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All content in this area was uploaded by Julia S W Wong on Jan 03, 2018
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http://jnep.sciedupress.com Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
ORIGINAL RESEARCH
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: https://doi.org/10.5430/jnep.v8n6p30
ABSTRACT
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.
Key Words: Fresh nursing graduate, High turnover rate, Retention strategy, Transitional period, Challenges
1. INTRODUCTION
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;
[1]
however, the duration of adaptation varies
among individuals. According to Duchscher,
[2]
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.
[2–4]
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.
[5]
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: juliawong@twc.edu.hk; Address: Tung Wah College, Hong Kong.
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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-
ronment.
[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]
Another
study showed that the nurses working in general medical or
surgical wards have high stress levels due to heavy work-
loads.
[3]
A stressful working environment with inadequate
support from staff and human resource management are the
factors that trigger resignation.
[5]
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,
[12–18]
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
stress.
[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. METHOD
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.
(1)
What are the situations in terms of work-
load/working environment/relationship with col-
leagues/expectations/support/communication/clinical
knowledge or skills/confidence in your workplace?
(2)
What are the differences in terms of work-
load/working environment/relationship with col-
leagues/expectations/support/communication/clinical
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.
(1)
Are there other challenges that we have not discussed
that you would like to share with me?
(2)
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.
3. FINDINGS
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
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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
them.
“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
intensive.”
“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
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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
conflicts.”
“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
once.”
“Since I worked here for quite a long time be-
fore graduation, they expect me to know most
things.”
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
me.”
“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
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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
needed.”
“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
here.”
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
stranger.
“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
myself.”
“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
practice.
“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
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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
self-confidence.
“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
thing.”
4. DISCUSSION
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
[6]
and Parker,
Giles, Lantry, and McMillan.
[3]
One of the reasons for the
heavy workload is the high ratio of nurses to patients and
insufficient labour in the ward. Tsang
[5]
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.,
[3]
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.
[12–18]
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-
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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
needed.
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.,
[12]
Parker et al.
[3]
and Suresh et al.
[8]
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.
Chandler,
[10]
Law and Chan
[11]
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,
[9]
Morales
[22]
and Teoh, Pua &
Chan.
[23]
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.
Limitations
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.
5. CON CL US IO NS
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.
CON FLI CT S OF INTEREST DISCLOSURE
The author declares that there is no conflict of interest.
36 ISSN 1925-4040 E-ISSN 1925-4059
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2018, Vol. 8, No. 6
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Published by Sciedu Press 37
