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.

Maslach and Leiter determined burnout to be caused by three major components: exhaustion, cynicism, and inefficiency. This literature review focuses on factors that directly contribute to new graduate nurse burnout. Major factors discussed in this paper are differences in expectations versus reality, influences from past education, developing professional identity, and the effect of the workplace environment on new graduate transition. Interventions to combat burnout are discussed along with recommendations for future research.

Competence and competency assessment in nursing are promoted as necessary to ensure the quality of health care services. The dominant discourse in the international nursing community suggests that competence should be assured through some form of competency assessment, however competence is a controversial concept, with many different definitions. There are significant concerns about the validity and reliability of currently available assessment technologies. Rather than continue the debate about definitions and measurement, I take as my research aim the discovery of how what has come to count as competence became settled. The data for this study was drawn from textbooks, journal articles, meeting minutes, government reports, interviews with senior nurse leaders who were active in the development of the ANRAC Competencies and the ANCI Competency Standards 3e and RN preceptors who assess competence, group interviews with Clinical Development Nurses who assess competence, and observations of newly qualified nurses being assessed by Clinical Development Nurses. Newly qualified nurses were chosen as the focus for this study as they are formally assessed as part of Transition to Practice programs offered by health agencies around Australia. The study focuses on the period 1985 to 2005. Theories from the science, technology and social (STS) discipline informed the analysis. I found that rather than existing as a singular definable reality, competence exists in an undecided set of potentials and is momentarily reified in daily nursing practices in the form of competency standards assemblages. Combined, the semiotic (competence) - material (competency standard) assemblages are created by inventive assessors who work allegorically with multiple competences. This is not the work of assessing competence; rather it is the work of producing competence. The findings of this thesis offer new insight into competence and assessment technologies that can inform further research and development into the practices of competence assessment.

The traditional new graduate nurse (NGN) orientation process places NGN with an experienced preceptor for 24 weeks and requires clinical skills checklists to be completed by the preceptor, a practice which is not an evidence-based practice for orienting NGNs. The purpose of this quality improvement project was to develop an evidence-based orientation to decrease time requirements and standardize the processes and evaluation of the NGN in the emergency department. The project was informed by Benner's novice to expert theory and focused on acquisition of clinical skills. The project team included 6 stakeholders: the Doctor of Nursing Practice student-leader, the unit manager, and several preceptors and novice nurses. The current evidence was identified utilizing various search terms via OVID, CINAHL, and MEDLINE. Five emergency department nurse residency programs and 7 rubric-based criterion articles were identified and evaluated. The team synthesized the available evidence to create the program. Resulting products included guidelines, evaluation rubrics, and projected pathways for ongoing development. Content validation was undertaken using peer review by 2 nurse scholars with area expertise, after which the project team revised all products based on feedback. Together, these products comprise an evidence-based solution to the problematic orientation of NGNs in the institution's emergency department. Adoption of methods that have proven valuable in undergraduate education, such as incorporation of syllabi and rubrics, may increase retention and improve clinical judgment in the NGN. These improved educational outcomes will, in turn, promote improved health outcomes for patients. Outcomes for the project will be monitored using retention rates and the results of the Casey-Fink Graduate Nurse Experience Survey.

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Bakgrund: Sjuksköterskeyrket är ett mångfacetterat yrke och den första tiden som nyutexaminerad sjuksköterska är viktig. Det finns ett samband mellan en bra start i professionen och att de nyutexaminerade sjuksköterskorna stannar inom yrket. Det är av stor vikt att nyutexaminerade sjuksköterskor stannar kvar i professionen för att på så sätt bibehålla kontinuitet och erfarenhet, då detta är komponenter som leder till en ökad patientsäkerhet. Syfte: Att beskriva nyutexaminerade sjuksköterskors upplevelse av sin första tid som yrkesverksam samt beskriva de inkluderade artiklarnas undersökningsgrupp. Metod: En beskrivande litteraturstudie baserad på tolv vetenskapliga artiklar. Artiklarna hämtades från databaserna Cinahl och PubMed via högskolan i Gävle. Resultat: Resultatet i denna litteraturstudie beskriver nyutexaminerade sjuksköterskor upplevelser i övergången till yrkesverksam. För att få en tillfredställande övergång till den nya professionen är det många bitar som ska stämma överens. De komponenter som framkom tydligast var arbetsplatsintroduktion, handledning, arbetskollegor samt den nya yrkesrollen. Nyutexaminerade sjuksköterskor upplevde arbetsplatsintroduktionen som både positiv och negativ. Hur handledningen upplevdes berodde till stor del på handledarens yrkeserfarenhet. Handledningen upplevdes betydande för kompetensutvecklingen. Om den nyutexaminerade sjuksköterskan integrerades och accepterades på ett bra sätt av nya kollegor så ökade det professionella självförtroendet. De nyutexaminerade sjuksköterskorna upplevde svårigheter att hantera den nya yrkesrollen på grund av avsaknad av kunskap och klinisk erfarenhet. Det totala antalet deltagare i studien var 396 stycken och fyra världsdelar finns representerade såsom Europa, Asien, Oceanien och Nordamerika. Slutsats: Vikten av en bra arbetsplatsintroduktion och första tid i yrket kan inte nog poängteras. Nyutexaminerade sjuksköterskor beskrev att det var av största vikt att de fick det stöd de behövde samt tilläts vara noviser i sin nya yrkesprofession, detta för att få en trygg och stabil grund att stå på. Stödet till de nyutexaminerade sjuksköterskorna borde ingå som en självklar del inom vården. / Background: The nursing profession is a multi-faceted profession in which the first time as a newly qualified nurse is important. There is a correlation between a good start in the profession and that newly graduated nurses stay in the profession. It is very important that graduated nurses remain in the profession to maintain continuity and experience, as this components leading to increased patient safety. Aim: To describe newly graduated nurses first experience as a registered nurse and to describe the included articles study-group. Method: A descriptive literature review based on twelve scientific articles. The articles were retrieved from databases CINAHL and PubMed through the University of Gävle. Results: The results of this study described the experiences of newly graduated nurses in their transition to professional. To obtain a satisfactory transition to the new profession, many details must be considered. Topics that emerged most clearly were the workplace induction, supervision, colleagues and the new professional role. Newly graduated nurses experienced workplace introduction as both positive and negative. How the supervision was experienced depended on the supervisor's professional experience and that the experience was described as significant for the development of skills. If the newly graduated nurses were integrated and accepted in a good way of new colleagues, the professional confidence increased. The newly qualified nurses experienced difficulties in dealing with their new professional role because of lack of knowledge and clinical experience. The total number of participants in the study were 396 and four continents were represented, such as Europe, Asia, Oceania and North America. Conclusion: The importance of a good workplace introduction and first time in the profession can’t be emphasized enough. Newly graduated nurses described that it was imperative that they got the support they needed and that they were permitted to be novices in their profession to have a solid foundation to stand on. Support for the newly graduated nurses should be an integrated part of healthcare.

As newly licensed registered nurses enter their first nursing role, their perceived preparation for practice may vary. This descriptive study addressed the education-practice gap that exists as nurses transition into nursing practice. The use of Benner's skill acquisition model offers a structure for connecting theory to practice. New graduate nurses responded to the Casey-Fink Graduate Nurse Experience Survey-© to identify gaps in preparedness for novice practice. A convenience sample of nurses within the first 12 months of hire (n = 35) was sent the survey link by educators from the chosen sites. Anonymity was maintained with 18 total responses and 5 respondents completing the entire 25-question survey. Responses were analyzed via descriptive statistics. New graduate nurses either strongly agreed or agreed that they were prepared for their new role and received positive support from preceptors and staff. However, nurses disagreed or strongly disagreed that they were prepared for transition from student to nurse in the areas of workload, unit integration, system, and interpersonal concerns. Thirty percent also felt uncomfortable with independent performance of some technical skills, such as emergency management and blood administration. None of the new graduate nurses felt unprepared in professional skills related to leadership, communication, and decision making, a finding which contrasts with the literature, which indicates that these are areas of difficulty for new graduates. These findings can be used to structure curriculum and educational strategies to address the perceptions of preparedness and transition-to-practice concerns discovered in this project. This project may lead to social change in its attempt to close the education-practice gap with a stronger population of new graduate nurses.

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.

Background: With the increasing older adult population, new graduate nurses will be providing care for patients with dementia more frequently and should be supported to care for this population during their transition period. Purpose: The purpose of this thesis was to explore the experiences of new graduate nurses providing care for patients with dementia in acute care environments. Methods: An interpretive descriptive qualitative study explored eleven Ontario new graduate nurses’ experiences providing dementia care in acute care environments. A thematic analysis was conducted. Findings: The thematic analysis resulted in three themes and several sub-themes: building of vision and values, clash of vision and values, and “make do with what you have”. Discussion and Conclusion: Facilitators to providing dementia care in acute care were supportive colleagues and early exposure to dementia care. The barriers identified were similar to the barriers experienced by nurses in the literature.

Bakgrund: cirka 5000 sjuksköterskor examineras varje år i Sverige. En sjuksköterska har många arbetsuppgifter utöver vården runt patienten. Som person skall sjuksköterskan vara respektfull och visa medkänsla. Erfarna sjuksköterskor ansåg att nyutexaminerade sjuksköterskor saknade den kunskap som krävdes för att självständigt utöva yrket. De erfarna sjuksköterskorna kände sig ansvariga över de nyutexaminerade sjuksköterskorna och uttryckte att de bland annat på grund av detta upplevde trötthet och utmattning.Syfte: att beskriva nyutexaminerade sjuksköterskors upplevelse av att arbeta som sjuksköterska samt granska de inkluderade artiklarnas undersökningsgrupp.Metod: en litteraturstudie med en beskrivande design. De elva vetenskapliga artiklarna som inkluderades i studien var av kvantitativ, kvalitativ och mixad ansats. Artiklarna söktes fram i databasen PubMed.Huvudresultat: nyutexaminerade sjuksköterskor upplevde att en bra handledning främjade kunskapsutvecklingen men att flera faktorer påverkade självförtroendet negativt i yrkesrollen; bland annat bristen på klinisk erfarenhet. Upplevelser av hierarki och mobbning beskrevs samt att situationer som innebar att kommunicera ledde till upplevelser av stress. Att nyutexaminerade sjuksköterskor funderade på att säga upp sig från sitt arbete berodde bland annat på att de kände sig inkompetenta och att de hade svårt att slappna av på fritiden.Slutsats: nyutexaminerade sjuksköterskor upplevde de första yrkesverksamma åren som psykiskt krävande och utmattande på grund av bland annat bristen på klinisk erfarenhet och upplevelser av mobbning. En bra handledare främjade kunskapsutvecklingen och bidrog till en bättre upplevelse. Ökad förståelse för nyutexaminerade sjuksköterskors upplevelser är av nytta för både erfarna sjuksköterskor och för verksamheten så de kan förbättra arbetsmiljön för de nyutexaminerade sjuksköterskorna. / Background: approximately 5000 nurses are examined each year in Sweden. A nurse has many tasks in addition to the care around the patient. As a person, the nurse should be respectful and show compassion. Experienced nurses felt that newly graduated nurses lacked the knowledge required to independently exercise the profession. The experienced nurses felt responsible for the newly graduated nurses, saying that, among other things, they experienced tiredness and fatigue.Aim: to describe newly graduate nurse´s experience of working as a nurse. Furthermore, the aim of this study was to examine the sampling of the included articles.Methods: a literature study with a descriptive design. The eleven scientific articles included in the study were quantitative, qualitative and mixed approaches. The articles were searched in the PubMed database.Main results: newly graduated nurses felt that good guidance promoted the development of knowledge, but that several factors negatively affected self-confidence in the professional role; including the lack of clinical experience. Experiences of hierarchy and bullying were described as well as the communication leading to experiences of stress. The fact that newly graduated nurses thought to quit their work was due, inter alia, to the fact that they felt incompetent and had difficulty feeling free because they thought about work all the time.Conclusion: newly graduated nurses experienced the first professional years as mentally demanding and exhaustive due to the lack of clinical experience and experiences of bullying. A good supervisor fostered the development of knowledge and contributed to a better experience. Increased understanding of the experience of newly graduated nurses is beneficial for both experienced nurses and for the occupations so that they can improve the working environment of newly graduated nurses.