The transition from student to new graduate nurse is a difficult conversion. The challenges of the new graduate are the demanding workload, lack of clinical skills, and incivility from staff nurses and unfamiliar institutional cultures. More than 40% of new graduate nurses report making medication errors and feel unprepared to recognize and intervene in life-threatening complications that keep the patient safe from harm. Preceptorship is a clinical instructive model in which a professional relationship provides new graduate nurses with access to a clinical expert and role model within a preset time frame. The goal of the program was to evaluate the outcomes of a preceptorship program that individualized a teaching-learning method in which a new graduate nurse was assigned a clinical expert in order to experience the day-to-day practice with a role model and a resource in the clinical setting. At the conclusion of the orientation process, the graduate nurse identified confidence in their ability to complete assigned skills, they were more motivated to remain on staff in the facility, and the retention of the new graduate nurses increased from 40% to 100% at the 1 year mark. The graduate nurses evaluated the program, the preceptor and the assigned competencies and the facility and the probability of continuing on staff. The surveys were collected by management, and evaluated for rigor, which revealed encouraging results of the program. The facilitation and integration of the preceptor program for new graduate nurses changed the perception of competency within the facility as it relates to the discipline of nursing and moves the graduate toward professional growth, establishing a changing environment in the facility's community of healthcare.

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Different studies show that stress is a common feeling that newly graduated nurses experience during the first period in the profession. What causes the stress are high expectations that they have on themselves and the expectations from colleagues, as well as the fear of making a mistake while working as a nurse. Newly graduate nurses go through five stages of development from being novice to expert. The aim of this study was to describe work experiences of newly graduate nurses in hospital ward settings. The research method was a literature study based on ten qualitative articles. Articles were analyzed by using the method of Friberg (2012). Four main themes were identified: experiences of leadership; experiences of the relationship with colleagues; experiences of support; experiences of knowledge level. Colleagues and managers must respond to the needs of newly graduated nurses in an adequate way to create a friendly and supportive working environment, which in turn can contribute to the professional development of the newly graduated nurse. Nursing education should prepare students for professional careers in terms of socialization, leadership and organization.

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.

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)

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Bakgrund: En sjuksköterska har stora och varierande arbetsuppgifter och en nyutexaminerad sjuksköterska förväntas göra arbetsuppgifter de inte känner sig kvalificerade för, men ansvariga för, i en miljö som andas stress. I övergången från student till arbetsliv är det många nyutexaminerade som väljer att lämna yrket när ansvaret blir alltför överväldigande. Syfte: Syftet med denna litteraturstudie var att undersöka nyutexaminerade sjuksköterskors erfarenheter av stöd på arbetsplatsen. Ett ytterligare syfte var att beskriva datainsamlingsmetoden i resultatets ingående artiklar. Metod: Litteraturstudien hade en deskriptiv design bestående av 13 systematiskt sökta artiklar. Databaserna Cinahl och Pubmed användes för artikelsökning. Huvudresultat: Resultatet visade att stöd i olika former kunde vara en ovärderlig hjälp för att klara av arbetet och för att hitta yrkesrollen. Stödet kunde komma från introduktion, att lära sig hur arbetsplatsen fungerar, möjlighet till utbildning, kollegor, handledare/mentorer och chefer. Slutsats: Nyutexaminerade sjuksköterskor upplevde stödet viktigt för att de skulle vilja stanna kvar och trivas på arbetsplatsen samt för möjligheten att växa in i sjuksköterskerollen och utvecklas till kompetenta sjuksköterskor. Författarna till föreliggande litteraturstudie tolkar resultatet som att arbetsplatser bör se över sina rutiner för introduktion, information och strategier för utslussning och mottagande av nyutexaminerade sjuksköterskor då dessa är sjukvårdens framtid vilka tryggt ska vårda patienter. / Background: A nurse has large and varied tasks where a newly graduated nurse is expected to do work they do not feel qualified, but responsible for in an environment that breathe stress. In the transition from student to working life, many graduate choose to leave the profession when the responsibility becomes too overwhelming. Purpose: The purpose of this study was to investigate newly graduated nurses experience of support in the workplace. A further aim was to describe data collection method in the result's depth articles. Method: The literature study had a descriptive design consisting of 13 systematically searched items. Databases Cinahl and Pubmed was used for article search. Main Results: The results showed that various forms of support could be an invaluable help to do the work and to find the professional role. The support could come from introduction, to learn how the workplace works, access to education, colleagues, tutors / mentors and managers. Conclusion: Newly graduated nurses felt that support was important to remain and thrive in the workplace as well as for the opportunity to grow into the nursing role and become qualified nurses. The authors of this literature interprets the result as workplaces should review their procedures for the introduction, information and strategies for channeling out and reception of newly graduated nurses since these are the future of health care which should be safely care for patients.

Evidence-based practice (EBP) is a key driver of care and advancements within nursing. It is essential to emphasize EBP early in a nurse's career to promote inquisitive minds and enthusiasm for seeking evidence. The purpose of this project was to implement an EBP mobile app into a nurse residency program (NRP) to improve the process of providing EBP information and resources to new graduate nurses. The intent of the project was to leverage mobile technology to engage new graduate nurses in evidence-based practice. Roger's diffusion of innovation framework guided the project. The target audience for the project was 16 new graduate RNs participating in a health system's NRP who attend the EBP module and were required to complete an EBP project. The EBP module was provided during a classroom lecture and the mobile application was downloaded. After using the EBP module, all attendees were sent an electronic survey with open-ended questions related to the mobile application. Responses were reviewed to identify patterns. Survey responses reflected that a 50% did not utilize the mobile application. However, those that did use the mobile application (50%) found it useful and had a positive perception of the mobile application. Continued use of the mobile application and promotion of the mobile application for new graduate nurses may help with their own personal development of an EBP project. Ultimately, allowing nurses to effectively integrate nursing research into practice and impact patient care quality. This project impacted social change by empowering new nurses with knowledge and information related to evidence based practice and allowed for increased information to be accessible to a large audience of new graduate nurses.

Bakgrund: Behovet av legitimerade sjuksköterskor förväntas öka de kommande åren. Högskolor och hälso- och sjukvården har en utmaning i att locka till sig fler att utbilda sig och stanna kvar inom sjuksköterskeyrket då många blir sjukskrivna på grund av utmattning eller slutar redan det första året som yrkesverksam. Syfte: Att beskriva nyutexaminerade sjuksköterskors upplevelser av yrket. Metod: En beskrivande litteraturstudie med resultat från 13 stycken artiklar, som alla sökts fram i PubMed via biblioteket på Högskolan i Gävle. Huvudresultat: I studien framkom 3 huvudteman med tillhörande underteman: En överväldigande start på arbetslivet, Arbetsmiljö och Från Novis till erfaren. Nyutexaminerade sjuksköterskor upplevde övergången från utbildningen till arbetslivet som svår, med brist på klinisk erfarenhet under studietiden. Detta bidrog till stress och en känsla av otillräcklig kompetens samt till att en holistisk omvårdnad inte hanns med. Bra arbetsmiljö och handledning med återkoppling från handledare, kollegor och chef beskrevs ha stor inverkan på den nyutexaminerade sjuksköterskans upplevelse, självförtroende och kompetens. Slutsats: Många sjuksköterskor upplevde brister i kliniska färdigheter och kände sig osäkra i sin nya yrkesroll vilket antyder att sjuksköterskeutbildningen bör integrera mer praktik med teorin. I studiens resultat framgår det att tryggheten och självförtroendet kommer med tiden, det gäller att inte ge upp under den första tiden med osäkerhet i den nya yrkesrollen, vilket stämmer väl överens med Benners modell Från novis till expert. / Background: The need for licensed nurses is expected to increase in the coming years. Universities and health care face a challenge in attracting more people to study and stay in the nursing profession as many either take sick leave due to exhaustion or quit during their first year as a professional nurse. Aim: To describe newly graduated nurses' experiences of the profession. Method: A descriptive literature study with results from 13 articles, all of which were searched for in PubMed via the library at the University of Gävle. Main results: In the study, 3 main themes emerged with associated sub-themes: An overwhelming start to working life, Work environment, and From novice to experienced. Newly graduated nurses experienced the transition from education to working life as difficult, with a lack of clinical experience during their studies. This contributed to stress and a feeling of insufficient competence, as well as a lack of holistic nursing. Good work environment and supervision with feedback from supervisors, colleagues and the manager was described as having a great impact on the newly graduated nurse's experience, self-confidence and competence. Conclusion: Many nurses experienced shortcomings in clinical skills and felt insecure in their new professional role, which suggests that nursing education should better integrate more practice with theory. The results of the study show that security and self-confidence come with time; it is important not to give up during the first period of insecurity and uncertainty in the new professional role, which is in good agreement with Benner's model From novis to expert.