Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses

2023 Pauline Cerasoli Lecture: It Takes a Village to Raise a Profession

BACKGROUND AND PURPOSE

Personal and profession-related factors affect graduate transition to practice. Social supports and a sense of belonging are recognized as critical factors affecting success. The need for a professional to postprofessional continuum of learning has been identified. Development of a process to effectively move learners through this continuum are affected by conflicts such as economic issues, varied educational and practice philosophies, and capacity demands for clinical sites and instructors. The purpose of this article was to discuss professional formation as an individual experience that needs environmental support. If we look to the intrinsic needs of the individual to develop effective systems, both individuals and the profession will thrive.

POSITION AND RATIONALE

The changing demographics of students and factors affecting health care and education offer compelling reasons to reconsider the pathway for early professional development. Education and practice must collaborate to cocreate the foundation for professional formation. Basic needs such as economic security and social belonging must be met to create optimal conditions for learning and growth.

DISCUSSION AND CONCLUSION

The profession has not adopted an intentional pathway for new graduates to meet foundational practice needs. Some new graduates seek residencies, but residencies are focused on specialization and supply does not meet the demand. Strategies to promote success of early career professionals include a professional to postprofessional curriculum with intentional mentorship, changes in the regulatory environment, and formation of effective partnerships to support education and practice.

Understanding the experiences of transition for newly qualified mental health nurses and their potential to stay in the role: A qualitative exploration

AIM

To understand the experiences of transition from the perspective of newly qualified mental health nurses and the impact this may have on their potential to remain in the role.

BACKGROUND

During the transitional period following registration newly qualified nurses experience feelings of being overwhelmed and shock. Internationally there is limited research on factors influencing transitional experiences in the field of mental health.

DESIGN

A qualitative exploration was conducted using thematic content analysis to analyse the data gathered from semi-structured interviews METHOD: 18 Newly qualified mental health nurses from two NHS Mental Health trusts were interviewed, all within 18 months of registration. Data were analysed and themes generated addressing the research aim.

RESULTS/FINDINGS

Five themes were co-created using this inductive technique: 'Transition to new role', 'Support for new role', 'Professional identity', 'Role development' and 'Working environment'. These themes are representative headings with the sub-themes making up the contributory content. Themes highlighted issues concerning newly qualified nurses and the transition which included aspects of anxiety and feeling overwhelmed initially. This highlighted the feelings associated with transition and progression through the process of liminality. Supervision was identified in the context of formal support, the presence of which is conducive to a positive transition. Imposter syndrome and experiencing reality shock were common aspects of role development and acknowledging the sense of responsibility gained once registered. Safety was highlighted as many experienced their first role on in-patient environments which was busy and potentially hostile.

CONCLUSION

The transition of newly qualified nurses in mental health services can prove to be a difficult experience, therefore it requires acknowledgment and careful consideration. Understanding the liminal process may allow staff to appreciate the effect of the transition and to understand that the NQN will face overwhelming and unfamiliar responsibilities. Despite the demands to boost the workforce in mental health services there is a need to understand how best to integrate NQN's into their role during this transition. Caution must be used if we are not to lose more NQN's, as despite concerns there are still NQN's looking to mental health nursing as their future and chosen career.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Echoes of silence

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

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

AIMS

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

BACKGROUND

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The transition of clinical nurses to nurse educator roles - A scoping review

AIM

To explore what is known about the lived experiences of novice nurse educators, including preparation or support strategies that may assist this transition.

BACKGROUND

Despite the crucial role of nurse educators in healthcare, the literature lacks clarity about the role and the preparation and support of nurse clinicians to transition into novice nurse educator roles.

DESIGN

Scoping review METHODS: A scoping review was carried out according to the Joanna Briggs Institute Methodology for Scoping Reviews. The Cumulative Index of Nursing and Allied Health Literature Complete (CINAHL), Medline (OVID), EMBASE, APA PsycINFO and Google Scholar databases were searched for English language sources of evidence between 1992 and 2022. Sources of evidence related to nursing education, transition, lived experience, preparation and support were included.

RESULTS

Fifty-two sources of evidence met the inclusion criteria with most originating in the United States and situated in the academic setting. There were 20 different titles used to identify nurse educators and a lack of clarity relating to the role and its expectations. There was alignment found between the lived experiences of novice nurse educators and Duchscher's transition shock model with a variety of preparation and support recommendations identified to mitigate this transition shock.

CONCLUSION

Clinical nurses transitioning into novice nurse educator roles have a predominantly negative experience that aligns with Duchscher's transition shock model. Although recommendations exist for support and preparation strategies to ease this transition shock, further research is required to establish which of these strategies are effective, especially for novice nurse educators in clinical settings outside of the United States.

Exploring the first-time transition to parenthood in mainland China: a qualitative study on the experiences of fathers and mothers using the transition shock model

Background

The transition to parenthood, which is influenced a lot by local parenting culture, is a dramatic stress for both men and women. Chinese social and cultural contexts form specific parental culture, shaping the unique experience of transition to parenthood. However, the understanding of the transition to parenthood in mainland China is limited. Additionally, few qualitative studies explored the transition to parenthood from both dyadic perspectives.

Aim

To explore the first-time transition to parenthood experience among mothers and fathers in mainland China during pregnancy, and compare the similarities and differences between their experiences in this transition period.

Methods

A descriptive qualitative study was conducted with 36 parents, including 18 primiparous women and their husbands. Data were analyzed by directed content analysis guided by the Transition Shock Model. The interview texts were first analyzed at individual levels and subsequently at the couple level to identify dyadic themes.

Results

Five themes and thirteen sub-themes emerged from the data analysis, including role integration, health risk, dilemma of preparation, protective isolation, and multi-dimensional expectation. Unexpectedly, the experiences and perspectives of mothers and fathers regarding the transition to parenthood were found to be similar, with the exception of the sub-theme extra-care requirement.

Conclusion

The findings shed light on the complex emotional journey and expectations of parents, as well as the challenges they face in terms of physical well-being, limited coping resources, and restricted social connections. Notably, fathers in China often shared the stress of the whole process during the transition period alongside mothers but often lacked accessible avenues for seeking and receiving support. These findings underscore the importance of actively involving fathers as a key support population in perinatal care, as well as the need for comprehensive support systems and tailored interventions to enhance the well-being and adaptation of parents.

The impact of prior care experience on nursing students' compassionate values and behaviours: A mixed methods study

BACKGROUND

Compassion is critical to the provision of high-quality healthcare and is foregrounded internationally as an issue of contemporary concern. Paid care experience prior to nurse training has been suggested as a potential means of improving compassion, which has been characterised by the values and behaviours of care, compassion, competence, communication, courage, and commitment. There is however a dearth of evidence to support the effectiveness of prior care experience as a means of improving compassion in nursing.

OBJECTIVE

To explore the impact of paid prior care experience on the values and behaviours of pre-registration nursing students indicated as characterising compassionate care.

DESIGN

Longitudinal mixed methods design employing a modified concurrent triangulation strategy, comprising two work packages. Work package 1 was qualitative, and work package 2 adopted a concurrent embedded strategy with a dominant quantitative component. Research is reported in accordance with the Good Reporting of a Mixed Methods Study framework.

SETTING(S)

Three United Kingdom universities.

PARTICIPANTS

Pre-registration nursing students attending one of three universities, and individuals who had previously participated in a Health Education England paid prior care experience pilot. Participant numbers at time point 1 were questionnaires n = 220, telephone interviews n = 10, and focus groups n = 8.

METHODS

Work package 1 consisted of longitudinal semi-structured telephone interviews. Work package 2 comprised validated online questionnaires measuring emotional intelligence, compassion satisfaction and fatigue, resilience, psychological empowerment, and career commitment (as proxies of compassionate values and behaviours), and focus groups. Qualitative data were thematically analysed. Quantitative data were analysed via Analysis of Variance in SPSS v 26.

RESULTS

Qualitative findings suggest that prior care experience has both positive and negative effects on students' compassionate values and behaviours, however positive effects do not extend to qualification. No statistically significant differences were found in any of the quantitative outcome measures between participants with and without paid prior care experience. A statistically significant increase in compassion fatigue was identified in both groups of participants post-qualification. Paid prior care experience did not prevent participants from experiencing reality shock on becoming a student or on qualification.

CONCLUSIONS

There is insufficient evidence of longitudinal beneficial impact to recommend paid prior care experience as an effective intervention to foster nursing students' compassionate values and behaviours. These findings do not support mandating a period of paid care experience as a prerequisite for entry into nurse education.

REGISTRATION

N/A. Tweetable abstract Insufficient evidence of longitudinal beneficial impact to recommend prior care experience as an effective intervention to foster nursing student compassion @PriorCareExp @Sarah_F_R.

The Impact of Restricted Clinical Experiences During a Pandemic on Newly Graduated Nurses' Experiences: A Descriptive Study

A multihospital study examined the impact of restricted clinical opportunities during COVID-19 on newly graduated nurses' experiences, self-reported competence, and self-reported errors upon entry into a nurse residency program and at 6 months. Newly graduated nurses' experiences (n = 2,005) were described using comparative data from cohorts before and during restricted experiences across 22 hospitals; minimal differences were observed. Nursing professional development specialists can utilize this information when creating and sustaining transition-to-practice programs.

Transition status and influencing factors of newly graduated nurses: A descriptive survey design

AIMS

To assess the transition status of newly graduated nurses in China and identify its influencing factors.

BACKGROUND

Newly graduated nurses are the indispensable part of nursing human resource. The successful transition of into clinical work is crucial for their future career development. However, the transition status of new nurses in China remains inadequately explored.

DESIGN

A descriptive survey design was employed in this study.

METHODS

From October 2022 to January 2023, 1261 newly graduated nurses were surveyed online with the Transition Status Scale for Newly Graduated Nurses. Description statistical analysis was adopted to evaluate the transition status of new nurses. Independent-samples t-test, Analysis of Variance and Multiple Regression Analysis was used to explore the influencing factors of the transition status.

RESULTS

The total mean score of Transition Status Scale for Newly Graduated Nurses was 4.00 (SD=0.61). Competence for nursing work (Mean=4.20; SD=0.57) was rated the highest among the five dimensions of the scale, while the dimension of balance between work and life (Mean=3.65; SD=0.89) was rated the lowest. Mentored by senior nurses, night shift, attribute of working hospital, educational background, interned in the same department, tertiary general hospital, reasons for choosing nursing and working time can affect the transition status of new nurses, accounting for 17.9% of the variance in transition status (R²= 0.179, P＜0.001).

CONCLUSION

The transition status of newly graduated nurses in China is at a relatively high level, especially in the dimension of competence for nursing work. However, newly graduated nurses are in a relatively poor status of work-life balance. Nurse educators and managers need to pay more attention to the transitional training of highly educated nursing talents and the optimization of clinical transition training programs to prevent talent loss. Experienced tutors should be allocated to provide guidance for newly graduated nurses.

The process of nurses' role negotiation in general practice: A grounded theory study

AIM

To explain the process by which nurses' roles are negotiated in general practice.

BACKGROUND

Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated.

DESIGN

Constructivist grounded theory.

METHODS

Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category.

RESULTS

The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed.

CONCLUSION

The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations.

IMPACT

What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles.

REPORTING METHOD

The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.

Perceived professional preparedness and identity among senior nursing students: a latent profile Analysis

BACKGROUND

Senior nursing students' perceptions of their professional preparedness help them for expectations of their future nursing role with more confidence, and professional identity may contribute to cultivating nursing students' perceptions of professional preparedness. In this study we applied latent profile analysis to identify the latent profiles of perceived professional preparedness among senior nursing students and to examine their identity and predictors.

METHODS

This was a cross-sectional descriptive study. A total of 319 senior nursing students from five universities in China were enrolled. Data were collected using the Perceived Professional Preparedness of Senior Nursing Students' Questionnaire and the Professional Identity Scale for Nursing Students.

RESULTS

Three latent profiles were identified and labeled as "low perceived professional preparedness" (n = 90, 28.2%), "low clinical competency-low EBP (Evidence-Based Practice)" (n = 190, 59.5%), and "high perceived professional preparedness" (n = 39, 12.2%). Place of residence, average clinical practicum hours per day, part-time experience, good relationships with classmates, and feeling nobility toward nursing due to COVID-19 significantly predicted profile membership. The average professional identity score was also statistically different across the three profiles (F = 54.69, p < 0.001).

CONCLUSIONS

Senior nursing students' perceptions of their professional preparedness were divided into three profiles, and out results show that promoting professional identity may effectively foster their perceived professional preparedness. This study therefore highlights the importance of targeted interventions by considering their distinct perceptions of professional preparedness patterns.

How are new nurses satisfied with their jobs? From the work value perspective of Generations Y and Z nurses

BACKGROUND

Job satisfaction has garnered significant interest across multiple disciplines as it plays a vital role in shaping human resource strategies. In the field of nursing, enhancing job satisfaction can help prevent workforce shortages. Work values and job-related characteristics are significant predictors of job satisfaction. However, the influence of factors may change as younger generations join the nursing workforce. Although research on generational commonalities and differences in work values is increasing, there is insufficient information on generational differences in the interplay between work values and job satisfaction. This study investigated the factors associated with job satisfaction of new nurses in each generational group based on a work value perspective.

METHODS

A total of 280 new nurses (151 from Generation Y and 129 from Generation Z) were selected from the Graduates Occupational Mobility Survey. Multiple linear regression analyses were performed to determine the factors associated with job satisfaction in both groups.

RESULTS

Most participants graduated with a diploma (61.1%), were paid less than the average salary of each group (60.4%), and conducted shift (72.9%) and overtime work (64.3%). Work values and job satisfaction levels were not significantly different between the two groups. Multiple linear regression analyses showed that career growth and task work values were associated with job satisfaction for Generation Z, while task, reputation, and environment work values were associated with job satisfaction for Generation Y. Among the job-related characteristics, nurses' job tenure was associated with job satisfaction in both groups; salary and overtime had varying relationships with job satisfaction between the two generations.

CONCLUSIONS

Understanding generational differences is crucial for improving the effective management of new generational nurses. Our study findings support that different work value dimensions and job-related characteristics were associated with job satisfaction in each generation. Accordingly, it is essential to develop distinct initiatives, such as a well-structured program, to support the continued career growth of the new Generation Z nurses, thereby enhancing their job satisfaction. Furthermore, providing a conducive working environment that helps new-generation nurses overcome challenges and ensures personal lives should be considered.

Relationship among core competency, self-efficacy and transition shock in Chinese newly graduated nurses: a cross-sectional study

OBJECTIVES

To investigate how core competency and self-efficacy of newly graduated nurses affect their experience of transition shock, and to determine the relationship between these factors.

DESIGN

A cross-sectional study.

METHODS

262 newly graduated nurses participated in a cross-sectional study by using demographic data, the transition shock scale, the competency inventory for registered nurses scale and the self-efficacy scale.

RESULTS

Among newly graduated nurses, the score of transition shock was 77.641±24.140, the score of core competency was 125 (109.5, 163.5) and the score of self-efficacy was 2.5 (2,3), all of which were at a moderate level. The core competency and self-efficacy of the newly graduated nurses had a negative impact on the transition shock (β=-0.151, p=0.026; β=-0.379, p<0.001). Additionally, self-efficacy played a mediating role in the relationship between core competency and transition shock, with a mediating effect accounting for 57.34% of the total effect.

CONCLUSIONS

The transition shock of newly graduated nurses was at a moderate level, with the highest level of transition shock occurring within the first year of employment. Self-efficacy plays a mediating role in the relationship between core competency and transition shock. Nursing managers should create standardised training for newly graduated nurses within the first year of employment to reduce their transition shock. This will help improve newly graduated nurses' core competency, enhance self-efficacy and support the graduates. This will alleviate the impact of transition shock on newly graduated nurses, helping them transition smoothly and successfully.

Program coordinators' perspectives on implementing a transition program for newly graduated nurses: a qualitative interview study

PURPOSE

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators' perspectives on implementing a transition program for newly graduated nurses.

DESIGN/METHODOLOGY/APPROACH

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

FINDINGS

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

ORIGINALITY/VALUE

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

Transition shock, future time perspective, professional self-concept, and professional identity among nursing interns: A cross-sectional study

Background

Transition shock is prevalent among nursing interns. Future time perspective helps nursing interns learn and work more effectively and improve their problem-solving skills. Professional self-concept and professional identity play an important central and driving role in nursing interns' career choices and career development. However, the mechanism by which future time perspective, professional self-concept and professional identity are linked to transition shock among nursing interns remains unknown.

Objectives

We assess the degree of transition shock experienced by nursing interns and investigate the connections among transition shock, future-focused viewpoint, professional identity, and professional self-concept.

Design

A descriptive, cross-sectional design was conducted.

Setting

Eight hospitals in Hunan Province, China were included in the study.

Participants

Nursing interns at the studied hospital participated in the study.

Methods

A total of 1090 nursing interns [929 female, 161 male] were recruited from eight hospitals. Data on transition shock, future time perspective, professional self-concept and professional identity among nursing interns were collected using questionnaires from 30 May to June 15, 2022.

Results

On a 4-point rating scale, the participants' felt transition shock had a mean overall score of 2.39 (SD = 0.52). The dimension with the highest score was overwhelming workload (mean = 2.74, SD = 0.58), while the dimension with the lowest score was incongruity between work and personal life (mean = 2.16, SD = 0.70).Professional identity was statistically significantly correlated with transition shock (r = -0.198, p < 0.01). The preferred level of nursing (β = 0.354, p < 00.01), professional self-concept (β = 0.226, p < 00.01), professional identity (β = -0.2576, p < 00.01) and future time perspective (β = 0.119, p < 00.01) were predictors of transition shock.

Conclusions

The development of nursing interns' sense of professional identity and future time perspective should be enhanced during both the education phase and clinical placement to help nursing interns overcome the experience of transition shock.

Writing for the role: A qualitative exploration of new graduate physiotherapists' transition to practice of clinical documentation

INTRODUCTION

Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation.

OBJECTIVE

To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors.

METHODS

This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes.

RESULTS

Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples.

CONCLUSION

New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed.

A longitudinal qualitative multi-methods study of new dental graduates' transition journey from undergraduate studies to professional practice

INTRODUCTION

New dental graduates' (NDGs) transition to professional practice is an important landmark and developmental stage in their career and in the UK it is supported by a formal educational transition process through a one-year salaried practice-based programme. However, little is known about graduates' experiences during this period. As part of a larger mixed-methods project, this study aimed to explore NDGs' experiences during their transition to professional practice, represented by Vocational Dental Practice.

MATERIALS AND METHODS

Sixty-six NDGs from one dental school were invited to participate. Two rounds of in-depth interviews were conducted: Interview 1 upon NDGs' graduation and then Interview 2 was a follow-up interview after they had spent six-nine months in vocational dental training (VDT). At Interview 1, a subset of participants agreed to record longitudinal audio-diaries (LADs) and continued these for 6-9 months into VDT. Data from the interviews and LADs were analysed together using a thematic analysis approach.

RESULTS

Eleven of the 66 invited NDGs agreed to be interviewed at Interview 1 (16.6%), seven at Interview2 (10.6%), and six (9.2%) recorded LADs. Four topic summaries were developed around NDGs transition experiences: (1) conceptualisation of the process; (2) responses to the transition, (3) challenges and support and (4) relationships with stakeholders.

CONCLUSION

NDGs' transition to professional practice was perceived as exciting and rewarding on personal and professional levels but carried challenges. VDT and related stakeholders play a vital role of supporting NDGs into their new professional life.

Experience of New Graduate Nurses in Nurse Residency Programs During the COVID-19 World Pandemic

BACKGROUND

Individuals who entered any nursing program during the coronavirus disease 2019 (COVID-19) world pandemic were exposed to a different and chaotic learning environment. The goal of this study was to describe the experience of 452 new graduate nurses (NGNs) who entered the profession between 2020 and 2022.

METHOD

This study was a qualitative thematic analysis of an open-ended survey from the American Nurses Credentialing Center Practice Transition Accreditation Program® (PTAP®).

RESULTS

The thematic analysis resulted in five themes: the pandemic was a significant disruptor, the program was a generally negative experience, the quality of the preceptors and mentors made a difference, the content of the program made an impact, and the residency program prepared NGNs for the RN role by building confidence and promoting relationship building and a sense of community.

CONCLUSION

The 2020-2022 world pandemic created a challenging environment for NGNs to enter nursing and had implications for practice. [J Contin Educ Nurs. 2024;55(2):87-93.].

Transition shock among nursing interns and its relationship with patient safety attitudes, professional identity and climate of caring: a cross-sectional study

BACKGROUND

Nursing interns often experience lots of challenges during their clinical nursing internships, which can adversely affect career decisions and result in a squandering of nursing education resources. Patient safety attitudes, professional identity and climate of caring may affect nursing interns' clinical experience. However, more evidence is requested to validate these relationships for nursing educators to develop effective education programs and facilitate interns' successful transition.

METHODS

This was a cross-sectional study, which used a convenience sampling method to recruit 387 nursing interns during December 2022 to April 2023 in university affiliated hospital in Hunan province, China. Data were collected using standardized scales. Spearman correlation and multiple regression analysis were employed to examine the relationship between transition shock, patient safety attitudes, professional identity, and climate of caring.

RESULTS

Nursing interns experienced transition shock at a moderate level and the highest levels of transition shock in response to overwhelming practicum workloads, with the second being related to the conflict between theory and practice. Transition shock was negatively correlated with patient safety attitudes, professional identity and climate of caring among nursing interns.

CONCLUSIONS

Nursing managers and educators need to value the transition shock experienced by nursing interns. Our study suggests that developing a strong sense of professional identity and a positive attitude toward patient safety can be effective in reducing the level of transition shock among nursing interns. In addition, a caring climate within the nursing unit can significantly enhance the overall experience of nursing interns. This can be achieved by enhancing the support of clinical mentors, providing patient safety-focused education, and facilitating team communication among nurses.

Primary care occupational, physical, and respiratory therapy role adaptation in the first year of the COVID-19 pandemic

BACKGROUND

Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation.

METHODS

This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation.

RESULTS

We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts.

CONCLUSIONS

Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.

Effectiveness of a preceptors' social support program to aid novice nurses' error experience on preceptors' skill and novice nurses' perception of social support: A quasi-experimental study

AIM

To evaluate the effectiveness of the preceptors' social support program (PSSP) on preceptors' social support skill-supportive relationships and post-error support-and novice nurses' perception of received social support.

METHODS

This study employed a quasi-experimental pretest-posttest design with a control group of a non-random assigned sample of 47 preceptors and novice nurses and an intervention group of 48 each. Intervention group preceptors received training in building supportive relationships skill and post-error support skills three times in the PSSP over 7 months. Preceptors' social support skill and novice nurses' perception of received social support were measured as primary outcomes. Data were collected at baseline (T0), 1 month after the second session (T1), and 1 month after the last session (T2) and analyzed.

RESULTS

No significant differences in demographics or scores were shown at baseline (T0). Preceptors in the intervention group showed significantly better supportive relationships (T2, 101.6 ± 9 vs. 96.9 ± 7.6, 95% CI [0.95, 8.42], p = .015) and better performance of post-error support (T2, 67.6 ± 5 vs. 62 ± 6.5, 95% CI [2.78, 8.32], p < .001). Intervention group preceptors' social support skill increased or remained stable, while it decreased over time in the control group. Novice nurses in the intervention group received significantly better supportive relationships and post-error support from preceptors (T2, median 112 vs. 101, p = .007; 70.5 vs. 65, p = .028, respectively).

CONCLUSIONS

The PSSP improved preceptors' supportive relationship skills and post-error support performance, leading to novice nurses' perceptions of better supportive relationships and receiving greater post-error support.

Just Culture: Nursing Students Transition to Practice-a Longitudinal Study

BACKGROUND

Although just culture is reportedly integrated across education and practice, little is known about how perceptions may change across time as students transition from prelicensure education to registered nurse in the practice setting.

PURPOSE

The purpose of this study was to describe and compare just culture perceptions of registered nurses at 2 time points: (1) as prelicensure students and (2) as new graduate nurses with a minimum of 6 months of experience.

METHODS

Utilizing the Just Culture Assessment Tool for Nursing Education (JCAT-NE) and the Just Culture Assessment Tool (JCAT), this within-subject, longitudinal study measured just culture perceptions across time.

RESULTS

Although there was no statistically significant change in total scores across time, 8 individual items demonstrated statistically significant change.

CONCLUSIONS

Students use the knowledge, skills, and attitudes about just culture taught in prelicensure education as new graduate nurses. However, findings reveal areas where the practice environment has altered perceptions of just culture.

Innovative Strategies to Facilitate Newly Licensed Nurse Transition to Practice During the COVID-19 Pandemic: A Quality Improvement Project

As healthcare facilities transition from initial phases of the COVID-19 pandemic, it is imperative to consider innovative strategies to overcome instructional challenges presented to nursing schools in order to maintain a competent workforce amidst nursing shortages and increasing patient volumes and complexity. Nursing professional development practitioners will play a pivotal role in revitalizing transition-to-practice programs to meet the demands of the new workforce. This article details an academia-practice initiative for newly licensed nurses who enter practice during the pandemic.

Path Model of Reality Gap on the Mental Health of Novice School Nurses in Japan

Introduction

Mental health is a serious concern among novice school nurses in Japan. Numerous novice school nurses with various health problems experience high stress levels, affecting their mental health. They may be experiencing reality shock, a known risk factor for burnout and turnover, or its factor, the "reality gap."

Objective

This study aimed to examine the hypothetical model by which the reality gap affects the mental health of novice school nurses.

Methods

This cross-sectional study conducted a self-administered questionnaire survey, and responses were obtained from 102 novice school nurses. A path model was created based on a hypothetical model.

Results

After several revisions on the hypothesis model, a modified path model was generated (CFI = .98, TLI = .93, RMSEA = .06). The path model showed that reality gaps negatively affected work engagement, work engagement positively affected intention to stay, and intention to stay positively affected mental health. Reality gap was also directly negatively associated with mental health. Having various support networks reduced the effects of reality gaps on mental health. Additionally, social support in the workplace boosted work engagement.

Conclusion

Unique from other studies, this study contributed to understanding the effects of reality gaps on mental health. School managers and administrators should establish a support system that enables school nurses to receive various supports from within and outside the school. In addition, novice school nurses should take advantage of networks and support inside and outside school to reduce reality gaps and grow as professionals.

Effectiveness appraisal of interventions to increase retention of newly qualified nurses implemented in the final year of pre-registration programmes: A literature review

AIM

To understand the effectiveness of interventions to increase retention of early career nurses, implemented during the pre-registration programme.

BACKGROUND

Retention of nurses is an issue of global concern. The transition period spanning the final year of pre-registration nurse education programmes and the first year of qualified practice is a point of high risk for attrition from the profession.

DESIGN

A systematic review without meta-analysis and a thematic synthesis of wider literature, reported using SWiM and ENTREQ guidelines.

METHODS

A convergent segregated approach was used to capture qualitative and quantitative study designs. A systematic review of quantitative papers reporting intervention and retention data and scoping review of a wider body of literature related to interventions supporting transition to qualified practice were conducted. Searches used Medline and CINAHL databases in October 2021. Data extracted from wider literature were inductively collated into themes relating to the intervention type and synthesised.

RESULTS

Six papers were included in the systematic review and 27 papers were included in the scoping review. Interventions included internships, externships, clinical immersion programmes, capstone projects, preceptorships and psychological wellbeing programmes. There was a lack of consensus about the benefits of implementing interventions during the final year of pre-registration programmes, but some evidence that interventions incorporating preceptors, expose students to the clinical environment and involve academic/clinical collaboration, report positive outcomes related to transition to qualified practice, which potentially has an impact on motivation to stay in the profession.

CONCLUSION

Greater understanding of interventions supporting student nurses to reduce likelihood of leaving once qualified has been achieved. There is some evidence these interventions lead to increases in retention, but this is limited by the quality of the reporting and the scarcity of data. Consideration should be given to maximizing students' exposure to clinical practice and the benefits that interventions with alternative approaches such as psychological wellbeing programmes may bring. This review has potential to influence effective implementation of interventions to increase retention of early career nurses if clinical practice and academic settings review proposed or actual interventions to maximise added value. REPORTING METHOD: the manuscript has been written in adherence with the EQUATOR guidelines following the SWiM reporting guidelines for the systematic review and the ENTREQ guidelines for the scoping review.

Do internship students do well in a clinical environment? A qualitative naturistic study

Background

The internship year marks the culmination of the nursing program across all Saudi universities, bridging theoretical learning and practical application. The significance of the internship year lies in the application of skills acquired during the preceding years of study. Understanding interns' experiences, identifying influences, and sharing their recommendations for best practices become crucial.

Objective

This study aimed to explore the experiences of internship students and address the challenges they encountered in a clinical environment.

Methods

A qualitative naturistic descriptive approach was employed, involving 20 purposively selected participants from internship students in two regions in Saudi Arabia. Data were collected in January 2023 through semi-structured interviews, focus group discussions, and observation. A conventional content analysis approach was used for data analysis.

Results

Four major themes were generated: 1) Transferring Shock, 2) Self-Learning, 3) Supportive Environments, and 4) Factors Facilitating Learning. Transferring Shock comprised two subthemes: feeling lost and feeling left out.

Conclusion

Internship students acknowledged the utility of orientation and mentorship programs in advancing the practical skills of new nurses and enhancing patient safety. The findings also indicated that those with prior preparation and robust communication skills reported a positive experience. Consequently, integrating communication courses into the nursing education curriculum could be beneficial. Establishing a supportive learning environment for nursing interns is imperative to address challenges and ensure the delivery of safe and effective patient care.

Level and influencing factors of transition shock among new nurses in China: A multicenter cross-sectional study

Background and Aims

New nurses are an important part of nursing teams. The failure of new nurses to successfully transition seriously affects personal career development and nursing work quality, and important influencing factors deserve the attention of nursing managers. At present, multicenter, large-sample investigations of transition shock among new nurses are lacking in China. This study aims to investigate the current level and influencing factors of transition shock among new nurses in China.

Methods

We conducted a multicenter, cross-sectional study with 3414 new nurses from 16 provinces in 7 regions in China from October 22, 2021, to November 8, 2021. We used the snowball sampling method and an online questionnaire produced by the researchers to collect data; the questionnaire included questions on demographic information, a transition shock scale for new nurses and open-ended questions. Data were analyzed using SPSS version 24.

Results

The effective response rate of this study was 97.89%, with 3342 effective participants from 189 hospitals in China, most of whom were female (94.88%). The study showed that the transition shock of new nurses in China was at a moderate level, with pre-job anxiety, unsatisfactory welfare treatment, resignation intention, adverse events, poor sleep quality, 1 or fewer exercise sessions per week, inability to balance work and life, and gluttony negatively affecting the transition shock of new nurses in China. Psychological shock was the strongest among the four dimensions of transition shock.

Conclusions

The transition shock of new nurses, especially their psychological shock, deserves more attention from international society. Nursing managers should continue to take supportive measures to intervene in the factors influencing transition shock, with the aim of reducing the level of transition for new nurses, promoting their personal thriving, improving the quality of nursing work and increasing the retention rate of nurses.

Reproductive endocrinology and infertility nurse online orientation program evaluation: a quality improvement initiative

Objective

To evaluate the effectiveness of a novel online orientation program (Nurses in REI Communication, Knowledge, and Skills [NRCKS]) among new and early-career reproductive endocrinology nurses to make recommendations for program quality improvement.

Design

Quality improvement.

Subjects

Reproductive endocrinology nurses.

Exposure

Online orientation program featuring 8 micromodules.

Main Outcome Measures

Knowledge acquisition, confidence, user experience, skills, and abilities.

Results

Nurses demonstrated a statistically significant increase in reproductive knowledge after completion of NRCKS. Most nurse users felt confident applying knowledge in the clinical settings after program completion. Nurse users had an overall positive experience with interactive components and quality of visuals. Most nurse users gained skills and abilities that they will implement into professional practice. Nurses suggested improving navigation, adding more visuals in content expert presentations, and teaching soft skills necessary for the role of reproductive endocrinology nurses.

Conclusions

Nurses in REI Communication, Knowledge, and Skills was well received by nurse participants and emphasized the receptivity and desire for reproductive health and fertility training among novice reproductive endocrinology nurses. Nurses in REI Communication, Knowledge, and Skills increased nursing knowledge, and nurses felt confident applying newly gained knowledge in the clinical setting on completion. Nurse participants provided invaluable feedback for quality improvement to inform the hard launch. The results emphasize the online orientation's strong potential to close the theory-practice gap.

The Prevalence and Predictors of Compassion Satisfaction, Burnout and Secondary Traumatic Stress in Registered Nurses in an Eastern Canadian Province: A Cross-Sectional Study

BACKGROUND

The quality of Registered Nurses' worklife is impacting nurses' mental health, and the standard of care received by clients. Contributing factors to nurses' stress are the trauma of continuous caring for those in great suffering, and adverse working conditions.

OBJECTIVES

i) to explore the prevalence of work-related stress in a provincial sample of Registered Nurses; ii) to compare the levels of compassion satisfaction, burnout and secondary traumatic stress reported by nurses in hospital, community, non-direct care settings, and, iii) to identify factors that predict levels of nursing work stress.

METHODS

A descriptive, predictive study with a self-report survey containing demographic questions and the Professional Quality of Life Scale was emailed to over 3,300 Registered Nurses. The scale measured the prevalence of three worklife indicators, compassion satisfaction, burnout and secondary traumatic stress. Multiple linear regression identified factors that predicted the levels of the three indicators. A subgroup analysis explored the quality of worklife based on three practice environments.

FINDINGS

Nurses (n  =  661) reported moderate compassion satisfaction, burnout, and secondary traumatic stress. The strongest predictor, satisfaction with one's current job, predicted high compassion satisfaction and lower burnout and secondary stress. The subgroup analysis identified hospital nurses as having the most work-related stress and the lowest level of compassion satisfaction.

CONCLUSION

Innovative, collaborative action can transform nurses' practice environments. Organizational support is essential to bring about needed improvements.

Mediating effects of transition shock and professional identity on the perception of a caring climate in hospitals and patient safety attitudes of nursing interns: A cross-sectional study

AIM

To determine the association between the perception of a caring climate in hospitals and patient safety attitudes of nursing interns, and the multiple mediating effects of professional identity and transition shock on this relationship.

BACKGROUND

Limited research has been conducted on the involvement of nursing interns in patient safety management and the direct relationship between the perception of a caring climate in hospitals and patient safety attitudes of nursing interns. Furthermore, it remains unclear whether professional identity and transition shock play significant roles as mediating factors in this relationship.

DESIGN

A cross-sectional study.

METHODS

This study employed a convenience sampling to recruit 356 nursing interns from 30 nursing schools in a comprehensive hospital in Hunan Province, China, between December 2022 and April 2023. Data on general information, the perception of a caring climate in hospitals, professional identity, transition shock, and patient safety attitudes was collected from nursing interns using a general information questionnaire and reliable scales. This study utilized a structural equation model with AMOS 24.0 to examine the relationship between variables.

RESULTS

The perception of a caring climate in hospitals directly impacted patient safety attitudes of nursing interns (Effect = 0.253, 95% confidence interval: 0.218-0.542). Meanwhile, the perception of a caring climate in hospitals indirectly influenced patient safety attitudes of nursing interns through multiple mediating factors, including professional identity and transition shock (Effect = 0.037, 95% confidence interval: 0.017-0.073).

CONCLUSION

To ensure patient safety, it is crucial to enhance patient safety attitudes of nursing interns. Our findings suggest that nursing educators and managers can enhance patient safety attitudes of nursing interns by establishing a caring climate. Professional identity and transition shock are important mediators of the patient safety attitudes. Additionally, nursing educators can implement measures to foster a positive work environment, including providing care and support to nursing interns and reducing their workload, to increase professional identity, alleviate transition shock, and ultimately enhance patient safety attitudes of nursing interns.

TWEETABLE ABSTRACT

The relationship between the perception of caring climate in hospitals and patient safety attitudes of nursing interns. Professional identity and transition shock play multiple mediating roles in the relationship. #PatientSafetyAttitudes #NursingInterns #CaringClimate.

Exploring the gap between school of nursing theoretical foundations and clinical practice

BACKGROUND

Theoretical and practical preparation is essential for developing competent nurses. The clinical setting is the most effective context for learning nursing skills. It gives opportunities for newly qualified nurses to practice clinical decision-making by applying theoretical knowledge. Integrating theory and clinical practice with good supervision improves newly qualified nurses' competencies to care for patients and enhance their self-confidence.

OBJECTIVE

To identify the gaps between theoretical preparation in the schools of nursing and actual hospital clinical work in a public hospital in Bahrain and to suggest possible solutions to overcome these gaps.

METHODS

A qualitative descriptive study design was used in a tertiary public hospital in Bahrain. Ten newly employed registered nurses were recruited using purposive sampling. Semi-structured interviews were conducted, and a thematic analysis was employed.

RESULTS

Two Over-arching themes emerged from the analysis of the responses. The first identified the causes of the gaps that new nurses face in the transition (Lack of autonomy, technology employed in healthcare settings, impact of the COVID-19 pandemic, and lack of clinical exposure). The second provided possible solutions for these gaps (Open communication and collaboration, orientation phase and preceptorship, empowerment and self-confidence, and more clinical exposure).

CONCLUSIONS

Good collaboration between schools of nursing and healthcare care organizations can incorporate suggested solutions given by the study participants to reduce the identified gaps.

Early career nurses and moral distress: An integrative review

AIM

The purpose of this integrative review was to evaluate and synthesize literature published in peer-reviewed journals within the past 40 years addressing moral distress in early career nurses (graduation to five years of experience).

BACKGROUND

Moral distress experienced in nursing education and practice manifests physically and psychologically, leads to workforce burnout and attrition, and compounds the nursing shortage. The transition to practice period is a vulnerable time for student nurses emerging into professional practice. Nurse educators serve a crucial role in the preparation of nurses for the recognition and management of moral distress in their professional nursing practice. A better understanding of the state of the science pertaining to the reports of moral distress in early career nurses is essential.

DESIGN

Whittemore and Knafl's Integrative Review method and the PRISMA 2020 Checklist were utilized in this integrative review.

METHODS

Five literature databases (CINAHL, ERIC, PsychInfo, PubMed, and Embase) were searched using 'moral distress' and 'new graduate nurses' as keywords. Studies were included for English language; qualitative and quantitative research; moral distress focus; years of nursing practice experience collected and analyzed in results or discussion; and all areas of clinical nursing practice, geographic locations, and nursing education levels. Studies were excluded for non-peer reviewed publications; moral distress in the academic setting; and the absence of analysis of years of nursing practice experience in the results or discussion.

RESULTS

Eight primary research reports, published between 2016 and 2022 met eligibility criteria. Research methods were largely quantitative with six countries geographically represented. Acute care healthcare settings had the greatest representation with considerations for the COVID-19 pandemic in two reports. Various formats of four moral distress research instruments were used. Years of nursing practice experience were collected as a mean or category. Inconsistent reports of moral distress in early career nurses were found based on experience, age, or nursing education level.

CONCLUSIONS

Research of moral distress prevalence in early career nurses was an identified literature gap. Varied reports of moral distress in early career nurses indicate a need to further understand this topic contextual to academic and clinical education. Nurse educators can prepare students for experiences of moral distress in their professional nursing practice by implementing teaching strategies that draw upon their diverse backgrounds and experiences. A research and education emphasis on moral distress in early career nurses can promote their transition to practice, support their career progression, and uphold nursing occupational commitment.

TWEETABLE ABSTRACT

An integrative review of moral distress in early career nurses found inconsistent reports of moral distress in this population and a need for further research.

Relationship between transition shock and humanistic practice ability among Chinese newly graduated nurses: Mediating effect of organizational socialization

BACKGROUND

Humanistic practice ability serves as an indispensable skills that newly graduated nurses strive to develop. Yet, there is a dearth of knowledge regarding the role of organizational socialization in mediating the association between transition shock and humanistic practice ability in Chinese newly graduated nurses.

AIM

To breakdown the association between humanistic practice ability and transition shock among Chinese newly graduated nurses, with a simultaneous concentration on the mediating effect of organizational socialization in the association.

DESIGN

Utilizing a descriptive cross-sectional study design, this research aimed to provide a comprehensive overview of the variables being examined.

METHODS

A web-based survey was completed by 417 newly graduated nurses from three general public hospitals in Shandong Province, eastern China from February to March 2023. Three questionnaires were administered: the Nurse Humanistic Practice Ability Scale (NHPAS), the Organizational Socialization Questionnaire(OSQ) and the Transition shock of Newly Graduated Nurses Scale (TSNGNS). The IBM SPSS 22.0, AMOS 22.0 and GraphPad Prism 9.0.0 was applied for figure preparation and statistical analyses.

RESULTS

Findings indicated a significant statistical association among organizational socialization, transition shock and humanities practicing ability. A significant negative correlation was uncovered between OrS and TrS (r=-0.468, p<0.001), significant and negative correlation (r = -0.412, p < 0.001) was unmasked between the TrS and the HPA,whereas a significant positive correlation was observed between OrS and HPA (r=0.641, p<0.001). Moreover, in the mediation models, organizational socialization was identified as a partial mediating role in the association between transition shock and humanities practicing ability (indirect effect -0.324, p<0.001; direct effect -0.100, p =0.026; total effect -0.424, p =0.001).

CONCLUSION/IMPLICATIONS FOR PRACTICE

TrS has a significantly negative influence on HPA among newly graduated nurses, and OrS partially mediating the negative effect of TrS on HPA. Nursing managers and nursing educators can reduce the adverse consequences resulted from TrS through enhancing the benefits of organizational socialization programs and eventually improve the level of HPA of newly graduated nurses.

Development and Validation of a Clinical Practicum Transition Shock Scale (CPT-Shock) for Korean Nursing Students

Clinical practice is an important educational tool for nursing students, and their emotions during clinical practice should be accurately understood. This study aimed to develop and verify the validity and reliability of a clinical practicum transition shock scale (CPT-shock) to measure Korean nursing students' emotional responses when transitioning from a theoretical learning process to clinical practice. This research design was a methodological study and the content, construct, criterion validity, and reliability of the items were verified. Content validity was evaluated by seven experts. The preliminary survey was conducted on 24 nursing students, and the factor analysis was conducted on 331 nursing students in various regions of Korea. Confirmatory factor analysis confirmed the model fit (χ2/df = 1.741, GFI = 0.930, AGFI = 0.902, NFI = 0.869, TLI = 0.923, CFI = 0.938, RMR = 0.035, RMSEA = 0.047) and established discrimination and convergence validity. Positive and negative correlations were found with existing transition shock (r = 0.779) and clinical practice adaptation (r = -0.505), respectively (p < 0.001), thus establishing criterion validity. The reliability was good, with a Cronbach's α of 0.85. The clinical practicum transition shock scale reflects nursing students' practice environment and is expected to accurately measure nursing students' unique emotional shock.

Socializing into a Profession with High Early Turnover: Nursing Students' Expectations for Leader-Member Relationships

The nursing profession is wrought with high levels of turnover, particularly among new nurses. One reason for this turnover may be explained by a disparity between what new nurses expect in terms of communication from leaders and coworkers and what they realistically receive. This study uses a mixed-methods experimental design to explore young adult nursing students' preferences for manager communication behaviors, how different managerial archetypes influence nursing students' perceptions of their leader, and how personal factors may influence nursing students' preferences for various managerial styles. Findings suggest that new nurses prefer more mentor- and teacher-type managers and that managerial archetypes influence young adult nursing students' perceptions of leader credibility, effectiveness, leader-member exchange, and employee commitment. Furthermore, personal factors such as self-worth and desire for relational communication behaviors influence preferred manager type. Participants' qualitative responses reveal several task and behavioral wants and needs of new nurses. Findings from this study can informatively help to bridge the gap between expectations and reality in the nursing profession, thus addressing a potential reason for consistent turnover.

"I believe…" - graduating midwifery students' midwifery philosophies and intentions for their graduate year: A longitudinal descriptive study

OBJECTIVE

Midwifery graduates may experience transition shock that makes them question their fit for their workplace and the profession and in extreme cases, may lead to them leaving. Understanding graduate midwives' worldviews, job intentions and work experiences is important to inform retention strategies. Factors such as having a strong professional identity and experiencing strong job satisfaction are important for midwife retention. Conversely, stress, trauma and work-life imbalances are examples of factors that lead to attrition from midwifery. Transition shock experienced by some graduates can exacerbate these factors if not managed effectively. This study aimed to identify causes and impact of any changes in graduate and early career midwives' philosophy, practice, and intention to stay in the profession.

DESIGN, SETTING AND PARTICIPANTS

We invited the 2021 and 2022 cohorts of graduating midwifery students from all educational pathways in Victoria, Australia to participate in a longitudinal descriptive study using a questionnaire with both closed and open -ended questions. This paper reports the findings from 16 participants that completed the first survey of a five-year longitudinal descriptive study.

FINDINGS

The sixteen participants predominantly held a woman centred philosophy and ideally wanted to work in a midwife-led model of care. Although excited about moving into practice, they also disclosed a sense of needing to 'survive' in a maternity care system that their beliefs were not fully in alignment with.

KEY CONCLUSIONS

The hopes, expectations and concerns of midwifery students who are anticipating moving into practice in this study resonate with those previously reported and demonstrate the need to consider personality-job fit in supporting this vulnerable group to transition.

IMPLICATIONS FOR PRACTICE

This study provides insights into graduating midwives' hopes for, expectations of, and concerns about transitioning into practice that may inform the design of transition programs and support expansion of midwifery led models of care.

Australian graduate radiographers' perspectives and experiences of work readiness

INTRODUCTION

Graduate radiographers entering their qualified positions need to orientate and familiarise themselves with a rapidly changing work environment to deliver a high standard of diagnostic imaging services. During this transitional phase, these newcomers also strive to meet self-expectations and workplace expectations. This study was performed to understand the work readiness perspectives and initial experiences of graduate radiographers on beginning their newly qualified roles.

METHODS

The study used a qualitative phenomenological approach to collect data through individual semi-structured in-depth telephone interviews with 14 purposively sampled undergraduate and postgraduate radiographers. The rich data were transcribed verbatim and then thematically analysed.

RESULTS

Four major themes emerged: (1) preparing to be 'work-ready', (2) initial encounters as qualified radiographers, (3) personal and professional challenges and (4) support strategies and advice for new graduates.

CONCLUSIONS

New graduate radiographers face many personal and professional challenges but agree that they thrive in supportive collegial environments. Most participants had a high perspective of their work readiness strongly related to their clinical placements as students, workplace familiarity, support networks and coping strategies. Further review into individual workplace orientations by organisation leaders may benefit the immersion and enhancement of graduate radiographers' initial experiences in their new role.

Relationship Between Style of Coping With Stress and Level of Transition Shock Among New Graduate Nurses: A Cross-Sectional Study

BACKGROUND

Transition shock is prevalent among new graduate nurses. Coping effectively with stress may be essential for a successful transition into practice. The relationship between transition shock and style of coping with stress remains unexplored. The goal of this study was to determine the relationship between style of coping with stress and level of transition shock among new graduate nurses.

METHOD

This descriptive, cross-sectional study was carried out with 252 new graduate nurses in two public hospitals in Istanbul, Turkey. Data were collected with a personal information form, the Coping Styles with Stress Scale, and the Nursing Transition Shock Scale.

RESULTS

Seeking social support, self-confidence, and optimism were the most commonly used styles of coping with stress, with median scores of 7 (range, 6-9), 12 (range, 10-14), and 8 (range, 7-10), respectively. Levels of transition shock for new graduate nurses were moderate, with a median score of 2.61 (range, 2.05-3.33). The helpless (rs = .34, p = .000) and submissive (rs = .23, p = .000) styles were correlated with higher levels of transition shock.

CONCLUSION

The level of transition shock increases with the helpless style and decreases with the use of the social support-seeking style. New graduates can cope with transition shock with simulation-based learning, effective orientation programs, a supportive working environment, and flexibility in the work shift. [J Contin Educ Nurs. 2023;54(8):350-359.].

The transition to advanced practice nursing: A systematic review of qualitative studies

BACKGROUND

Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes.

AIM

To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role.

DESIGN

A systematic review of qualitative studies.

DATA SOURCES

Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL.

REVIEW METHODS

This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis.

FINDINGS

A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition.

CONCLUSIONS

Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.

Mentoring & support practices for final year medical students during a pandemic - 'The covid doctors'

BACKGROUND

Transition from final-year medical student to newly graduated doctor is challenging with evidence of associated increased patient mortality and medical errors. Previous work suggests tackling preparedness alone does not 'solve' this transition. The current focus on mentoring and support provision during this period and is an under-researched area. The COVID-19 pandemic represents a unique disruptive critical incident in which to examine mentoring and support practices, exposing strengths and weaknesses. The perspectives of this cohort and their implications remains an under-researched area.

METHODS

Individual semi-structured interviews were conducted with nine graduate-entry final-year medical students. An inductive latent phenomenological approach explored individual experiences of mentoring and support practices during final-year and transition to professional practice.

RESULTS

Three major themes emerged: 1) Mentoring & Support; 2) Clinical Exposure; 3) Graduation & Transition. A journey metaphor was used to aid the description of participants' lived experience of mentoring and support practices during their final year. Final year medical students (FYMs) felt under-supported and found practices inadequate. Reduced clinical exposure yielded unpreparedness and regression, potentially impacting future careers. Positive experiences were variable and unstructured. 'The COVID Doctors', subtheme provided rich insights into shared narratives and identities amongst participants.

CONCLUSIONS

This study provides qualitative evidence for perceived inadequate mentoring and support provision for final year medical students at transition during a critical incident (the COVID-19 pandemic). Several themes using the metaphor of a journey explore the lived experience of this unique cohort determining their perceptions on the delivery of their medical education and their identity as 'covid doctors'. There are several implications for this study in a post-pandemic era and for pandemic-preparedness, both rapidly growing areas of research in medical education. Recommendations include updating contingency plans, balancing clinical exposure with patient safety issues, and providing support to 'bottom-up' mentoring practices.

Evaluation of a graduate nurse residency program: A retrospective longitudinal study

BACKGROUND

There is an urgency to retain nurses globally. Evidence has shown that nurse residency programs promote retention of new graduate nurses. However, there is a dearth of studies examining the impact of nurse residency programs longitudinally.

AIM

To evaluate the impact of a transition-to-practice program on new graduate nurses' practice confidence and job satisfaction over 24 months.

DESIGN

A retrospective longitudinal study.

SETTING

A 1200-bed public tertiary academic hospital.

PARTICIPANTS

New graduate nurses from local universities who joined the hospital and were enrolled in the Graduate Nurse Residency Program (n = 104).

METHODS

The program was conducted for 24 months and consisted of modules on bedside knowledge and skills, and a mentorship program with senior nurse leaders. Practice confidence and job satisfaction were measured using the Casey-Fink graduate nurse experience survey. The survey was administered four times over the 24 months as part of the program. Data was analyzed using repeated measures ANOVA.

RESULTS

Practice confidence increased and job satisfaction decreased over the 24 months. Practice confidence total score at 6 months and an extended probation period were factors associated with attrition during the 24-month clinical practice.

CONCLUSIONS

This is the first longitudinal study to demonstrate the impact of a transition-to-practice program in a multiethnic Asian setting. The Graduate Nurse Residency Program enhanced the practice confidence of 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.

Readiness to Practice in Health Care: An Empirical Definition Based on a Content Analysis of the Literature

BACKGROUND

Health care services require practitioners to be ready to practice (R2P), but evidence shows new graduates vary in R2P. Unfortunately, there is a lack of clarity about what R2P entails.

METHOD

A content analysis of the empirical literature (Gaur & Kumar, 2018) was used to quantify the elements and higher-order categories of R2P.

RESULTS

Across 108 articles, professional development activities, communication, previous experience, confidence, clinical skills, patient-centered care, integration of knowledge, teamwork, competency, management, and interpersonal skills were used to define R2P at least 25% of the time. We identified seven domains of R2P: clinical experience, social experiences, professional development experiences, personal attributes, cognitive aspects, onboarding experiences, and educational experiences.

CONCLUSION

Our study empirically defined what is associated with health professionals who were perceived as or perceived themselves as R2P in health care. Our results inform training, preparation, research, and the transition from medical training to the workplace. [J Contin Educ Nurs. 2023;54(7):302-312.].

Exploring nursing students' perceptions from nursing role function (SP-NRF) during the COVID-19 pandemic in Ardabil Province: a cross sectional study from Iran

BACKGROUND

Perception of nursing roles among nursing students significantly influences their active engagement in nursing processes and care delivery. However, there is evidence to suggest that students' interest in and perceptions from the nursing profession at the undergraduate level are often insufficient.

OBJECTIVE

This study aimed to assess nursing students' perceptions of nursing role function and identify areas that require improvement.

METHODS

A cross-sectional study was conducted in 2021 among nursing students in the third- and fourth-years from three faculties in the Ardabil Province. The participants were selected through census sampling. The data were collected through interviews with the Standardized Professional Nursing Role Function (SP-NRF) questionnaire. Statistical analysis was performed using the SPSS-18 software at a significance level of less than 0.05.

RESULTS

A total of 320 nursing students participated in this study. The mean score for nursing role perception was 223.1 ± 20.3 out of 255. The results indicated significant gender differences in the mean scores of perception of the nursing role function, particularly in the supportive, professional-moral care, and professional-educational dimensions. Women scored significantly higher than men did (P < .05). Additionally, students who obtained a mean score of 19 to 20 (A) had significantly higher total scores in perception of the nursing role function than other students. Furthermore, a positive correlation was observed between students' interest in nursing and their perceived ability with nursing role perception (r = .282, P < .01) and all its dimensions.

CONCLUSION

Overall, nursing students demonstrated a favorable perception of nursing role function. However, their perception of mental and spiritual care was relatively weak. These findings highlight the need to review nursing education programs and incorporate the spiritual care dimension to enhance students' understanding of and preparation for their role as nurses.

The experience of resilience in newly graduated nurses: A qualitative metasynthesis

AIM

The aim of the present study was to understand the experiences and perceptions of newly graduated nurses in relation to resilience by providing an interpretive synthesis of the existing qualitative literature on this topic.

BACKGROUND

Resilience in newly graduated nurses has been associated with increased satisfaction and decreased turnover. As the experience of resilience is unique to each individual, qualitative studies are well suited to explore this concept, yet the existing data is heterogenous.

DESIGN

A qualitative metasynthesis was conducted using a meta-ethnographic approach.

METHODS

The search was performed using PubMed, CINAHL, Embase, PsycINFO, ProQuest Dissertations and Theses Global for the English literature and NDSL, KCI, RISS, KISS and DBpia for the Korean literature. The JBI Critical Appraisal Checklist for Qualitative Research was used to assess the quality of studies. An a priori protocol was created and registered on the Open Science Framework (Randall & De Gagne, 2022).

RESULTS

The final review included seven articles published between 2008 and 2021. Three main themes were identified: (1) internal experience of resilience; (2) external sources of resilience; and (3) building resilience over time. Subthemes were also identified.

CONCLUSIONS

This study indicates that resilience can be developed over time during the period of transition from student nurse to professional nurse and is impacted by personal and organizational influences. The promotion of resilience presents considerations and opportunities for health care leaders and administrators.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

A cross-sectional study.

SETTING

Seventeen hospitals in Gansu province of China.

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Crossing the 'flaky bridge' - the initial transitory experiences of qualifying as a paramedic: a mixed-methods study

Introduction

Newly qualified paramedics (NQPs) may experience emotional turbulence as they transition to professional practice. This may negatively affect confidence and have an adverse effect on attrition. This study highlights the initial transitory experiences of NQPs.

Methods

The study utilised a mixed-methods convergent design. Qualitative and quantitative data were collected simultaneously and triangulated to more fully interpret participants' experiences. A convenience sample of 18 NQPs from one ambulance trust was used. The Connor-Davidson Resilience 25-point Scale questionnaire (CD-RISC25) was administered and analysed using descriptive statistics. Semi-structured interviews were conducted simultaneously and analysed using Charmaz's constructivist grounded theory approach. Data were collected from September to December 2018.

Results

There was a range of resilience scores, with a mean of 74.7/100 (standard deviation 9.6). Factors relating to social support were scored highly, and factors relating to determinism and spirituality were scored lower. Qualitative data constructed a process whereby participants were navigating a new identity across three spheres simultaneously: professional, social and personal identity. Attending a catalyst event such as a cardiac arrest was a trigger for starting to navigate this process. Participants had different pathways through this transitional period. Participants who found this process particularly turbulent seemed to have lower resilience scores.

Conclusion

The transition from student to NQP is an emotionally turbulent time. Navigating a changing identity seems to be at the centre of this turbulence, and this is triggered by a catalyst event such as attending a cardiac arrest. Interventions which support the NQP in navigating this change in identity, such as group supervision, may improve resilience and self-efficacy and reduce attrition.

The well-being of young leaders: demands and resources from a lifespan perspective

Building on the job demand resources (JD-R) model, we examined the experience of work environment and well-being among young leaders in a two-wave survey study of 1,033 leaders within the private sector in Sweden. Our results reveal that young leaders report higher levels of burnout and lower rates of vigor compared to older colleagues. Further, they appraise demand and resources differently, perceiving higher emotional demands and less organizational support, and they seem to struggle with the leader role, seeing it as unclear and conflicting. Our findings underline the necessity of viewing the leader role from a lifespan perspective as well as considering age-specific aspects in the JD-R model. In practice, we urge organizations to improve prerequisites for young leaders by providing support and role clarifications to prevent impaired well-being and improve retention. By bringing leadership and lifespan studies together, we aim for a better understanding of what specific prerequisites young leaders need to thrive in the leader role thus showing how age matters and bring the field of research forward.