Best practice principles for the transition from student to registered nurse

Exploring the factors that affect the transition from student to health professional: an Integrative review

BACKGROUND

The nature of a new health professional's transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice.

METHODS

Whittemore and Knafl's methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach.

RESULTS

Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates.

CONCLUSION

The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.

Facilitating the transition from a nursing student to a Registered Nurse in the final clinical practicum: a scoping literature review

BACKGROUND

Transition from a nursing student to a Registered Nurse is a stressful and challenging process. Different postgraduate residency and orientation programmes have been developed to ease the first year of employment, but less attention has been paid to pregraduate programmes and how the final clinical practicum of nursing education should be conducted to facilitate this transition.

AIM

To review the empirical studies concerning interventions that aim to facilitate the transition from nursing student to Registered Nurse in the final clinical practicum of nursing education. The aim was to scrutinise the structures and contents of the interventions and factors connected with the facilitated transition.

METHOD

A scoping literature review was conducted with systematic searches in three electronic databases: CINAHL, MEDLINE and ERIC. The searches were limited to studies that were written in English, had available abstract and were published between 2005 and 2016. Two researchers assessed the studies regarding their eligibility with reference to the inclusion and exclusion criteria, and 17 articles were included in this review. Inductive content analysis was used to categorise the contents of studies.

RESULTS

The structures of the interventions described included: the participation, learning environment, amount of clinical work, supervisor criteria and supervision methods. The contents of the interventions included supervisor support, transition supportive learning activities and the student's practicum duties. The factors that were connected with facilitated transition were the quality of the supervision, adjusting to a professional nurse's role, achieved comfort and confidence and achieved competence.

CONCLUSION

This scoping review offers insight into the diversity of interventions facilitating transition implemented in the final clinical practicum of nursing education. In order to unify these practices and determine the elements necessary to include, studies with stronger designs need to be conducted.

Qualified nurses' perceptions of nursing graduates' abilities vary according to specific demographic and clinical characteristics. A descriptive quantitative study

BACKGROUND

Evidence from the literature and anecdotally from clinical settings suggests that newly graduated nurses are not fully prepared to be independent practitioners in healthcare settings.

AIMS AND OBJECTIVES

The aim of this study was to explore perceptions of qualified nurses in relation to the practice readiness of newly registered nursing graduates and determine whether these views differ according to specific demographic characteristics, clinical settings, and geographical locations.

DESIGN

A descriptive quantitative design was used.

METHODS

An online survey tool was used to assess how qualified nurses (n=201) in Victoria, Australia, rated newly graduated nurses' abilities on 51 individual clinical skills/competencies in eight key skill areas. A composite score was calculated for each skill area and a comparative analysis was undertaken on the various cohorts of participants according to their demographic and clinical characteristics using one-way ANOVA and post hoc tests.

RESULTS

Newly graduated nurses were found to be lacking competence in two key skill areas and were rated as performing adequately in the remaining six skill areas assessed. Significant differences (p≤0.05) in performance were found according to the age of the nurse, number of years registered, the educational setting in which they undertook their nurse education, their role, and the clinical area in which they worked. There were no significant differences according to whether the nurse worked in the private or public healthcare sector. Few differences were found between nurses working in a metropolitan vs. regional/rural healthcare setting.

CONCLUSION

This is the first study to quantify the scale of this problem. Our findings serve as a reference for both nurse education providers and healthcare settings in better preparing nursing graduates to be competent, safe practitioners in all clinical areas.

Developing an evidence-based transition program for graduate nurses

BACKGROUND

The catalyst to revise the graduate nurse program at an inner city hospital was a major service reconfiguration, which reduced services, staffing and graduate nurse positions. Parameters for the new program were that it was evidence-based and could function within the reduced resources.

OBJECTIVE

Review current literature and design an evidence-based transition program.

METHODS

Eight databases were searched for primary and secondary research and unpublished theses (2004-2014), which were then hand searched. Eighty-three articles were reviewed and 50 retained as they informed development of a program designed to actively promote the graduates' transition from undergraduate to independent health professional.

RESULTS

Three key concepts emerged from the literature: the graduates' need for support, socialisation and facilitated learning opportunities. This article reviews the literature and outlines a program designed to maximise these concepts in an evidence-based transition program. Proposed evaluation tools are identified for use throughout the program.

The role of high-involvement work practices and professional self-image in nursing recruits' turnover: A three-year prospective study

BACKGROUND

The retention of young graduate nurses has become a major management challenge among hospitals in Western countries, which is amplified in a context of aging of populations and an increasing demand for services from patients. Moreover, as it has been reported that 50% of experienced nurses do not recommend a career in nursing, it is likely that retention problems occur not only at the level of the organization, but also at the level of the nursing profession. Although research has identified some predictors of nurse turnover, it is unclear which factors influence nurses' turnover from the organization and from the profession and how these factors interrelate with one another over time.

OBJECTIVE

The present study extends previous research on nurse turnover by looking at the combined effects of nurses' pre-entry expectations, perceived high-involvement work practices, and professional self-image, on intended and actual turnover from the organization and the profession.

DESIGN AND METHODS

A prospective, longitudinal study of a sample of 160 graduated nurses affiliated with the Quebec Nurses' Association, Canada, was conducted. Participants were surveyed at three points in time, spread over a 3-year period. Graduated nurses' pre-entry expectations and professional self-image were surveyed at graduation (Time 1), while perceived high-involvement work practices, professional self-image, and intention to leave the organization and the profession were captured six months following nurses' entry into the labor market (Time 2). Finally, participants were surveyed with respect to organizational and professional turnover three years after the Time 2 survey (Time 3). Structural equations modeling was used to examine the structure of the measures and the relationships among the constructs.

RESULTS

Although pre-entry expectations had no effect, perceived high-involvement work practices were positively related to Time 2, professional self-image (controlling for pre-entry professional self-image). Moreover, high-involvement work practices exerted an indirect, negative effect on organizational and professional turnover through intention to leave the organization, and an indirect negative effect on intention to leave the profession through professional self-image. Nonetheless, professional self-image did not affect turnover.

CONCLUSIONS

The current study indicates that hospitals and nurse directors can take advantage of developing high-involvement work practices as these practices foster a stronger professional self-image among nurses, thereby contributing to their sense of value as care providers, and indirectly reduce intended and actual turnover from the organization and the profession.

Professional development utilizing an oncology summer nursing internship

The aim of this study was to examine the effect of an oncology student nursing internship on role socialization and professional self-concept. This mixed-methods study utilized a convergent parallel approach that incorporated a quasi-experimental and qualitative design. Data was collected through pre and post-survey and open-ended questions. Participants were 11 baccalaureate nursing students participating in a summer oncology student nursing internship between their junior and senior years. Investigators completed a content analysis of qualitative questionnaires resulted in categories of meaning, while the Wilcoxon signed-ranks test was used to compare pre and post internship scores. Aggregated mean scores from all instruments showed an increase in professionalism, role socialization, and sense of belonging from pre to post-internship, although no differences were significant. Qualitative data showed participants refined their personal philosophy of nursing and solidified their commitment to the profession. Participants did indicate, however, that the internship, combined with weekly debriefing forums and conferences, proved to have a positive impact on the students' role socialization and sense of belonging. Despite quantitative results, there is a need for longitudinal research to confirm the effect of nursing student internships on the transition from student to professional.

Situational Transitions and Military Nurses: A Concept Analysis Using the Evolutionary Method

BACKGROUND

Situational transitions in nursing remain a significant issue for both new graduates and experienced nurses. Although frequently discussed in current nursing literature, nursing research has exclusively focused on the transition experience of civilian (nonmilitary) nurses. With differing role and practice expectations, altered practice environments, and the risk of deployment, the outcome of negative transition experiences for military nurses is significant.

PURPOSE

The purpose of this analysis is to clarify the concept of transition, in a situational context, as it relates to military nurses by investigating the attributes, antecedents, and consequences.

METHODS

Rodgers' evolutionary method served as the framework to this study. The sample included 41 studies, published in English, between 2000 and 2013. Data were retrieved from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, ProQuest, Ovid, and PsycINFO databases.

CONCLUSION

Antecedents of situational transitions include any change in work roles or work environments. Attributes of situational transitions include journey, disequilibrium, finding balance, conditional, and pervasive. Consequences of transition range from successful to unsuccessful. Additional research that investigates the specific needs and challenges unique to nurses practicing in a military environment is needed.

Self-assessed level of competence of graduating nursing students and factors related to it

BACKGROUND

The transition from a nursing student to a professional nurse is both challenging and stressful. Competence of graduating nursing students is related to patient safety and there is a need for assessment of competence. However, there is a lack of research on the level of competence at the moment of graduation.

OBJECTIVES

To describe the level of competence of graduating nursing students based on students' self-assessments and to identify possible related factors.

DESIGN

Cross-sectional survey design.

METHODS

The data were collected using an on-line survey (the Nurse Competence Scale) in 2011 and administered to 302 graduating nursing students in Finland practicing in their final clinical placement in university hospitals. The sample contained 154 students (response rate 51%). The data were analyzed statistically.

RESULTS

The self-assessed overall competence was on good level (66.7, VAS 0-100). The competence was highest in helping role and in diagnostic functions, being slightly lower in therapeutic interventions and work role. Pedagogical atmosphere during the final clinical placement had a statistically significantly positive correlation with the overall level of competence.

CONCLUSIONS

Graduating nursing students have good competence at the moment of graduation based on their self-assessments. Self-assessment is a basis for competence development, and systematic self-assessments should be used during the education. Teacher and supervisor assessments and knowledge-tests could be used alongside with self-assessments of competence to give a wider picture of the competence.

Graduate registered nurse practice readiness in the Australian context: an issue worthy of discussion

An ageing Australian population coupled with declining nursing numbers is predicted to have a significant impact on the Australian Healthcare industry, with numbers of nurses expected to be in greater demand at a time when the need for nursing care is on the rise. The report released recently by Health Workforce Australia predicted a potential shortage of approximately 110,000 nurses by 2025. In Queensland alone, the Queensland Nursing Union estimates the shortage of nurses to be closer to 10,000 positions by 2016 and 14,000 positions by 2020 based on the anticipated Queensland Health hospital expansions. The Commonwealth Government has responded by increasing funding to train more registered nurses across Australia. Hence a significant number of graduate registered nurses are expected and required to join the workforce. However, an analysis of the literature reveals that opinions differ between clinicians and education providers as to whether recently graduated registered nurses are adequately prepared for the challenges of the current healthcare system. Even though much research has been done in Australia on the issue of transition support programmes, graduate registered nurses' transition to practice remains problematic and is perceived to pose a significant challenge to healthcare industry. This paper contributes to the contemporary discourse on graduate registered nurses' practice readiness at a time when a forecasted nursing shortage, the difficulties in accessing sufficient quality clinical placements and the need for fiscal responsibility pose added challenges to education providers and the healthcare industry.

A patient safety focused registered nurse transition to practice program

Abstract As undergraduate rural nursing students approach completion of their degree and become eligible for registration as a nurse they anticipate becoming part of a transition to practice program. Promises of clinical support, guidance and being welcomed into the profession are provided. Unfortunately the reality for new graduate registered nurses is often quite different. Promised clinical support does not eventuate and patient safety is often compromised. Graduate nurse transition programs need to have the physical and human resources to deliver the clinical support that was promised in their prospectus. This paper describes the nature of professional support experienced by participants of transition to practice programs. Three core elements are recommended to ensure patient safety.

Nurse managers' strategies for the integration of newly graduated nurses into clinical units in Japan: a qualitative exploratory study

AIM

The purpose of this study was to explore the strategies used by nurse managers in Japan to facilitate the integration of newly graduate nurses (NGNs) into their clinical units.

BACKGROUND

The integration of NGNs into clinical units is an important issue for both NGNs and nurse managers because the first year of practice plays a vital role in a NGN's career.

METHOD

Data were generated through semi-structured interviews with 9 nurse managers in 9 acute care hospitals. Data analysis was conducted using a qualitative content analysis method.

RESULTS

Nurse managers used a total of 6 strategies: understanding the circumstances of NGNs, providing opportunities for experience and learning, supporting nurses who teach NGNs, facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. Three of these strategies were particularly important for NGNs' integration into clinical units: facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. These strategies were described in this study.

CONCLUSIONS

The strategies adopted by nurse managers should be aimed at all nurses, not just NGNs, in order to strengthen the sense of comradeship in clinical units. This approach would create a supportive environment for the integration of NGNs into clinical units. The strategies presented in this study can be utilized not just by nurse managers but all senior nurses in the unit. NGNs can use these strategies to help them understand what they need to do to become a full member of their unit.

Graduate nurses' transition and integration into the workplace: a qualitative comparison of graduate nurses' and Nurse Unit Managers' perspectives

A three-year longitudinal qualitative study was undertaken to compare graduate nurses' (GNs') and Nurse Unit Managers' (NUMs') perceptions regarding the workplace factors that affect GNs' during the first year of clinical practice in a regional context in Victoria, Australia. In the first year a pilot study was used to develop a qualitative survey seeking information about GNs' transition experiences. Over the next two years 69 GNs and 25 NUMs from one health organisation completed the qualitative survey. Based on the literature and a pilot study, a directed content analysis was used to code the qualitative survey data into two initial categories: job-related and personal stressors. Themes within the two categories were subsequently identified and refined. GNs' and NUMs' perspectives were compared in relation to the categories and themes identified. GNs and NUMs differed with respect to perceptions of unprofessional workplace behaviour and coping with death and dying. GNs were more likely to report unprofessional workplace behaviour than NUMs and this was identified as a main factor affecting workforce integration. Alternatively, NUMs were more likely than GNs to report that coping with death and dying was a major issue. GNs and NUMs were found to hold similar perceptions in relation to shift work and the importance of emotional support. These findings suggest that NUMs and GNs do not always have a shared understanding of the stressors that GNs face in the first year of clinical practice. Further research in other contexts is necessary before any conclusions can be drawn.

Graduate nurses' perceptions of mismatches between themselves and their jobs and association with intent to leave employment: a longitudinal survey

BACKGROUND

Graduate nurses experience mismatches between themselves and their jobs. One of these is the demands-abilities misfit, which is a mismatch between the abilities of employees and those required by a job (demands). Another is the supplies-needs misfit, which occurs when employees' work-specific needs are not fulfilled by opportunities (called environmental supplies) work can supply to reinforce them.

OBJECTIVES

The aim of this study was to investigate how graduate nurses' perceptions of the demands-abilities and supplies-needs misfits changed over time, and to examine how these misfits impact their intention to leave the jobs.

DESIGN

A longitudinal study design was used.

SETTING

Five hospitals in the western region of Japan cooperated in the study.

PARTICIPANTS

A total of 176 graduate nurses participated in the study one or more times. From among them, 150, 109, 102, and 96 graduates participated in the study conducted in the 3rd, 6th, 9th, and 12th months of the employment, respectively. In addition, 62 graduates participated in all studies.

METHODS

Surveys were distributed to the graduates 3, 6, 9 and 12 months after their employment commenced. The results were analysed using multiple regression analysis.

RESULTS

The results showed that the graduates perceived both demands-abilities and supplies-needs misfits, although the degree of the demands-abilities misfit became smaller towards the end of the graduate year. As for the impact on graduates' turnover intention, the graduates' abilities and their perception of the environmental supplies served as more significant predictors of their turnover intention, rather than the misfits per se. The variances of turnover intention explained by the supplies-needs variables were greater than those explained by the demands-abilities variables from the third to ninth months into the employment. On the other hand, the variance explained by the demands-abilities variables increased towards the end of the year, and finally exceeded that of the supplies-needs variables.

CONCLUSIONS

The graduates' turnover intention is complex, and may not be explained by simple demands-abilities and supplies-needs misfits. Different factors influence their turnover intention at different times to different degrees.

Fitting in: a pervasive new graduate nurse need

AIM

This qualitative study aims to provide insight into how Australian New Graduate Nurses (NGNs) experienced their transition to acute care nursing practice.

METHOD

Nine NGNs each participated in three in-depth interviews conducted across their first year of practice. Constant comparative analysis was used to identify the emergent themes.

FINDINGS

The desire to fit in (establishment of secure social bonds) with ward staff is an important element of NGN transition experiences. Fitting in was about feeling one's self to be part of a social group, and participants made it clear that their perceptions of their success in establishing secure and meaningful social bonds in each new ward was extremely important for their sense of being as NGNs. Current NGN Transition Programmes (NGNTPs) involve multiple ward rotations, increasing the demand for the NGN to fit in. Thus participants were engaged in a deeply personal transition experience that was not necessarily aligned with multiple ward rotations.

CONCLUSIONS

Although NGNTPs have the word "transition" in their title, it may be that current programmes are more focussed on organisations' desire to "orient" NGNs to working within the acute care setting than facilitating personal transitions to practice. Further investigation of the impact of NGNTPs on NGNs and the associated multiple ward rotations is required.

Tailoring a graduate nurse program to meet the needs of our next generation nurses

Graduate Nurse (GN) transition into clinical practice is recognised by nursing academics and clinicians alike as being problematic on a number of levels, particularly around GN support. The general consensus is that Graduate Nurse Programs (GNP) provided by health care organisations are the most effective strategy for providing support to GN during their first 12months in clinical practice. This study reports on the redevelopment of an existing GNP in response to GN feedback. The new GNP incorporated specific strategies to meet the needs of the newest cohort of Graduate Nurses - Generation Y. Evaluation of the new GNP was undertaken through on-line surveys and two focus groups. The findings confirmed that GNs continue to experience stress and anxiety during their first year, but this can be mitigated by participation in a formal GNP which has a strong focus on support and socialisation. Further, by directing attention toward meeting some of the more specific needs of Generation Y GNs the retention of this valuable resource can be increased. In 2009, the retention of GN for the 12months following completion of the GDP was 88% compared to 64% in 2008.

The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse

EXECUTIVE SUMMARY

Background: The transition period from student to newly qualified nurse where nurses are adjusting to their new role and consolidating their knowledge and skills can be stressful. It is a time when many newly qualified nurses are left feeling inadequately prepared. A variety of strategies to ease the transition process have been reported, which aim to increase confidence, competence, sense of belonging of new graduates, improve recruitment and retention and reduce turnover costs.

OBJECTIVES

To synthesise the best available evidence on the effectiveness of support strategies and interventions aimed for newly qualified nurses.

METHODS

A comprehensive search was undertaken on major electronic databases to identify both published and unpublished studies from 2000 to the present date. Reference lists of retrieved papers were searched and authors contacted. Only quantitative studies published in English language were considered.Methodological quality and data extraction: Two reviewers independently assessed methodological quality and extracted data from the included studies. A third reviewer resolved any disagreements through discussion.

DATA SYNTHESIS

The review did not identify comparable Randomised Controlled Trials (RCTs), and as such meta-analysis of the data was not appropriate. The data extracted from the included studies were synthesized into a narrative summary.

RESULTS

Thirty three studies were included in the review: RCT (1), Quasi-experimental (3) and observational/descriptive studies (29). Countries of origin were: USA (25), Australia (4), England (2), New Zealand (1) and Thailand (1). Studies were categorised according to the type of programme or support strategy provided: nurse internship/residency programmes (14) and graduate nurse orientation programmes (7), preceptorship (4), simulation (3) and mentoring (2), final year nursing students transition programs (2) and externship (1).Outcomes were categorised as being important to the employer (recruitment, retention, turnover rates, competence, confidence and costs), or to the new graduate (stress and anxiety reduction, job satisfaction, knowledge/skills acquisition, critical thinking and interpersonal skills, confidence and professional nursing behaviours).

CONCLUSIONS

The range of outcomes reported across the studies made it difficult to report firm conclusions. A general increase in level of confidence was noted, along with reduction in stress and anxiety. Some success in relation to increases in knowledge, critical thinking and levels of job satisfaction were reported. A number of studies reported a V shaped pattern (initial high levels, dipping at 6 months and then reverting to baseline levels) for autonomy, job satisfaction, and professional transition. Research relating to improvements in retention and reduction in turnover was generally poor.

IMPLICATIONS FOR PRACTICE

The overall impact of intervention programmes appears positive, irrespective of the intervention. This may suggest that it is the organisation's focus on new graduate nurses with support from colleagues that is important. .Mentors/preceptors need to be adequately prepared for the role.

IMPLICATIONS FOR FUTURE RESEARCH

Future research should build on the strengths and limitations of the current studies. A lack of experimental studies means there is commonly little control over other variables that might influence the outcome. There is a need for larger studies using more objective and reliable measures.

Attracting students to aged care: the impact of a supportive orientation

INTRODUCTION

The 'Building connections in aged care' project sought to investigate quality clinical placements for undergraduate nursing students in residential aged care facilities in Tasmania, Australia.

BACKGROUND

Aged care reportedly holds little attraction to student nurses as an employment option, exacerbating problems with recruiting staff into the sector. This, coupled with knowing the quality of an undergraduate learning experience can influence career choices, provided the impetus for the study.

METHODS

Informed by action research and conducted in three-stages, the project scoped the problem, implemented improvement strategies and assessed sustainability of their effectiveness. Data were collected via structured research meetings and surveys/check lists, and subjected to qualitative and quantitative analysis.

RESULTS

A key finding was the importance of providing students with a comprehensive orientation to the aged care environment.

DISCUSSION

The critical nature of orientation processes in the establishment of a supportive and welcoming environment for students, and to 'setting up' a positive and enjoyable learning experience in aged care settings has not been shown by research to date.

CONCLUSION

Student orientation warrants greater attention. We recommend strategies concerning the structure of student orientation programs, links with university schools of nursing, use of preceptors, and preparing aged care facility staff.

Evaluation of a forensic psychiatric setting to provide a graduate nurse programme

There has been growth in the number and diversity of models of Australian graduate nurse programmes in psychiatric nursing. Programmes have also been established in specialist areas, and evidence is needed regarding best models of graduate nurse programmes and the ability of specialist areas to prepare nurses for psychiatric nursing. This paper reports on a qualitative project that examined the adequacy of a forensic psychiatric hospital to provide a graduate nurse programme. Individual, semistructured interviews were undertaken with nurses participating in the programme, and nurses who had completed the programme and had remained at the hospital or were nursing in other areas. Participants identified that the environment was safe and supportive of professional practice and development, and that skilled nurses were willing to encourage and teach graduates. Processes such as orientation, preceptorship and academic study were appreciated; however, their colleagues' willingness to be available, to teach, and to support were more valued. Participants reported that they felt confident and prepared as psychiatric nurses. Although limitations of undertaking a graduate nurse programme in a forensic setting were identified, the participants from past programmes who had gone on to work in other services did not report that their nursing careers had been disadvantaged. It can be concluded that as long as the context of the programme has adequate resources to support and assist graduates to develop the skills, knowledge and attitudes of psychiatric nursing, then the specialist nature may not be a limitation.

The transitional journey through the graduate year: a focus group study

BACKGROUND

Becoming a new graduate nurse is both a complex and stressful transition. Graduates must socialise into the context of nursing practice, become accountable for patient care and ward activities, interact with other health professionals and develop their own clinical expertise. In Australia, many hospitals provide Graduate Year Programmes to assist new graduates to assimilate into their new roles and environments.

AIMS

This paper describes a study that explored how graduate nurses develop their knowledge and skills during their graduate programmes, as well as identifies factors assisting or hindering knowledge and skill acquisition.

METHODS

Employing a qualitative approach, this study used a series of focus groups and anecdotes to collect data from 25 participants recruited from four different hospitals in Victoria, Australia. Focus groups were conducted between 4 and 6 months, 11 and 12 months into, and 4-6 following completion of the graduate programme. Interview transcripts were analysed allowing feedback to be provided to participants.

RESULTS

Six themes emerged from the focus groups analysis that described graduates' knowledge and skill acquisition and reflected their development at the different stages. These were: 'gliding through' during undergraduate studies, 'surviving', 'beginning to understand', and 'sheltering under the umbrella' in the first interview, 'knowing how to', and 'we've come a long way' by the end of their programme.

CONCLUSIONS

The year following graduation is one of immense personal and professional development. Despite nurse education being in tertiary settings for many years, preparation of undergraduate students still appears unable to reduce reality shock and ease transition for graduates into their working lives.

New graduate nurse self-concept and retention: A longitudinal survey

Graduate nurse attrition is an increasing phenomenon within a world of decreasing nursing numbers. The newly developed nursing self-concept of the graduate nurse may provide a key indicator for predicting graduate retention. This study explores the development of multiple dimensions of nursing self-concept and examines their relationship to graduate nurse retention plans. A descriptive survey design with repeated measures was utilised to assess nurse self-concept and retention plans. The key findings suggest that multiple dimensions of graduate nurse self-concepts rise significantly in the second half of their graduate year and that nurse general self-concept is a strong predictor of graduate nurse retention. The implications of this study are that monitoring of self-concept throughout the transitional period for new nurses can lead to early detection and appropriate intervention strategies thereby improving retention rates for new nurses.