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

Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey

AIM

To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation.

DESIGN

A secondary explorative analysis of a cross-sectional survey.

METHODS

The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates.

RESULTS

The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'.

CONCLUSION

The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay.

IMPACT

Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention.

REPORTING METHOD

This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions.

TRIAL AND PROTOCOL REGISTRATION

This study has not been registered.

The mediating effect of transition shock on the relationship between readiness for practice and turnover intention of new graduate nurses in South Korea: A longitudinal study

BACKGROUND

Nurses' turnover intention has garnered significant global attention due to the shortage of the nursing workforce. New graduate nurses encounter challenges as they transition from students to professional nurses. Many new graduate nurses have experienced transition shock, which impacts their turnover intention. Researchers show that undergraduate readiness for practice is linked to transition shock and turnover intention, but there is a lack of longitudinal studies investigating their associations and causality.

OBJECTIVES

To explore the longitudinal factors affecting turnover intention among new graduate nurses, as well as the mediating role of transition shock in the relationship between readiness for practice and turnover intention.

DESIGN

A retrospective longitudinal design.

SETTINGS

This study was conducted in 54 nursing schools in South Korea.

PARTICIPANTS

A total of 232 new graduate nurses who participated in the New Nurse e-Cohort Panel Study as students and have continued working at the same hospital since graduation were included.

METHODS

Surveys were conducted during three periods: two months before graduation (T0), six months after graduation (T1), and one year after graduation (T2). Hayes' PROCESS macro Model 4 was utilized to analyze the mediating effect of transition shock (T1) on the relationship between readiness for practice (T0) and turnover intention (T2) among new graduate nurses.

RESULTS

Readiness for practice (β = -0.140, p = 0.028) and transition shock (β = 0.259, p < 0.001) were significantly associated with turnover intention. Transition shock acted as a mediator between readiness for practice and turnover intention (β = -0.165, 95 % confidence interval -0.311 to -0.051) among new graduate nurses after controlling for work experience, working in desired units, and completion of internship before nursing school graduation.

CONCLUSIONS

This study explored the causal relationships among readiness for practice, transition shock, and turnover intention of new graduate nurses. The findings suggest that higher readiness for practice decreases transition shock and influences the intention to leave. To retain a valuable nursing workforce, nursing schools should strive to create a supportive learning environment that prepares students with a high level of readiness for practice. Additionally, hospitals' nursing managers and administrators should implement a structured adaptation program for new graduate nurses to facilitate a smooth transition into the profession.

Examination of Transition Shock and Colleague Violence Among Newly Graduated Nurses: A Cross-Sectional Study

Background: The adaptation process for new nursing graduates is challenging, with transition shock and colleague violence impacting both individuals and institutions. Objective: This study investigates transition shock and colleague violence among newly graduated nurses in Turkey during their adaptation process. Methods: The study involved 235 newly graduated nurses from a state university in Turkey with at least six months of clinical experience. Data were collected using the Nursing Transition Shock Scale and the Exposure to Colleague Violence Scale. Results: Among the participants, 27.23% experienced colleague violence and 56.17% witnessed it. The mean score on the Nursing Transition Shock Scale was 53.62 ± 15.39. Female nurses and younger age groups faced more challenges. Conclusion: Supportive work environments, mentorship programs, and collaborative teamwork are crucial for newly graduated nurses. Updating nursing education programs to prepare students for these challenges is essential. This study underscores the need for targeted interventions.

Novice nurses' transition shock and professional identity: The chain mediating roles of self-efficacy and resilience

AIMS AND OBJECTIVES

The aim of this study was to explore the association between transition shocks and professional identity and the mediating roles of self-efficacy and resilience among Chinese novice nurses.

BACKGROUND

Novice nurses experience transition shock when they start their careers, which might lead to decreased professional identity and ultimately turnover. By contrast, self-efficacy and resilience are excellent psychological resources that may be associated with higher professional identity. It is unclear how transition shock affects professional identity by influencing these two internal resources.

DESIGN

A cross-sectional survey.

METHODS

The STROBE guidelines were followed to report this study. Convenience sampling was used to recruit participants, and 252 novice nurses completed the Transition Shock of Novice Nurses Scale, the Professional Identity Assessment Scale, the General Self-Efficacy Scale and the Connor-Davidson Resilience Scale between April 2022 and May 2022. Influencing factors were primarily identified using independent-sample t-tests and a one-way ANOVA. Structural equation modelling was used to detect the mediating effects of self-efficacy and resilience.

RESULTS

Differences in novice nurses' levels of professional identity were found across age groups, hospitals and departments. Transition shock was negatively related to professional identity. Self-efficacy and resilience mediated the complete chain relationship between transition shock and professional identity.

CONCLUSION

To our knowledge, this study is the first to explore the mediating effect of self-efficacy and resilience on transition shock and professional identity. Higher transition shock may lead to lower professional identity by reducing self-efficacy and resilience.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers ought to emphasise the significant role of psychological resources in the work adaptation process of novice nurses. It may be more effective to improve professional identity and maintain the stability of the health care system.

PATIENT OR PUBLIC CONTRIBUTION

Nursing administrators working at seven preselected hospitals actively assisted us in the process of collecting self-report questionnaires from novice nurses, such as by booking appointments and providing access for questionnaire administration. In addition, the participants were actively involved in the data collection process.

Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana

INTRODUCTION

Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes.

AIM

This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.

METHOD

In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0.

RESULTS

The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing.

CONCLUSION

Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

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.

Predicting New Graduate Nurses' Retention during Transition Using Decision Tree Methods: A Longitudinal Study

Background

Although retaining new nurses is imperative for the future of the nursing profession, it remains a challenging task in the healthcare industry. Understanding the career journey of new graduates as they transition from students to nurses is vital. However, longitudinal studies investigating the factors influencing retention during this period are lacking.

Aim

The aim of this study is to identify the influencing factors and develop a longitudinal prediction model for new graduate nurse retention.

Methods

A secondary data analysis was conducted using the New Nurse e-Cohort Study dataset from two survey periods, November-December 2020 and February-March 2022. The participants were categorized into either retention or turnover groups based on their turnover experiences. A decision tree based on classification and regression tree (CART) analysis was utilized.

Results

Of the total 586 participants, 463 (79%) were in the retention group. The CART model highlighted that new nurses' retention was significantly associated with younger age, higher readiness for practice (clinical problem-solving) during the nursing program, lower transition shock (such as confusion in professional values, loss of social support, and conflicts between theory and practice), and a higher person-environment fit (person-job fit). The predictive accuracy of the CART model was 79.7%.

Conclusion

To retain new nurses, nursing educators and hospital managers should collaborate to prepare nursing students for actual practice, offer support during organizational socialization, and foster healthy professional values for competence in the workplace. Implications for Nursing Management. Transforming the educational strategies of nursing programs and hospital management policies is imperative to ultimately enhance the retention of new graduate nurses.

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.

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.

Exploring the relationship between simulation-based team training and sick leave among healthcare professionals: a cohort study across multiple hospital sites

OBJECTIVE

Burnout and mental illness are frequent among healthcare professionals, leading to increased sick leave. Simulation-based team training has been shown to improve job satisfaction and mental health among healthcare professionals. This study seeks to investigate the relationship between simulation-based team training and sick leave.

DESIGN

Cohort study.

SETTING AND INTERVENTION

Five Danish hospitals.

PARTICIPANTS

A total of 15 751 individuals were screened for eligibility. To meet the eligibility criteria, individuals had to be employed in the same group (intervention or control) for the whole study period. A total of 14 872 individuals were eligible for analysis in the study.

INTERVENTION

From 2017 to 2019, a simulation-based team training intervention was implemented at two hospital sites. Three hospital sites served as the control group.

OUTCOME MEASURES

Data on sick leave from 2015 to 2020 covered five hospital sites. Using a difference-in-difference analysis, the rate of sick leave was compared across hospital sites (intervention vs control) and time periods (before vs after intervention).

RESULTS

Significant alterations in sick leave were evident when comparing the intervention and control groups. When comparing groups over time, the increase in sick leave was -0.3% (95% CI -0.6% to -0.0%) lower in the intervention group than in the control group. The difference-in-difference for the complete case analysis showed that this trend remained consistent, with analysis indicating a comparable lower increase in sick leave by -0.7% (95% CI -1.3% to -0.1%) in the intervention group.

CONCLUSION

The increase in sick leave rate was statistically significantly lower in the intervention group, implying that simulation-based team training could serve as a protective factor against sick leave. However, when investigating this simulation intervention over 5 years, other potential factors may have influenced sick leave, so caution is required when interpreting the results.

The Mediating Effect of the Perceived Professional Benefit of New Nurses in Cancer Hospitals on the Nursing Work Environment, Psychological Resilience, and Transition Shock: A Cross-Sectional Questionnaire Survey

Aim

The aim of this study was to determine whether the relationship among the nursing work environment, psychological resilience, and transition shock was mediated by nurses' perceived professional benefits and to explore the associations among these variables.

Background

Nurses' transition shock is an important factor in reducing the nursing staff turnover rate. Thus, clarifying the factors influencing nurses' transition shock has become a priority.

Methods

Cross-sectional research was used in this study. A total of 200 newly graduated Chinese nurses were recruited by convenience sampling in 2022 from three tertiary hospitals in Beijing, Tianjin, and Hebei. Data were collected through questionnaires and included demographic data in addition to the perceived professional benefit scale of nurses, the nursing work environment scale, the brief resilience scale, and the transition shock scale. The data were analysed using SPSS 25.0 and the SPSS PROCESS macro programme, Model 6.

Results

The perceived professional benefit of new nurses, the nursing work environment, and psychological resilience directly influenced transition shock (p < 0.01). The perceived professional benefit of new nurses mediated the relationship among the nursing work environment, psychological resilience, and transition shock (p < 0.01). The final model's mediating influence contributed 21.53% and 6.85% to the total influence.

Conclusion

Nursing managers can improve nurses' perceptions of professional benefits from psychological resilience and the nursing work environment to reduce the impact of transition from school to work for new nurses. Implications for Nursing Management. This study provides a reference for the development of intervention strategies and training programmes to assist new nurses in cancer hospitals in effectively navigating the transition into their careers. In the future, appropriate training methods should be used at the individual cognitive, psychological, and organizational levels to improve the physical and mental health of new nurses and their ability to provide high-quality patient care.

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.].

Exploring facilitators and barriers for successful transition among new Saudi graduate nurses: A qualitative study

AIM

This study aims at exploring Saudi newly graduated nurses' perspectives on the facilitators and barriers for successful transition from being a student to being a nurse.

DESIGN

A phenomenological qualitative methodology was employed.

METHODS

Focus group discussions were carried out among 35 Saudi nurses at one major university hospital in Saudi Arabia.

RESULTS

Under the theme of barriers to transition three main subthemes emerged, namely "Fear of making medical errors," "Intense Workload and Expectations," "Bullying and lack of support," while under the facilitators of transition the subthemes which emerged were "Supportive preceptor," "Training workshops," "Need for transition programs." This research found that formal and informal techniques for strengthening institutional variables and improving individual factors are critical for new graduate nurses' effective transition into professional responsibilities.

Factors Affecting the Resilience of New Nurses in Their Working Environment

Resilience and working environment are variables that affect turnover. However, how these two variables impact each other is unclear. This study is a descriptive correlation study to identify the factors of the nursing working environment affecting the resilience of new nurses in general tertiary hospitals. This study was conducted by convenience sampling of 233 new nurses with less than 1 year of working experience. Data were collected through questionnaires from 20 to 27 October 2019, and analyzed using correlation analysis and stepwise multiple regression analysis. The results show that the work environment impacts the resilience of new nurses by 30.2%. Specifically, the following qualities of a work environment were found to affect new nurses’ resilience, including “nursing foundation for quality of care”, “nurse participation in hospital affairs”, “nurse manager ability, leadership, and support of nurses”, “collegial nurse–physician relations”, and “staffing and resource adequacy”. These findings imply that a satisfactory working environment improves new nurses’ resilience and reduces their intent to leave their workplace. Further studies are needed to elucidate this relationship, especially considering the ever-changing work environments.

Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care

PURPOSE

New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model.

DESIGN AND METHODS

Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey.

RESULTS

Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL.

PRACTICE IMPLICATIONS

This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children. Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.

Effects of resilience, social support, and work environment on turnover intention in newly graduated nurses: The mediating role of transition shock

AIM

The aim of this work was to examine the mediating role of transition shock on the relationships between resilience, social support, work environment, and turnover intention in newly graduated nurses.

BACKGROUND

Reports assessing the associations between nurses' resilience, social support, work environment, and turnover intention, both directly and through the mediating effect of transition shock, are scarce.

METHODS

This was a cross-sectional study, which recruited 361 Chinese newly graduated nurses with <1 year of work experience.

RESULTS

Resilience, social support, and work environment directly and significantly predicted transition shock (direct effect -0.158 to -0.350, p < .01). Resilience, work environment, and transition shock directly and significantly affected turnover intention (direct effect -0.118 to -0.257, p < .05). Transition shock mediated the relationships between resilience, social support, work environment, and turnover intention indirectly and significantly (indirect effect -0.019 to -0.041, p < .05).

CONCLUSIONS

The results suggest that nurse managers could enhance resilience and social support and establish a positive work environment to reduce transition shock and turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers could continuously provide resilience training and develop a supportive workplace climate for newly graduated nurses to facilitate smooth transition into clinical practice, could alleviate their transition shock and turnover intention.