New Graduate Nurses Research Articles

Exploring the Relationship Between Psychological Capital and Turnover Among New Nurses

The COVID-19 pandemic drastically changed the health care work environment and exacerbated workplace demands and stress. New graduate nurses (NGNs) transitioning into their first registered nurse role were not exempt. Little is known about the emotional well-being of NGNs during the COVID-19 pandemic. In this article, we share NGN psychological capital (PsyCap) trends from 2019 to 2022 and explore the relationship between NGN PsyCap and turnover. Organizational, leadership, and individual implications for practice are discussed. Findings from this study can help health care leaders tailor emotional development and coping strategies for this important segment of the nursing workforce.

The Impact of Accreditation on Nursing Transition Into Practice Residency Programs

The evidence is clear: transition to practice (TTP) residency programs are essential for new graduate nurses (NGNs) entering the profession, for effective organizational efficiency, and for enhanced, safe patient care. Meanwhile, some nurse leaders struggle to inspire others, including chief executive and financial officers, to invest in TTP residency programs, and some nurse leaders are not convinced of the value. In this article, we reinforce the case for TTP residency programs and the impact of their being accredited. We do so by offering an example of a health care system's experience standardizing a TTP across 7 states (53 acute care hospitals). Furthermore, we offer a model to demonstrate how accredited programs benefit nurses and organizations by having a significantly lower turnover rate than nonaccredited programs. Finally, this article offers concrete actions that nurse leaders can take to ensure a safe and meaningful journey for new graduate nurses entering our profession.

Nursing The Future 2.0: Reimagining New Graduate Transition in the COVID-19 Era (Part II).

For newly graduated nurses (NGNs), the characteristically challenging and dynamic period of transition from student to professional practitioner is being further strained by global crises and the uncertainty and insecurity they motivate, health care systems and institutional restructuring, and extreme workload burdens. A novel approach to aiding the transition of NGNs is detailed in this article, culminating in the offering of an inclusive framework of potential strategies aimed at supporting NGNs and those who lead, manage, and educate them. This approach outlines strategies of support deliverable by both centralized and local means and acknowledging contemporary needs such as workload burdens and generationally-sensitive employee needs. Nursing The Future is a platform that uniquely situates an evidence-based, grassroots-driven response to the needs of NGNs, while encouraging collaborative partnering of health care institutions with governmental, professional, and regional advanced education bodies. This is the second article in a 2-part series that builds on the historical and developmental intents of Nursing The Future as an organization and outlines how evidence-informed, creative, and affordable grassroots-driven supports may be offered to NGNs for the purpose of sustaining and advancing our future nurse professionals.

Effects of Mock Code Blue Simulations on New Graduate Nurses Confidence Levels

Objective: Determine if new-graduate nurses' participation in mock code simulations improves their confidence during code blue situations. Design: Quasi-experimental, Comparative Setting: Hays Medical CenterParticipation: New Graduate Nurses from Fort Hays State UniversityResults/Conclusion: Pending results and data collection.

Transitioning to Independent Nursing Practice during COVID-19: A Mixed Methods Study.

The COVID-19 pandemic presented challenges to onboard and support new graduate nurses (NGNs). This study sought to explore the perceptions of nurses entering clinical practice during the COVID-19 pandemic. Using mixed methods, we investigated the experiences of NGNs entering the field during the pandemic and how a nurse residency program (NRP) adapted to meet their needs. Newly graduated nurses entering practice in November 2019 described their transition through nurse experience surveys and focus group discussions. Results from the quantitative data reported on compassion satisfaction, burnout, and exposure to secondary traumatic stress. The qualitative data mirrored these findings with the discovery of the following five themes: transitioning through an NRP, impact to nursing care, value of coworkers, coping, and professional growth. These findings illustrate the need to better support future practice transitions in times of disruption and change.

Perceptions and experiences of psychological trauma in nursing and psychiatric nursing students: A small scale qualitative case study.

Entry-level health care professionals are socialized to accept the norms and values associated with institutions in which violence and suffering is considered an anticipated and even routine and normalized part of frontline care. The objective of the study was to illuminate the subjective experience of psychological trauma in graduates from a baccalaureate nursing and psychiatric nursing program using the McGill Illness Narrative Interview, an ethnographic interview guide. Participants included graduates from each program in a western Canadian province who reflected back on their experiences of trauma as students and newly-graduated nurses within their first year of practice as a regulated health professional. Results: Six key themes were identified. Witnessing sudden change in patient or client status and unexpected death; Emotional labour; Faculty incivility; Sabotage, bullying and verbal abuse from the health care team; Exposure to physical violence and sexual inappropriateness; and Mobilizing supports. All exposures were linked to the participants' definition of psychological trauma. Conclusions: The study findings highlight the power dynamic, abuses, and vulnerability between students, faculty, and their clinical counterparts without adequate recourse. There is a need to foster emotional intelligence, self-efficacy, and resilience when potentially traumatic and stressful experiences occur with student nurse and early-career nursing populations.

Development and Psychometric Evaluation of a Japanese Version of Newly Graduated Nurses' Difficulties with End-of-Life Care for Cancer Patients (NDEC Scale).

(1) Background: End-of-life care (EoL care) for cancer patients is stressful for nurses and can easily lead to burnout. Newly graduated nurses (NGNs) have a particularly difficult time, but no scale or inventory has been designed to evaluate their difficulties. This study developed and tested the reliability and validity of a scale to measure NGNs’ difficulties with EoL care for cancer patients (NDEC scale). (2) Methods: This study population consisted of 1000 NGNs and 1000 nurses with at least five years of clinical experience (GNs) that were working in hospitals in Japan. The initial scale consisted of six factors and 28 items. The reliability and validity of the scale were tested. (3) Results: A total of 171 NGNs and 194 GNs responded to the survey. The scale consisted of five factors and 25 items with the factors including “Feeling painful”, “Can’t deal with patients and their families”, “Don’t know the answer”, “Cannot afford”, and “Being afraid of death”. The criteria validity, known population validity, and internal consistency were confirmed. (4) Conclusions: The scale was validated to have a certain level of reliability and validity. The NDEC scale is expected to be used for self-care for NGNs and as an effectiveness indicator for educational programs.

The relationship betweennurse-nurse collaboration and work readiness among new graduate nurses.

Communication and collaboration with colleagues are crucial for new graduate nurses (NGNs) because of the adaptation to both the healthcare system and professional role. Therefore, working units with effective collaboration among nurses may increase new graduates' work readiness. This study aimed to determine the relationship between the perceptions of nurse-nurse collaboration and the work readiness level among NGNs. This descriptive, cross-sectional study was carried out with 198 NGNsin four private hospitals affiliated with a university. A self-administered questionnaire, including a personal information form, the Nurse-Nurse Collaboration Scale, and Work Readiness Scale, was used to collect data. Data analysis was performed using descriptive tests, and Spearman's rank correlation coefficients. NGNshad moderate perceptions of nurse-nurse collaboration, with a median score of 2.46 (2.23-2.88) out of 4. Work readiness among NGNswas moderate, with a median score of 304 (270-332) out of 460. There was a statistically significant correlation between nurse-nurse collaboration and work readiness (rs = 0.26; p < .001). The results of this study demonstrated that improving nurse-nurse collaboration is an effective way to increase work readiness among NGNs.

An Innovative Workforce Initiative to Support New Graduate Nurses: Clinical Nurse Transition Coaches.

Nursing leaders at Yale New Haven Health System identified a need among new-graduate nurses for further support beyond their accredited new-graduate residency program. The Clinical Nurse Transition Coach (CNTC) program focused on moving from individual tasks to caring for the entire patient, fostered by focused mentoring and education. The CNTC nurses were experienced and worked with a team of 10 new-graduate nurses.

Improving Communication and Collaboration Skills in Graduate Nurses: An Evidence-based Approach

New graduate nurses (NGN) often have an idealistic view of nursing compared to the reality of providing complex patient care. NGNs may lack communication and collaborations skills needed to effectively interact with challenging patients, families, and interdisciplinary teams, leading to stress and burnout. This evidence-based quality improvement project provided NGNs an opportunity to practice communication and collaboration techniques within a nurse residency program (NRP). Two scenarios with role-playing and debriefing were developed to practice communication techniques to enhance NGNs’ confidence. Results indicate the NRP improved these skills in NGNs. NRPs may assist NGNs transition to practice and successful integration into the registered nurse (RN) role.

Factors influencing the transition shock of newly-graduated nurses

Purpose: The purpose of this study was to identify factors that can affect transition shock in newly-graduated nurses. Methods: The first descriptive written survey was conducted on 450 graduate students from five nursing colleges. After their employment, the second survey was conducted on 316 participants who had responded to the first survey. A total of 158 respondents were used for the final analysis. Data were analyzed using an independent t-test, ANOVA, Tukey test, Pearson’s correlation coefficient, and hierarchical multiple regression analysis with the SPSS Win 25.0 Program. Results: The average age of the participants was 24.25±4.47. Of the participants, 126 (79.8%) were satisfied that they had majored in nursing. The average score for transition shock was 2.61±0.55 points. Factors influencing the transition shock of newly-graduated nurses were the working department, working period, and working environment. The more positively the newly-graduated nurses perceived the nursing work environment, the less of a transition shock they experienced. Grade point average, clinical competence, confidence in performing core nursing skills, and nursing professionalism did not affect their transition shock. It could be confirmed that there is a gap between college nursing education and the clinical field. Conclusion: In order to reduce the transition shock of newly-graduated nurses, it is necessary to improve the nursing work environment and apply educational and emotional support strategies according to the characteristics of each work department and the period of work.

An online communication skills training program for nursing students: A quasi-experimental study.

In South Korea, in 2019, approximately 45.5% of newly-graduated nurses quit their jobs within one year of employment. To better understand the adjustment to nursing practice upon graduation, we developed an online communication skills training program based on nonviolent communication and evaluated its effectiveness. A quasi-experimental design was adopted. The sample included 28 participants in the experimental group and 27 in the control group after one participant in the control group dropped out. The participants were fourth-year nursing students at the K and S University in Gyeonggi Province, South Korea, with some clinical training in a hospital setting. Data were analyzed using the χ2 test, Fisher's exact test, and independent t-test. Participants' empathy, communication skills, anger, and self-efficacy were assessed before and after the training, as well as across the two groups. The experimental group showed significantly higher levels of empathy, communication skills, and self-efficacy compared to the control group after the program completion. However, there were no significant differences in anger. This study suggests the effectiveness of the online version of the nonviolent communication training. Therefore, providing this program to nursing students scheduled for graduation may help retain newly-graduated nurses.

Newly-graduated nurses’ work-integrated learning: A qualitative study from an educational and occupational perspective

AimThe aim of this study was to describe newly graduated nurses’ (NGNs’) experience of work-integrated learning (WIL), from an educational and occupational perspective. BackgroundNGNs often find themselves unprepared to meet occupational demands on their competence on entering working life, and express difficulties integrating educational theory into a practical context. Qualitative and effective WIL becomes particularly important for NGNs to develop the competence required to handle the transition from education to working life. DesignThis is a qualitative, descriptive study with an inductive approach. MethodsSeven focus-group discussions were performed and subjected to qualitative content analysis. ResultsThe results revealed that WIL for NGNs includes personal mastering of several professional roles: a self-directed and collaborative learning role, a relational nursing role, and a transition from a student role to a collegial role. Furthermore, WIL entails adapting to organisational requirements, including development of contextual workplace knowledge and understanding; striving for confidence in medical-technical performance; and developing an experience-based understanding of clinical situations. ConclusionThe results reveal that WIL is complex, encompassing adaptation to roles and personal capabilities that increase new graduates’ competence and preparation for work. In addition, WIL requires personal commitment to one’s own learning as well as organisational and social support.

Where Do We Go From Here?: The Impact of COVID-19 on Practice Readiness and Considerations for Nurse Leaders

The COVID-19 pandemic has impacted nurses transitioning to practice in a variety of ways over the past 2 years. Analysis from the Versant Database comparing new graduate nurses (NGNs) from 2018–2021 revealed a widened practice gap for NGNs in these specialty areas of practice: critical care, perinatal, and emergency. Additionally, NGNs achieved 100% competency validation sooner in 2020–2021. The analysis also revealed greater diversity of NGNs who participated in a transition to practice program in 2020–2021. Based on these findings, this article proposes recommendations for nurse leaders to consider as NGNs transition into the workforce.

Commentary – Transition to Practice: Future Considerations for New Graduate Nurses

There is a growing concern in education and healthcare that we are not adequately preparing or transitioning newly graduated nurses (NGNs) into the workplace. Several studies over the past decade have revealed relationships between the mental health of NGNs and their experience of the workplace environment. Even before the destabilizing impact of the global COVID-19 pandemic, overwhelming workload intensities were forcing nurses to become organizational task masters and crisis facilitators rather than clinical case managers and direct-care providers. This paper outlines numerous practical and evidence-based interventions for mitigating transition shock and assisting NGNs in successfully navigating the stages of transition.

Nurse-physician collaboration, intention to leave job, and professional commitment among new graduate nurses.

The quality of communication and collaboration with colleagues, managers, and physicians affects the intention to leave a job and the profession for new graduate nurses (NGNs). New graduates have difficulties communicating and collaborating with physicians, especially. This study aimed to determine the relationship between the attitudes of nurse-physician collaboration and the levels of intention to leave the current job and professional commitment among NGNs. This descriptive, cross-sectional study was carried out with 231 NGNs in four private hospitals affiliated with an university. Data were collected by using a self-administered questionnaire, including a personal information form, the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration, Intention to Leave Scale, and Nursing Professional Commitment Scale. Data analysis was performed using descriptive statistics, and Spearman's rank correlation coefficients. NGNs had a high positive attitude towards nurse-physician collaboration with a median score of 49 (45-54). The professional commitment of NGNs was high level with a median score of 75 (69-86). The intention to leave the current job median score was 3 (2.3-3.6) out of 5. There was a statistically significant correlation between attitudes towards nurse-physician collaboration and the levels of intention to leave the current job (rs = -0.22; p < 0.01) and professional commitment (rs = 0.42; p < 0.01). The results showed that improving NGNs' attitudes towards nurse-physician collaboration increases the professional commitment and reduces turnover intention.

The Use of Checklists Among New Graduate Nurses in a Surgical Intensive Care Unit to Improve Patient Safety and Outcomes.

New graduate nurses (NGNs) in the intensive care unit have trouble learning standards of care essential to patient safety and outcomes. Two checklists were developed to help NGNs learn to consistently practice to the unit standards of care during orientation. NGNs were more consistently able to practice to the standards of care compared to a control group that had not utilized the checklists. Preceptors noticed modest improvements in the abilities of NGNs to practice to the standards of care.

The information system stress, informatics competence and well-being of newly graduated and experienced nurses: a cross-sectional study

BackgroundThe use of information systems takes up a significant amount of nurses’ daily working time. Increased use of the systems requires nurses to have adequate competence in nursing informatics and is known to be a potential source of stress. However, little is known about the role of nursing informatics competence and stress related to information systems (SRIS) in the well-being of nurses. Moreover, the potential impact of nurses’ career stage on this matter is unknown. This study examined whether SRIS and nursing informatics competence are associated with stress and psychological distress in newly graduated nurses (NGNs) and experienced nurses.MethodsA cross-sectional study was conducted in Finland between October and December 2018. The participants were NGNs (n = 712) with less than two years of work experience and experienced nurses (n = 1226) with more than two years of work experience. The associations of nursing informatics and SRIS with nurses’ stress and psychological distress were analyzed with linear regression analysis. Analyses were conducted separately for NGNs and experienced nurses. Models were adjusted for age, gender, and work environment.ResultsSRIS was associated with stress / psychological distress for both NGNs (β = 0.26 p < 0.001 / β = 0.22 p < 0.001) and experienced nurses (β = 0.21 p < 0.001/ β = 0.12 p < 0.001). Higher nursing informatics competence was associated with lower stress (β = 0.20 p < 0.001) and psychological distress (β = 0.16 p < 0.001) in NGNs, but not among experienced nurses.ConclusionsSRIS appears to be an equal source of stress and distress for nurses who are starting their careers and for more experienced nurses, who are also likely to be more experienced users of information systems. However, informatics competence played a more important role among NGNs and a lack of adequate competence seems to add to the strain that is already known to be high in the early stages of a career. It would be important for educational institutions to invest in nursing informatics so that new nurses entering the workforce have sufficient skills to work in increasingly digital health care.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study.

AimsThe aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.DesignA longitudinal design with two data collections points (pre‐ and post‐graduate).MethodsThe data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.ResultsSeveral associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.ConclusionHaving a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.ImpactThis study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

Changes in Registered Nurse Employment and Education Capacity during the COVID ‐19 Pandemic and the Risk of Future Shortages

Research ObjectiveDuring the first months of the COVID‐19 pandemic, numerous concerns about the nursing workforce were reported. Nursing education programs have reported that their students were not able to continue their clinical education due to worries about infection risks within hospitals and some have cancelled or reduced entering cohorts. At the same time, anecdotal reports suggested that some RNs near retirement chose to retire early to reduce the risk of infection with SARS‐Cov2. These changes, if true, could undermine the progress made over the past 20 years toward a balanced nursing labor market and lead to shortages of RNs in the near future.Study DesignThis study uses data from two surveys conducted in California to assess the current and future supply of RNs, and to learn how the coronavirus pandemic is affecting this essential workforce. Early data from two surveys have been analyzed to provide a rapid assessment of the workforce: (1) the biennial Survey of California Registered Nurses, and (2) the Board of Registered Nursing Annual Schools Survey. Data from the Survey of California RNs, which is based on a stratified sample of the state's nurses, are weighted to represent the total population of nurses. Analysis methods include tabulating means and frequency distributions for the 2020 surveys and comparing the results to prior years. The data from these surveys are then used in a stock‐and‐flow supply projection model to learn the extent to which RN shortages might emerge in the future.Population StudiedRegistered nurses and nursing education programs in California.Principal FindingsApproximately 2000 RNs responded to the biennial Survey by November 2020. The data indicate that: (1) employment rates of older nurses dropped substantially: 6 percentage points for RNs 60‐64 years old and 10 percentage points for RNs 65 years and older. Employment rates for nurses younger than 30 years also dropped, but not significantly. Employment of nurses 30‐49 years increased approximately 6 percentage points, making up for the decreases of older RNs. Among RNs 55‐64 years old, the percent reporting they intend to retire or leave nursing within two years increased from 11.4% in 2018 to 24.5% in 2020.The survey of RN education programs finds that 16 of California's 147 nursing programs skipped a cohort of students in 2020 and another 18 programs enrolled fewer students than the prior academic year. The estimated decrease in students statewide is approximately 350 ‐ 2.3% of ~15,000 new enrollments in 2018‐2019.ConclusionsAlthough RN enrollments decreased only negligibly, the rapid decrease in employment of older nurses and increase in projected retirements suggest that RN shortages may rapidly emerge.Implications for Policy or PracticeOver the past five years, hospitals have been increasingly uninterested in hiring newly‐graduated nurses, even while reporting shortages of experienced RNs. Hospitals need to rapidly hire newly‐graduated RNs in order to compensate for the rapid outflow of older RNs from the labor supply.