The ongoing shortage of registered nurses is a nationwide phenomenon. Many factors contribute to the dissatisfaction and stress of new graduate nurses during the initial transition phase of their career. The lack of peer and leadership support is among the many factors that lead to constant turnover. New nurses entering the workforce are caring for patients with more complex health problems. The Commission on Collegiate Nursing Education (CCNE) has developed standards for accreditation of entry-to-practice nurse residency programs (NRP). The purpose of this DNP project was to propose a formal evidenced-based nurse residency program to the stakeholders of an acute care hospital based on the CCNE standards. The Iowa model of evidenced-based practice was used to outline this formal residency program, and Benner's novice to expert theory guided its development. Eight organizational stakeholders participated in the presentation of the proposal for the evidenced-based nurse residency program. A questionnaire based on the standards for accreditation of entry-to-practice nurse residency programs was used for evaluation. The majority of respondents indicated that the standards presented in the presentation were consistent with the requirements of accredited NRPs. For the three primary categories, program faculty, institutional commitment and resources, and management of patient care delivery, 89% of participants indicated an excellent rating on a four-point scale on the questionnaire. The proposed education, once implemented, could result in social change by ultimately improving work satisfaction, improved retention, improved quality of care, and ultimately improved patient health outcomes.

Background New graduate nurses face many workplace-related challenges in their first year of practice, which contributes to physical and mental strains. As a result, high levels of occupational stress are experienced among newly graduated nurses, leading them to doubt their willingness to continue in nursing. Furthermore, occupational stress is proven to interfere with both personal and professional risk factors, making it an important subject to highlight. Aim The overall purpose of this study was to describe newly graduated nurses’ experience of occupational stress during their first working-year. Method This literature study is based on twelve qualitative scientific articles, which has been analysed and assessed through a five-step model. Results The most frequently described state was feeling unprepared or unable to meet the various requirements of their profession. Challenges were associated with a knowledge gap between theory and practice, an overwhelming reality, leadership, responsibilities and difficulties adapting. There were also connections between the prevalence of long-term stress and early career burnout or turnover. Four main themes emerged from the results; A demanding work environment; To be on your own; Inability to relax; After adversity comes success. Conclusion New graduate nurses experience a mismatch between the external expectations of them as nurses and their own perception of their ability to perform accordingly. As they develop into professionals in their field, much support is needed. This increases the chances of them succeeding in fighting through their stressful challenges and remain sustainably in their positions.

Efforts to maintain a sufficient nurse workforce are hampered by dissatisfaction with the work environment. Incivility in the work environment is a major source of dissatisfaction. A healthy work environment is associated with higher levels of job satisfaction and improved retention. New graduate transition programs have been recommended as a deterrent to high levels of turnover associated within the first two years of employment, some of which is related to incivility. The purpose of this thesis was to examine the influence of incivility in the nursing workplace on new graduate job satisfaction and determine if there is an association between participation in new graduate nurse transition programs and satisfaction with the work environment. A systematic review of the literature was performed using MEDLINE- EBSCOhost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixteen studies, which met search criteria, were reviewed. Themes that emerged included workplace incivility, nurse residency programs, mentoring through preceptors, and empowerment. Findings indicated that incivility in the workplace was a significant predictor of low job satisfaction in new graduate nurses. While graduate nurse transition programs are associated with improved satisfaction and retention rates for these nurses, nothing in the literature indicated that graduate nurse transition programs had a direct impact on empowerment and job satisfaction related to the incivility these nurses experience.

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This project, which used a qualitative, explanatory case-study design explored the transition to practice of new graduate Registered Nurses (RNs) and Registered Practical Nurses (RPNs) in long-term care (LTC). Specifically, this study focused on the self-described transition to practice experience of the new graduate nurse (NGN), the contextual factors present in LTC that influenced this transition to practice, and how the transition experience was similar and different for the new graduate RN and RPN. Both NGNs and LTC directors were included in the study. In total, 7 NGNs and 2 LTC directors participated in semi-structured interviews. The NGN participants were employed as a nurse in one of the two LTC sites and had been working as a nurse for less than one year. Data were collected through Key Informants (NGNs and LTC directors), and Key Documents (LTC policies and orientation material). Results of this study introduced six contextual factors present in LTC that influence the transition to practice of NGNs and five processes that, as a result of the contextual factors, accelerate the transition to practice experience. This described accelerated transition to practice refutes the previously universally applied transition to practice theory and contributes new knowledge and understanding to the transition to practice experience of the NGN in LTC and more specifically how the new graduate RPN experiences transitioning. The findings also described the many similarities and some differences between the transition to practice experience of the new graduate RN and RPN in LTC. With increasing demands on the long-term care sector, these findings will be of interest to a broad audience including policy makers, educators, LTC directors and administrators, as well as nursing students and NGNs. It is anticipated that these results will direct further research on this topic, and inform policy, practice, and educational programs. / Thesis / Master of Science (MSc)

Ett bra introduktionsprogram är grundläggande för en lång framgångsrik karriär och gör det lättare för den nyexaminerade att lära sig, då övergången från studier till att börja arbeta som en legitimerad röntgensjuksköterska kan vara en stressig period. Syftet med denna studie var att undersöka nyexaminerade röntgensjuksköterskors upplevelse av introduktionen på en ny arbetsplats. Data samlades in till denna studie genom att intervjua nio röntgensjuksköterskor som tagit examen sommaren 2014. Dessa röntgensjuksköterskor arbetar på röntgenkliniker i mellan- och södra Sverige. All insamlad data analyserades med hjälp av innehållsanalys och det resulterade i tre kategorier: Introduktionsprogrammet, Handledarnas kunskap och egenskaper och Sociala relationers betydelse och påverkan. De nyexaminerade röntgensjuksköterskorna upplevde att introduktionen var tillräcklig och bra. Det fanns vissa delar som var mindre bra, till exempel att de blev räknade som en av den ordinarie personalen medan de hade introduktion. Alla informanter ansåg att det blir bäst ifall de har en specifik handledare i början av introduktionen, då det lätt kan bli förvirrande med flera handledare. / A good introduction program is essential for a long successful career and makes it easier for new graduates to learn. As the transition from studies to beginning working as a licensed radiographer can be a stressful period. The purpose of this study was to investigate the new graduate radiographers experience of the introduction at a new workplace. Data was collected for this study by interviewing nine new graduate radiographers who graduated in the summer of 2014. These radiographers are working on radiology departments in central and southern Sweden. All collected data was analyzed using content analysis and it resulted in three categories: Introduction program, The preceptors knowledge and qualities and Social relationships importance and impact. The new graduate radiographers felt that the introduction was sufficient and good. There were some parts that were less good, for example, they were counted as one of the regular staff while they still had the introduction. All the informants believed that it will be best if they have a specific preceptor in the beginning of the introduction, as it can easily become confusing with several preceptors.

The aim of this study was to examine, understand and conceptualise the critical thinking and clinical reasoning adopted by new graduate occupational therapists as they enter the workforce to become newly autonomous practitioners. The study obtained the perspectives of new graduates, their supervisors and service managers on the means by which critical thinking and clinical reasoning develop to meet the expectations of employers. Factors which impeded the transition between new graduate and autonomous practitioner were identified and explored. Ethical approval was obtained to conduct the study. The study adopted a qualitative phenomenological research approach; Interpretative Phenomenological Analysis (IPA), which informed framing, data gathering and analysis. Semi-structured interviews were conducted with new graduates (n=6), supervisors (n=7) and managers (n=7) from multiple sites within one National Health Service Board. Interviews were transcribed verbatim from audio-recordings. The findings indicate that new graduates are expected to develop critical thinking and clinical reasoning in a manner that might challenge traditional conceptualisations of the transitioning process. A phenomenon, historically named the “shock of practice”, was reflected on by therapists in each phase of the study and adaptive and mal-adaptive responses to this in the thinking and behaviour of new graduates was identified. The clinical supervisor-supervisee relationship appeared to be the key source of support, and the supervisor the most significant knowledge resource, for new graduates. This relationship was supplemented by both peer support and Preceptorship. Discharge planning was a significant source of anxiety and development of an algorithm to support this process is proposed. Recommendations for further research and theoretical implications for practice and undergraduate education are discussed.

Most hospitals orient new graduate nurses and experienced nurses in the same generalized orientation programs. To address the cost of orientation to specialty units, a pediatric hospital developed a tailored transitional residency orientation program for experienced nurses. The purpose of this project was to describe, compare, and evaluate the existing generalized orientation program and the transitional orientation program to determine how the orientations differed in structure, process, and outcomes. Donabedian's model assessing quality of care services and Benner's novice-to-expert theoretical framework served as guides in evaluating the orientation outcomes. Qualitative data about residency classroom time, preceptor selection and time, mentor selection and time, debriefing, and total length of orientation were collected for the generalized and transitional programs. The findings were that interview process and time, classroom time, mentor time, debriefing time, and length of orientation were decreased in the new transitional orientation program. Orientation costs were less for the transitional program than the generalized program ($20,000 to $30,000 versus $50,000 per nurse, respectively) and nursing staff retention was better for the transitional program than the generalized program (90% versus 68%). The generalized orientation and separate transitional orientation have resulted in a social change by delivering cost-effective orientation to both novice and experienced nurses. Outcomes will be of interest to hospital human resource departments and nurses who conduct orientation programs.

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