Success factors in adaptation of newly graduated nurses: a scoping review

BACKGROUND

Difficulties in adapting to the workplace can affect newly graduated nurses' transition. Such nurses must adapt quickly, as it can affect their future career prospects. Therefore, this review aimed to identify the success factors that promote newly graduated nurses' effective transition and adaptation.

METHODS

The Joanna Briggs Institute scoping reviews methodology was used. Data were extracted from MEDLINE, Scopus, EBSCOhost, and Web of Science publications published between 2011 and 2020. A total of 23 articles were included in this review, which comprised qualitative, quantitative, and mixed methods primary research studies focusing on the contributing factors that aided newly graduated nurses' adaptation to the work environment during their transition period. Key emerging themes were identified with thematic analysis.

RESULTS

Three main themes were identified: (1) organisational contribution (social development, organisational culture, work characteristics, work readiness, work commitment, professional role), (2) personality traits (self-embodiment, personality masking, being proactive and confident), and (3) academic institutions (pre-entry knowledge and role of nursing faculty). Newly graduated nurses' adaptation should begin during nursing education, be supported by the workplace organisation, and driven by the nurse's personality. We determined that that the role of nursing education in aiding the provision of the required knowledge and actual clinical experiences to students profoundly affected developing nurses' self-confidence levels in delivering nursing care effectively. Additionally, a warm environment supported nurses emotionally and physically.

CONCLUSIONS

While organisations and educational institutions have undertaken numerous efforts to ensure that newly graduated nurses are adequately supported, the nurse's personality and values are also equally important to ease adaptation during the transition process. Academic and workplace programs designed for newly graduated nurses should apply and emphasise this knowledge to develop and strengthen their personalities and values, especially to increase confidence and promote proactive values that facilitate newly graduated nurses' rapid and effective adaptation to their new employment.

The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review

AIMS AND OBJECTIVES

This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and stress and enhance new graduate nurses' resilience during the transition from education to clinical practice.

BACKGROUND

Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown.

DESIGN

A scoping review of the current literature (with no date limit) using the PRISMA-ScR checklist for reporting scoping reviews was utilised.

METHOD

Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched.

RESULTS

This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students.

CONCLUSION

The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying.

RELEVANCE TO CLINICAL PRACTICE

Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.

Effectiveness of a standard clinical training program in new graduate nurses' competencies in Vietnam: A quasi-experimental longitudinal study with a difference-in-differences design

OBJECTIVE

This study aimed to estimate the effectiveness of a standard clinical training program for new graduate nurses in Vietnam.

METHODS

A quasi-experimental longitudinal study with a difference-in-differences design was conducted. A total of 280 new graduate nurses completed a self-administered questionnaire. The intervention group consisted of 206 respondents (those having participated in standard clinical training) and the control group (those that did not receive training) of 74. Differences in mean increases in competency scores between the intervention and control groups were estimated. The effect size of the intervention was estimated by calculating Cohen's d. A generalized linear model was employed to identify the factors associated with mean increases.

RESULTS

The mean increase in total competency scores (range: 0-6 points) in the intervention group was 0.73 points greater than in the control group with an intermediate effect size (Cohen's d = 0.53; 95% CI 0.26 to 0.80). A greater reduction in standard deviation of total competency scores in the intervention group was confirmed. Participation in standard clinical training produced a positive association with a mean increase in total competency score without significance (β = 0.04, P = 0.321). Provincial hospitals as clinical training venues had a significantly positive association (β = 0.11, P = 0.007) with the mean increase in total competency scores. Competency at pre-clinical training was negatively (β = -0.75, P < 0.001) associated with the mean increase.

CONCLUSION

Findings implied that the standard clinical training program could contribute to both increasing and standardizing new graduate nurses' competencies in Vietnam. Further studies are needed to more precisely examine the attribution of standard clinical training to better increase new graduate nurses' competencies.

Developing an evidence-based transition program for graduate nurses

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

Supporting newly qualified nurse transition: A case study in a UK hospital

BACKGROUND

Nurse education in the United Kingdom (UK) has been university based since the mid-1990s but despite careful preparation and assessment of student nurses it has been considered necessary to provide a period of additional support for newly qualified nurses (NQNs) to help them settle into their new role and responsibilities. Preceptorship is the process of supporting NQNs over the transition from student to registered nurse (RN) and it is recognised that this can be a difficult time for NQNs.

LITERATURE REVIEW

A systematic review was conducted as part of this project and has been published in an earlier edition of Nurse Education Today (Whitehead et al, 2013). This suggests that preceptorship is a positive and essential experience for NQNs.

METHODS

Lincoln and Guba's Naturalistic Inquiry (1985) was used. A qualitative case study method was developed and consisted of a multi-stage approach including semi-structured interviews with key personnel; documentary analysis of preceptorship material; and focus groups with key actors. Ethical approval was attained for the project. The aim was to interpret the social phenomena and to produce an evidence based tool to improve preceptorship.

RESULTS

Findings are grouped under the headings indicated by the research design. In addition a further 11 themes emerged, including: the need for specific time for preceptors and preceptees; formal recognition of the role and a culture of support; selection and preparation of preceptors and the management structure to support preceptorship.

CONCLUSIONS

The findings indicate that there are a range of factors which are reported to affect the successful transition from student to NQN. Based on these factors recommendations are made for practice and for further research. Practice recommendations: to provide supported preceptorship following the recommendations of the research findings.

RESEARCH RECOMMENDATIONS

to concentrate on enhancing preceptorship as preceptorship in any form is better than none.

A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse

BACKGROUND

The transition from student to newly qualified nurse can be stressful for many newly qualified nurses who feel inadequately prepared. A variety of support strategies to improve the transition process have been reported across the international literature but the effectiveness of such strategies is unknown.

OBJECTIVES/AIM

To determine the effectiveness of the main strategies used to support newly qualified nurses during the transition into the clinical workplace and, where identified, evaluate the impact of these on individual and organisational outcomes.

DESIGN

Systematic review.

DATA SOURCES

A search of electronic databases to identify published studies (CINAHL, MEDLINE, British Nursing Index, Cochrane Library, EMBASE, PsychLit, PsychINFO, PsychARTICLES, Web Of Science, EBM Reviews, BioMed, TRIP, ERIC, SCOPUS (January 2000-April 2011) was conducted. Relevant journals were hand-searched and reference lists from retrieved studies were reviewed to identify any further studies. The search was restricted to English language papers. The key words used were words that described new graduate nurses and support strategies (e.g. internship, residency, orientation programmes).

REVIEW METHODS

The inclusion criteria were quantitative studies that investigated the effectiveness of support strategies for newly qualified graduate nurses. Studies that involved students in their final year of graduate study were excluded (for example extern programmes). Extraction of data was undertaken independently by two reviewers. A further two reviewers assessed the methodological quality against agreed criteria.

RESULTS

A total of 8199 studies were identified from the database search and 30 met the inclusion criteria for the review. The evidence suggests that transition interventions/strategies do lead to improvements in confidence and competence, job satisfaction, critical thinking and reductions in stress and anxiety for the newly qualified nurse.

CONCLUSIONS

This systematic review demonstrates the beneficial effects of transitional support strategies for newly qualified nurses from the perspective of the new nurse and their employer. The overall impact of support strategies appears positive, irrespective of the type of support provided. This may suggest that it is the organisations' focus on new graduate nurses that is important, rather than simply leaving them to acclimatise to their new role themselves. Future research should involve well designed randomised controlled trials with larger sample sizes, using more objective and reliable outcome measures.

New graduate nurses' experiences in their first year of practice

AIMS

This study aimed to explore new graduates' experiences of entering the nursing workforce in NSW, Australia, and to identify factors that impact on their transition to the workforce, satisfaction and likelihood of retention.

BACKGROUND

The nature of new graduates' experiences in their first year of employment has been shown to have a significant impact on their future career directions. It is well reported that often these experiences are stressful and unsatisfying.

METHODS

A mixed method cross sectional design was used combining quantitative and qualitative approaches. Data was gathered by online survey and focus groups.

RESULTS

A total of 282 new graduates, aged 21 to 54, responded to the online survey (response rate 24%). Overall, respondents were satisfied with their recruitment process (mean 3.54) and support for professional development (mean 3.37) but job satisfaction was rated lower (mean 2.91). Qualitative findings from focus groups and survey comments revealed a number of key factors impacting on the experience of transition for new graduates. These are; the nature of the workplace environment, the level and nature of support available to new graduates, together with their propensity to learn and adapt to workplace cultures and to accommodate their own expectations and the expectations of others, and to a lesser degree, the amount of prior experience.

CONCLUSION

There is an urgent need to develop and test a range of evidence based approaches that will both empower nurses and embed systematic approaches that enable equitable and contextually relevant stewardship of new graduate nurses into the future.