Nurse Transition Programs Research Articles

Does transition theory matter? A descriptive study of a transition program in Australia based on Duchscher’s Stages of Transition Theory and Transition Shock Model.

Objective: Explore the impact of transition program policy directives grounded in foundational elements of transition theory. Background: Within fast-track health service environments nurse leaders remain committed to improving transition programs that support wellbeing and retain new graduate nurses. Duchscher’s Stages of Transition Theory and Transition Shock model was the framework chosen by the health service nurse leaders to implement in the clinical environment, however, implementing elements can be problematic without sufficient support and clear policy directives. Study Design and methods: Descriptive study using multiple methods in one major national health service that incorporates a number of private (eight) and public (four) hospitals across Australia. Online surveys were distributed to new graduate nurses at one, five and eleven months into the initial transition year. The survey tool was a synthesised adaptation of the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework. At the end of the transition year telephone interviews were conducted with the Nurse Managers who were responsible for implementing transition programs policies and processes. Resulting data were summarised using descriptive statistics for quantitative data and a thematic analysis for qualitative data. Results: 158 new graduate nurses returned the online survey and eight Nurse Managers participated in the telephone interviews. As a whole the new graduate registered nurses described feeling accepted during their transition and expressed feeling comfortable when approaching senior staff. They managed challenges of shift work and took time for self-care. The clear majority (88%) of participants reported no plans to leave the profession. Nurse Managers were able, in most clinical areas, to apply transition program policy and directives and enable the implementation of Duchscher’s Stages of Transition as the framework for the transition support initiatives. Retention of new graduates on their wards at the end of the program was determined to be a positive outcome for Nurse Managers. Discussion: A carefully structured Graduate Nurse Transition Program founded on sound theoretically grounded ideology alongside integrated policy directives guided the Nurse Managers implementation of Duchscher’s Stages of Transition Theory and Transition Shock model into practice. Additionally, a dedicated Graduate Nurse Coordinator role with a manageable ratio of graduate nurses was an important component included in the transition program at each participating hospital as it facilitated support of both graduates and Nurse Managers. These positions should be costed into any Graduate Nurse Transition Program. An interesting finding was the consistency in smaller units that were unable to provide or mobilise preceptors for the required allocated mirrored shifts and it was felt this workload management issue impacted the success of graduate transition nurse programs on those units. Conclusions: Implementing policy directives grounded in foundational elements of Duchscher’s Stages of Transition theory and Transition Shock model delivered consistent experiences for new graduate nurses across one major health service that incorporates a number of hospitals across Australia. Data suggested some practical challenges to program implementation for Nurse Managers, including unit/ward size, staffing, and varying levels of understanding of preceptor roles. Implications for research, policy, practice: Introducing formal policy directives that are grounded in strong theoretical frameworks of professional role transition, agreed to and funded by health service nurse leaders are important in guiding a consistent approach across health services in the implementation of evidence-based Graduate Nurse Transition Programs. What is already known about the topic? Duchscher’s foundational research on the Stages of Transition theory and Transition Shock model is applied to inform Graduate Nurse Transition Programs on an international level. There is a current workforce shortage within Australia and internationally. The importance of retention of newly graduated nurses has become a focus for health care services implementing supportive transition programs to prevent new graduates from leaving the profession in the first year. What this paper adds The inclusion of specific policy directives based on Duchscher’s Stages of Transition theory and Transition Shock model provides clear direction to Nurse Managers related to the required implementation steps and time frames to be met during the transition year. Additional Graduate Nurse Coordinator positions, with a manageable ratio of New Graduate Registered Nurses (NGRNs), are important supports for both graduates and Nursing Managers to meet policy directives. Additional positions should be costed within transition programs. Provides additional evidence that well supported newly graduated nurses are likely to remain within the health service.

Transition and pathway programs from second to first level nursing: A scoping review

BackgroundSecond-level nurses comprise a large proportion of the nursing workforce in many countries. Despite differences in nomenclature, these nurses work under the supervision of first-level registered nurses and possess a more restricted scope of practice. Transition programs facilitate second-level nurses upgrading their qualifications to become first-level nurses. Globally, the impetus for transition of nurses to higher levels of registration has been to increase the skill mix demands in health care settings. However, no review has sought to explore these programs internationally and experiences of those making the transition. ObjectivesTo explore what is known about transition and pathway programs from second to first level nursing. DesignScoping review informed by the work of Arksey and O'Malley. Data sourcesFour databases were searched, CINAHL, ERIC, Proquest Nursing and Allied Health and DOAJ, using defined search strategy. Review methodsTitles and abstracts were uploaded into the online program Covidence for screening, followed by full-text screening. Two members of the research team screened all entries at both stages. Quality appraisal was performed to assess overall quality of research. ResultsTransition programs are often undertaken to open up career pathways, job and financial advancement. These programs can be challenging as students seek to maintain dual identities, grapple with academic requirements and juggle work, study and personal demands. Despite their prior experience, there is a need for students to receive support as they adjust to their new role and scope of practice. ConclusionMuch of the existing research around second to first-level nurse transition programs is dated. There is a need for longitudinal research to examine students' experiences as they transition across the roles.

Transition to Practice Programs in Nursing: A Rapid Review.

Background Transition to practice can be exceedingly stressful for newly qualified nurses as they grapple with the "reality shock" of everyday practice as an RN. Transition to practice programs were implemented as a support strategy to ease the transition from student to RN and are designed to increase graduates' confidence and competence, improve their professional adjustment, and increase their retention. Method This rapid review was framed by the Cochrane Methods Rapid Review, supported by the PRISMA statement checklist, aiming to identify and describe the benefits of transition to practice programs for newly graduated RNs and their impact on workforce retention. Results The literature revealed that mixed evidence exists regarding the value and benefits of graduate nurse transition programs to both the graduate and the health service. Conclusion There are multiple inconsistencies across clinical settings, organizations, and preceptor-ship/mentoring training, among others, particularly in relation to duration of the program and the amount of formalized contact/study days. [J Contin Educ Nurs. 2022;53(10):442-450.].

External Evaluation of the Clinical Nurse Transition Program: The Next Step.

Evaluating Nurse Transition programs has undergone an evolutionary process to more accurately report outcomes. Based on a previous work, this project used the Clinical Nurse Transition Program-Evaluation Tool to externally evaluate the effectiveness of nurse transition programs within the U.S. Army Nurse Corps. The results support the belief that a new graduate nurse performs better at 24 weeks within the Clinical Nurse Transition Program than at 12 weeks. In addition, new graduates perform above standards 6 months postgraduation.

Graduate Nurse Transition Programs Pivotal Point of Participants' Practice Readiness Questioned During the COVID-19 Pandemic Crisis: A Scoping Review.

The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses' transition to become practice ready. A scoping review was conducted using the Joanna Briggs Institute scoping review framework. Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses' clinical skills and confidence development. With nursing confidence and competence gained through professional practice experience, it is apparent that for a sustainable nursing workforce, greater access for graduating nurses to transition programs is imperative. Recommendations include restructuring transition programs with possible time reductions, limited rotations, comprehensive orientations inclusive of preceptorship, and dedicated educators to increase and enhance supportive graduate nurse transitions. [J Contin Educ Nurs. 2021;52(8):392-396.].

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

ObjectiveTo 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). MethodNarrative 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. SettingIn total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited. FindingsThemes 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. ConclusionIn 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.

Evaluating the transition from nursing student to practicing nurse: An integrative review.

The transition period from student nurse to novice nurse is a stressful time. Patient outcomes, healthcare organizations, the new nurse, and the nursing profession can be negatively affected if the transition from nursing student to novice nurse is not a positive and successful experience. Currently, there are numerous interventions aimed at easing the transition for the new nurse with just as many instruments used to evaluate the success of the interventions in doing so. This integrative review examined quantitative studies that evaluated the outcomes of interventions implemented to ease the transition from student to professional nurse. The seven articles that met the criteria for this review discussed four types of programs and one curriculum revision and collectively used 14 instruments to measure a total of 18 concepts related to new nurse transition. Despite the significance of the studies' results that indicate interventions to ease the transition-to-practice experience are beneficial and can have a positive impact on areas such as job satisfaction and retention, overall findings from this integrative review suggest the need for greater standardization of concepts that should be evaluated and the instruments used to determine if new nurses are successfully transitioning into professional nursing.

Effective orientation programs for new graduate nurses: A systematic review

To determine the most effective orientation program for new graduate nurses (NGNs) in hospital settings. A systematic review of existing literature was conducted following a search of the electronic databases Science Direct, PubMed, EBSCOhost, ProQuest, and Wiley Online (2008-2018). Searches utilized the following keywords nurse orientation, new nurse orientation, practical orientation, nurse transition, and nurse transition program. A total of fourteen studies met our review criteria. Evidence from these studies showed that current orientation protocols consist of preceptorship, classes, and simulations of patient care. The most efficacious orientations had well-established goals and utilized proven learning materials, support systems such as preceptorship and mentorship, learning methods, and evaluation instruments within the organization. Well-designed orientation programs will result in positive effects on NGNs and patient care in the hospital.

Evaluation of Clinical Nurse Transition Program at US Army Hospitals

The purpose of this evaluation was to determine the effectiveness of the clinical nurse transition program (CNTP) for newly commissioned Army nurses. This is one of the first evaluations conducted to document the outcomes of the Army Nurse Corps (ANC) transition-to practice residency program. This project was a prospective pre-test/post-test design evaluation of newly licensed registered nurses (RNs) entering the military health system from Fall 2017 to Fall 2018 using Casey-Fink Readiness for Practice Survey and the New Graduate RN Transition Program Competency Assessment Tool. Data were analyzed using SAS 9.4. All tests were two-tailed as applicable and p-values less than 0.05 were considered significant. Missing data were treated as missing for individual items; their values were not imputed. No participant was excluded due to missing items. This evaluation was determined to be exempt from human subject protection regulations by the Human Protections Administrator at Womack Army Medical Center. A total of 92 pre-test surveys were sent to the nine CNTP training sites which actively trained RNs during the study timeframe. Due to a shipping error, 6 of the 92 completed pre-test surveys from one CNTP site were not received, for an overall response rate of 93.4% (86/92), from eight CNTP sites. Of the 86 participants from whom pre-tests were received, all 86 successfully returned their post-test survey, for a 100% response rate pre- to post- survey. The participants were predominately white (73.3%) and female (70.9%) with a median age of 23 years (IQR: 22-24 years) and an undergraduate GPA of 3.5 (IQR: 3.4-3.7, Table II). Quantitative data analysis revealed that after the training, all participants reported a significant improvement in providing safe (p < 0.0001) and quality care (p < 0.0001) for an average workload of in-patient patients. It also showed a significant improvement in team leading (p < 0.0001), effective decision making (p < 0.0001), incorporating evidence into practice (p < 0.0001), and demonstrated professionalism (p < 0.0001). The overall clinical competence and readiness to practice (p < 0.0001) also improved. Data shows that participants perceive significant improvement in all the objectives set by the ANC for the transition program. The results of this program evaluation provide evidence that the CNTP has been a success in meeting the intended objectives. Participants showed a significant improvement in their perceived readiness and level of competency in clinical, technical, and leadership skills performance at the end of the program, as well as improved communication and teamwork. The CNTP experience provides an effective means to facilitate the development of newly licensed Army nurses' clinical competence and confidence in practice. The study limitation includes the Casey-Fink Readiness for Practice Survey had relatively low reliability, but it was chosen as it was better aligned to the specified CNTP objectives. And also, with any self-reported evaluation, there is potential bias regarding the accuracy of participants' self-perception. Follow-up study may include examining the demographics of the incoming nurses, such as their source of commission. To determine if and how the comfort and confidence self-reported by the new graduate nurses is reflective of actual ability, nurse preceptors may be asked to complete skills assessments or simulations with objective measurements may be used.

Psychological impact of traumatic events in rural nursing practice: An Integrative review

Purpose: The purpose of this article is to present findings from a pilot quality improvement evidence-based new nurse transition program that facilitates clinical leadership skills in novice nurses at the point of patient care at a rural critical access hospital. Descriptive data from pre- and post-intervention scores are reported, and the percent change was evaluated. Sample: Due to the solitary nature of rural nursing, new graduate nurses in rural areas need support in transitioning to their new role as registered nurses. The author designed, and pilot tested a quality improvement evidence-based new nurse transition program in a rural critical access hospital utilizing complexity science as a framework. Method: A quality improvement pilot program designed for new graduate nurses was provided at a critical access hospital in a rural Midwestern State. Data was collected using pre- and post- intervention scores on the Leadership Characteristics and Skills Assessment and TeamSTEPPS Teamwork Attitudes Questionnaire. Descriptive data was evaluated. Findings: Participant post- test percent change scores increased in perceptions of ability to lead but decreased in attitudes about teamwork. Observations of participant interactions in the quality improvement project suggested that the new nurses were developing new ideas, patterns and structures regarding their roles as a team member in the healthcare setting. Conclusion: In a rural midwestern critical access hospital a quality improvement leadership program that used a complexity science framework was provided to novice nurses in transition. After the program participant total mean post scores increased in perception of what makes a good leader and in the participant’s perception of their ability to lead. An overall mean score decrease in attitudes about teamwork was noted among the small group of rural novice nurses. Keywords: rural, frontier, new registered nurse graduate, transition program, complexity science, leadership

Stakeholders External Evaluation of the Clinical Nurse Transition Program.

Nurse transition programs have predominantly used internal evaluations to evaluate quality outcomes, and thus, there appears to be a lack of current literature on external evaluation of these programs. External evaluation provides an objective and valuable tool for the nursing professional development practitioner to demonstrate return on investment. The results support the use of the innovative and groundbreaking Clinical Nurse Transition Program Evaluation Tool to externally evaluate the nurse transition program.

The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety: An Integrative Review.

Stronger evidence on the value of new graduate nurse transition programs is needed to justify the cost and warrant expansion of these programs to more health systems. The aim of this integrative review was to critically analyze published research on the relationship between new graduate nurse transition programs and patient safety outcomes. Limited evidence was found on actual safety improvement; rather, transition programs have predominately measured the development of competency as a process outcome variable for improving patient safety. A systems model is proposed to guide future research examining structure, process, and outcome variables, linking transition programs with patient outcomes.

Transition support for new graduate and novice nurses in critical care settings: An integrative review of the literature.

Transition into critical care areas for new graduate nurses may be more difficult than transitioning into other areas due to the specialised knowledge needed. It is unknown which aspects of transition programs best support new graduate nurses improve competence and confidence to transition into critical care nursing specialties. Identifying these aspects would assist to design and implement best practice transition programs for new graduates in critical care areas. Themes identified in the literature include; having a designated resource person, workplace culture, socialisation, knowledge and skill acquisition, orientation, and rotation. Allocation of a quality resource person/s, supportive workplace culture, positive socialisation experiences, knowledge and skill acquisition and structured orientation based on new graduates' learning needs all positively supported increased confidence, competence and transition into nursing practice. Rotations between areas within graduate programs can potentially have both positive and negative impacts on the transition process. Negative impacts of including a rotation component in a transition program should be carefully considered alongside perceived benefits when designing new graduate nurse transition programs.

Attributes of Effective Transition to Practice Program Leaders.

Providing management and support for nurse transition programs requires strong leadership. This article identifies the key knowledge, skills, and attitudes that leaders of nurse residency programs should possess to ensure that the residency achieves program and organizational goals. J Contin Educ Nurs. 2017;48(2):57-59.

New graduate nurse transition programs: Relationships with bullying and access to support.

Abstract New graduate nurses are often targets of bullying and horizontal violence. The support offered by new graduate nurse transition programs may moderate the effects of bullying and limit its negative impact on new graduate nurse transition. This study examined the relationships between access to support, workplace bullying and new graduate nurse transition within the context of new graduate transition programs. As part of a mixed methods study, an online survey was administered to new graduates (N = 245) approximately a year from starting employment. Bullied new graduate nurses were less able to access support when needed and had poorer transition experiences than their non-bullied peers. Participation in a formal transition program improved access to support and transition for bullied new graduate nurses. People supports within transition programs positively influenced the new graduate nurse transition experience. Formal transition programs provide support that attenuates the impact of bullying on new graduate nurses and improves transition.

New graduate nurses, new graduate nurse transition programs, and clinical leadership skill: a systematic review.

This systematic review evaluated the relationship between new graduate nurses and clinical leadership skill, and between new graduate nurse transition programs and clinical leadership skill. New graduate nurse transition programs have been cited as one strategy to improve clinical leadership skill, but to our knowledge, no one has synthesized the evidence on new graduate nurse transition programs and clinical leadership skill. Results of this review showed that new graduate nurse transition programs that were at least 24 weeks in length had a positive impact on clinical leadership skill. New graduate nurse transition programs using the University HealthSystem Consortium/American Association of Colleges of Nursing Nurse Residency curriculum had the greatest impact, followed by curriculum developed by the Versant New Graduate RN Residency, an important finding for nursing professional development specialists.

New Graduate Nurses, New Graduate Nurse Transition Programs, and Clinical Leadership Skill

New Graduate Nurses, New Graduate Nurse Transition Programs, and Clinical Leadership Skill

New graduate nurse transition programs and clinical leadership skills in novice RNs.

The objective of this study was to determine predictors of clinical leadership skill (CLS) for RNs with 24 months of clinical experience or less. New graduate nurse transition programs (NGNTPs) have been proposed as a strategy to increase CLS. CLS is associated with positive patient outcomes. Method used was hierarchical regression modeling to evaluate predictors of CLS among individual characteristics of RNs and characteristics of NGNTPs. Perceived overall quality of an NGNTP was the strongest predictor of CLS (R = 0.041, P < .01). Clinical experience and NGNTP characteristics accounted for 6.9% of the variance in CLS and 12.6% of the variance among RNs with assigned mentors (P < .01). RNs participating in NGNTPs for more than 24 weeks were 21 times more likely to remain employed within the organization when compared with NGNTPs of 12 weeks or less, a significant cost-benefit to the organization. Although perceived overall quality of a NGNTP was the strongest predictor of CLS, much of the variance in CLS remains unexplained.

The support needs of new graduate nurses making the transition to rural nursing practice in Australia.

The aim of this paper is to present the findings from the new graduate nurse participants of a larger study that explored the transitional experiences of newly graduated nurses making the role transition in rural health care facilities in Australia. Evidence indicates that workload, skill mix and organizational pressures are still of concern for new nursing graduates within the Australian context and internationally. Many graduates are expected by employers to have high levels of independence, well developed problem solving abilities and be able to assume management and leadership responsibilities early in their graduate year. An exploratory, descriptive, qualitative case study design was utilised to determine the particular support needs over time that would assist with a safe transition to the rural nursing workforce. The aims of the study were to: (1) Explore the new graduate nurses' perceptions and experience of the nature and timing of support throughout their Transition to Practice Program in a rural setting; (2) Identify the functional elements of rural graduate nurse transition programs and develop guidelines that will assist in the design of Transition to Practice Programs that match the rural context and capacity. A purposive sample of 15 new graduate nurses who had commenced a 12 month Transition to Practice Program within a rural health facility from northern New South Wales, Australia, participated in this study. In-depth individual interviews with the new graduate nurses were conducted at time intervals of three to four months, six to seven months and 10 to 11 months. One of the key findings of this study is that as the new graduate nurse making the transition to professional rural nursing practice moves along the transition continuum, there are particular and unique aspects of the rural nurse's role and responsibilities for which the new graduate nurse will require specific learning support during their transition. When the new graduate moves from the role of the student to the less familiar role of professional practitioner, it is important that a rural Transition to Practice Program offers an incrementally staged workload and responsibilities that recognises the graduate's beginning nurse status. The study contributes new knowledge to the discussion of issues concerning support mechanisms for new graduate nurses as they make the transition to rural nursing practice.

Graduate nurse program coordinators’ perceptions of role adaptation experienced by new nursing graduates: A descriptive qualitative approach

Aims : This research explores the challenges that new nursing graduates experience whilst adapting to their new role in their first year of practice. These challenges are presented from the perspectives of Graduate Nurse Program Coordinators in the state of Victoria, Australia, previously not described in the literature. Background : Each year, thousands of new nursing graduates join the workforce in Australia, with many suffering major stressors and dissatisfaction in their first year of practice. Much has been written about challenges faced by this group from their own perspectives, yet nothing has been heard from the perspectives of those who support them; that is, the coordinators of year-long graduate nurse transition programs. Methods : This descriptive qualitative study used individual, semi-structured interviews to access information and perceptions from sixteen Graduate Nurse Program Coordinators about the challenges experienced by nursing graduates in their first year of practice. Transcripts were thematically analysed to reveal reoccurring themes and sub-themes. Results : The interviews provided an insight into various challenges that nursing graduates experience in relation to role adaptation in their first year of practice. Nursing graduates found difficulties with reality shock, work-life balancing and having unrealistic assumptions in their capacity to work, assuming they should be at a higher level despite being a beginner practitioner. Conclusions: This study reinforces the need for education providers to maintain currency in their undergraduate nursing programs and to work closely with health care services in providing a quality clinical experience to all nursing students. It also provides evidence that graduate transition programs are essential, with Graduate Nurse Program Coordinators performing a crucial role in providing appropriately planned strategies to support graduates through this vulnerable time.