The first year of practice: new graduate nurses transition and learning needs

Graduate nurses' capability upon entering the workforce: An integrative review

2023, Nurse Education Today

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To clarify capability for work readiness in newly graduated registered nurses as viewed from the perspective of clinicians in practice, educators in tertiary institutions, and graduates.

Integrative review.

Databases searched for peer-reviewed studies included PubMed, MEDLINE, ERIC, Campbell collaboration, Google Scholar, and Cochrane databases.

Pragmatism informed this integrative review. The five-stage method described by Whittemore and Knafl was used to enable rigorous examination of the expected capability of graduate nurses. A comprehensive database search was conducted using PRISMA guidelines. Eighteen articles were appraised and analysed for this review. The capability concept was used as a framework for analysis.

Eighteen articles met the inclusion criteria. Findings revealed that although there is no definition for graduate nurses' work readiness, there is a common theme. Graduate nurses are expected to have broad theoretical knowledge [knowing] along with practical knowledge [doing]. They are also expected to demonstrate integrity, honesty, respect, compassion, and a moral compass. A list of personal attributes and organisational acumen was also reflective of graduate readiness upon entering the workforce and identified as necessary capabilities for graduates.

A picture of the perfect employee is illustrated in the definition of work readiness by the participants of the original studies. Yet there is a lack of stakeholder consensus on the capabilities expected from a graduate nurse.

Effectiveness of the use of concept maps and simulated cases as a teaching-learning strategy in enhancing the learning confidence of baccalaureate nursing students: A qualitative approach

2022, Nurse Education Today

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Didactic lectures and exam-oriented learning can lead to students becoming passive learners who rely on rote memory. This learning style negatively impacts their ability to cultivate the core nursing values and critical thinking.

This study aimed to investigate the impact of a concept mapping teaching-learning strategy on undergraduate nursing students' ability to integrate theoretical biosciences knowledge into care practice and on their skills in critical thinking and teamwork.

A qualitative research design was adopted. A course entitled Evaluation and Analysis of Adult Nursing Cases was developed based on a concept mapping strategy involving 24 simulated cases relevant to medical and surgical nursing. The participants were students from the two-year undergraduate nursing programme at a university in Taiwan. Data were collected from September 2020 to February 2021. Qualitative data were collected from semi-structured face-to-face interviews with 20 students and from 100 reflective reports on students' learning journeys. The data were analysed using qualitative content analysis.

Two major themes were identified: [1] changes in learning style and thinking and [2] rewards from learning. The participants reported that their learning style had changed from reliance on rote learning to image memory, and their thinking process from linear [cause-effect] to multifaceted thinking at different levels. The teaching and learning strategies contributed to feelings of ability advancement and psychological safety, which led to learning achievement and confidence.

The use of a concept mapping strategy and simulated cases enhanced students' learning by enabling them to integrate theoretical knowledge and improve their thinking abilities. The teaching and learning strategies helped participants in learning about psychological safety and increased their learning confidence.

The experiences and perceptions of newly qualified nurses in the UK: An integrative literature review

2022, Nurse Education in Practice

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This integrative review aimed to develop an understanding of the experiences and perceptions of newly qualified nurses in the United Kingdom [UK].

In the transitional period following registration, newly qualified nurses may feel socially isolated and overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Despite this, the experiences and perceptions of newly qualified nurses remains an under-researched area in the UK, with much of the existing research having been conducted internationally.

An integrative framework methodology was used as a basis for the literature review. The methodology comprised of five stages: problem identification, literature search, data evaluation, data analysis and presentation of the findings. 20 papers were assessed for quality and analysed thematically.

Data were synthesised under four themes: Preparation for real-world practice, the transition experience, growing into the role and preceptorship and support from the wider team.

The review suggests that newly qualified nurses require on-going support post qualification. Workplace culture appears to have a significant impact on the transition experience. The review provides further evidence in relation to the experiences of newly qualified nurses in the UK context. The review may help to inform the development of strategies to support and retain newly qualified nurses in an ever-changing health care environment.

Practice readiness of new graduate nurses and factors influencing practice readiness: A scoping review of reviews

2022, International Journal of Nursing Studies

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For many years there has been concern that new graduate nurses may not have been adequately prepared for the workplace, often framed in terms of whether they are work ready or practice ready and able to deal with the ‘reality shock’ of transitioning from student to clinician. This has prompted significant research to investigate the practice readiness of new graduate nurses.

Identify what is known about the practice readiness of new graduate nurses upon commencement of employment, how practice readiness changes over their first year of employment and explore the factors which influence practice readiness.

Scoping review of existing reviews guided by the framework developed by Arksey and O'Malley, with search results based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] Statement.

MEDLINE, CINAHL, PsycINFO, Scopus and Web of Science were searched to identify literature reviews synthesising evidence about new graduate nurses, work readiness, practice readiness, competency and transition to practice. New graduate nurses were defined as nurses who were working in any clinical setting as a nurse within their first year of employment after graduation. Database searching was supplemented with snowball searching and limited to English language papers published between 2011 and 2020. Full-text copies of included reviews were imported into an NVivo [Version 12] database to facilitate analysis and synthesis of findings.

Forty-five reviews were included. The findings indicate that transition is influenced by a wide range of intrapersonal, interpersonal and organisational factors, many of which are beyond the control of new graduate nurses. The findings also suggest that, overall, there are no major concerns about the practice readiness of new graduate nurses consistently supported by strong evidence. However, there is evidence to suggest that they ‘lack confidence’ during the first few months of employment.

The ‘receptivity’ of the clinical environment to new graduate nurses appears to be a critical influence on their experience of transitioning from student to clinician and can also influence their readiness for the role of a registered nurse. Rather than focusing on the question of whether new graduate nurses are adequately prepared for the workplace, it may be time to shift the question to whether the workplace is ready to support new graduate nurses. The findings suggest two research priorities for advancing our understanding of workplace support for new graduate nurses.

New Graduate Nurses in the Intensive Care Setting: Preparing Them for Patient Death

2022, Critical Care Nursing Clinics of North America

Confirmation of an instrument monitoring quality of nursing student accompaniment

2022, International Journal of Africa Nursing Sciences

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The quality of support provided by preceptors should be optimal to develop students’ competence. We describe the validation of the measuring instrument to monitor support offered by preceptors during their accompaniment.

A quantitative survey design was used to validate the self-administered instrument. A sample of 346 s- and third-year undergraduate nursing students at two higher education nursing institutions provided 930 assessments of preceptor support, 750 which contained no missing data and were used for the analysis. Descriptive data analysis was conducted to determine the reliability and validity.

The Cronbach alpha coefficient showed high reliability [0.98] overall and for each subscale [0.95–0.97]. The confirmatory factor analysis showed good fit [RMSEA = 0.057] with items measuring various elements of support loading strongly on their respective latent variables.

The confirmatory factor analysis confirmed the instrument as fit for purpose to monitor preceptor support, specifically system, cognitive and emotional support.

Research article

New graduate nurses' experiences about lack of professional confidence

Nurse Education in Practice, Volume 19, 2016, pp. 19-24

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Professional confidence is an essential trait for new graduate nurses to possess in order to provide quality patient care in today's complex hospital setting. However, many new graduates are entering the workforce without it and this remains to be explored. This study describes how new graduate nurses accounted for their lack of professional confidence upon entry into professional practice and how it developed during their first year of practice in the hospital setting. Two face-to-face, individual interviews of 12 participants were utilized to capture the lived experiences of new graduate nurses to gain an understanding of this phenomenon. After manual content analysis seven themes emerged: communication is huge, making mistakes, disconnect between school and practice, independence, relationship building, positive feedback is important, and gaining experience. The findings indicate that the development of professional confidence is a dynamic process that occurs throughout the first year of practice. New graduate nurses must experience both positive and negative circumstances in order to move toward the attainment of professional confidence. Knowing this, nurse educators in academia as well as in the hospital setting may better support the development of professional confidence both before and during the first year of practice.

Research article

Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies

International Journal of Nursing Studies, Volume 71, 2017, pp. 17-27

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This systematic review describes the experiences of the orientation into nursing of newly graduated nurses.

Systematic review.

Data was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC [ProQuest]. Qualitative, peer reviewed, original studies published in English, Swedish or Finnish before February 2016 and exploring newly graduated nurses’ experiences of the nursing orientation process were included. The studies were selected by screening titles, abstracts and full texts and the quality of the studies was assessed by two researchers independently. Data was analysed using content analysis.

Thirteen studies were chosen for the review. Newly graduated nurses’ orientation experiences were divided into four main categories: experiences related to orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation and suggestions for changes based on orientation experiences. The findings establish that the orientation and the preceptor have a great impact on how newly graduated nurses experience the start of their career. Often, newly graduated nurses wish to continue their relationship with their preceptor after the orientation period.

Results bring together both the positive and negative aspects that newly graduated nurses relate as regards their current orientation programmes. Attention needs to be paid to the variation and imbalance in the quality of orientation programmes and preceptors. A more formal form of mentorship needs to be developed further.

Research article

Supporting graduate nurse transition to practice through a quality assurance feedback loop

Nurse Education in Practice, Volume 27, 2017, pp. 121-127

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This mixed-method study focused on new graduate nurses and their transition to practice. Transition to practice can be a time of heightened stress and anxiety, leaving many new graduates disillusioned and dissatisfied with their work. The study explored how satisfaction levels with transition may improve during their first year, using a unique approach of a continuous quality assurance feedback loop. This assurance framework is utilised in hospitality, automotive and supply chain logistics and in health, primarily to monitor patient outcomes. However, an association with graduate nurse satisfaction has not been previously reported. Graduate nurses from two health services completed a short survey questionnaire every four weeks for 12 months. De-identified aggregated data was sent to health service management, giving them an opportunity to integrate the findings with the objective of potentially increasing graduate satisfaction ratings. Quantitative findings showed no statistical significance of graduate nurse satisfaction scores between health services, however, one health service consistently outperformed the other. Qualitative findings drawn from a seminar and interviews confirmed that one health service took a more proactive stance with the monthly reports, communicating the results to ward managers. Outcomes reflected a greater commitment of support and an overall increase of satisfaction scores.

Research article

Transition and integration experiences of Australian graduate nurses: A qualitative systematic review

Collegian, Volume 24, Issue 5, 2017, pp. 505-512

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This paper reports on a systematic review of Australian qualitative nursing literature [2004–2014], identifying common features that impact Australian graduate nurses’ transition and integration into the workforce. Two researchers independently and systematically reviewed the literature using strict inclusion criteria. Initially 105 studies were identified, of which 13 met the inclusion criteria and were reviewed. The included studies were analysed, and qualitative findings across studies were categorised and synthesised. Four higher order categories were identified: responsibilities, nursing culture, work readiness, and support. It was concluded that proactive organisational support and preceptor availability fostered a positive transition experience, professional competence, and growth by the end of the graduate year. However negative experiences were common; limited support, exposure to unprofessional workplace behaviour, full workloads and responsibilities beyond their expertise, undermined graduate nurses’ successful transition and integration. Recommendations for improving Australian graduate nurses’ transition experiences are discussed.

Research article

Exploration Into How Simulation Can Effect New Graduate Transition

Clinical Simulation in Nursing, Volume 13, Issue 10, 2017, pp. 465-470

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Transition into the professional role can be difficult for new graduate nurses. The level of responsibility changes immediately on licensure. Simulation experiences may assist with this transition.

A descriptive phenomenological methodology was used to explore how simulation affected practice of new graduate nurses.

Six themes emerged: confidence, communication, critiquing, theory to practice integration, seeing the big picture of patient care, and responsibility for independent practice.

Although transition into the profession is influenced by many factors, simulation experiences that support student confidence, communication skills, reflection, and decision making can help new graduate transition into the professional role and its responsibilities.

Research article

Graduate nurse experiences of support: A review

Nurse Education Today, Volume 40, 2016, pp. 7-12

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The first year of practice as a nurse is recognized as stressful. Graduate nurses [GNs] report gaps in their education, reality shock, burnout and other negative experiences that influence their intentions to remain in nursing. Objectives: The aim of this literature review was to gain a greater understanding of the experiences of GNs. Review methods: It included thirty-six articles that focused on GNs and their transition to nursing, as part of a graduate nurse program [GNP], from 2005 to present. Result: The review identified three main themes that influence the transition from student to registered nurse. These themes included, 1] feeling stressed and overwhelmed by nursing responsibilities, 2] the amount of support from senior nurses and 3] the importance of feedback on their performance as nurses. Conclusions: Further research that is focused on the support and feedback provided to new nurses is needed.

What are the factors that influence a new graduate nurse's transition into practice?

What are the challenges for new graduate nurses?

What is the transition to practice?

What is the role of a new graduate nurse?