ArticlePDF Available

Challenges of fresh nursing graduates during their transition period

  • Tung Wah College, Hong Kong


Objective: The shortage of nurses is an overwhelming problem worldwide. Numerous studies indicate that fresh nursing graduates encounter many challenges in their first year after graduation. These difficulties affect their psychological health and influence their perseverance which results in a high resignation rate. Hong Kong is not an exceptional case; therefore, the aim of this study was to explore the challenges encountered by fresh nursing graduates during the transition period in order to provide insights to academics and clinical administrators in order to facilitate the transition and alleviate the negative impacts, thus increasing the retention rate.Methods: This was a qualitative study and eight new nursing graduates (M = 4; F = 4) from the same local higher education institute were interviewed individually. Thematic coding was used to analyse the data.Results: Finally, nine themes were identified including eight areas of challenges and one common attribute. Workload, lack of knowledge, communication, expectation, change of role, working atmosphere, support and a blame/complaint culture are the common areas of challenges that they encounter in the transitional period. Furthermore, this study also found that new nursing graduates possess a common attribute, i.e. positive personal attitude which seems able to enhance their perseverance in this period.Conclusions: The identified themes are interrelated and all the stakeholders should join together and form a cycle of continuous improvement in order to improve the nursing programme and clinical supports to the fresh nursing graduates. Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
Challenges of fresh nursing graduates during their
transition period
Sze Wing Julia Wong
, Wing Sze Wincy Che, Man Ting Crystal Cheng, Ching Ki Cheung, Tsz Yau Jasmin Cheung, Ka
Yan Lee, Kin Chi So, Sin Lung Yip
Tung Wah College, Hong Kong
Received: September 5, 2017 Accepted: December 19, 2017 Online Published: January 2, 2018
DOI: 10.5430/jnep.v8n6p30 URL:
The shortage of nurses is an overwhelming problem worldwide. Numerous studies indicate that fresh nursing
graduates encounter many challenges in their first year after graduation. These difficulties affect their psychological health
and influence their perseverance which results in a high resignation rate. Hong Kong is not an exceptional case; therefore, the
aim of this study was to explore the challenges encountered by fresh nursing graduates during the transition period in order to
provide insights to academics and clinical administrators in order to facilitate the transition and alleviate the negative impacts,
thus increasing the retention rate.
This was a qualitative study and eight new nursing graduates (M = 4; F = 4) from the same local higher education
institute were interviewed individually. Thematic coding was used to analyse the data.
Finally, nine themes were identified including eight areas of challenges and one common attribute. Workload, lack of
knowledge, communication, expectation, change of role, working atmosphere, support and a blame/complaint culture are the
common areas of challenges that they encounter in the transitional period. Furthermore, this study also found that new nursing
graduates possess a common attribute, i.e. positive personal attitude which seems able to enhance their perseverance in this
The identified themes are interrelated and all the stakeholders should join together and form a cycle of continuous
improvement in order to improve the nursing programme and clinical supports to the fresh nursing graduates.
Key Words: Fresh nursing graduate, High turnover rate, Retention strategy, Transitional period, Challenges
Every nurse has experienced a turning point from being a
student nurse to a staff nurse. Nurses need time to adapt to a
change of identity, roles, responsibilities and a new environ-
ment, particularly when switching from a protected environ-
ment where they are supervised by their school teachers to an
authentic world where they need to take care of the afflicted.
Transition is the process of changing from one state or condi-
tion to another;
however, the duration of adaptation varies
among individuals. According to Duchscher,
the transition
period refers to the first 12 months after graduation when a
student nurse transitions to a qualified nurse. Several studies
show that transitional challenges, such as stress and work dis-
satisfaction cause fresh nursing graduates to quit their jobs,
thereby resulting in a high turnover rate.
Hong Kong is
not an exceptional city. The resignation rate of fresh nursing
graduates ranged from 6% to 14.5% from 2011-2013 in a
local public hospital.
Therefore, this phenomenon calls
for an exploration of the challenges encountered by fresh
nursing graduates during the transition period in the local
Correspondence: Sze Wing Julia Wong; Email:; Address: Tung Wah College, Hong Kong.
30 ISSN 1925-4040 E-ISSN 1925-4059 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
context. This study aimed to provide insights to academics
and clinical administrators in order to facilitate the transition
and alleviate the negative impacts in order to increase the
retention rate.
Literature review
The review of literature helps identify areas that fresh nurs-
ing graduates commonly encounter in the first year after
graduation which provided a framework for developing ques-
tions for the individual semi-structured interviews. Several
fresh nursing graduates report feeling stressed out in their
initial ward experience as a staff nurse, particularly in the
first month, due to the change of role and new working envi-
[5, 6]
Their stress when they were nursing students
came from clinical placements, academic assignments, and
insufficient time for study. Their stress as qualified nurses
comes from excessive workload in the ward.
[7, 8]
They also
express challenges in managing and prioritizing routine work
and heavy workloads in the first few months.
[3, 6]
study showed that the nurses working in general medical or
surgical wards have high stress levels due to heavy work-
A stressful working environment with inadequate
support from staff and human resource management are the
factors that trigger resignation.
Fresh nursing graduates ex-
press difficulty in developing relationships with colleagues,
which makes them feel excluded from the team; they be-
lieve that supportive colleagues can facilitate their adapta-
tion to a new role.
[8, 9]
They expect to adapt and learn new
roles immediately; they feel frustrated when they fail to
meet their own or others’ expectations.
[3, 5, 10, 11]
They also
fear duty handover and hesitate to speak up when there is
a need to communicate with physicians, senior nurses, pa-
tients and relatives.
[3, 8, 11, 12]
In addition, they are discour-
aged when they find variance between theory and practice
in clinical contexts which causes them a lack of confidence
and poor clinical performance,
given their lack of suffi-
cient knowledge, skills, and experience to bridge the gap.
Fresh nursing graduates encounter numerous challenges,
but some studies have found that orientation, preceptorship,
and mentorship programmes could help increase job satis-
faction, confidence in caring for patients, and coping with
[5, 19–21]
Existing studies identify the following eight
areas of challenges encountered by fresh nursing graduates:
1) workload,
2) working
environment, 3) relationship with
colleagues, 4) expectations, 5) support, 6) communication,
7) clinical knowledge or skills, and 8) confidence.
2.1 Study design
This qualitative descriptive study conducted one-hour individ-
ual semi-structured interviews to collect data. The interview
questions were prepared based on the eight themes identified
from the literature.
What are the situations in terms of work-
load/working environment/relationship with col-
knowledge or skills/confidence in your workplace?
What are the differences in terms of work-
load/working environment/relationship with col-
knowledge or skills/confidence in your workplace
between you as a registered nurse and a student nurse?
The following four additional questions were added to under-
stand the phenomenon in a broader and deeper sense.
Are there other challenges that we have not discussed
that you would like to share with me?
Among the challenges discussed, which component(s)
is/are your stressors?
(3) What are the impacts of these components on you?
(4) Which of the three affects you the most? Why?
2.2 Inclusion and exclusion criteria for participants
First, we ensured that the participants graduated from the
same bachelor’s nursing programme in a local higher ed-
ucation institute in 2016. This criterion ensured that the
participants came from a similar academic background be-
cause their feedback is valuable in identifying the strengths
and weaknesses of the programme. Second, the participants
were required to be working as full-time registered nurses
(RNs) in a public hospital within one year of graduation
because public hospitals may have different practices and set-
tings from private hospitals and the majority of hospitals in
Hong Kong are public. Participants who had prior full-time
healthcare-related working experience were excluded from
the study.
2.3 Ethical consideration
Ethical approval was obtained from the School Research
Committee in a local higher education institute in December
2016. Informed consent was obtained from the participants
and an information sheet was provided before conducting
the audio-recorded interviews. Individual semi-structured
interviews were conducted in a private meeting room.
Invitation emails were sent to all the alumni graduated from
the same bachelor nursing programme. Eventually, eight
nursing graduates (M = 4, F = 4) participated in this study,
which is equivalent to 15.4% of the total number of nurs-
ing graduates from the same programme in the same year.
The age of participants ranged from 23-25 years and they
Published by Sciedu Press 31 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
work in different specialties of public hospitals. The contents
of interview were transcribed verbatim. Coding was then
commenced until data saturation was reached and thematic
coding was utilized to identify the themes. Investigator trian-
gulation was employed to increase the reliability of results.
Finally, nine themes were identified: 1) workload, 2) lack of
knowledge, 3) communication, 4) expectations, 5) change of
role, 6) working atmosphere, 7) support, 8) blame/complaint
culture, and 9) personal attitude. The first eight themes are
the areas of common challenges identified in this study. The
last theme, namely personal attitude, is a common type of
behaviour that helps them overcome challenges. The findings
from male and female participants were also compared but
no obvious difference was detected.
3.1 Workload
The participants experienced heavy workloads. They men-
tioned that the average ratio of nurse to patients is 1:12,
whereas the highest ratio is 1:21. Heavy workload included a
lot of paperwork and simultaneous management of multiple
tasks, such as providing treatment after the doctor completed
ward rounds, answering the enquiries of patients and rel-
atives, providing guidance to student nurses, and frequent
monitoring of dangerous drugs. Heavy workload with insuf-
ficient manpower and resources further increased their stress
level. One of the participants in a rehabilitation hospital was
required to complete all tasks within office hours. These
tasks included sending specimens because the supporting
departments are open only until 5 pm on weekdays. Given
their heavy workload, they lacked time to communicate with
patients and relatives, which further raised conflicts and mis-
understanding. Thus, the nurses frequently missed meals and
failed to use their break time. Seven participants mentioned
that overtime work lasts around 15-90 minutes in most shifts.
Only two of the participants indicated that they were able
to cope with the workload. Five participants admitted that
heavy workload is one of the challenges that primarily affect
“It is totally different between a student nurse
and qualified nurse. I need to follow the doctor
around, take the vital signs at specific times, ad-
minister the medications to patients, as well as
bath them within a short period of time.”
“I never go off the duty on time and I never have
time for a meal or tea during my shift.”
“The labour ward shares the same problem. We
also lack labour force similar to other wards. Al-
though the total number of patients is less than
the general wards, the demand for care is very
“Since I am assigned to the admission ward, the
turnover rate of patients is very high. It is quite
exhausting to keep on doing admission and dis-
charge work, and much medical treatment re-
quires follow up.
3.2 Lack of knowledge
According to the participants, basic knowledge and skills
learned in school are helpful, but they are not sufficient, par-
ticularly in terms of advanced knowledge and skills. For
instance, they encounter difficulties in handling emergency
situations and handover cases because they lack experience
and confidence. They hope to receive additional in-service
training on basic life support (BLS), advanced cardiovascular
life support (ACLS), use of the electronic clinical manage-
ment system (CMS), entry of in-patient medication order
(IPMOE), and performing venepuncture and blood extrac-
tion. Seven participants indicated that lack of knowledge
was one of the challenges that highly affect them.
“I was unfamiliar with the use of the CMS and
conducting follow up in medical treatment after
the doctor’s rounds because we were not taught
about it in school. These tasks are very impor-
tant in our career.
“The school only taught simple wound dress-
ing techniques. Thus, I did not know how to
perform complicated wound dressing, such as
adding packing into the wound and managing
wound gaps.
“The nurses in my ward are expected to perform
blood extraction when the technicians are off
duty, but I was not taught this task in the past.”
“There are many new things in the ward that we
did not learn from textbooks. These tasks in-
clude management of peripherally inserted cen-
tral catheters and administration of different an-
tibiotics with different dilutions.
“Sometimes I need to assist in clinical proce-
dures that I have never seen before.
“The knowledge I learned from school was def-
initely insufficient for practical use. I have
learned many lessons in school, but I have for-
gotten most of them.”
3.3 Communication
Participants expressed difficulty in communicating with dif-
ferent parties, but the most difficult aspect was dealing with
patients and relatives because their expectations were higher
than what they could provide, which easily results in con-
flicts. Translating medical terms into layman form through
32 ISSN 1925-4040 E-ISSN 1925-4059 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
simple and clear presentation was a challenging task for the
participants. They encountered difficulty in understanding
the doctor’s handwriting in the treatment record, but they
were afraid to clarify it with the doctors because of their
poor skills in handling calls. Participants preferred face-to-
face communication with allied health colleagues instead of
merely reading their notes in the progress record because
they wanted to understand the progress of patients. The
participants engaged in relaxed communication with junior
colleagues, but they needed to watch their attitude when talk-
ing to senior colleagues to avoid being ridiculed. They also
experienced stress when they needed to hand over a case to
senior nurses because they would pinpoint fresh graduates.
“The greatest difficulty is communicating with
patients or relatives due to different expectations
between nurses and patients.”
“I feel stressed and afraid when communicating
with senior staff.
“The most difficult task is translating medical
terms from English to Chinese and explaining
them to relatives in simple words.
“Communication with relatives is the most im-
portant thing as they sometimes fail to un-
derstand the reasons behind the interventions,
which could easily cause misunderstanding and
“Handing over cases to the doctors and col-
leagues is difficult because I am afraid of mak-
ing mistakes or overlooking information. This
task stresses me out.”
“When I was a student, I seldom touched the
ward telephones, but now, I always need to con-
tact the doctors for reporting and clarification.
This task is very stressful.
3.4 Expectations
This category involves two kinds of expectations, namely
self-expectation and expectations from others. Seven par-
ticipants reported that they had high expectations from self
and others, and five of them indicated that expectation is
one of the top three challenges that primarily affect them.
Participants expected to observe proper time management
and finish tasks before handover. They wanted to work inde-
pendently and competently as soon as possible because they
did not want their colleagues to be disappointed. They were
anxious about being the subject of gossip.
“They expect you to know everything when you
are a registered nurse.
“I expect to perform my work efficiently without
making mistakes and complete my tasks in the
shortest period of time.”
“Every day, I expect to not commit mistakes,
or overlook any information, and receive com-
plaints from anybody.”
“When I miss a task, my colleagues help me and
encourage me. I think this is also one of their
expectations. I do not want to let them down.”
“Senior staff assume that I am capable of per-
forming the same task after supervising me
“Since I worked here for quite a long time be-
fore graduation, they expect me to know most
3.5 Change of role
The responsibility of a RN is heavier than that of a student
nurse because they are accountable for each action and de-
cision. When the participants were student nurses, their
work was supervised by school teachers or clinical mentors.
As RNs, they are expected to work independently with less
supervision. All participants shared two same working prin-
ciples of playing safe and avoiding harming the patient. They
always ask their colleagues to double check all kinds of drug
administration with them. Some of them developed insom-
nia, which was associated with their responsibilities because
they always re-think the tasks they handled in the PM shift.
They also think about conducting follow-up work in the AM
shift the following morning.
“We cannot inflict harm on the patients.”
“We have to sign several documents to ensure
that each error committed can be traced. For
example, you have to sign your name on the
operation record and handover sheet. It scares
“Since I am a RN, I have to be responsible for
the patients, relatives, and the whole ward.
“Patients and their relatives are not concerned
whether or not you are a fresh graduate. When
they see you, they expect that you are a pro-
fessional nurse who can perform professionally.
This kind of stress is much greater than when
I was a student nurse. The variance of others’
expectations on me is very large.
“When I was a student nurse, every step was su-
pervised and someone would correct me when I
Published by Sciedu Press 33 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
was about to make a mistake. Now that I have a
licence, I have to work independently.
“When I am the team in-charge for PM and AM
shifts, I cannot get to sleep after the PM shift.”
3.6 Working atmosphere
Most of the participants established a good working relation-
ship with their colleagues because they were supportive and
helpful, and only a few of them were not willing to provide
assistance. Good relationships with colleagues enhanced
their sense of belonging, facilitated their self-development in
the ward, and affected their motivation and clinical perfor-
mance. However, they also feel disheartened due to being the
subject of rumours and for being blamed during handover,
which is a common situation in the ward.
“If everyone is willing to work as a team, the at-
mosphere in the ward will improve. I will raise
enquiries with other junior colleagues.”
“Relationships and communication among col-
leagues are good. We help each other when
“We conduct regular gatherings to maintain a
harmonious relationship among colleagues.”
“Senior staff members are quite mean. They
even scold me for minor mistakes.
“My ward has a good working atmosphere. My
colleagues are helpful and the atmosphere is
better than others I have experienced.
“Relationships among colleagues are good as the
age gap of staff is comparatively large. We had
three fresh graduates this year. All colleagues
treat us as their children. Less gossip happens
3.7 Support
Various supportive programmes were offered to the respon-
dents, such as pre-RN training programme, orientation pro-
gramme, mentorship programme, and peer support pro-
gramme. However, this kind of support varies across hospi-
tals. The pre-RN training and orientation programmes were
highly effective and useful for work adaptation because dif-
ferent clusters had different protocols. These programmes
provide basic nursing skill revision and impart advanced
skills, such as resuscitation. About half of the participants
believed that these mentorship or preceptorship programmes
are ineffective because the assigned mentors’ duty usually
differs from theirs, yet some felt empowered. They were
frightened and felt helpless at the beginning. Thus, they pre-
ferred to work with their mentor in the same shift. One of
the participants mentioned that the hospital provided a peer
support programme, which aims to provide psychological
support to freshmen. However, this programme was not use-
ful because he or she cannot disclose his or her feelings to a
“The mentor only approached me once. She
taught me nothing special.”
“The assigned mentor is not on the same duty
shift as me every shift. I felt confused in the
initial month.”
“These kinds of support helped me with about
30%. In other words, I needed to learn 70% by
“There are supporting resources, but they are
insufficient for me.
“My mentor is responsible and helpful. She or
he taught me a lot.”
“There is a lack of support for junior staff as
there are 3 to 4 new staff, which is difficult for
seniors to handle.”
“The support provided is fair because the men-
tor only audited me once and there were lots of
emergency cases which were difficult to handle
by myself.”
“Our department is running a preceptorship pro-
gramme. A senior RN was assigned to each new
graduate and the ward manager will try her best
to arrange the preceptor to work with me in the
same shift. It is good for me to integrate into
their circle faster and the preceptor would teach
me skills.”
3.8 Blame/complaint culture
Five participants mentioned that a blame/complaint culture
is common in their workplace. This culture stems from se-
nior staff, patients and relatives. The participants hesitated
to ask their seniors regarding uncertainties due to their low
self-confidence and anxiety that they would be criticised
for their insufficient knowledge. Several participants expe-
rienced being criticised by their seniors after committing
minor mistakes. They did not do anything wrong and these
so-called mistakes were merely discrepancies in individual
“I dare to speak with junior nurses, but not se-
nior ones.”
The complaint culture in hospitals caused them stress be-
cause the patients and their relatives have high expectations
of high-quality care, but they have to bear a heavy workload
34 ISSN 1925-4040 E-ISSN 1925-4059 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
with insufficient manpower and time. Most of the patients
want to be prioritized for treatment, but resources are lim-
ited despite exerting their best efforts. They would complain
when the nurses fail to fulfil the patients or relatives’ requests.
Thus, one of the participants mentioned that the hospital’s
consideration of patient feedback induced additional stress.
“The patients thought that we were too slow in
providing investigations and kept criticising us,
but we had already done what we could.
“When the relatives are unsatisfied with our
work, they complain outright.
“I am afraid of complaints. The complaint cul-
ture in Hong Kong is so.. . However, their ac-
tions were understandable. They were just con-
cerned about their family members. We could
not blame them.”
“I encountered a patient who told me that he or
she would complain about me if I do not smile.
The complaint culture is very serious.
“I need to be careful when answering relatives’
questions. If I say something wrong, they might
grasp that point, magnify it, and complain.”
3.9 Personal attitude
The participants were optimistic about learning and chal-
lenges. They learn by consistently searching on the Internet,
reading books, or seeking help from colleagues or seniors if
they encounter uncertainties. Some of the participants attend
courses during their personal time because they believe that
such approach will aid their career. The participants were
stressed at the beginning after graduation, but the pressure
motivated them to read and learn more, which was good
for them in terms of personal growth and self-development.
They accepted the mistakes they made and are willing to
learn from mistakes instead of avoiding the same situation be-
cause they believe that practice makes perfect and enhances
“I mark down the query and search for it on the
Internet at home. Stress has a positive impact
on me because it empowers me and motivates
me to learn more.”
“No matter which school I have come from, I be-
lieve my performance will prove my capability.
I try my very best to work hard and learn more.
“Challenge is unavoidable and we should not es-
cape it. I think we have to learn how to face and
overcome it. We have to further equip ourselves
to perform better.
As a RN, you cannot escape when you en-
counter difficulties. You may escape once, but
you probably cannot escape twice. You have to
face it positively.
Although there is a gap between theory and
practice, we may need to modify some proce-
dures. I think that to stick to the principle of “do
no harm to the patients” is the most important
The eight challenges influence one another. The personal
attitude of fresh graduates plays an important role in over-
coming these hurdles. Among these eight challenges, heavy
workload is the most challenging for fresh nursing gradu-
ates which is in line with O’Shea and Kelly
and Parker,
Giles, Lantry, and McMillan.
One of the reasons for the
heavy workload is the high ratio of nurses to patients and
insufficient labour in the ward. Tsang
indicated that the in-
ternational standard of the nurse to patient ratio is 1:6, but the
nurse to patient ratio in public hospitals in Hong Kong is two
to four times higher. Although the participants were working
in different clinical contexts, heavy workload is observed in
both acute and subacute settings. This finding contradicts
Parker et al.,
who indicated that nurses working in gen-
eral medical or surgical wards have a high workload. Heavy
workload is a critical problem in nursing around the world.
Nurses need to work as case nurses for 12 patients every shift,
provide nursing care, manage sudden issues, interview pa-
tients and families and handle administrative work. However,
for a fresh graduate, this is a catastrophic challenge because
they also need to adapt to the new working environment and
new role. As a result, it induces stress and affects the quality
of care and their resting time.
Fresh nursing graduates in previous and current studies re-
ported that knowledge and skills learned from school are
useful but insufficient.
As a result, they lack confi-
dence when working independently, especially in managing
emergency situations due to lack of prior experience. The
school adopted simulation training, but it can only provide
basic generic and discipline knowledge and nearly 1,500
clinical hours in a five-year course programme. Thus, many
limitations in the clinical practice hinder student learning.
For instance, numerous tasks cannot be accomplished, the
clinical management system cannot be accessed, and commu-
nication with doctors, allied health colleagues, and patients’
families is difficult. These challenges explain why fresh
graduates lack confidence in coping with complex authentic
clinical settings. Hence, enabling them to overcome this
transition is paramount. Orientation, preceptorship, and men-
Published by Sciedu Press 35 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
torship programmes can help nursing graduates increase their
job satisfaction and improve their confidence in taking care
of patients and coping with stress.
[5, 19–21]
However, in Hong
Kong, support varies from one hospital to another and from
a particular department to a different one, even though all
of them are working under public hospitals governed by the
same authority. For instance, only a few participants could
work with their mentors in the same shift. This situation
sheds light on the adequacy and appropriateness of training
for fresh graduates and it gives some insights for the hospital
administrators that a standardized training protocol with a
checklist including daily ward operation, cardio-pulmonary
resuscitation (CPR) drill, duty handover, doctor rounds and
psychological support for new nursing graduates may be
Communication is important in the nursing profession be-
cause nurses need to collaborate with ward staff, allied health
professionals, and doctors. Nurses should deal with patients
and their relatives. However, it is difficult for fresh nursing
graduates to communicate with doctors, senior nurses, pa-
tients, and relatives. This finding is consistent with Casey
et al.,
Parker et al.
and Suresh et al.
They are hesi-
tant to speak up because they have less prior experience of
communication with others except nurses when they were
student nurses. In addition, the superior–inferior relationship
with doctors and senior nurses and the blame and complaint
culture in hospitals also obstruct effective communication.
Law and Chan
and this study found that
fresh nursing graduates have high expectations from them-
selves and others as they are expected to take up their new
role and adapt to a new environment in a short period of time.
Expectations cause an increased level of anxiety as they
worry about being gossiped about or criticised by colleagues
which echoes Kelly & Ahern,
and Teoh, Pua &
Furthermore, a complaint culture is common in the
workplace, which is particularly serious in public organisa-
tions because of the discrepancy between the patient/family’s
expectations of service and the service provided. The exces-
sive healthcare service demand and shortage of labour further
overloads the psychological burden of fresh graduates.
Fresh graduates report several challenges, but no participant
in this study had attempted to resign. They were eager to cope
with the challenges instead of quitting their job. This phe-
nomenon may relate to the participants’ optimism and strong
resilience, which shows that the half-year post-graduation ex-
perience will not provoke negative thoughts. The respondents
possessed a positive thinking and learning attitude. For in-
stance, they utilize different methods to learn by themselves
to ease their work and enhance their knowledge. Besides,
they view the situation from the perspectives of different
stakeholders and do their best to improve their communica-
tion skills with others. Therefore, a positive personal attitude
may contribute to their perseverance.
A few limitations existed in this study. First, given that all the
participants pursued the same bachelor nursing programme,
it may not represent all the fresh nursing graduates as there
are around 600 nursing graduates in the same year. Second,
transitional period refers to the first 12 months after gradua-
tion, and these eight graduates were interviewed at the 6th
month after graduation, so follow-up research is suggested
to explore any changes throughout the transitional period
instead. Third, the results revealed that coincidently all these
eight participants’ attitude are positive but it is uncertain if
this is the case across the population.
To facilitate the transition from a student nurse to a registered
nurse and further reduce the turnover rate in the nursing pro-
fession, the results showed that higher education institutes,
hospital administrators, and fresh graduates have responsi-
bilities to facilitate the changes. The shortage of labour in
the nursing profession is a common challenge all over the
world and it probably cannot be solved in a short time. So
how the academics and hospital administrators can help fresh
graduates? A few recommendations have been drawn from
this study’s results as follows. First, academics may con-
sider adding the completion of Basic Life Support (BLS),
venepuncture, and blood extraction courses as mandatory
requirements for graduation. Second, the existing simulation
training may need to be reviewed and enhanced. Third, hospi-
tal administrators are suggested to devise a standardized pre-
RN training programme for all the hospitals which should
include daily ward operation, CPR drill, CMS, IPMOE, elec-
trocardiography and duty handover training. Fourth, the roles
and responsibilities of mentors/preceptors is also suggested
to be devised, a learning contract can be employed to facil-
itate the mentors/preceptors and graduates to set goals and
objectives together which can provide a clear direction to
both parties. Thus, mentors/preceptors can easily monitor
the graduates’ learning process. Lastly, responsible hospital
administrators may meet the graduates regularly to provide a
platform to understand more about their needs and concerns.
As a result, the responsible hospital administrators may pro-
vide inputs in the meetings with academics for programme
enhancement. This mechanism is able to form a cycle with
continuous improvement of nursing programmes as well as
clinical supports for the fresh nursing graduates.
The author declares that there is no conflict of interest.
36 ISSN 1925-4040 E-ISSN 1925-4059 Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
Philips C, Kenny A, Esterman A, et al. A secondary data analysis
examing the needs of graduate nurses iin their transition to a new role.
Nurse Education Practice. 2014; 14(2): 106-111. PMid:23932667
Duchscher J. Transition shock: the initial stage of role adaptation for
newly graduated Registered Nurses. Journal of Advanced Nursing.
2008; 1103-1113 p.
Parker V, Giles M, Lantry G, et al. New graduate nurses’ experi-
ences in their first year of practice. Nurse Education Today. 2014;
34(1): 150-156. PMid:22857819
Salt J, Cummings G, Profetto-McGrath J. Increasing retention of new
graduate nurses: A systematic review of interventions by healthcare
organisations. The Journal of Nursing Administration. 2008; 287-296.
Tsang L, Sham S, Law S, et al. ToUCH Program on competence,
occupational stress and self-efficacy of newly graduated registered
nurses in United Christian Hospital: A mixed method research study.
Journal of Nursing Education and Practice. 2016; 6(8): 129-137.
O’Shea M, Kelly B. The lived experiences of newly qualified nurses
on clinical placement during the first six months following registra-
tion in the Republic of Ireland. Journal of Clinical Nursing. 2007;
16(8): 1534-1542. PMid:17655542
Lea J, Cruickshank M. Supporting new graduate nurses making the
transition to rural nursing practice: Views from experienced rural
nurses. Journal of Clinical Nursing. 2015; 24(19-20): 2826-2834.
Suresh P, Matthews A, Coyne I. Stress and stressors in the clinical
environment: A comparative study of fourth-year student nurses and
newly qualified general nurses in Ireland. Journal of Clinical Nursing.
2013; 22(5-6): 770-779. PMid:22931367
Kelly J, Ahern K. Preparing nurses for practice: A phenomenological
study of new graduate in Australia. Journal of Clinical Nursing. 2009;
18(6): 910-918. PMid:18665878
Chandler G. Succeeding in the first year of practice: Heed the wisdom
of novice. Journal for Nurses in Staff Development. 2012; 28(3): 103-
107. PMid:22617780
Law B, Chan E. The experience of learning to speak up: A nar-
rative inquiry on newly graduated registered nurses. Journal of
Clinical Nursing. 2015; 24(13-14): 1837-1848. PMid:25753769
Casey K, Fink R, Krugman A, et al. The graduate nurse experi-
ence. Journal of Nursing Administration. 2004; 34(6): 303-311.
Ebrahimi H, Hassankhani H, Negarandeh R, et al. Barriers to sup-
port for new graduated nurses in clinical settings: A qualitative
study. Nurse Education Today. 2016; 37: 184-188. PMid:26611573
Feng R, Tsai Y. Socialisation of new graduate nurses to practising
nurses. Journal of Clinical Nursing. 2012; 21(13-14): 2064-2071.
Malouf N, West S. Fitting in: A pervasive new graduate nurse need.
Nurse Education Today. 2011; 31(5): 488-493. PMid:21036429
Qiao G, Li S, Hu J. Stress, coping, and psychological well-being
among new. Home Health Care Management & Practice. 2011; 23(6):
St Clair M. New graduate nurses’ experiences of transition during
orientation into. Theses and Dissertations. 2013; 1-163 p.
Zinsmeister L, Schafer D. The exploration of the lived experience of
the graduate nurse making the transition to registered nurse during
the first year of practice. Journal for Nurses in Professional Develop-
ment. 2009; 25(1): 28-34. PMid:19182555
Beecroft P, Santner S, Lacy M, et al. New graduate nurses’ per-
ceptions of mentoring: Six-year programme evaluation. Journal of
Advanced Nursing. 2006; 55(6): 736-747. PMid:16925622
Dyess S, Sherman R. The first year of practice: New graduate
nurses’ transition and learning needs. The Journal of Continu-
ing Education in Nursing. 2009; 40(9): 403-410. PMid:19754027 03
Scott E, Engelke M, Swanson M. New graduate nurse transitioning:
Necessary or nice? Applied Nursing Research. 2008; 21(2): 75-83.
Morales E. Lived experience of Hispanic new graduate nurses–a qual-
itative study. Journal of Clinical Nursing. 2014; 23(9-10): 1292-1299.
Teoh Y, Pua L, Chan M. Lost in transition—a review of qualita-
tive literature of newly qualified Registered Nurses’ experiences in
their transition to practice journey. Nurse Education Today. 2013;
33(2): 143-147. PMid:23040878
Published by Sciedu Press 37
... These difficulties can impede the integration and functioning of NGNs within the healthcare team. The challenges faced by NGNs during this transition period can be multifaceted and demanding [3,7]. ...
... In their qualitative study on the transition challenges of fresh nursing graduates, it was found that the presence of supportive mentors and preceptorship programmes facilitated the integration process [7]. This finding aligns with our subtheme on the positive role of trainers in the work environment, with participants highlighting the importance of having experienced supervisors who guided them, answered their questions, and provided continuous support. ...
... This theme included three subthemes: difficulty dealing with the health system and devices in a work environment; fear of dealing with new patients; and difficulty applying policies and procedures in the workplace. These findings are consistent with previous research, which highlighted the challenges encountered by newly graduated nurses during their transition period [3,4,7]. Furthermore, the lack of awareness of work policies is one of the reasons for conflict between nurses in general [23]. ...
Full-text available
Abstract: The present study aimed to explore the experiences of newly graduated nurses during their first year of practise. A qualitative descriptive design was employed in this study. In-depth, semi- structured interviews were conducted with newly graduated nurses to gather detailed descriptions and experiences during their transition to the workplace in the first year after graduation. Thematic analysis was utilised to identify patterns and themes in the collected data. Ethical considerations were strictly enforced throughout the study. There are two main themes: factors contributing to the integration of new nurses into the workplace and the difficulties faced by new nurses in a work environment. Within the first theme, three subthemes emerged: the positive role of trainers, the gradual handling of patients, and the benefit of pre-employment training and volunteering. The theme of difficulties faced included three subthemes: difficulty dealing with the health system and devices, fear of dealing with new patients, and difficulty applying policies and procedures in the workplace. The study provides insights into the challenges faced by newly graduated nurses and the factors that contribute to their integration into practise settings. Educational departments in hospitals’ support and efficient access to policies are crucial for these nurses as they begin their early professional years.
... Understanding how to optimize the workforce and prepare novice nurses for health care delivery is increasingly important. (1) Novice nurses face a critical role transition process through their first months on the job. (2) Role transition is defined as the process of moving from one state to another, which is usually associated with significant changes in goals, roles, and responsibilities. ...
... The role transition process is difficult and full of stress and challenges for novice nurses where their knowledge and skills are insufficient to handle routine work, feelings of anxiety related to fears of incompetence, and communication difficulties are also faced. (1) These problems increase nurses' turnover rate due to lack of necessary knowledge, experience, and confidence to work in clinical settings and the end result of ineffective transition management is inferior nursing care and negative patient outcomes. (4) The novice nurse leaves the comfort zone as a new graduate to enter an advanced practice role which is accompanied by associated stress, anxiety, isolation, inadequacy and role ambiguity, commonly leading to feelings of incompetence. ...
... Role transition into practice programs that are offered for novice nurses help them to adopt appropriate attitudes and approaches to practice, care for patients independently, seek role models, and adapt to workload. (1) Moreover, it develops their confidence, knowledge, skills regarding good communication, proper documentation and clinical competencies, possessing critical and analytical thinking skills to independently ensure appropriate decision-making with advanced problem solving. (9) Transition program focused mainly on six dimensions namely: communication skills, documentation practices, clinical reasoning skills, evidencebased practice, legal issues in nursing practices and ethical nursing practices. ...
... The transition into an initial role as a practising midwife can be exciting for some newly qualified nurse-midwives and overwhelming for others [1,2]. Evidence reveals that the transition to practice for many newly qualified nurse-midwives is characterised by learning and adapting to a new role, a change of identity, taking on new responsibilities and independence to practice [3,4]. In most cases, the transition period usually lasts from 12 to 18 months, with the first six months being used for orientation and adjusting to the new environment [5,6]. ...
... Another finding in this study that affected proper support for the newly qualified nurse-midwives was heavy workloads. The heavy workload increased the stress levels of newly qualified nurse-midwives, which is similar to the findings from other studies [4,18,33]. Shortage of staff and heavy workload have an implication on midwifery leaders' ability need to increase the workforce in Malawian hospitals considering that it is one of the contributing factors to the provision of low quality patient care, burnout and high staff turnovers [37][38][39][40]. Although in this study graduates had no intention of leaving the profession, feelings of increased stress and decreased morale were high, which may lead to midwives' attrition in the three hospitals. ...
... Similarly, Tembo et al. (2019) recruited newly qualified registered midwives who complained of negative attitudes by older midwives. Literature shows that poor professional relationships impact new midwives' confidence and clinical performance negatively [4]. However, support from midwives in a clinical setting has proved to create a conducive environment where newly qualified nurse-midwives feel secure and confident and their clinical performance is enhanced [4,16]. ...
Full-text available
Background Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi. Methodology A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview guides; one for the newly qualified nurse-midwives and another one for the key informants. The interview guides had questions related to newly qualified nurse-midwives experiences of transitioning to practice and the support they received. Participants were from three selected hospitals in the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis. Findings Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practice in midwifery units emerged from the thematic analysis of the data. These included (1) Theory—practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict. Conclusion Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from education to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.
... This finding is similar to the results of previous studies (Barreto et al., 2021;Sveinbjarnardottir et al., 2011;Hsiao & Tsai, 2015) which indicated that clinically experienced psychiatric nurses are more likely to value engaging with families than newly qualified nurses. This finding may be explained by the fact that Hong Kong allocates less experienced nurses to front line tasks due to a very hierarchical structure (Wong et al., 2018). They are therefore less likely to recognize the importance of including families due to a lack of confidence that results in focusing on physical care tasks, technical skills, team relationships and the safety of the patient (Gusdal et al., 2017). ...
... In these circumstances the family may be seen as a barrier to finishing the job. Whereas, more senior staff need to be a leadership role to drive nursing practice forward to improve quality of services (Wong et al., 2018). The regression model also revealed that gender was statistically significantly associated with overall attitudes towards family involvement, with female nurses reporting more positive attitudes than male nurses. ...
Unlabelled: WHAT IS KNOWN ON THE SUBJECT?: Family-involved interventions can result in better outcomes than traditional mental health care for both service users and their families. Nurses' attitudes towards family involvement can affect family participation in care. Earlier studies on psychiatric nurses' attitudes towards family involvement in care report ambiguous findings. Hong Kong's unique integrated cultures may influence Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The majority of psychiatric nurses had positive views on family involvement in care in Hong Kong. Four variables (i.e. gender, clinical experience, nature of working unit and family nursing training) of psychiatric nurses are associated with their attitudes towards family involvement in care in Hong Kong. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Policy makers should develop strategies to increase psychiatric nurses' awareness of the importance of family involvement in patient care. Nurse educators help to design family nursing training to enhance psychiatric nurses' competence in collaborating with families of people suffering from mental disorders. Abstract: INTRODUCTION: In Hong Kong, involving the family in nursing care is still optional and mainly depends on nurses' attitudes and the willingness of the family. Hong Kong psychiatric nurses' attitudes towards family involvement in nursing care may be influenced by the unique integrated Eastern and Western cultures, however earlier studies report ambiguous findings. Aims: This study aimed to assess Hong Kong psychiatric registered nurses' attitudes towards family involvement in care and its associated factors. Methods: This study is a cross-sectional descriptive online survey with convenience sampling based on the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument. Results: Most of the psychiatric nurses had supportive attitudes towards family involvement in care. Females with more clinical experience, working in a rehabilitation-related unit and having attended a family nursing education course were associated with positive attitudes towards family involvement in care. Discussion: The supportive attitude of psychiatric nurses may be explained by the shift of mental health nursing care from hospital care to community care in recent decades. Implications for practice: Mental health nurse education and training in Hong Kong could place more emphasis on building family work skills, particularly for newly qualified nurses and those working in acute inpatient settings.
... Examining nursing students' evaluations of practice learning environments against the states of relatedness and processes or social competences within the theory of human relatedness may capture important information regarding the quality of their learning experiences in these settings and how well different placements have helped them develop the knowledge, skills and professional values expected of a Registered Nurse. International concerns have been expressed regarding retention on pre-registration nursing programs (Cust, 2020;Parry, 2021;Petit dit Dariel et al., 2014) and within the newly qualified nurse population (Buchan et al., 2018;Flott & Linden, 2016;Wong et al., 2018). Providing more detailed pre-placement preparation for nursing students/practicum staff, addressing the states of relatedness and processes or social competences identified in the theory of human relatedness within current pre-registration nursing curricula, and assessing placements in terms of their potential to promote positive relatedness as described in this theory may help address such retention problems. ...
Full-text available
The purpose of this study was to establish whether application of the four states of relatedness (connectedness, disconnectedness, enmeshment, and parallelism) and four processes or social competencies (belonging, reciprocity, mutuality, and synchrony) within the theory of human relatedness may have relevance and transferability to the practicum experiences of an international nursing student population. Secondary data transcriptions derived from focus groups involving 20 final-year pre-registration nursing undergraduates at an academic institution in Hong Kong which directly examined their placement reflections and views were analyzed against the states of relatedness and process or social competences identified within this theory. Data from the study provided evidence to support every state of relatedness and process or social competency within the theory of human relatedness. Evaluating pre-registration nursing student placement experiences against this theory suggests that improving a practicum may necessitate creating conditions for workplace learning which more effectively foster connectedness, belonging, reciprocity, mutuality, and synchrony, minimize the need for parallelism and help prevent disconnectedness and enmeshment.
... Transition shock, feeling pressured, learning excitement, and needing support were also the emerging themes in the transition experiences reported in a qualitative study among new graduate Filipino nurses (Labrague, McEnroe-Pettite, & Leocadio, 2019). Other studies conducted in other countries among new graduate nurses in the United States (Fink, Krugman, Casey, & Goode, 2008); New Zealand (Walton et al., 2018), Australia (Kelly & Ahern, 2009;Ankers, Barton, & Parry, 2018), Hongkong (Wong et al., 2018), and Oman (Al Awaisi, Cooke, & Pryjmachuk, 2015) reported similar themes about transition difficulties and positive experiences in the first year of practice. Hussein et al. (2017) cited that new graduate nurses experience stress in the first year of practice as they strive to "fit in" and apply newly acquired skills. ...
Recruitment and hiring of new graduate nurses is seen as a potential strategy to mitigate the problem of nurse shortage. However, previous studies disclosed that new graduate nurses are inadequately prepared to enter practice and experience transition difficulties. This study aimed to determine the perceived competence and transition experience of new graduate Filipino nurses. Seventy-nine conveniently chosen new graduate nurses were surveyed in this descriptive cross-sectional research. Self-administered instruments were used to gather data. Descriptive statistics, Mann–Whitney U test, and Kruskal–Wallis test were the statistical tools employed. Results indicated that new graduate nurses had a high level of self-reported fundamental nursing skills (M= 7.99) and core competence (M= 8.16), although areas needing improvement were identified. There were no significant differences in the perceived competence based on the length of experience, year graduated, area of assignment, sex, type of school graduated, CPD participation, and hospital bed capacity (p> .05). The major difficulty experienced by new graduates during their transition was related to changes in role expectations (72.2%). Majority expressed the need for increased support during their transition (83.5%). The most satisfying aspects of their working environment were ongoing learning (81%) and peer support (74.7%), while the least satisfying was the negative nursing work environment (55.7%). New graduate nurses are equipped with the necessary nursing skills and core competencies. However, there are still gaps and areas needing improvement that should be addressed and supported to assist them in their transition to the world of professional nursing practice. Follow up, feedback, mentoring, and preceptorship are beneficial to enhance the competencies of new graduate nurses and facilitate their successful transition into the nursing workforce. AbstrakPersepsi Kompetensi dan Pengalaman Transisi Perawat Lulusan Baru Filipina. Rekrutmen dan perekrutan perawat lulusan baru dipandang sebagai strategi potensial untuk mengurangi masalah kekurangan perawat. Namun, penelitian sebelumnya mengungkapkan bahwa perawat lulusan baru tidak cukup siap untuk memasuki praktik dan mengalami kesulitan transisi. Penelitian ini bertujuan untuk menentukan persepsi kompetensi dan pengalaman transisi perawat lulusan baru Filipina. Tujuh puluh sembilan perawat lulusan baru yang dipilih dengan mudah disurvei dalam penelitian cross-sectional deskriptif ini. Instrumen yang dikelola sendiri digunakan untuk mengumpulkan data. Statistik deskriptif, uji Mann-Whitney U, dan uji Kruskal-Wallis adalah alat statistik yang digunakan. Hasil menunjukkan bahwa perawat lulusan baru memiliki tingkat tinggi keterampilan keperawatan fundamental yang dilaporkan sendiri (M= 7,99) dan kompetensi inti (M= 8,16), meskipun bidang yang perlu perbaikan diidentifikasi. Tidak ada perbedaan signifikan dalam kompetensi yang dirasakan berdasarkan lama pengalaman, tahun lulus, bidang tugas, jenis kelamin, jenis sekolah yang lulus, partisipasi CPD, dan kapasitas tempat tidur rumah sakit (p> 0,05). Kesulitan utama yang dialami oleh lulusan baru selama transisi mereka terkait dengan perubahan dalam ekspektasi peran (72,2%). Mayoritas menyatakan perlunya peningkatan dukungan selama masa transisi mereka (83,5%). Aspek yang paling memuaskan dari lingkungan kerja mereka adalah pembelajaran berkelanjutan (81%) dan dukungan sebaya (74,7%), sedangkan yang paling tidak memuaskan adalah lingkungan kerja keperawatan negatif (55,7%). Perawat lulusan baru dilengkapi dengan keterampilan keperawatan dan kompetensi inti yang diperlukan. Namun, masih ada kesenjangan dan bidang yang perlu diperbaiki yang harus ditangani dan didukung untuk membantu mereka dalam transisi mereka ke dunia praktik keperawatan profesional. Tindak lanjut, umpan balik, pendampingan, dan pelatihan guru bermanfaat untuk meningkatkan kompetensi perawat lulusan baru dan memfasilitasi keberhasilan transisi mereka menjadi tenaga kerja keperawatan.Kata kunci: penilaian kompetensi, perawat lulusan baru, keterampilan keperawatan, pengalaman transisi
... Perawat baru memandang ekspektasi tersebut sebagai tantangan yang memengaruhi mereka dalam menjalani praktek klinis. Ekspektasi kerja yang muncul dalam diri perawat baru, meliputi: adanya tuntutan bahwa perawat baru harus memiliki menajemen waktu yang baik karena harus menyelesaikan tugas mereka sebelum waktunya, serta adanya keinginan untuk dapat bekerja secara mandiri dan kompeten karena mereka tidak ingin mengecewakan rekan kerja (10). ...
Full-text available
Perawat baru sering merasa frustasi karena beberapa konflik terkait perubahan peran saat menjadi mahasiswa dan bekerja setelah lulus. Penelitian ini bertujuan untuk menganalisis pengaruh pelatihan pengembangan program preceptorship bagi preceptor terhadap ekspektasi kerja, lingkungan kerja, dan turnover intention perawat baru di Rumah Sakit X. Penelitian ini merupakan penelitian kuasi eksperimental dengan one group pre-test post-test, jumlah sampel sebanyak 23 responden yang ditentukan dengan menggunakan purposive sampling. Hasil penelitian menunjukkan karakteristik demografi perawat baru yaitu rata-rata usia 24,1 tahun, mayoritas berjenis kelamin perempuan (78,3%), dan seluruh responden memiliki tingkat pendidikan S1 Keperawatan Ners. Berdasarkan hasil analisis t-test menunjukkan terdapat peningkatan tingkat pengetahuan preceptor dari sebelum dibandingkan sesudah intervensi pelatihan pengembangan program preceptorship (p = 0,011). Berdasarkan hasil uji mann whitney menunjukkan terdapat perbedaan yang signifikan antara ekspektasi kerja (p = 0,001), lingkungan kerja (p = 0,011), dan turnover intention (p = 0,004) perawat baru sebelum dan sesudah intervensi pelatihan pengembangan program preceptorship pada preceptor. Hasil analisis secara simultan menunjukkan usia, jenis kelamin, tingkat pendidikan, dan pelatihan pengembangan program preceptorship berpengaruh terhadap ekspektasi kerja (p=0,041) dan lingkungan kerja (p=0,012) serta tidak berpengaruh terhadap turnover intention (p=0,650) perawat baru. Karakteristik perawat baru dan pelatihan pengembangan program precetorship, secara simultan bersama ekspektasi kerja dan lingkungan kerja, berpengaruh terhadap turnover intention perawat baru (p=0,037). Penelitian ini merekomendasikan institusi pelayanan rumah sakit diharapkan dapat menerapkan program preceptorship sebagai bentuk dukungan bagi perawat baru dengan memberi kesempatan bagi preceptor untuk lebih banyak waktu dinas bersama dengan perawat baru yang menjadi tanggung jawabnya terutama pada bulan pertama penugasan.
... The transition from student nurse to registered nurse is a critical step and can be fraught with many emotions ranging from excitement to fear and anxiety (Wong et al., 2018). The initial reaction of new graduate nurses to clinical practice has been described as reality shock (Kramer, 1975) and transition shock which has been seen as stemming from more idealistic than realistic expectations (Duchscher, 2009). ...
Aims and objectives: To evaluate the impact of the professional transition of new graduate nurses during the COVID-19 pandemic. Background: The transition from the role of student to the professional role can be challenging for new graduate nurses for the acquisition of higher autonomy and responsibility. The COVID-19 pandemic impacted the quality of the professional transition. Design: This was a cross-sectional observational study following the Strengthening and Reporting of Observational Studies in Epidemiology checklist. Methods: One hundred and two nurses who graduated in three consecutive sessions (November 2019-pre-pandemic, March 2020-pandemic outbreak, and November 2020-2nd wave) in a north Italian university located in the most affected Italian region by the COVID-19 pandemic, completed an online survey assessing well-being, risk of burnout, resilience, perceived stigma, strengths and limitations and quality of the professional transition. The study was performed between March and May 2021. Results: 81.4% of participants described the professional transition as worse than expected, and new graduate nurses who worked in COVID-19 settings reported a more difficult transition to professional life. No differences emerged in burnout, mental well-being and perceived stigma between new graduate nurses who worked in COVID-19 settings and those who did not. Similarly, no differences emerged amongst the three graduated cohort sessions. The most commonly mentioned challenges faced during the transition were organisational aspects, suddenly acquired autonomy and lack of suitable coaching. Conclusion: New graduate nurses reported a challenging academic-professional transition, in particular, those who worked in COVID-19 settings. The mid- and long-term impact of experiencing an academic-professional transition in COVID-19 settings should be assessed and monitored. Relevance to clinical practice: The professional transition of new graduate students should be adequately planned and monitored, new graduates should be assisted to develop realistic expectations about the transition, and an adequate coaching period should be guaranteed all the more during health emergencies.
Reflection is a strategy that may enhance transition into practice for the new graduate registered nurse (NGRN). If introduced in the early stages of practice, reflection can be used as a tool to continuously evaluate and improve practice. A theory synthesis of Meleis’ transition theory and Schon’s reflective practice model was developed to support reflection as a tool for new nurses transitioning into the role of professional nurses. Reflection has the potential to improve the NGRNs’ perception of their role, decrease feelings of disconnectedness, and improve patterns of response.
Full-text available
Background Newly qualified professional nurses (NQPNs) are ready to practice caring to patients immediately after the completion of training. Practising caring in nursing is the relationship between the patient and the care provider (NQPNs), and the caring involves alleviation of suffering. However, they experience a struggle in balancing between their role and intention to practice holistic caring. Aim The purpose of this study was to gain an understanding of the lived experiences of NQPNs who are practising caring at an academic hospital. Methods A qualitative, descriptive, exploratory and contextual research design was used (Martínez-Linares, Parra-Sáez, Tello-Liébana & López-Entrambasaguas 2019:3). Purposive sampling was done of NQPNs (R425 of 15 February 1985). Data collection entailed in-depth phenomenological interviews, observations and field notes. Giorgi’s method of analysing data was used, and the ethical principles of autonomy, non-maleficence, beneficence and justice were valued. Results Three themes were identified from the results of the study. Participants experienced their practice of caring as a struggle to balance all their responsibilities and their intention to provide holistic care. Participants also experienced having to face overwhelming expectations from different groups in the hospital. Conclusions Finally, participants experienced new coping mechanisms to deal with challenging situations. It was thus described and explored that practising caring is an imperative role of NQPNs.
Full-text available
Introduction: Despite the structural concept and framework of the preceptorship program developed by Hospital Authority could facilitate the transitional period amongst preceptees, during implementation, the content of the program solely emphasizes on the skill and knowledge and the aspect of psycho-social support is being neglected. Objectives: The aims of this study were to facilitate smooth psycho-social and professional reality integration for first-year preceptees during the transition to Registered Nurses in UCH, to foster a caring culture for newly graduated RN and to promote a sense of belonging and commitment to ToUCH. Method: The ToUCH program entails 3-domain of integrations and 6-stage of themes. A mixed method research study was conducted between 11th August 2014 and 16th July 2015. Three validated questionnaires were adapted to assess preceptees' competencies, stress level, and coping ability respectively along their employment of first year. Result: All newly graduated registered nurses in August 2014 (n=98) with majority of female (71.4%) were invited to participate in the study. Using a ANOVA test to compare the difference of measuring outcomes at baseline and other 4 measuring points after program commencement, there was a significant increase in overall mean clinical competence [F (4, 473) = 13.53, p < .0001). The overall mean OSSNN was significant improvement [F (4, 471) = 8.5, p < .0001]. It was found that new graduates had a significant improvement in goal-setting, effort investment, persistence when encountering barriers and recovery from setbacks [F (3, 371) = 7.77, p < .0001]. When comparing the 2013 preceptee’s resignation rate, the 2014 preceptee’s resignation rate has prominently proved the ToUCH program more effective to increase retention. It was found that the rate of resignation due to work stress was sharply decreasing from 5 to 1 out of 85 and 101 preceptees 2013 and 2014 respectively. Conclusion: This one-year ToUCH program can increase preceptees’ confidence in providing patient care, cope with stress more effectively as well as return quickly to state of mind after suffering stress. Based on the findings, increased skill competencies and improved stress level suggest that the ToUCH program enriches bonding, promotes sense of belonging and maintains a high retention rate of new graduates.
Full-text available
This study examined the relationships between demographic characteristics, sources of nursing stress and coping strategies, and psychological well-being within graduate nurses. Moving from the student role to the staff nurse role can be an uneasy journey, transition is recognized as a stressful experience, and many graduate nurses find it difficult to cope with their new roles in their first few months. Four self-report questionnaires were administered to a sample of 96 new graduate nurses in central China. Death and dying, workload, and inadequate preparation were the most common sources of nursing stress, whereas the most frequently used coping strategies were planning, acceptance, and positive reframing. A number of significant correlations were found among demographic characteristics, sources of nursing stress, coping strategies, and psychological well-being. Negative predictors of psychological well-being were denial (coping strategies) and death and dying (workplace stressor). Role transition is often difficult when an individual comes to a new environment and is given new responsibilities and expectations. Although this transition is stressful and they feel inadequately prepared, with assistance, the new graduate nurses can develop effective coping strategies to adjust to the new role.
Full-text available
The transition from student to nurse has been described as traumatic, confusing, and shocking. The difficulties encountered by the graduates have led to the premature termination of their first position, and sometimes they leave nursing altogether. To coach new nurses in preparation for their first year of practice using an appreciative inquiry framework, this study focused on the new graduates' perspective of the processes that enabled them to successfully integrate into their new role. From the analysis of 36 interviews, three themes were identified: "They were there for me," "There are no stupid questions," and "Nurturing the seeds." New nurses know what works for them; educators need to heed their wisdom.
To present the findings from the experienced rural nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. There are specific and unique aspects of rural nursing practice that influence the nature and timing of support for new graduate nurses that have not been explored or acknowledged as influencing the new graduate nurses' experience of transition. Specifically, the difficulties and challenges that experienced rural nurses face in providing effective and timely support for new graduate nurses who are making the transition to rural nursing practice is yet to be explored. Using a qualitative case study framework, this study specifically aimed to investigate and describe the nature and timing of support required during the transition to nursing practice that is specific for the rural context and capacity. Individual in-depth interviews were conducted with 16 experienced rural nurses who, at the time of the study, worked with new graduate nurses in the rural practice environment. The findings from this study showed that the provision of timely on-ward support for new graduates making the transition to rural nursing practice is affected and influenced by the skill mix and staffing allocation within the rural environment. As well, there is a lack of awareness by rural nurses of how to meet the on-ward support needs of new graduate nurses. This study has identified the specific and unique aspects of the rural nurse's role and responsibilities for which the new graduate nurse requires incremental learning and intensive clinical support. The findings can be used by rural health services and experienced rural registered nurses to assist in implementing adequate and timely support for new graduate nurses. © 2015 John Wiley & Sons Ltd.
Aims and objectivesTo explore the process of learning to speak up in practice among newly graduated registered nurses.Background Speaking up is an important aspect of communication to ensure patient safety within a healthcare team. However, nurses have reported being hesitant about speaking up or being unable to be heard, despite adopting various safety tools. A power differential could be a factor in their hesitation to speak up. While a large number of new graduates are employed in the lower rungs of the hospital hierarchy to resolve local and global nursing shortages, the process of their learning to speak up remains under-explored.DesignThe narrative concept of experience is addressed through the three-dimensional space of a narrative inquiry.Methods Eighteen new graduates were recruited. Stories of experiences of speaking up emerged naturally during repeated unstructured interviews and ongoing email conversations with three participants.ResultsThe complex process of learning to speak up is schematically represented. Three interrelated narrative threads were identified: (1) learning to speak up requires more than one-off training and safety tools, (2) mentoring speaking up in the midst of educative and miseducative experiences and (3) making public spaces safe for telling secret stories.Conclusions Speaking up requires ongoing mentoring to see new possibilities for sustaining professional identities in the midst of miseducative experiences under the potential shaping of the Chinese culture and generational differences. Appreciative inquiry might be a new approach that can be used to promote positive cultural changes to encourage newly graduated registered nurses to learn to speak up to ensure patient safety.Relevance to clinical practiceCultivating a safe and open culture of communication and mentoring new graduates to speak up will benefit patient safety now and in the future by helping to retain committed patient advocates who could mentor future generations.
To seek understanding of lived experience from the voice of Hispanic new graduate nurses. Nurse educators and leaders have called for a more diverse nursing workforce while the body of the literature and knowledge about Hispanic registered nurses in the United States appears underdeveloped. A qualitative approach with a phenomenological methodology was used. A purposive sampling of Hispanic new graduate nurses (n = 7) completed a demographic questionnaire and semi-structured interviews. The study setting was within the Midwest and the south-west of the United States. There were seven general themes: (1) being an employee, (2) an orientation with or without preceptors, (3) a transition, (4) shadows of doubt, (5) being Hispanic, (6) being bilingual and being pulled, and (7) blessed. Hispanic new graduates would prefer Hispanic preceptors and anticipated that their first employment would be in a hospital setting. Hispanic new graduate nurses anticipate, desire and expect orientation programmes and preceptors in acute care and outpatient healthcare settings to aid in their transition from student to professional nurse. Hispanic new graduate nurses described an experience of transition typical of new graduate nurses in the United States, but with added dimensions such as cultural understandings and language proficiency with Spanish. Appropriate support and interventions for all new graduate nurses across multiple employment settings may retain a diverse nursing workforce appropriately positioned to serve vulnerable populations.
The failure of newly qualified Registered Nurses to be appropriately transitioned into the new practice has been mentioned in numerous nursing literatures. Along with the need to decrease turnover rates, increase satisfaction rate of nurses and improve patient outcomes, nursing educators in Singapore are interested in the experiences of these nurses in their transition to practice journey. In this paper, the author attempts to critically review qualitative research conducted in that area to identify why nurses are leaving the profession and how nursing educators in Singapore can reduce stress and uncertainty in the newly qualified Registered Nurses during their transition to practice journey. In conducting a qualitative literature review, the author aims to explore interpretation of these nurses' subjective experiences and description of their social context, ultimately paying attention to lay knowledge as human behaviour is context specific rather than being represented in the quantitative form.
Aims and objectives: To measure and compare the perceived levels of job-related stress and stressors of newly qualified nurses and fourth-year student nurses in the clinical environment and to explore the participants' views on stress and stressors. Background: Stress in the nursing workplace has significant consequences for the person, the patient and the organisation, such as psychological and physical health deterioration and impaired professional practice. To address this problem, stress and stressors need to be measured and identified. Design: This study used a cross-sectional survey design and self-reporting questionnaires to measure and compare levels of stress in both groups. Convenience sampling involved all newly qualified nurses (n = 120) and fourth-year student nurses (n = 128) in Dublin North-East region in Ireland. Methods: The instrument used was 'The Nursing Stress Scale' (Gray-Toft & Anderson 1981, Journal of Behavioral Assessment 3, 11-23). Descriptive, qualitative analysis was conducted on an open-ended question. Data were obtained from newly qualified nurses (n = 31) and fourth-year student nurses (n = 40) in six acute hospital sites. Results: Levels of perceived stress and stressors were high in both groups. Themes identified from the responses to the open question by both groups included excessive workload, difficult working relationships and unmet clinical learning needs. Student nurses also reported the combination of academic demands with clinical placement as a major stressor. There was no significant difference between each group. Conclusion: Stress continues to be a problem for nurses in the clinical setting. Excessive workload requires urgent attention by hospital managers in view of widespread retention difficulties. Themes identified could provide a framework for possible interventions for improving the clinical environment for nurses. Relevance to clinical practice: These results can help stakeholders in nurse education and practice to develop interventions to reduce stress for both groups and to ease the transition from student to graduate nurse.
The aim of this study was to explore the socialisation experiences of new graduate baccalaureate nurses to practising nurses. How nurses contend with the stress of their professional role has been of interest to both researchers and healthcare administrators over the past 30 years. Work stress of clinical nurses comes mainly from organisational and professional factors. However, few studies have explored the professional and organisational socialisation experiences of new graduate nurses. A qualitative descriptive approach was adopted. Participants were graduates of a baccalaureate nursing programme and employed full time at four medical centres in Taiwan, their first full-time work experience. Data were collected through semi-structured, open-ended, in-depth interviews, which were transcribed verbatim and analysed by content analysis. Three themes were identified: overwhelming chaos, learning by doing and being an insider. Although the professional socialisation process was hard for the new graduate nurses, they needed much time to increase their knowledge and clinical skills to fulfil clinical needs. However, the hardest work was the organisational socialisation process, which involved fitting into the bureaucratic system, such as maintaining interpersonal relationships with colleagues and familiarising themselves with the ward rules and culture. Neophyte nurse participants were also frustrated by the conflict between professional and organisational values. The study findings show that the transition from new graduate nurse to practising nurse was stressful for these participants, particularly due to the clash between the professional value of patient-oriented nursing care and the organisational value of task-oriented nursing. Senior clinical nurses can consider this study's descriptions of new graduate nurses' experiences to help them become insiders and provide quality care.