Supporting new graduate registered nurse transition for safety: A literature review update

Evaluating the effectiveness of the education program developed for the empowerment of new graduate nurses: A randomized controlled trial

PURPOSE

To evaluate the effectiveness of the education program developed based on the structural empowerment (SE) and psychological empowerment (PE) theories and flipped classroom model for the empowerment of new graduate nurses (NGNs).

DESIGN

Single-center, parallel-group, randomized controlled trial.

METHODS

The study was conducted between June 2021 and September 2023 in two phases: developing the education program to empower NGNs and evaluating its effectiveness. An education program consisting of two parts, online and face-to-face, was developed. The online part consists of eight modules implemented for two weeks. The face-to-face part was implemented for two days and included the in-class activities. NGNs were randomly assigned to the intervention group (n: 32) and control group (n: 32). An education program was applied to the intervention group, whereas the control group continued their routine orientation program. A range of outcome measures of SE, PE, and education programs' effectiveness were evaluated. Data were analyzed using descriptive, chi-squared, and t-tests.

RESULTS

The study determined that the intervention and control groups showed homogeneous distribution in the pretest. A statistically significant difference was identified between the intervention and control groups regarding the mean scores of PE and SE three months following the implementation of the education program, and the total mean score of the intervention group was higher.

CONCLUSION

The education program developed to empower NGNs was a highly effective intervention in increasing nurses' perceptions of SE and PE. There is a need to carry out studies and activities to disseminate this program.

CLINICAL RELEVANCE

The findings of this study will guide educators, researchers, and administrators in future strategies and innovative programs for empowering NGNs.

Immersive solutions: South African community service nurses' perspectives on virtual reality potential in hypertension management

Introduction

With the rapid development of information technology globally and the scarcity of educators in higher education institutions, educational reforms are crucial to prepare students for an advancing and complex work environment. Virtual reality (VR) makes education widely available as it bridges the gap between students and educators, as educators and students enter an immersive world where educators can guide students.

Aim

The researchers' aim for this study was to explore community service nurses' (CSN's) experiences with a VR prototype when managing a hypertensive patient.

Method

The study comprised nine CSN with varied knowledge, skills, experiences, and who have been allocated to certain disciplines within a public hospital. The study was split into three phases: phase one, focus group and individual interviews were used to gain an understanding of the CSN's current knowledge and experiences regarding the assessment and implementation of nursing interventions used in the management of hypertensive patients. In the second phase, participants were exposed to the VR environment, where they were prompted by the programmed patient avatar to perform several nursing diagnostic procedures and interpret the clinical data provided in order to formulate a nursing diagnosis. During the third phase, the researchers conducted focus groups and individual interviews to acquire and comprehend the participants experiences regarding their interaction with the VR prototype and describe the benefits and drawbacks of the prototype they encountered.

Results

Constructive feedback and recommendations were provided by participants regarding the VR program's interactiveness and the accuracy of diagnostic tests. Participants claimed the experience was enjoyable, and based on the researchers' observations, the VR program stimulated critical thinking as well as clinical reasoning as intended. Their feedback was used to alter the VR prototype before the main study's commencement.

Mentors' and supervisors' perspectives regarding newly qualified nurses' practice in digitally enabled workplaces: A qualitative study

BACKGROUND

Contemporary healthcare environments are becoming increasingly reliant on digital health technologies, presenting new opportunities and challenges for the nursing profession and nurses across practice settings and roles. Little is known about newly qualified Canadian nurses' experiences as they transition from academic settings to digitally enabled healthcare workplaces.

OBJECTIVE

To explore (1) perceptions of nurse managers, clinical preceptors and educators regarding newly qualified nurses' practice with digital health, and (2) identify strategies to enhance new nurses' practice with digital health technologies as they transition to the workplace.

METHODS

A descriptive qualitative design was used. Fifteen participants representing nurse managers, clinical preceptors, and educators from two Canadian provinces participated in semi-structured interviews. Thematic analysis was applied to analyze the data.

RESULTS

Three themes were identified: 1) Onboarding upon joining the workplace, 2) Factors influencing new hires' practice with technology, and 3) Improving the transition experience to the workplace. Newly qualified nurses have strong digital skills and access to technology training; however, they also face challenges that affect their overall transition and practice. Having a broader understanding of digital health during formal education and in the workplace, mentorship and support from mentors and colleagues, user-friendly technologies, and stable nursing practice environments are key for safe practice and can facilitate the transitional experience and professional growth of new nurses.

CONCLUSION

Clearly, digital health is here to stay and will further advance in the years to come. Considering global nursing shortages and the demand for a digitally capable workforce, it is imperative to address gaps and challenges that newly qualified nurses and all nurses face when providing care in digitally enabled healthcare environments.

New graduate nurses' readiness for practice, transition and integration into the workplace: A longitudinal study with mixed methods research

AIM

To examine the readiness of new graduate nurses for practice and evaluate factors influencing their transition into the workplace.

BACKGROUND

This is new research in Bahrain. Understanding readiness for practice is important during a time when there is a national initiative to promote nursing as a career among the indigenous Bahraini population. The worldwide nursing shortages and aging workforce require new and innovative recruitment and retention measures. There is change, increased demand and complexity, in nursing and healthcare needs with accompanying healthcare specialization. In such a health care environment, the transitioning and readiness of newly qualified nurses is an increasing challenge.

DESIGN

A longitudinal design, with a triangulated, mixed methods, research approach was used.

METHODS

The study population consisted of 50 newly graduated nurses. Data were collected over one year through self-administered questionnaires, reflective diaries and focus groups. Quantitative data were analysed using SPSS and qualitative data using thematic analysis with adherence to GRAMMS reporting guidelines.

RESULTS

In Bahrain, there are actions to recruit young Arabic students to nursing including schools and community presentations by trained nurse ambassadors, social media activities and career exhibitions, however there is a lack of objective information on the perspective of cohorts of nurses who have successfully completed graduate nursing registration programmes and transitioned into practice. International literature suggests that the transition of newly graduated nurses can be stressful and challenging. On entry to practice, the respondents positively perceived their characteristics and attributes; however, their confidence was affected by challenges in the workplace. The transitioning of the new graduate nurses was affected by the availability of support and leadership, induction programmes and the new complex work environment.

CONCLUSION

Understanding work readiness and the emotional needs of new graduate nurses, accompanied by improved support, will enhance the transition of newly qualified nurses into the workplace and reduce attrition.

STUDY REGISTRATION

KHUH/Research/No.279/2019.

Gratitude interventions to improve wellbeing and resilience of graduate nurses transitioning to practice: A scoping review

Background

New graduate nurses are the nursing cohort at greatest risk for turnover and attrition in every context internationally. This has possibly been heightened during the COVID-19 pandemic. Workplace conditions significantly impact nursing turnover; however, interventions under the positive psychology umbrella may have a mediating impact on the intention to leave. New graduate nurses are generally challenged most in their first three years of clinical practice, and the need for support to transition is widely accepted. Gratitude practice has been reported to improve individual control and resilient response to setbacks and, therefore, is of interest in testing if this intervention can impact turnover intention in the workforce.

Objective

To report on a scoping review undertaken to identify whether 'gratitude practice' as an intervention had the potential to improve new graduate nurses' wellbeing and resilience.

Methods

Arksey and O'Malley's scoping review approach. Primary research papers of any methodology, published in English between January 2010 and July 2022 were included. Literature was sourced from seven databases, including CINAHL PLUS, ERIC, MEDLINE, Professional Development Collection, APA PsychInfo, APA PsychArticles, and Psychological and Behavioural Sciences Collection.

Results

We identified 130 records, of which we selected 35 for inclusion. A large range of interventions were identified; most had some form of writing, journaling, or diarising. The next most common intervention was teaching gratitude strategies via workshops, and many interventions had some form of list or activity trigger for participants to complete. Five studies had complex combined interventions, while the rest were simple, easily reproducible interventions. Interventions were delivered both face-to-face or asynchronously, with some being online only and others sent out as a 'kit' for participants to work through.

Conclusion

Our review of existing literature shows a significant gap in research on gratitude practice and its impact on nursing populations. To ensure robust future studies, we suggest defining concepts clearly and selecting outcome measures and tools that are not closely related. Intervention design may not be as important as the choice of measures and tools to measure outcomes.

New Graduate Nurse Transition into Rural Home: A Case Study

The global shortage of nurses and high attrition rates for newly graduated nurses along with the shifting demand for home care has created a critical need for retention strategies that address the specific challenges of rural settings. The effectiveness of structured transition or mentoring programs are primarily studied in acute care settings, making it difficult to translate to the unique context of rural home care nursing. The complexities of the independent nature of home care nursing practice and limited resources to address transition shock make it difficult to successfully transition newly graduated nurses to rural home care. A case study supports mentorship facilitation as a readily available, effective strategy that can overcome the challenges of rural home care settings. A comparative analysis will link Duchscher's (2008) transition shock theory to mentorship as an effective strategy for supporting NGNs' transition in home care nursing. Recommendations offer rural care leaders practical strategies bundled with mentorship to optimize the successful transition and retention of newly graduated nurses in their workplaces.

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

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

BACKGROUND

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

DESIGN

A cross-sectional survey design was used.

METHOD

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

RESULTS

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

Job Satisfaction and Negative Coping Style Affect the Relationship between Transition Shock and Intent to Stay among Newly Graduated Nurses during the COVID-19 Pandemic

Aim

The study is aimed at exploring the relationship between newly graduated nurses' transition shock, negative coping, job satisfaction, and intent to stay during the time of COVID-19.

Background

The shortage of nurses is a global dilemma aggravated by the COVID-19 pandemic. It has been a hot topic in recent years to help newly graduated nurses transition smoothly. Transition shock is one of the essential indicators to describe the transition state of newly graduated nurses, which has a far-reaching impact on the intention of newly graduated nurses to stay in their posts. However, few studies have studied the mechanism behind this relationship, which may affect the effectiveness of retention strategies.

Methods

A descriptive cross-sectional study was conducted from July to August 2021 in 31 tertiary hospitals in Shanghai, China. Participants comprised a convenience sample of 759 newly graduated nurses for surveys. Structural equation models were used to examine the study's hypothetical model.

Results

The results showed that transition shock had a significant direct effect on job satisfaction (b = -0.412, p < 0.001) and intent to stay (b = -0.145, p < 0.001). Job satisfaction had a significant direct effect on intent to stay (b = 0.702, p < 0.001). The indirect effect of transition shock on intent to stay through job satisfaction was statistically significant (b = -0.289), the 95% C.I. was (-0.493, -0.357), and the proportion of mediating effect to total effect was 66.59%. Moreover, the moderated mediation analysis showed that the interaction effect of transition shock and negative coping style on job satisfaction was significant (b = -0.082, p < 0.001).

Conclusion

This study revealed the impact of transition shock on intent to stay of newly graduated nurses during the time of COVID-19, and found that job satisfaction played a mediating role and negative coping played a moderating role. These findings are of great significance for nursing managers to take measures to improve the intention of newly graduated nurses to stay. Implication for Nursing Management. The level of transition shock is an important indicator reflecting the transition state of newly graduated nurses, and can further predict the job satisfaction and intention of newly graduated nurses to stay. Therefore, nursing managers should pay attention to taking corresponding measures to reduce the level of transition shock of newly graduated nurses.

Qualitative Findings for Supporting Newly Graduated Nurse and Teacher Sleep During Their First Year

BACKGROUND

New graduate role transition for nurses and teachers is stressful. Poor adaptation may manifest as insomnia, which has implications for the new professionals, their employers, and the public served. This study examines factors that impact new graduate sleep, with the aim of identifying perceived helps and hindrances to sleep-during-transition.

METHODS

Targeted content analysis of transcripts from a larger longitudinal mixed methods study comparing new graduate sleep during their first year of practice. Study participants (N = 21) answered questions in the final interview regarding the most positive and negative impact(s) on sleep during the transition year. Transcripts were analyzed and compared based on the new graduate sleep typology (i.e., Got Better, Got Worse, Stayed Varied) which emerged from the parent study.

FINDINGS

Most participants, regardless of sleep type, identified a person/group as most positively impacting sleep. They identified work thoughts, stress/anxiety, people, work hours/sleep schedules, and environmental factors as negatively impacting sleep. Work thoughts and stress/anxiety were mentioned together and most frequently by participants in all three sleep types.

CONCLUSION/APPLICATIONS TO PRACTICE

This study provided insight into new graduate nurse and teacher sleep during transition. Support persons and/or groups may be essential regardless of sleep type. Thought management/stress mitigation strategies and good sleep hygiene may also improve the sleep experiences of these new professionals. Occupational health nurses can support sleep-during-transition among new nurses and teachers by acting as sleep advocates. They may also identify a need for medical intervention and/or sleep specialists and should promote fatigue risk mitigating policies.

Improving Practice Readiness Among Nurse Residents

Background Recent evidence indicates a mere 8% of new graduate RNs are prepared to make entry-level clinical judgments. Residency programs, designed to overcome the academic-practice gap, lack universal guidelines for content, delivery, structure, and consistent assessment of practice readiness prior to independent practice. Method Virtual simulation to overcome practice gaps, with pre- and post-assessment of practice readiness prior to independent practice, was implemented in an existing nurse residency program. Results A 373% improvement in virtual clinical performance scores, as well as reductions in medication errors, sentinel events, and failures to rescue, was noted. These improvements readily translated to practice, as noted in a corresponding decrease in the rate of practice errors during actual clinical performance. Conclusion Transformed pedagogical technologies and learning methodologies are providing promising interventions to overcome the practice readiness deficit and set the stage for safer practice among new graduate RNs. [J Contin Educ Nurs. 2022;53(9):411-416.].

Exploring facilitators and barriers for successful transition among new Saudi graduate nurses: A qualitative study

AIM

This study aims at exploring Saudi newly graduated nurses' perspectives on the facilitators and barriers for successful transition from being a student to being a nurse.

DESIGN

A phenomenological qualitative methodology was employed.

METHODS

Focus group discussions were carried out among 35 Saudi nurses at one major university hospital in Saudi Arabia.

RESULTS

Under the theme of barriers to transition three main subthemes emerged, namely "Fear of making medical errors," "Intense Workload and Expectations," "Bullying and lack of support," while under the facilitators of transition the subthemes which emerged were "Supportive preceptor," "Training workshops," "Need for transition programs." This research found that formal and informal techniques for strengthening institutional variables and improving individual factors are critical for new graduate nurses' effective transition into professional responsibilities.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perceptions and Representations of Senior Nursing Students about the Transition to Professional Life during the COVID-19 Pandemic

The COVID-19 pandemic caused disruptions in education systems worldwide. The suspension of face-to-face lectures and clinical placements directly impacted nursing students’ learning. This study aimed to identify the perceptions and representations of senior nursing students about the transition to professional life during the COVID-19 pandemic. This descriptive, observational, cross-sectional study used a web-based survey from a convenience sample of 162 senior nursing students, from nine different nursing schools. Data collection was carried out in the second quarter of 2020. Male students have more negative representations related to training (p = 0.048); working students have a better perspective of professional integration (p = 0.038); students who are in a relationship have a more positive perception of interaction with patients (p = 0.047); those who have already defined a service of choice have less insecurity and less fear of making mistakes (p = 0.043). Those who report anxiety about their first place of work have more negative representations about the future in other professional dimensions. The COVID-19 pandemic represents a frequent concern among students. However, it is a dimension that does not negatively contaminate other representations about the professional future. Overall, students showed concerns regarding their performance in providing direct care to the patient and lived up to their fellow nurses’ expectations.

Transition experiences of newly qualified registered graduate nurses employed in a Neonatal Intensive Care Unit

OBJECTIVE

To explore the experiences of newly qualified registered graduate nurses' clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU).

METHOD

Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses' accounts via semi-structured interviews, conducted between January 2018 - January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit.

SETTING

In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited.

FINDINGS

Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout.

CONCLUSION

In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.

Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea

Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35-54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses.

Transition shock and newly graduated nurses' job outcomes and select patient outcomes: A cross-sectional study

AIM

This study examined transition shock experiences in newly graduated nurses as well as its relative influence on job outcomes (job satisfaction, stress and burnout, and intent to leave their organisation) and select patient outcomes (missed care, adverse events and perceived quality of care).

BACKGROUND

Transition shock is a reality common among newly graduated nurses and has been considered an issue relevant to nursing administrators. To date, the mechanism by which transition shock perception is linked with nurse and patient outcomes remains unexplored.

METHODS

A descriptive, cross-sectional design was used. One hundred seventy-six newly graduated nurses (nurses with <1 year of work experience) were included in the study. Data were collected using seven standardized scales.

RESULTS

Hospital classification (e.g., being employed in a government-owned hospital) (β = 0.255; p = .001) predicted transition shock. Overall, newly graduated nurses reported greatest challenges with regard to their expectations of the actual work environment (mean = 2.60, standard deviation = 0.42) and in balancing their professional and personal lives (mean = 2.51, standard deviation = 0.35). Higher levels of reality shock were associated with adverse patient events (β = 0.821; p = .001).

CONCLUSION

New graduates experience great challenges in balancing their professional and personal lives. Ensuring work-life balance and work readiness in newly graduated nurses may potentially reduce the occurrence of missed nursing care and adverse events.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can adequately support newly graduated nurses' transition through the implementation of empirically based transition programmes. By providing flexible work arrangement, reasonable workload, adequate nurse staffing, limited mandatory overtime and self-scheduling, nurse managers can effectively assist newly graduated nurses in attaining work-life balance.