross-sectional, descriptive, observational study.

PARTICIPANTS/SETTINGS

106 first-year nursing students at the University of Huelva, Spain.

METHODS

Data on social and academic variables and variables relating to the instrumental and expressive roles were collected via an adapted, pilot-tested questionnaire assessed by experts.

RESULTS

For participants, caregiving is the core of the nursing role in the clinical setting, including both technical execution and patient care aspects. They highlighted the disease prevention, health promotion, restoration, and education profiles of nurses rather than their teaching, professional, and technical profiles. They were acquainted with the concept of postgraduate professional development, but were unaware of the academic pathways leading to it. They considered nurses to be decision-makers, who are nevertheless subordinate to doctors.

CONCLUSIONS

Students did not consider nursing to be an autonomous profession, although they highlighted its decision-making capacity. They placed greater emphasis on the traditional profile of primary care nurses than on their technical profile, and were able to identify the members of the multidisciplinary healthcare team.

Learning Experience of Chinese Nursing Students during Clinical Practicum: A Descriptive Qualitative Study

The change in clinical environment can have a significant impact on nursing students’ clinical learning and as a consequence, to their competency. Students’ learning experiences could provide important insights for improving the existing approach towards clinical education. This descriptive qualitative study aimed to explore nursing students’ clinical learning experience. Focus group interviews were conducted with 20 final year nursing students studying a bachelor nursing programme at a self-financing tertiary institution in Hong Kong. Thematic analysis was conducted. 16 female and four male students were recruited. Six themes were identified: Anxiety towards clinical practicum, expectations of roles and responsibilities in practicum, ward environment, adequacy of support, learning attitude, and practicum arrangement. The findings suggest that nursing students are more discontented with their clinical training than before. Nursing faculty must look for possible ways to improve the clinical learning environment.

Clinical teaching behaviour effects professional identity and transition shock in new nurses in western china: A cross-sectional study

Aim

To examine the interrelationship between professional identity, clinical teaching behaviour and transition shock for new nurses in Western China.

Design

A cross‐sectional design.

Methods

A total of 779 new nurses were recruited in Gansu province and Lanzhou city from June to July 2019. Each patient was given three questionnaires to complete, and structural equation modelling was used to identify the relationships.

Results

The overall mean scores for the transition shock, professional identity and clinical teaching behaviour were 92.53(SD = 22.17), 89.74(SD = 16.57) 80.12(SD = 12.38), respectively. The most important aspects identified were the Physical aspect, the Sense of Mastery and Committing to Teaching. Professional identity and clinical teaching behaviour were negatively related to transition shock, a better sense of identity coupled with supportive clinical teaching were keys to a smoother journey from new to experienced nurses.

Clinical decision making in undergraduate nursing students: A mixed methods multisite study

BACKGROUND

Clinical decision making is an integral part of what nurses do, yet little is known about how students learn how to make clinical decisions or about the nature of the clinical decisions they make-whether intuitive or analytical. This multischool, multistate embedded mixed methods study was conducted to better understand these phenomena within the context of Hammond's Cognitive Continuum Theory. The content for this manuscript was taken from the primary author's dissertation.

METHODS

Students (N = 168) completed the NDMI-Revised 2014; followed by focus groups.

RESULTS

Three quarters of the participants (n = 127) scored in the quasi-rational range of clinical decision making indicating they are flexible making decisions dependent on the situation. Six themes described how students made clinical decisions.

CONCLUSIONS

Participants were flexible decision makers who used the help of others, lessons learned, the wisdom of nurses, experience, the situation at hand, and systematic cognitive processing to make clinical decisions.

Developing and validating the transition status scale for newly graduated nurses in China

AIM

The present study aimed to develop and examine the psychometric properties of the Transition Status Scale for Newly Graduated Nurses.

METHODS

Three phases were conducted: Phase I involved a qualitative research to explore and establish the potential items pool; Phase II reduced the items using the item analysis with a sample of 73 nurses. Phase III evaluated the psychometric properties of the final scale. Data from 814 valid questionnaires were analysed using exploratory factor analysis and confirmatory factor analysis.

RESULTS

Five factors, including 'Interpersonal integration', 'Profession-related positive emotion', 'Competence for nursing work', and 'Active coping strategies', 'Balance between work and life', accounted for 68.87% of total variance. Cronbach's α was 0.891. Confirmatory factor analysis indicated acceptable model fitness.

CONCLUSIONS

The Transition Status Scale for Newly Graduated Nurses has good psychometric properties. It can be used to measure the transition status conveniently and effectively.

IMPLICATIONS FOR NURSING MANAGEMENT

The assessment result with the Transition Status Scale for Newly Graduated Nurses can provide information about the transition status of new nurses, thereby providing reference to guide the specific nursing interventions to smooth the transition process. It can also work as an alternative instrument to compare the effectiveness of different transition programs.

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.

Effect of clinical teaching behaviours on transition shock in graduate nurses

AIM

This study aimed to explore the impact of preceptor clinical teaching behaviours on transition shock in graduate nurses using bi-directional feedback between graduate nurses and clinical preceptors and to assess preceptor clinical teaching behaviours.

DESIGN

This was a descriptive cross-sectional study.

METHODS

This study was conducted from January-February 2019. Participants included graduate nurses (N = 117) and clinical preceptors (N = 908) from a major public tertiary hospital in Western China.

RESULTS

Overall level of transition shock of graduate nurses was moderate (mean = 89 SD  17.54). Transition shock level of graduate nurses rose with the increasing of time in clinical work. Intensive care unit graduate nurses suffered the strongest transition shock, whereas surgery graduate nurses suffered the least. Graduate nurses thought that clinical preceptors were best at evaluation and feedback, whereas clinical preceptors thought they were best at showing concern and support. The primary factors associated with transition shock in graduate nurses were the time admitted to the hospital, feedback, and evaluation, use of appropriate teaching strategies, and showing concern and support, explaining 63.5% of the total variation in transition shock in graduate nurses.

CONCLUSION

In Western China, where the development of economic and medical conditions lag, transition shock is a major obstacle to the professional development of graduate nurses and clinical teaching behaviours is the key to overcoming transition obstacles. However, the serious shortage of nurses makes it difficult to not only complete heavy clinical nursing work but also to undertake the teaching of students and graduate nurses. The clinical teaching system is influenced by many factors. Focusing on clinical teaching behaviours and transition shock in graduate nurses will provide valuable data for future intervention studies.

IMPLICATION

The findings of this study will be of interest to managers at all levels and will enable them to support graduate nurses by engaging in excellent clinical teaching behaviours. In the clinical teaching process, giving more feedback and evaluation, improving the ability of using appropriate teaching strategies and focusing on the physical and mental health of graduate nurses may effectively decrease transition shock of graduate nurses and reduce the turnover rate.

Newly qualified nurses' transition from learning to doing: A scoping review

OBJECTIVES

To identify newly qualified nurses' experiences during transition to professional practice, and explore their and other key stakeholders' perceptions of nursing transition programmes.

DESIGN

Scoping review using the Arksey and O'Malley framework.

METHODS

Several electronic databases were searched for relevant articles, which were supplemented by hand-searching and internet searches for grey literature. 1823 potentially relevant articles published between 1974 and 2019 were retrieved from the initial search, and an additional ten articles were obtained from the supplemental search. Each article was independently reviewed, leaving 60 articles eligible for inclusion in the review.

FINDINGS

Two overarching themes emerged: 1) the transition experience; 2) the perceived benefits of nursing transition programmes. Evidence that nursing transition programmes positively impact the transition experience is inconclusive. Some studies suggest a positive impact on newly qualified nurses' competency, level of confidence and attrition rates; others reported no impact. There was a general consensus that newly qualified nurses still encounter difficulties when transitioning into professional practice. Most articles found were quantitative in nature, focusing on measurable outcomes of nursing transition programmes. Few investigated the experiences and perceptions of newly qualified nurses, preceptors, and managers regarding the transition to professional practice.

CONCLUSIONS

Literature mapping suggests that newly qualified nurses frequently struggle to successfully complete the transition into professional practice, and that this transition is complex and multifaceted. There is limited evidence to justify the widespread implementation of nursing transition programmes. Additional research focusing on experiences and perceptions of newly qualified nurses and their transitory process is warranted. Tweetable abstract: Are newly qualified nurses receiving sufficient transition support (e.g. #nursing residency programs or #preceptorship)? #Nurse #Nurses #nursing_intern.

Experiences and responses of nursing students as second victims of patient safety incidents in a clinical setting: A mixed-methods study

AIM

To investigate the degree of second victim syndrome among nursing students in clinical practice and determine the rehabilitation process.

BACKGROUND

Empirical evidence suggests that health care providers who are considered second victims suffer from various difficulties. Nursing students in a clinical setting could be potential second victims, but few studies have quantitatively investigated the experiences and explored their response processes.

METHODS

A mixed-methods design was used. A questionnaire was sent to nursing students via a link to an electronic survey, and a semi-structured interview was conducted to explore their response process as second victims.

RESULTS

The quantitative results showed that nursing students in the clinical setting suffered second victim-related distress and that the most significant influences were psychological distress and professional efficacy. Four stages of rehabilitation experiences emerged from the qualitative data.

CONCLUSION

Being a second victim for nursing students in a clinical setting is psychological suffering, and although they can be expected to recover, an impact on professional efficacy is inevitable.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers must be aware that nursing students in a clinical setting might experience difficult situations after patient safety incidents and that developing appropriate programmes to support at-risk students is important.

Identifying the experiences of new graduate nurses during the transition period to practice as a professional nurse

AIMS AND OBJECTIVES

To assess the impact of orientation programmes on new graduate nurses' transition periods.

BACKGROUND

The transition of graduate nurses from students to the practising professional nurse is often found to be stressful.

DESIGN

The study has employed a descriptive correlational design.

METHODS

The data were collected from 95 participants who were working as registered nurses in public hospitals in Al-Bahah region. Questionnaire was used for collecting data which was based on the Casey-Fink graduate nurse experience survey. SPSS software was used to analyse the results. The methods of this study are in line with the STROBE checklist.

RESULTS

The findings indicated statistically significant relationship between preceptor's support and communication leadership, professional satisfaction and job satisfaction, whereas an insignificant relationship was observed between preceptor's support and organising patient safety. The results also indicated that new graduate nurses were uncomfortable while performing different procedures/skills independently.

CONCLUSION

The study implied instigation of the structured orientation programme to overcome the challenges faced by the new graduate nurses in their transition period.

RELEVANCE TO CLINICAL PRACTICE

The upsurge in the nurses' demand across Saudi Arabia makes this study highly relevant. It helps in optimising the transition experience of the nurses who are required to provide service in the acute sector.

[Nurses and Nursing Students' Recognition of Good Instruction]

PURPOSE

The purpose of this study was to identify and assess from nursing students and nurses in the clinical field what constitute good instruction, through the review of nursing students' opinions and clinical field demands.

METHODS

The study design was used Creswell's exploratory sequential design by collecting and analyzing qualitative data obtained from interviews and then analysis of quantitative data. The participations were 79 seniors in nursing schools and 85 nurses with less than three years of clinical experience. The data were collected through individual interviews and analyzed based on Elo and Kyngäs's content analysis method. The quantitative data were collected using the questionnaire developed based on qualitative results and analyzed by SPSS 23.0 program and Importance Performance Analysis (IPA).

RESULTS

The results showed that IPA extracted seven items with high importance but low satisfaction: "nursing fads and trends," "teacher-learner communication and reflection," "materials used in clinical settings such as monitoring results and test results," "special presentations by experienced practitioners," "instruction assures learners' comprehension," "accurate and detailed evaluation standards" and "feedback on homework and exam."

CONCLUSION

The factors comprising good instruction were verified, and the necessity for additional efforts to improve high importance and low performance factors was noted. Therefore, this study can serve as a guide for nursing education facilities and educators in developing of a thorough education system with excellent instruction designed to achieve an ideal nursing education.

Relationships between reality shock, professional self-concept, and nursing students' perceived trust from nursing educators: A cross-sectional study

BACKGROUND

Nursing students establish their professional role through clinical practice. However, during the first clinical practice, they might experience reality shock given the gap between theory and practice, which could negatively influence their professional self-concept. Furthermore, nursing educators in clinical practice play an important role in improving nursing students' clinical experience.

OBJECTIVES

To examine the relationship between nursing students' reality shock and professional self-concept, and to examine the associations of perceived trust from nursing educators with nursing students' reality shock and professional self-concept.

DESIGN

A cross-sectional, descriptive correlational study.

SETTING

Nursing schools in one metropolitan area and three cities in South Korea.

PARTICIPANTS

Data were collected from 184 nursing students who experienced their first clinical practice in preceding four weeks of data collection.

METHODS

Surveys assessing participants' characteristics, reality shock, professional self-concept, and perceived trust from nursing educators were conducted. A hierarchical regression analysis was performed to examine the relationship between reality shock and professional self-concept, and the relationships between perceived trust from nursing educators and nursing students' reality shock and professional self-concept.

RESULTS

Nursing students' reality shock was negatively related to their professional self-concept. Perceived interpersonal relationship with nursing educators was positively related to professional self-concept and negatively related to the experienced reality shock. Furthermore, this negative relationship decreased when reality shock was combined with perceived interpersonal relationship with nursing educators.

CONCLUSIONS

Nursing students' reality shock during their first clinical practice may be negatively associated with the establishment of their professional self-concept. However, students' reality shock could be reduced by enhancing their interpersonal relationship with the nursing educator, which might reduce the negative association of reality shock with professional self-concept. Therefore, nursing educators should develop skills to establish interpersonal relationships with students to positively influence students' clinical adaptation.

Nursing-Related Barriers to Children's Pain Management at Selected Hospitals in Ghana: A Descriptive Qualitative Study

Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children's pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children's pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children's pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n = 24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses' inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children's pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children's pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management.

Nursing student's expectations for their future profession and motivating factors - A longitudinal descriptive study from Sweden

BACKGROUND

The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored.

OBJECTIVE

To describe students' motives to become registered nurses and their expectations regarding their future profession.

DESIGN

A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.

PARTICIPANTS AND SETTING

A purposive sampling of a group with initially 75 students starting a three-year nursing program at a university in Sweden.

METHODS

A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students' education. At data collection two and three, a copy of the earlier answers was attached. Data were analysed using manifest and latent content analysis.

RESULTS

An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.

CONCLUSION

The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.

Nurse Preceptor Role in New Graduate Nurses' Transition to Practice

The transition to practice period is a challenging and demanding time for new graduate nurses. Leaving the structured environment of nursing school and entering professional practice can cause reality and transition shock for the new nurse resulting in unsafe patient care, as well as intention to leave their position or the profession. Successful transition to practice depends on the new nurse building confidence and gaining essential clinical reasoning abilities while orienting to their role. In critical care settings, patient care is more complex and fast-paced, which adds another dimension of overall stress to the new graduate. Structured orientation programs with trained preceptors have been found to be the most successful means of preparing new graduate nurses for clinical practice. Ensuring preceptors are provided with education related to the development of clinical reasoning is essential to successfully assist new nurses in their transition to practice. Safe and effective patient care, especially in the critical care unit, is dependent upon having nurses who are well prepared for their role through being provided guidance and support from trained preceptors.

The experience of transition from nursing students to newly graduated registered nurses in Singapore

Objectives

To investigate the experience of newly graduated registered nurses (NGRNs) in Singapore following their initial 6–12 months of transition from nursing student to registered nurse.

Methods

This mixed-methods study consisted of two phases. In the first phase, data were collected via the administration of the online survey to 30 NGRNs. The questionnaire contained 42 items of the four-point Likert scale survey. In the second phase, a focus group interview was conducted with 5 NGRNs to gather complementary information regarding the major findings from the first phase.

Results

The survey revealed despite most NGRNs (80%) in this study expressed overall satisfied with their transition, the item score was (2.97±0.61) out of 4, the majority (83.3%) also perceived their transition to professional practice being stressful, the item score was (3.07±0.74) out of 4.Three themes emerged from the interview, ‘personal transition experience’, ‘professional transition experience’, and ‘organizational transition experience’, which are entwined to construct overall NGRNs’ transition experiences.

Conclusions

This study reaffirms the theory-practice gap phenomenon. This signifies the need for closer collaboration between educational, healthcare industry and regulatory stakeholders to examine and address factors that influence their transition experience to better support them for workforce readiness.

Nurse graduates' experiences and support needs: A qualitative systematic review of South Africa's community service programme

BACKGROUND

The student-to-nurse graduate transition is a pivotal phase in the professional development of nurses. In South Africa, this transition is part of a compulsory community service programme, which requires newly graduated nurses to work in rural and/or underserved areas for a period of 1 year.

OBJECTIVES

The aim of this study was to review nurse graduates' experiences and support needs during their transition in the compulsory community service programme.

METHODS

A qualitative systematic review of experiences was conducted. Qualitative research studies that addressed nurses' experience in South Africa (2008-2017) were identified in Cochrane, Joanna Briggs Institute (JBI), Academic Search Complete, CINAHL, PubMed, SABINET, Science Direct, SCOPUS and Google Scholar databases. The systematic review methods included searching, sifting, abstracting and quality assessment of relevant qualitative studies by two reviewers and cross-checking by a third reviewer. Two reviewers independently performed blinded data extraction and quality assessment using the confidence in qualitative synthesis findings (ConQual) approach.

RESULTS

A total of 1257 studies were identified of which 12 met the inclusion criteria. Seven of the 12 studies were published articles and six were theses. The quality of the studies was found to be of high standard based on the ConQual rating. Four main themes emerged from the analysis: (1) rich developmental experiences through practice exposure, (2) difficulties in reconciling theory and practice, (3) contextual challenges in the workplace and (4) need for professional support structures, educational measures and public guidelines.

CONCLUSION

Although positive experiences were reported, various challenges emerged, indicating the need for more systematic support mechanisms during transition.

Development of assertive communication skills in nursing preceptorship programmes: a qualitative insight from newly qualified nurses

BACKGROUND

Being able to speak up is a prerequisite for establishing safe communication in healthcare settings. The nursing preceptorship programme represents an opportunity for newly qualified nurses to develop and practise assertive communication skills.

AIM

To examine newly qualified nurses' views on how nursing preceptorship programmes contribute to shaping their assertive communication skills.

METHOD

42 newly qualified nurses from four acute hospital trusts in east England completed open-ended questions included in a cross-sectional survey. Participants' qualitative comments were analysed using thematic analysis.

FINDINGS

Three themes related to speaking up during the nursing preceptorship programme emerged: enthusiastic versus sceptical, the role of a supportive working culture, and logistical challenges.

CONCLUSION

Nursing preceptorship programmes can develop newly qualified nurses life-enhancing assertive communication skills if they provide inspiring preceptors who act as role models, create a supportive working culture and support nursing preceptors to deliver effective preceptorship. It is imperative that nursing preceptorship programmes are adapted to enable newly qualified nurses to learn and practise assertive communication skills.

Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study

BACKGROUND

The transition of newly graduated nurses to nursing practice is a considerable challenge and can lead to transition shock, which is defined as the difficulty experienced by newly graduated nurses during the transition from student to nurse. However, there have only been a few studies on the transition shock of newly graduated nurses and its influencing factors.

OBJECTIVES

The purpose of this study was to determine the effects of pre-graduation characteristics and working environments on the transition shock of newly graduated nurses.

DESIGN

A prospective, longitudinal, and correlational design was used.

SETTINGS

Data were collected from 5 nursing colleges in South Korea.

PARTICIPANTS

Participants included 312 newly graduated nurses who had graduated from the 5 nursing colleges in February 2016 and were working in hospitals.

METHODS

A convenience sample of 526 undergraduate nursing students completed questionnaires, capturing demographic data and measuring grade point average, self-efficacy, and professional nursing values. After graduation, 317 of the participants responded to the second survey, which included measures of transition shock and working environments. Of these, 312 were used for the final analysis, excluding 5 with incomplete responses. Data were analyzed using descriptive, bivariate, and multivariate analyses as appropriate.

RESULTS

The mean transition shock perceived by newly graduated nurses was 2.81 points on a 4-point scale. The factors significantly influencing transition shock were age, self-efficacy, working unit, desired unit, and nurse work environment.

CONCLUSIONS

In order to reduce transition shock of newly graduated nurses, it is necessary for undergraduate programs to enhance their self-efficacy. It is also optimal to assign nurses into their desired unit and to improve nurse work environments. These changes will not only mitigate the transition shock of newly graduated nurses but will also contribute to the provision of quality nursing services at a hospital level.

Barriers and Strategies for Transition from Student to Successful Hospital Pharmacist

BACKGROUND

Many health care professionals experience a process of transition when entering the workforce. Various barriers have been documented in the literature, including a lack of confidence, challenging interactions with patients and colleagues, workload, increased responsibility, and a fear of making mistakes. Strategies to overcome these barriers, such as orientation and support programs, have been proposed. However, evidence for the transition of students into successful hospital pharmacists is limited.

OBJECTIVES

To identify key barriers to the transition from student to successful hospital pharmacist and to outline strategies to overcome these barriers.

METHODS

An electronic survey was distributed to Lower Mainland Pharmacy Services (LMPS) pharmacists, and subsequent one-on-one interviews were completed with a subgroup of new pharmacists.

RESULTS

A total of 137 LMPS pharmacists (about 32% of potential respondents) responded to the survey, and 3 of these also participated in an interview. A performance score (used to quantify the transition experience) was calculated for 113 respondents, and there was a correlation between performance score and role satisfaction (r = 0.550, p < 0.001). Performance score was also correlated with years spent working as a hospital pharmacist (r = 0.333, p < 0.001) and with highest level of pharmacy education (r = 0.210, p = 0.026). Work in a specialty area and presence of an orientation program were additional factors associated with higher average performance scores. The greatest need for transitional support was during the first year of work, with trainers and social supports being identified as the most helpful resources. Various perspectives were offered during the interviews, with multiple barriers and strategies proposed.

CONCLUSIONS

Among respondents to this survey, the key barriers faced during the transition from student to successful hospital pharmacist were limited time working as a hospital pharmacist, lack of additional pharmacy education, lack of knowledge, rotation among multiple areas, uncertainty about role identity, and limited university preparation. Given that successful transition is associated with subsequent job satisfaction, workplace strategies such as limiting the number of practice areas, developing an orientation program, and providing continued support during the first year of work should be encouraged.

The Iranian Psychiatric Nurses' Perception of Transition in Psychiatric Wards: A Qualitative Study

BACKGROUND

Transition means moving from one period to another and it is usually associated with significant changes in objectives, roles, and responsibilities. Considering the challenges of the psychiatric ward, psychiatric nurses experience numerous problems, especially at the early stages of their job engagement. This study aimed to examine the perception of the Iranian psychiatric nurses in psychiatric wards and their transition period.

MATERIALS AND METHODS

The study was designed as a qualitative content analysis study in three referral hospitals in Mazandaran and Tehran, Iran 2016. Participants included 18 nurses who had experienced transition at the psychiatric ward and had at least 3 months job experience in three referral hospitals of Iran and were selected purposefully. Data were collected using unstructured interviews and analyzed using the inductive approach and conventional content analysis. To ensure the trustworthiness of the data, Guba and Lincoln's criteria were used.

RESULTS

The major themes of transition among the nurses of psychiatric wards included "inadequate preparation," "mental stress," "self-awareness and capabilities," and "the effective role of nurses' full support in adjustment."

CONCLUSIONS

The findings revealed that nurses did not have a decent transition. In this regard, educational systems must provide training courses to prepare nurses to support them in their arrival stage and to facilitate their transition. The findings of this study can help mentally prepare nurses for their preparation to perform their role and improve the quality of care.