Background
Health services offer new graduate registered nurses (NGRNs) employment primarily
via specialized transition programs. However, findings continue to indicate that these
programs are mostly counterproductive in the provision of a supportive environment.
As a consequence, the health of graduates and safety of their patients is often at
risk.
Purpose
The specific aim of this integrative review was to review, critique, and synthesize
the existing literature with regard to the spectrum of factors and perceptions that
have an impact on NGRNs and their passage to becoming competent professional nurses.
The overall aim was to reconceptualize the approach to NGRN transition and develop
new frameworks or perspectives.
Methods
This study used an integrative review of qualitative, quantitative, and mixed methods
research guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines and the McGill Mixed Methods Appraisal Tool. The CINAHL, PsycInfo,
Google Scholar, and Ovid MEDLINE databases were searched for relevant quantitative,
qualitative, and mixed methods studies published in English in an academic journal
between 2015 and 2021. Eligible studies were categorized conceptually in accordance
within a recognized framework for integrative reviews.
Results
A total of 41 studies were included in the review. This review found that healthcare
organizations are primarily solipsistic and provision of consistent quality support,
or any support at all, for NGRNs was not assured. As a consequence, purposive psychosocial
preparation of nursing students for self-support during transition is needed.
Conclusion
An intense focus on psychosocial preparation of nursing students in order to scaffold
the transition to practice experience and thus ensure patient safety is advocated.
Proposals for change are recommended at the undergraduate level, which includes comprehensive
curriculum development in both theory and practice.
Keywords
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References
- The orientation period: Essential for new registered nurses’ adaptation.Nursing Science Quarterly. 2015; 28: 142-150https://doi.org/10.1177/0894318415571600
- From novice to expert.American Journal of Nursing. 1982; 82: 402-407
- Using the Dreyfus Model of Skill Acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education.Bulletin of Science, Technology & Society. 2004; 24: 188-199https://doi.org/10.1177/0270467604265061
- Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying.Nursing Administration Quarterly. 2013; 37: 144-151https://doi.org/10.1097/NAQ.0b013e318286de5f
- Expertise in performance assessment: Assessors’ perspectives.Advances in Health Sciences Education. 2013; 18: 559-571https://doi.org/10.1007/s10459-012-9392-x
- Novice nurse productivity following workplace bullying.Journal of Nursing Scholarship. 2012; 44: 80-87https://doi.org/10.1111/j.1547-5069.2011.01436.x
- Engaging new nurses: The role of psychological capital and workplace empowerment.Journal of Research in Nursing. 2015; 20: 265-277https://doi.org/10.1177/1744987114527302
- Nurse graduates’ perceived educational needs after the death of a patient: A descriptive qualitative research study.The Journal of Continuing Education in Nursing. 2020; 51: 267-273https://doi.org/10.3928/00220124-20200514-06
- Creating a long-term care new nurse residency model.The Journal of Continuing Education in Nursing. 2016; 47: 234-240https://doi.org/10.3928/00220124-20160419-10
- The importance of reflective practice in nursing.International Journal of Caring Sciences. 2013; 6: 319-326
- The graduate nurse experience.The Journal of Nursing Administration. 2004; 34: 303-311https://doi.org/10.1097/00005110-200406000-00010
- Improving the graduate nurse experience through support on a social media platform.Medsurg Nursing. 2020; 29: 83-87
- Factors influencing the practice of new NGRNs: A focused ethnography of acute care settings.Journal of Clinical Nursing. 2019; 28: 3618-3631https://doi.org/10.1111/jocn.14959
- Accreditation of transition to practice programs: Assessing the value and impact.Journal for Nurses in Professional Development. 2019; 35: 180-184https://doi.org/10.1097/NND.0000000000000555
- ‘Being young’: A qualitative study of younger nurses’ experiences in the workplace.International Nursing Review. 2012; 59: 555-561https://doi.org/10.1111/j.1466-7657.2012.01005.x
- Exploring how new registered nurses construct professional identity in hospital settings.The Journal of Continuing Education in Nursing. 2008; 39: 255-262https://doi.org/10.3928/00220124-20080601-03
- Teaching and assessment strategies for nursing self-care competencies in Ontario’s nursing education programs.Nurse Education in Practice. 2019; 36: 108-113https://doi.org/10.1016/j.nepr.2019.03.011
- Transition shock: The initial stage of role adaptation for newly graduated registered nurses.Journal of Advanced Nursing. 2009; 65: 1103-1113
- From surviving to thriving: Navigating the first year of professional nursing practice.(2nd ed.). Nursing the Future, 2012
- The prevailing winds of oppression: Understanding the new graduate experience in acute care.Nursing Forum. 2008; 43: 191-206
- Stages of transition and transition shock.Journal for Nurses in Professional Development. 2018; 34: 228-232https://doi.org/10.1097/NND.0000000000000461
- The relationship between the undergraduate clinical learning environment and work readiness in new graduate nurses: A pre-post survey study.Nurse Education Today. 2020; 94. Article 104587https://doi.org/10.1016/j.nedt.2020.104587
- The influence of psychological capital, authentic leadership in preceptors, and structural empowerment on new NGRN burnout and turnover intent.Applied Nursing Research. 2019; 48: 37-44https://doi.org/10.1016/j.apnr.2019.04.005
- Evaluation of self-efficacy and confidence levels among newly graduated nurses exposed to an end-of-life simulation: A comparison study.Journal of Hospice and Palliative Nursing. 2020; 22: 504-511https://doi.org/10.1097/NJH.0000000000000698
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies, 52(7), 1254–1268. Retrieved from https://doi.org/10.1016/j.ijnurstu.2015.03.007
- Relationships among sex, empowerment, workplace bullying and job turnover intention of new graduate nurses.Journal of Clinical Nursing. 2021; 30: 1273-1284https://doi.org/10.1111/jocn.15671
- How graduate nurses adapt to individual ward culture: A grounded theory study.Journal of Advanced Nursing. 2019; 75: 616-627https://doi.org/10.1111/jan.13884
- Socialisation of new graduate nurses to practising nurses.Journal of Clinical Nursing. 2012; 21: 2064-2071https://doi.org/10.1111/j.1365-2702.2011.03992.x
- Stabilizing and retaining a quality nursing work force through the use of the married state preceptorship model.Journal of Continuing Education in Nursing. 2013; 44: 365-373https://doi.org/10.3928/00220124-20130603-08
- Problems with task mastery, social acceptance, and role clarity explain nurses’ symptoms of burnout during the first professional years: A longitudinal study.Work. 2019; 62: 573-584https://doi.org/10.3233/WOR-192892
- Preventing stress-related ill health among new registered nurses by supporting engagement in proactive behaviors—A randomized controlled trial.Worldviews on Evidence-Based Nursing. 2020; 17: 202-212https://doi.org/10.1111/wvn.12442
- Graduate nurses’ experience of feedback, support, and anxiety: A pilot study.Australian Journal of Advanced Nursing. 2017; 35: 6-15
- Phenomenology and psychological research.Duquesne University Press, Pittsburgh, PA1985
- Residency for transition into practice.The Journal of Nursing Administration. 2016; 46: 82-86https://doi.org/10.1097/NNA.0000000000000300
- Contemporary nursing graduates’ transition to practice: A critical review of transition models.Journal of Clinical Nursing. 2020; 29: 3097-3107https://doi.org/10.1111/jocn.15234
- New graduate identity: Discursive mismatch.Contemporary Nurse. 2005; 20: 67-77https://doi.org/10.5172/conu.20.1.67
- Educational preparation for clinical practice: Reflections of newly graduated RNs.Nurse Educator. 2019; 44: 93-97https://doi.org/10.1097/NNE.0000000000000550
- ‘It was quite a shock’: A qualitative study of the impact of organisational and personal factors on newly qualified nurses’ experiences.Journal of Clinical Nursing. 2021; 30: 2373-2385https://doi.org/10.1111/jocn.15777
- Mixed Methods Appraisal Tool (MMAT), version 2018: User guide.2018 (McGill)
- New graduate nurse wellbeing, work wellbeing and mental health: A quantitative systematic review.International Journal of Nursing Studies. 2021; 121, Article 103997https://doi.org/10.1016/j.ijnurstu.2021.103997
- The associations between the final clinical practicum elements and the transition experience of early career nurses: A cross-sectional study.Nurse Education in Practice. 2020; 42, Article 102680https://doi.org/10.1016/j.nepr.2019.102680
- On the difficulty of finding one’s place: A qualitative study of new nurses’ processes of growth in the workplace.Journal of Clinical Nursing. 2019; 28: 4321-4331https://doi.org/10.1111/jocn.14996
- Interventions to support graduate nurse transition to practice and associated outcomes: A systematic review.Nurse Education Today. 2021; 100, Article 104860https://doi.org/10.1016/j.nedt.2021.104860
- Exploring barriers and facilitators for successful transition in new graduate nurses: A mixed methods study.Journal of Professional Nursing. 2020; 36: 560-568https://doi.org/10.1016/j.profnurs.2020.08.006
- Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study.Nurse Education Today. 2019; 78: 32-36https://doi.org/10.1016/j.nedt.2019.04.002
- The influence of psychological capital and work engagement on intention to remain of new graduate nurses.Journal of Nursing Administration. 2018; 48: 459-465https://doi.org/10.1097/NNA.0000000000000649
- Reality shock: Why nurses leave nursing.Mosby, 1974
- Transition experiences of newly graduated Filipino nurses in a resource-scarce rural health care setting: A qualitative study.Nursing Forum. 2019; 54: 298-306https://doi.org/10.1111/nuf.12330
- Magnet hospital recognition in hospital systems over time.Health Care Management Review. 2019; 44: 19-29https://doi.org/10.1097/HMR.0000000000000167
- Starting out: A time-lagged study of new graduate nurses’ transition to practice.International Journal of Nursing Studies. 2016; 57: 82-95https://doi.org/10.1016/j.ijnurstu.2016.01.005
- The experience of learning to speak up: A narrative inquiry on newly graduated registered nurses.Journal of Clinical Nursing. 2015; 24: 1837-1848https://doi.org/10.1111/jocn.12805
- Spirituality and job satisfaction among Jewish Israeli hospital nurses.Journal of Advanced Nursing. 2010; 66: 334-344https://doi.org/10.1111/j.1365-2648.2009.05172.x
- Supporting new graduate nurses making the transition to rural nursing practice: Views from experienced rural nurses.Journal of Clinical Nursing. 2015; 24: 2826-2834https://doi.org/10.1111/jocn.12890
- Educational needs for new graduate nurses in Korea.Nurse Education in Practice. 2019; 34: 167-172https://doi.org/10.1016/j.nepr.2018.11.021
- Breaking through the dilemma of whether to continue nursing: Newly graduated nurses’ experiences of work challenges.Nurse Education Today. 2018; 67: 72-76https://doi.org/10.1016/j.nedt.2018.04.025
- Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses.Journal of Advanced Nursing. 2020; 76: 577-587https://doi.org/10.1111/jan.14266
- Fitting in: A pervasive new graduate nurse need.Nurse Education Today. 2011; 31: 488-493https://doi.org/10.1016/j.nedt.2010.10.002
- A cross-sectional survey of British newly graduated nurses’ experience of organization empowerment and of challenging unsafe practices.The Journal of Continuing Education in Nursing. 2018; 49: 474-481https://doi.org/10.3928/00220124-20180918-08
- Topic 1: Fit for purpose / work ready / transition to practice. Centre for Health Service Development.Australian Health Services Research Institute, University of Wollongong, 2019 (Retrieved April 24, 2021, from)
- The lived experience of new graduate nurses working in an acute care setting.The Journal of Continuing Education in Nursing. 2015; 46: 122-128https://doi.org/10.3928/00220124-20150220-17
- Transitioning from nursing student to successful graduate registered nurse.([Doctoral thesis].) Flinders University, College of Nursing and Health Sciences, 2021, July
- A patient safety focused registered nurse transition to professional practice program.Contemporary Nurse. 2014; 47: 51-60https://doi.org/10.1080/10376178.2014.11081906
- Ways of being: Preparing nursing students for transition to professional practice.The Journal of Continuing Education in Nursing. 2016; 47: 330-340https://doi.org/10.3928/00220124-20160616-10
- New graduate registered nurses and the spectrum of comfort in clinical practice.Journal of Continuing Education in Nursing. 2019; 50: 563-571https://doi.org/10.3928/00220124-20191115-08
Mellor, P., Gregoric, C., Atkinson, L. M. & Greenhill, J. A. (2017). A critical review of transition-to-professional-practice programs: Applying a standard model of evaluation. Journal of Nursing Regulation, 8(2), 23–30. https://doi.org/10.1016/S2155-8256(17)30095-9
Mellor, P., Gregoric, C., & Gillham, D. (2017). Strategies new graduate registered nurses require to care and advocate for themselves: A literature review. Contemporary Nurse, 53(3), 390–405. 10.1080/10376178.2017.1348903
Meyer Bratt, M. (2013). Nurse residency program: best practices for optimizing organizational success. Journal for Nurses in Professional Development, 29, (3),102-110. 10.1097/NND.0b013e318292649f
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.PLoS Medicine. 2009; 6https://doi.org/10.1371/journal.pmed.1000097
- Professional socialization: The key to survival as a newly qualified nurse.International Journal of Nursing Practice. 2007; 13: 75-80https://doi.org/10.1111/j.1440-172X.2007.00617.x
- New graduate nurses’ understanding and attitudes about patient safety upon transition to practice.Journal of Clinical Nursing. 2019; 28: 2543-2552https://doi.org/10.1111/jocn.14839
- How to review the evidence: Systematic identification and review of scientific literature.Biotext publishers, Hand book series on preparing clinical practice guidelines1999
- Speaking up for patient safety by hospital-based health care professionals: A literature review.BMC Health Services Research. 2014; 14, Article 61https://doi.org/10.1186/1472-6963-14-61
- Balance, health, and workplace safety: Experiences of new nurses in the context of total worker health.Workplace Health & Safety. 2019; 67: 520-528https://doi.org/10.1177/2165079919833701
- Examining the impending gap in clinical nursing expertise.Policy, Politics & Nursing Practice. 2007; 8: 158-169https://doi.org/10.1177/1527154407309050
- Speak up for patient safety [Editorial].Nursing Critical Care. 2016; 11: 4https://doi.org/10.1097/01.CCN.0000503425.05594.02
- New graduate nurses’ experiences in their first year of practice.Nurse Education Today. 2014; 34: 150-156https://doi.org/10.1016/j.nedt.2012.07.003
- Mastering the professional role as a newly graduated registered nurse.Nurse Education Today. 2013; 33: 739-745https://doi.org/10.1016/j.nedt.2012.11.021
- Factors influencing new graduate nurse engagement in inter-professional collaboration.Journal of Advanced Nursing. 2014; 70: 4-20
- How magnet hospital status affects nurses, patients, and organizations: A systematic review.The American Journal of Nursing. 2020; 120: 28-38
- Newly graduated nurses’ experiences of horizontal violence.Advance online publication, Nursing Ethics2020https://doi.org/10.1177/0969733020929063
- A survival guide for health research methods.McGraw-Hill Open University Press, 2012
- Generalized self-efficacy scale.in: Weinman J. Wright S. & M. A user's portfolio. Causal and control beliefs. Windsor Publishers, Johnston, Measures in health psychology1995
- Report on the inquiry into nursing – The patient profession: Time for action. Commonwealth of Australia.(Retrieved May 2, 2021, from)
- Preparation for practice in newly licensed registered nurses: A mixed-methods descriptive survey of preceptors.Journal for Nurses in Professional Development. 2018; 34: 325-331https://doi.org/10.1097/NND.0000000000000487
- Debriefing as a supportive component for registered nurses in transition.Journal for Nurses in Professional Development. 2016; 32: 212-218
- Phase II: Multi-institutional, randomized study of the transition to practice (TTP) model on patient safety and quality outcomes in other health care settings.National Council of State Boards of Nursing, 2011
- The National Council of State Boards of Nursing’s transition to practice study: Implications for educators.Journal of Nursing Education. 2015; 54: 119-120
- Transition to practice study in hospital settings.Journal of Nursing Regulation. 2015; 5: 24-38https://doi.org/10.1016/S2155-8256(15)30031-4
- Social capital and the nursing student experience.Nurse Education Today. 2012; 32: 250-254https://doi.org/10.1016/j.nedt.2011.05.006
- The voice of nurses: Novice nurses’ first experiences in a clinical setting. A longitudinal diary study.Journal of Clinical Nursing. 2018; 27: e1612-e1626https://doi.org/10.1111/jocn.14307
- Competency of new graduate nurses: A review of their weaknesses and strategies for success.The Journal of Continuing Education in Nursing. 2013; 44: 406-414https://doi.org/10.3928/00220124-20130617-38
- Resilience in nursing students: An integrative review.Nursing Education Today. 2016; 36: 457-462
- Preparing new nurses to address bullying: The effect of an online educational module on learner self-efficacy.MEDSURG Nursing. 2016; 25: 412-417
- A comparative study of newly licensed registered nurses’ stressors: 2003 and 2015.The Journal of Continuing Education in Nursing. 2018; 49: 132-140https://doi.org/10.3928/00220124-20180219-08
- Writing integrative literature reviews: Using the past and present to explore the future.Human Resource Development Review. 2016; 15: 404-428https://doi.org/10.1177/1534484316671606
- Writing integrative reviews of the literature: Methods and purposes.International Journal of Adult Vocational Education and Technology. 2016; 7: 62-70
- A comparison of working conditions among nurses in Magnet® and Non-Magnet® nospitals.The Journal of Nursing Administration. 2010; 40: 309-315https://doi.org/10.1097/NNA.0b013e3181e93719
- The Impact of new NGRN transition programs on competency development and patient safety: An integrative review.Advances in Nursing Science. 2018; 41: E26-E52https://doi.org/10.1097/ANS.0000000000000217
- Transition to practice: The lived experience of new graduate nurses in early solo flight.Journal for Nurses in Professional Development. 2020; 36: 74-81https://doi.org/10.1097/NND.0000000000000608
- Light at the end of the tunnel: New graduate nurses’ accounts of resilience: A qualitative study using Photovoice.Nurse Education Today. 2017; 52: 43-49https://doi.org/10.1016/j.nedt.2017.02.007
- Work readiness of graduate nurses and the impact on job satisfaction, work engagement and intention to remain.Nurse Education Today. 2013; 33: 1490-1495https://doi.org/10.1016/j.nedt.2013.05.008
- The integrative review: Updated methodology.Journal of Advanced Nursing. 2005; 52: 546-553https://doi.org/10.1111/j.1365-2648.2005.03621.x
- Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses.Journal of Clinical Nursing. 2021; 30: 83-92https://doi.org/10.1111/jocn.15483
- The influence of empowerment and incivility on the mental health of new graduate nurses.Journal of Nursing Management. 2015; 23: 632-643https://doi.org/10.1111/jonm.12190
- Lack of preparation: Iranian nurses’ experiences during transition from college to clinical practice.Journal of Professional Nursing. 2015; 31: 365-373https://doi.org/10.1016/j.profnurs.2015.01.005
- Lessons learned: Newly hired nurses’ perspectives on Lea & Cruickshank, 2015transition into practice.Journal for Nurses in Professional Development. 2016; 32: E1-E8https://doi.org/10.1097/NND.0000000000000278
Article info
Footnotes
Conflicts of Interest: None.
Identification
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© 2022 National Council of State Boards of Nursing. Published by Elsevier Inc. All rights reserved.
