Newly qualified nurse transition:stress experiences andstress-mediating factors –a longitudinal study

Abstract

The first twelve months for newly qualified nurses (NQNs) is a time of transition producing a myriad of experiences, emotions and personal development. There has been very little research into the phenomenon that has emanated from the UK and what is available may no longer reflect contemporary NQNs’ experiences. Using a pragmatic epistemology, this unique four-phased, mixed methods, cohort study investigated NQNs’ transition through monitoring stress experiences together with potentially mediating factors of coping, social support, hardiness and resilience. Adult branch NQNs (n= 288) completed questionnaires on nursing stress and mediating factors at the point of qualification (baseline). The original sample were followed-up at six months (n= 107) and then at twelve months post-qualifying (n= 86), along with individual interviews (n= 14). The results indicate transition as a complex process lasting 6-12 months depending on the NQN’s workplace experience. Multiple stressors included ‘workload’, which was consistently the most frequently reported, due to factors such as inadequate staffing levels. The NQNs revealed impressive personal qualities; for example, a forthright commitment to the high ideals of professionalism and quality standards of patient care, together with their attention to continued learning and development as a nurse. Hardiness, resilience, increased age and, most notably, prior healthcare experience, each mediated the frequency of reported stressors over the first twelve months. Active support from a ‘good’ team and an inspirational manager were also important stress-mediators. Personal barriers included extreme fluctuations in confidence, which was affected negatively by colleagues’ incivility, or mediated through workplace colleague support. An integrated model for NQN transition is presented to depict the core elements of the evolving professionalisation and socialisation process. The model is entwined with the NQNs’ ability to undertake a cognitive appraisal of the stressors within their work environment, as the NQN progressed towards adapting to their new status, roles and work environment. Key recommendations include: the development of a transition preparation process for pre-registration nurse education; a proposed new model of preceptorship; improvement of the management of workplace incivility for healthcare organisations that employ NQNs; and research to further explore the benefits of prior healthcare experience. These are some of the pragmatic, practical outcomes of this research.