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)

Background: The transition to clinical practice is a phenomenon that all health care professionals experience and one that has been studied in many fields of health care, yet remains largely unexamined for Canadian midwives. This study asked the question: How do new registrant midwives in Ontario navigate the transition from student to clinician during their first year of clinical practice? Methodology: In this grounded theory study, a total of 13 semi-structured interviews were conducted with Ontario midwives from three participant groups: A) New registrants in their first year of clinical practice; B) Registered midwives with 1-5 years of clinical experience; C) Registered midwives who work with new registrants as supervisors or mentors. Findings: The Building, Bridging, and Being theory describes how new registrants transitioned to clinical practice. During the Building phase, individuals developed the knowledge and skills for clinical practice; midwifery students experienced elements of this phase during their final clinical placement. The Bridging phase occurred when new registrants embarked on independent clinical practice; this phase was characterized by providing clinical care without the safety net of a preceptor. Finally, the Being phase occurred when new registrants developed confidence in their skills and professional identity as midwives. A final theme, Bettering, encompassed participants’ suggestions of ways to help improve the transition process. Conclusion: The Building, Bridging, Being theory contributes to the present understanding of the transition to clinical practice for midwives in Ontario. This study highlighted the importance of strengthening the Preparation, Orientation, Mentorship, and Ongoing Education of new registrants through their transition to clinical practice. The findings of this study are relevant to individuals and organizations invested in educating and integrating midwives into the Ontario health care system and provides a starting point for further research centered on the transition to clinical practice for midwives in Ontario and throughout Canada. / Thesis / Master of Science (MSc) / The transition to clinical practice is a phenomenon that all health care professionals experience and one that has been studied in many fields of health care, yet remains largely unexamined for Canadian midwives. This study asked the question: How do new registrant midwives in Ontario navigate the transition from student to clinician during their first year of clinical practice? Thirteen interviews were conducted with Ontario midwives from three participant groups: A) New registrants in their first year of clinical practice; B) Registered midwives with 1-5 years of clinical experience; C) Registered midwives who work with new registrants as supervisors or mentors. The findings of this study led to the development of the Building, Bridging, and Being theory, which helps explain how midwives in Ontario transition to clinical practice and provides a starting point for further research centered around the transition to clinical practice midwives in Ontario and throughout Canada.

Qualified registered nurses are needed to provide bedside care to patients, yet there is a known registered nurse shortage in the United States, which has a global impact on the healthcare industry. Contributing to the nursing shortage is turnover, which is partly due to the inadequacies of preparation for role transition of newly qualified registered nurses. The purpose of this quantitative descriptive study was to determine if there was a relationship between retention and nursing career satisfaction of registered nurses who experience a transition to practice program and those who did not. Duchscher's transition shock theory served as the theoretical basis of this study. The Mariani Nursing Career Satisfaction Scale and the Turnover Intention Scale were completed by 271 registered nurses with 24 months or less of bedside clinical practice. Data collected were analyzed by performing a one-way multivariate analysis of variance. Results revealed there was no statistically significant difference between those who did and those who did not have a transition to practice program on the combined dependent variables of nursing career satisfaction and retention. A positive linear relationship was found between nursing career satisfaction and retention. Retaining satisfied nurses and easing the burden associated with transitioning into practice can impact positive social change. The positive social change can also impact other healthcare professionals, businesses, and consumers who are associated with the newly qualified registered nurse who is transitioning into practice. Results from this study can inspire future researchers to continue to focus on seeking effective methods that will increase nursing career satisfaction and retention of newly qualified registered nurses transitioning into practice.

After nursing school, graduate nurses complete a licensure examination to demonstrate possession of the minimal knowledge necessary to practice nursing. Even with the successful completion of the examination, many new graduate nurses still lack the competencies required for safe practice. This discrepancy between demonstrated knowledge and competent practice, which is termed a transition-to-practice gap, is a safety issue especially for persons with chronic illnesses. The purpose of this study was to identify and clarify this transition gap to determine possible solutions in the local setting of a large health care system. The theoretical model framing this investigation was Benner's novice to expert theory. A descriptive case study was used to answer the research question regarding which competencies new graduate nurses should possess to facilitate their transition from an educational setting to a practice setting. Purposeful sampling yielded 4 nursing staff educators who had worked with graduate nurses in the past 12 months. Data from interviews with participants were coded using in vivo, initial, and axial coding. Participants reported that graduate nurses lacked adequate communication, socialization, and technical skills. Poor communication and socialization proficiencies compromised collaborative patient care, while the absence of technical skills such as physical assessment impaired direct patient care. Findings supported the development of a transition-to-practice course to prepare graduate nurses to provide quality health care. The implications of social change resulting from this transition-to-practice course may include the positive transformation of new graduate nurses, the improved professional nursing practice setting, and the positive health outcomes of community members.

A perceived discrepancy exists in understanding between nursing educators' and hospital nurse leaders' views on job performance expectations and the reality of current job performance that may contribute to the difficulty experienced by novice nurses during their transition period. Lack of clarity in expectations may lead novice nurses to change jobs or leave the nursing profession within the first year of practice. The purpose of this descriptive study, guided by Benner's novice to expert theory, was to determine whether a difference exists between hospital nurse leaders' beliefs and nursing educators' beliefs about the frequency and competency levels, including leadership for novice nurses transitioning into practice, critical care nursing performance, teaching and collaboration, ability to plan and evaluate, interpersonal relations and communications, and professional development. Survey data were collected from 52 nursing educators and 52 hospital nurse leaders using the Schwirian's 6-dimension scale of nursing performance and analyzed using MANOVA and independent t tests. No differences were identified between hospital nurse leaders' and nurse educators' beliefs on the frequency and competency level in all areas examined for novice nurses transitioning into practice. Hospital nurse leaders' and nurse educators' expectations for novice nurses aligned. Further research should focus on ways to strengthen novice nurses' knowledge, critical thinking, and skills so they are better prepared to enter the transition period. Outcomes from this study may be used to improve education and transition to practice for novice nurses, which can result in positive social change.

PURPOSE: The purpose of this research was to identify the value of undergraduate nursing student clinical preparation within a dedicated education unit on transition to practice. SPECIFIC AIMS: Describe perceived competence, practice readiness, self-efficacy, job satisfaction, intent-to-stay and orientation length of students who participated in a clinical experience in a dedicated education unit upon graduation, 3- and 6-months employment. Explore new graduate nurses’ perception of the impact of a dedicated education unit clinical experience on transition to practice. Examine relationships between outcome variables. Explore associations between outcome variables and demographic and employment characteristics. FRAMEWORK: This research was guided by Albert Bandura’s Social Learning Theory. DESIGN: This study used a descriptive, longitudinal design with quantitative measures and qualitative interviews. RESULTS: 18 participants provided quantitative data, and five participated in an interview. Competence, practice readiness and job satisfaction were relatively high. Self-efficacy remained essentially unchanged at all three time points. Average orientation length was 13 weeks, with 41.7% reporting their orientation was shorter than planned. At 6-months employment, 91.7% planned to stay in their current position for one year. Competence and Self-efficacy were associated at 3- and 6-months. Prior healthcare work experience was associated with higher competence at 3- and 6-months. Participants valued the experience of working with a preceptor and the supportive learning environment that allowed them to develop technical and professional nursing skills. CONCLUSION: These findings support dedicated education units as having a positive impact on new graduate nurse’s transition to practice.

This study focused on the transitioning of graduate nurses (GNs) employed by a teaching hospital in the eastern United States to the professional role of registered nurse after a 6-week orientation was the focus of this study. Benner's novice-to-expert theory served as the framework for this qualitative case study. Twelve participants were chosen from 3 specific populations: GNs, nursing preceptors, and nurse managers. Three research questions asked about the perceptions of newly licensed nurses after completion of the orientation process related to their ability to make critical decisions in the professional role of RN, how the preceptor educational training program prepared staff nurses for the role of preceptor, and the beliefs of newly licensed nurses and nurse managers regarding the role of nurse mentor. Interviews and documents were the sources of the qualitative data collected from the participants and the organization. The data were coded manually in a comparative manner to extract the themes that emerged from the findings. Participants agreed that the orientation program did not provide sufficient time and education for GNs to learn and grow professionally and did not offer training to nurses serving as preceptors. Results identified the need for revisions to the orientation program that would offer consistency and relevancy to the needs of all stakeholders. The preceptor workshop and a transition-to-practice (TTP) program were developed based on the outcomes. The TTP program could benefit this teaching hospital as well as local, state, and national health care facilities that employ newly licensed nurses. Improving the training of preceptors and implementing the orientation program for GNs for a minimum of 6 to 12 months would improve patient outcomes and increase nurse competency.

This quantitative non-experimental descriptive correlational design sought to answer the question if there was a difference in newly licensed RN (NLRN) performance at one-year post hire after participation in a nurse residency program that offers a formalized curriculum that extends throughout the entire year, one that offers a formalized curriculum that does not extend throughout the entire year, or one that does not provide a formalized curriculum. The study utilized the Six Dimension Scale of Nursing Performance (SDNP) and evaluated NLRN performance on six subscales: leadership, critical care, teaching/collaboration, planning/evaluation, interpersonal relations/communication, and professional development at one-year post hire. Benner’s novice-to-expert model served as the theoretical framework for this study. The results of the Mann-Whitney U test revealed there was not a statistically significant difference between the type of nurse residency the NLRN participated in and his or her self-reported performance on the individual subscale scores of the SDNP. The results of the point-biserial correlation based on how well the NLRN performed the task did not reveal any significant correlations between the nurse residency and performance. However, a negative correlation was noted within the critical care (r = -.052) and the planning/evaluation (r = -.050) subscale scores. Results from this study corroborate what the literature has previously noted. NLRNs need an experiential opportunity to transition into the practice environment and progress on the novice-to-expert continuum.

Forty years after Kramer's (1974) seminal work, Reality Shock, new graduate nurses continue to have difficulty transitioning to the registered nurse (RN) role. The purpose of this phenomenological study explores the lived experience of new graduate nurses who completed a Veterans Affairs externship program in their senior year of nursing coursework and its perceived impact on their successful transition into the practice role 3-24 months following graduation. Benner's (1984) Novice-to-Expert Model, Karmer's (1974) Reality Shock Theory, and Selder's (1989) Life Transition Theory support a framework for this study. Twelve telephone interviews were conducted using van Manen's (1990) method for researching the lived experience. One overarching theme "feeling confident" and three main categories, "transitioning to the RN role," "making decisions," and "interacting with professionals," were identified from the data. Externship programs assist the student to comfortably and smoothly transition as a new graduate nurse by offering additional clinical and practice experiences. Given the complexity of today's health care environment, there is a growing need to better prepare the graduate nurse for their transition into nursing practice. Externship programs can serve this purpose.

Indiana University-Purdue University Indianapolis (IUPUI) / Nurse residency programs (NRPs) have been identified as a means to promote transitioning of new nurses into the professional nursing role. Questions have arisen related to which elements within those programs are most meaningful to the development of new nurses. As the nursing shortage drives the need for quick transition and development of nurses to meet workforce needs, nursing must identify what is meaningful to nurses in their transition to practice. The purpose of this multi-site study was to explicate meaning from the experiences of newly licensed registered nurses (NLRNs) who have just completed NRPs. The research question was “What factors have meaning for NLRNs who have experienced transition to practice in nurse residency programs in acute care settings?” Semi-structured interviews were used to collect data from six NLRNs from three different NRPs after completion of their programs. Using interpretative phenomenological analysis, themes and variations within those themes were derived from the descriptive narratives provided from participant interviews. Overarching themes identified were Relationships, Reflection, Active Learning, Resources and Organizational Systems. Findings have implications for practice and education as the nursing profession strives to find ways to transform nurses in an effective and efficient manner.