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

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.

Comparative analysis of newly graduated nurse support through periods of turmoil: lessons learnt for building a future workforce for uncertain times

AIM

To compare newly graduated nurse retention and employment experiences across two distinct graduate nurse programs through periods of health care delivery stability and instability.

BACKGROUND

A global nursing workforce shortage, coupled with increasing demands on health services, requires a specific focus on building capability and improved retention of nurses. The graduate nurse cohort is a critical supply source that potentially can be harnessed if their needs are better understood.

DESIGN

A longitudinal (2015-2023) cross-sectional design was used to examine retention and experiences of newly graduated nurses from two ('traditional, unit-based' versus 'mobile') supported programs.

METHODS

Retention rates were obtained through analysis of employment databases. Descriptive data on impressions and experiences was collected at two time points via a short series of questions contained in a survey, from graduate nurses who remained in employment.

RESULTS

Retention rates for graduate nurses were high (85%) during periods of stability, but even higher for the 'mobile' graduate nurse program. Both programs were adversely affected by instability however, the impact was substantial (around 50%) for the peak period of instability (2020) in the 'mobile' program. Survey data indicated that during the period of instability graduate nurses in traditional, unit-based programs had a more positive experience when compared with graduate nurses participating in the 'mobile' program; This contrasts with the period of stability, where graduate nurses in the 'mobile' program indicated more positive responses.

DISCUSSION

Findings re-emphasise the importance of supportive structures for newly graduated nurses as effective in retaining these staff. However, for the first time, evidence is provided that 'mobility', diversity, and difference can be viewed positively by graduate nurses. Furthermore, it provides improved understanding about mechanisms, support and boundaries, all interrelating factors, in 'stretching' capacity of graduate nurses.

CONCLUSION

Longitudinal analysis of graduate nurses, participating in two diverse programs, through periods of stability and instability offers insights into their challenges and outcomes. These insights can directly inform targeted strategies for inclusion in supported programs that lead to improved graduate nurse retention and contribute to building an agile nursing workforce.

Newly qualified general nurses' experiences of pre-registration internship: A Republic of Ireland cross-sectional study

Aim

The aim of this study was to examine Newly Qualified General Nurses' (NQGNs') experiences of and the value of the internship period.

Background

Internship was introduced as the final part of the undergraduate nursing degree in Ireland in 2002. The aim was to provide students with clinical experience, whereby they work more independently and in doing so, seamlessly progress their transition to the role of registered nurse.

Design

A cross-sectional, quantitative, descriptive study.

Setting and Participants

Newly Qualified General Nurses who completed their undergraduate degree in general nursing and graduated from Higher Education Institutions (HEIs) in the Republic of Ireland between 2018 and 2020 were eligible for inclusion in the study.

Methods

Participants were recruited using snowball sampling. Data were collected anonymously using the electronic Experience of Internship Questionnaire. Analysis was undertaken using the Statistical Package for Social Sciences (SPSS 27).

Results

Pre-internship preparation experiences differed across hospitals. The NQGNs would have preferred more support with their caseloads and help with understanding the rationale for care delivery. However, internship provided good opportunities to link theory to practice and was considered valuable by most in preparing them for practicing as a registered nurse.

Conclusion

Internship assists intern nursing students to link theory to practice. Further, support in internship is crucial when managing a caseload and to enhance understanding of the care provided. The value of internship was identified with suggestions on ways to strengthen the experience of internship.

Newly Graduated Perioperative Nurses' Experiences of Transitioning to Clinical Practice: A Qualitative Explorative Secondary Analysis

AIM

The aim of this secondary analysis was to explore newly graduated perioperative nurses' experiences of transitioning to clinical practice to gain more in-depth knowledge of this phenomenon.

DESIGN

A qualitative explorative study of secondary data was used, and this study was reported following the Consolidated Criteria for Reporting Qualitative Research checklist.

METHODS

A secondary analysis of data collected between March 2019 and November 2020 via 16 semi-structured interviews with newly graduated perioperative nurses. The interviews were conducted 3 to 5 months after they graduated from five different educational institutions in Norway and entered clinical practice as perioperative nurses. A three-step phenomenological hermeneutical analysis inspired by Ricoeur's theory was applied: naïve reading, structural analysis and comprehensive understanding.

RESULTS

We identified three themes: expectations of competence, facilitation for newly graduated perioperative nurses and the transition from being a student to a newly qualified perioperative nurse.

CONCLUSIONS

Newly graduated perioperative nurses emphasised the critical role of supportive facilitation, manageable expectations and support from leaders and colleagues, which seemed essential for a successful transition to clinical practice.

IMPACT

This study addresses knowledge essential for universities, universities colleges and clinical practice, specifically healthcare organisations, to understand the transition process for newly graduated perioperative nurses. This can support the establishment of improved practices to ensure patient safety via more specific education and mentoring and more accurate expectations of competence.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the impact of the mentoring new nurses for transition and empowerment program led by clinical nurse educators in South Korea: A mixed-methods study

BACKGROUND

"New nurses" are those with less than a year of work experience at a hospital. To address the challenges of new nurses caused by their limited experience, the Mentoring New Nurses for Transition and Empowerment Program (MNTEP) was designed based on the Stress-Appraisal-Coping Model of Lazarus and Folkman.

OBJECTIVES

This study aimed to explore the impact of the MNTEP, in which clinical nurse educators teach stress-coping strategies, on the clinical transition of new nurses in South Korea.

DESIGN

This study used a mixed-methods design with a pretest-posttest non-equivalent comparison group and focus group interviews (FGIs).

SETTINGS

The research was conducted at a hospital in South Korea.

PARTICIPANTS

The intervention and comparison groups comprised 30 and 28 new nurses, respectively. Also, 12 MNTEP participants were subjected to three separate FGIs.

METHODS

To comprehensively assess the program's effects, quantitative data were collected through self-report surveys, while qualitative data were obtained from March 2022 to March 2023 using semi-structured interviews that allowed for open-ended responses.

RESULTS

There were significant differences in mean self-efficacy scores (t = 2.45, p = 0.017) and perceived social support from clinical nurse educators (F = 4.51, p = 0.038) between the intervention and comparison groups. Additionally, significant changes were observed in the field adaptation pre-test and post-test scores within the intervention group (t = -3.12, p = 0.004). However, there was no statistically significant difference between the groups in terms of active and passive coping strategies. FGIs yielded two main themes: (1) gaining positive energy through empowerment and solidarity; and (2) clinical nurse educators sharing strategies for improved role adaptation and capacity building.

CONCLUSIONS

MNTEP led by clinical nurse educators positively influenced new nurses' self-efficacy and facilitated their transition to clinical settings. These findings underscore the importance of mentorship programs and clinical nurse educators.

Novice nurse educator professional learning and teaching at a transnational nursing campus: A case study

AIM

This study aimed to explore how novice nurse educators are supported in cultivating an understanding of teaching and learning as they become educators in higher education, how they understand their roles as nursing educators and to identify the opportunities and challenges in developing pedagogical content knowledge experienced at one transnational nursing campus is Qatar.

BACKGROUND

Novice nurse educators are frequently employed to begin educator roles because of their specialised clinical backgrounds and experiences. Yet, they often have little or no formal education regarding educational pedagogy and current teaching practices. These professional learning needs can be difficult to navigate and contribute to a challenging new role. Novice nurse educators often describe a need for more confidence in their teaching practices and understanding of their limitations and knowledge gaps regarding teaching and learning. Although research and policy emphasise the need for well-trained nurse educators with the appropriate education and knowledge to teach in post-secondary academic settings, nursing education still struggles with inconsistent approaches to recruitment and inadequate support for professional development, raising ongoing concerns.

DESIGN

A qualitative case study was used for this study.

METHODS

Four methods were used to collect data: teaching artifact collection, individual guided reflective questions, one-on-one interviews and observational notes. Seven novice nurse educators participated in this study. Data analysis was done using cycle coding to identify themes.

RESULTS

Three themes related to novice nurse educators' professional development include 1) initial and ongoing preparation, 2) professional learning and support needed during transitions into educator roles and 3) barriers to novice nurse educator professional learning.

CONCLUSIONS

Novice nurse educators may have significant professional learning needs as they begin new roles. It is essential to ensure that thoughtful and well-designed onboarding processes includes an early introduction to professional development while offering ongoing professional learning opportunities. Novice nurse educators will draw on various supports as they start their new roles. Developing well-rounded teaching practices and pedagogical content knowledge is difficult while navigating a full teaching load. Therefore, workload adjustments early in novice nurse educators' careers will allow time for professional development.

Employers' requests when advertising for nurses-A national mapping of recruitment advertising for nurses in Sweden

INTRODUCTION

There is a shortage of nurses and many are leaving the profession. Maintaining sufficient nursing staff is a major healthcare challenge for societies worldwide. Work conditions, job orientation, and career opportunities all factor into nurses' rates of attrition, exit, and turnover. Newly graduated nurses have requested structured introductory and/or mentoring programmes to ease their transition from education to work life and develop the skills and knowledge necessary in their particular work setting. Nurses also seek opportunities to continue learning and developing professionally.

AIMS

To map and describe the content of recruitment advertisements for nurses. Research questions were: 'What qualifications do healthcare employers request when recruiting nurses?' and 'What sorts of professional development do healthcare employers offer nurses?

MATERIALS AND METHODS

A comprehensive national mapping of recruitment advertisements for nurses in Sweden where all advertisements, N = 450, on 20 of the 21 regional hospital websites were collected. A qualitative and a quantitative content analysis was performed.

RESULTS

Personal characteristics dominated requested competence in recruitment advertisements. Employers offered general nursing opportunities with unspecific work content and focused more on recruiting newly registered, rather than experienced, nurses. In only a few advertisements, employers asked for a master's degree. No employer requested nurses with a PhD or research experience.

CONCLUSION

While the World Health Organization stresses the need for a sustainable recruitment and attainment of nurses to secure health care, employers' recruitment of mostly newly graduated nurses and offering little professional development and few career opportunities may be one explanation for the difficulties in securing safe nurse staffing.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

Factors that contribute to turnover and retention amongst emergency department nurses: A scoping review

BACKGROUND

Internationally, the emergency nursing workforce shortage is of critical concern.

AIM

To synthesise the evidence and assess the scope of literature regarding factors that contribute to turnover and retention amongst emergency nurses.

METHOD

A scoping review using the Joanna Briggs Institute approach was undertaken. Fivedatabases (Embase, MEDLINE, PsycINFO, CINAHL, and Business Source Complete) were searched for papers published in English between January 2011 and June 2023 where the population was nurses, context was the emergency department, and the concept was turnover or retention. A quality appraisal was performed on included studies.

RESULTS

A total of 31 articles met the inclusion criteria. Twenty-six studies focussed on turnover and five studies focussed on retention. Factors that contribute to ED nursing turnover included workplace violence, personal aspects (e.g., burnout or depression), organisational characteristics, and environmental/ job characteristics. Factors that contributed to ED nursing retention included mentoring programs, the advancement in nursing skills, and the transition to practice speciality (emergency) programs.

CONCLUSIONS

A large body of literature exists regarding ED nurses' reasons for leaving their area of practice, yet limited evidence exist on retention. Research exploring factors that promote retention of emergency nurses that leads to subsequent stability and growth in the emergency nursing workforce is needed.

Competence and Confidence With Quality and Safety Education for Nurses Competencies by Newly Licensed Registered Nurses

Understanding newly licensed registered nurses' perceived confidence in the Quality and Safety Education for Nurses (QSEN) competency domains and corresponding knowledge, skills, and attitudes will help inform clinical leaders to develop successful transition-to-practice programs. Newly licensed registered nurses and prelicensure nursing students had confidence in their understanding of QSEN competencies as they began their transition to practice. Online learning and virtual practicums were effective for attaining QSEN competencies, offering support for using these interventions in academic settings and transition-to-practice programs.

Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion

BACKGROUND

Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.

METHODS

A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = -0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078-0.0997) and nursing care quality (β = -0.0142, 95 % CI = -0.0412 to -0.0095).

CONCLUSIONS

Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography

BACKGROUND

The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace.

AIM

To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment.

DESIGN

A focused ethnographic study.

METHODS

Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022.

RESULTS

The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.'

CONCLUSION

Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover.

RELEVANCE FOR CLINICAL PRACTICE

A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures.

REPORTING METHOD

This study reports to the SRQR guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program

INTRODUCTION

Emergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement.

METHODS

The emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence.

RESULTS

Using the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%.

DISCUSSION

This development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.

Newly employed nurses' transition into their new role in the ambulance service- a qualitative study

BACKGROUND

Nurses are essential to ensure safe and high-quality care worldwide. The World Health Organization (WHO) forecasts a shortfall of 5.9 million nurses by the year 2030, and in the ambulance service, the turnover rate ranges between 20% and 30%. With this study, we seek to increase knowledge by exploring the transition of newly employed experienced nurses into their roles in the ambulance service using the Meleis theory of transition. Through understanding transition, support for newly employed nurses can be developed, turnover rates can decrease, and in the long term, patient safety may increase.

DESIGN

The study employed a qualitative approach.

METHODS

Eighteen newly employed experienced nurses were individually interviewed four times during their first six months of employment. Deductive qualitative content analysis was used to analyse the data. The reporting of this research adheres to the COREQ checklist.

RESULTS

The results show that the transition process for newly employed nurses in the ambulance service encompassed all five aspects of Meleis' transition theory: Awareness, Engagement, Change and Difference, Time Span, and Critical Points. The transition period varied among the participants, and it was also observed that not all nurses went through a transition in line with Meleis' theory. Additionally, there were findings that nurses highlighted the impact of the ambulance service culture on their transition.

CONCLUSIONS

The findings provide a more profound insight into how newly employed nurses with previous experience as nurses navigate their roles and transition into a new profession in a new context. An ambulance service where the organisation is aware of the newly employed nurses' transition processes and what the transition entails can develop and promote a supportive and permissive culture within the ambulance service. For newly employed nurses who are adequately supported, health transitions are more likely to occur, which may increase retention and in the long term increase patient safety. The insights gained from the study can empower ambulance organisations to improve their introduction programmes and offer enhanced support for newly employed experienced nurses entering the ambulance service.

Reality shock in newly graduated critical care nurses and its association with missed nursing care: The mediating role of caring ability

OBJECTIVES

This study is a report assessing the intermediary role of caring ability in the association between reality shock in newly graduated nurses and missed nursing care.

RESEARCH METHODOLOGY/DESIGN

This descriptive study involved 286 newly graduated nurses working in various critical care units. Three standardized scales were used to collect data, including the Missed Nursing Care Scale, the Environmental Reality Shock-Related Issues and Concerns (ERS-RIC) Scale, and the Caring Ability Inventory (CAI). The Hayes' PROCESS macro in SPSS (Model 4) was utilized to perform mediation testing. The data was collected from March 2022 to July 2022.

SETTING

Critical care units in seven Philippine hospitals.

RESULTS

Newly graduated critical care nurses reported moderate levels of reality shock (mean = 50.31). Reality shock was directly associated with missed nursing care (β = 0.0493, p = 0.0066). Caring ability partially mediated the association between reality shock and missed nursing care through caring ability (β = 0.0042, SE = 0.0027).

CONCLUSIONS

Newly graduated critical care nurses experience reality shock during the initial two years of employment. Reality shock diminishes the caring abilities of the newly graduated nurses, leading to a higher incidence of missed nursing care.

IMPLICATIONS FOR CLINICAL PRACTICE

Institutional strategies aimed at facilitating a smooth transition for newly graduated nurses should be prioritized to prevent a decline in their caring abilities and ultimately reduce compromises in nursing care.

When and how does the practice environment most benefit the job outcomes of newly graduated nurses?

BACKGROUND

Providing a favourable practice environment has been regarded as an essential to improve the job outcomes of newly graduated nurses (NGNs). However, little is known about how and when NGNs can best utilize their practice environment to produce optimal job outcomes.

AIM

The aim of this study, which is based on the Conservation of Resources Theory and the Social Cognitive Model of Career Self-Management, is to investigate whether NGNs who have a higher level of personal growth initiative are more likely to benefit from their practice environment and achieve better job outcomes by increasing their occupational self-efficacy.

DESIGN

A cross-sectional study.

METHODS

From 1 September 2022, to 30 September 2022, 279 NGNs from five Chinese state-owned hospitals were recruited for this study. The participants completed measures of practice environment, personal growth initiative, occupational self-efficacy, job stress, job satisfaction, turnover intention and quality of care. A descriptive analysis and a moderated mediation model were computed. Reporting adhered to the STROBE statement.

RESULTS

The influence of the practice environment on job outcomes was significantly mediated by occupational self-efficacy, with personal growth initiative acting as a moderator of this mediation effect.

CONCLUSIONS

NGNs who exhibited a higher degree of personal growth initiative were more likely to derive benefits from their practice environment and attain positive job outcomes by enhancing their occupational self-efficacy. To boost NGNs' occupational self-efficacy and achieve optimal job outcomes, hospital administrators may not only provide a supportive practice environment for them but also conduct interventions that promote their personal growth initiative.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was designed to examine the psychosocial factors associated with NGNs' job outcomes. The study was not conducted using suggestions from the patient groups or the public.

IMPACTS

Our findings indicate that favourable practise contexts may not always benefit the nursing job outcome if NGNs do not exhibit a high level of personal growth initiative and produce increased occupational self-efficacy. Therefore, hospital administrators should consider implementing an intervention to improve the personal growth initiative of NGNs so that they can take full advantage of the practice environment and gain resources at work to create optimal job outcomes.

Experiences of new nurses in the United States during the acute phase of the COVID-19 pandemic

AIM

This qualitative descriptive study describes the experiences of new nurses during the acute phase of the COVID-19 pandemic in the United States.

BACKGROUND

New nurses faced the dual challenge of transitioning to practice while working during a global pandemic. Although multiple studies have described nurses' experiences during the COVID-19 pandemic, research is warranted to understand new nurses' experiences during the acute phase of the pandemic.

METHODS

Registered nurses (n = 46) with less than two years of work experience, who participated in the COVID-19 Study and Registry of Healthcare and Support Personnel (CHAMPS), participated in this study. Thematic analysis was used to examine their responses. The COREQ guidelines were used in reporting this study.

RESULTS

Five themes were extracted: feelings of increasing isolation, feelings of intense fear, personal health concerns, shattered and disrupted expectations, and living in a constant dilemma.

DISCUSSION

New nurses described their distress and profound sense of isolation which was compounded by their status as new employees and being shunned by others. There was intense fear for their safety and health. They viewed their limited nursing experience with only COVID-19 patients as detrimental to their careers and encountered complex dilemmas and were obligated to make problematic choices.

CONCLUSIONS

New nurses revealed unrelenting psychological and physical distress during the pandemic. Identification and implementation of strategies to address their distress and alleviate its negative consequences were needed but not provided.

IMPLICATIONS FOR NURSING POLICY

The development and implementation of policies to address the challenges new nurses encounter are needed. Action strategies to promote professional socialization and job retention are required.

New graduate nurses' delivery of patient care: A focused ethnography

AIM

To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings.

DESIGN

Qualitative study using focused ethnography.

METHODS

During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi-structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis.

RESULTS

Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'.

CONCLUSION

Newly graduated nurses were committed to delivering high-quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally.

RELEVANCE TO CLINICAL PRACTICE

Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high-quality patient care.

REPORTING METHOD

The reporting adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: 'No Patient or Public Contribution'.

Prepared to learn but unprepared for work: A cross sectional survey study exploring the preparedness, challenges, and needs of newly graduated nurses entering a hospital-based transition program

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

BACKGROUND

Previous research has raised questions about new graduate nurses' (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs' expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

DESIGN

A cross-sectional survey design was used.

METHOD

NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

RESULTS

Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit. The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses' readiness for clinical work, the challenges they perceive, and their needs for learning and support.

Transition to professional practice: Perspectives of new nursing graduates of Nepal

BACKGROUND

Internationally, the transition from student nurse to practicing nurse is recognized as being the most stressful period. Yet very little is known about how new nursing graduates perceive this transition in Nepal. The study aimed to explore new nursing graduates' perceptions of the transition to professional practice.

METHODS

A qualitative descriptive methodology was used. In-depth semi-structured interviews were conducted with 10 purposively recruited participants from two private hospitals in Nepal. Data were analyzed using inductive thematic analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to report the findings of this study.

RESULTS

New nursing graduates perceived the transition to professional practice as an intense experience. Inductive thematic analysis yielded four intrinsically linked themes that encompassed new nursing graduates' transition experiences: 'getting hit by reality', 'losing confidence', 'feeling unsupported', and 'gathering strengths.' The theme 'getting hit by reality' included three sub-themes: 'gap between theory and practice,' 'no protective shield,' and 'plethora of responsibilities', which explains nurses' initial encounter with real-world practice. The theme 'losing confidence' contained three sub-themes: 'being fearful,' 'being ignored,' and 'being accused,' which describes how nurses started losing confidence as they confronted the real side of the profession. The theme 'feeling unsupported' included two sub-themes: 'left without guidance,' and 'limited support from seniors,' which explains how nurses perceived their work environment. The theme 'gathering strength' contained two sub-themes: 'reflecting' and 'asking for help,' which describes how nurses coped with the challenges related to the transition.

CONCLUSION

To facilitate the transition to practice, educational institutions must impart to students a realistic understanding of the transition process, address the theory-practice gap, and collaborate with hospitals. Similarly, hospitals should have realistic expectations from new nurses, assign work according to their capabilities, and allow them sufficient time for role integration. Likewise, well-conceived detailed orientation, mentorship or preceptorship programs, and regular professional development programs are vital to easing the transition. Furthermore, establishing and maintaining a supportive work culture, which promotes equity, respect, and safety among employees, is crucial for positive transition experiences.

Associations Between the COVID-19 Pandemic and New Nurses' Transition to Practice Outcomes: A Multi-site, Longitudinal Study

Background

The transition between nursing school and nursing practice has been well studied and recognized as a turbulent time for new nurses. Existing literature suggests that transition to practice (TTP) programs can successfully support new nurses through this challenging period. However, TTP program outcomes have not been studied related to the COVID-19 pandemic, which altered TTP experiences for many new nurses by limiting their access to clinical sites for hands-on patient care experience and shifting delivery of nursing education and TTP programs from in-person to virtual environments.

Purpose

The purpose of this study was to analyze the associations between TTP outcomes and the COVID-19 pandemic.

Methods

This was a retrospective correlational, longitudinal study using secondary analysis of Vizient /AACN Nurse Residency Program survey data from the Casey-Fink Graduate Nurse Experience Survey and the Nurse Resident Progression Survey. Self-reported data from new nurses in Southeast Texas who participated in a standardized TTP program before the COVID-19 pandemic (2017-2019) were compared with self-reported data from nurses who participated in the TTP program during the pandemic (2020 and 2021).

Results

A total of 2,673 nurses participated in this study. When adjusting for demographic composition of the cohorts, statistically significant differences (p < .05) were identified in the advocacy, patient safety, and commitment outcomes with a decline in change scores from baseline to 12 months in the COVID-19 pandemic cohort compared to the pre-COVID-19 pandemic cohort.

Conclusion

Our findings provide new information on the impact of the COVID-19 pandemic on new nurses' participating in a standardized TTP program. The results indicate that patient safety and commitment to staying employed in the organization and the nursing profession should be priority improvement areas for employers and TTP program staff as they work to support new nurses' TTP in a pandemic.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs

Background

The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward.

Purpose

To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic.

Methods

We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data.

Results

The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19.

Conclusion

This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

The Challenges of Transition to Practice Expressed Through the Lived Experience of New-to-Practice Nurses

Background: The nurse’s transition into practice is challenging. The need to facilitate a safe transition into practice and retain nurses is crucial in today’s healthcare. Objective and Design: The qualitative study aim was to describe the lived experiences of new nurses’ safe transition into practice and their perceptions of functioning as safe practitioners. Method: This descriptive, phenomenological arm of a larger, mixed methods study (Safety Transition Education to Practice study) interviewed 11 nurses with varied clinical backgrounds regarding their first six months as licensed nurses. Semistructured, one-to-one interviews with nurses representing geographical locations across the nation were conducted. Colaizzi’s method of analysis was used to extract themes. Results: The data revealed five themes with subthemes. The most universal theme was lack of practical knowledge (skills dexterity, real-world knowledge), followed by impostor syndrome, safety culture (unsafe environment, lack of supplies, lack of mentoring/management), internalized fear, and seeking the sage. Conclusion: The experiences support the understanding that transition to practice is overwhelming and uncertain. Academic faculty and practice nurses’ cooperative efforts can aid novice nurses in safe transition to practice through academic curriculum enhancement, preceptors, and nurse residency programs working toward narrowing the academic practice gap.