Social Ecological Perspective Organization

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Introduction:
A new graduate nurse is an individual who has just completed their nursing training and
has less than six months experienced as a registered nurse. Each newly placed graduate nurse
need to go through the period of transition when they try to develop from a student nurse to a
professional nurse. Transition is a first 12 months after graduation, when a student nurse enters
into clinical practice (Duchscher & Windey, 2018). However, this process of changing from state
to another is associated with many adjustments and challenges for nurses. Nurses are
overwhelmed by a sudden change in responsibility, identity and roles and this period is
associated with increase in stress level and work distraction issue for nurses (Wong et al., 2018).
According to Helgesen (2017), there is a rise in incidence of stress in newly graduate nurse and
they are at high risk of leaving their place of work or employment because of work stressors and
inability to handle challenges during the transition period. Due to the shortage of nurse, there is
a need to reduce rate of turnover among this group of nurse during the transition period (Hussein
et al., 2017). However, job satisfaction and turnover rate can be reduced only when there is clear
understanding regarding the challenges faced by graduation during the transition period. A
comprehensive review of the literature may help to get in-depth knowledge about transition
issues and provide adequate support to graduate nurse. The key themes that will be explored
include workload, team communication, theory-practice gap and blame culture. Based on the
review of findings under this theme, several areas of improvement and clinical practice
implications have been suggested.
Background:

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Newly graduate nurse, who are in the transition period suffer from high stress and poor
motivation because of transition shock. Transition shock is a term to define the experience of
moving from the familiar role of a nursing student to the unfamiliar role of professional
registered nurse (Duchscher & Windey, 2018). It is the initial stage of the role adaptation
process, graduate nurse suffer from emotional as well as psychological burden because of the
inability to provide safe care and frequently experiencing feelings of not being able to cope with
workload burden. According to the Kramer’s explanation, new graduate nurse display
withdrawal from the shock by showing emotions such fatigue, withdrawal, rejection and illness
(Wakefield, 2018). Transition shock is not a recent phenomenon. The first incidence of
transition shock was identified in 1970 and issues related to transition persist till the present time
too with majority of nurse feeling unprepared for the demands of professional practice (Ankers,
Barton and Parry, 2018).
There are many factors that lead to such kind of transition shock for nursing students.
One of the explanations given by Murray, Sundin and Cope (2019) is the high rate of theory-
practice gap. Due to limited exposure to clinical settings and experience of handling real patients,
nurses are vulnerable to making errors and not identifying any clinical deterioration on time. Due
to lack of experience and too many tasks at hand, many graduate nurses fail to prioritize time
management and end up ignoring patient safety responsibility (Murray, Sundin &Cope, 2019).
Thus, it is crucial that active support and encouragement is given to nurse at this time so that
they learn to identify deterioration and manage their time. According to Azimian, Negarandeh
and Fakhr-Movahedi (2014), staff shortage is another area leading to nurse’s struggle during the
transition period. The study explored factors affecting coping with transition among nurse by
conducting a qualitative interview with nurses. The study revealed lack of preparation for

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transition as one of the major cause behind transition shock. Factors like staff training,
development, professional relationship, welfare services and perceived level of support strongly
contributed to staff shortage. Moreover, Charette, Goudreau and Bourbonnais (2019) explained
the role of both organization as well as personal factors in influencing transition to practice.
Organizational factors included stability, orientation, workload and safety culture in any
hospitals and personal factors included personality of individual graduate nurse and lack of
professional curiosity.
Nursing or health care organization have identified the transition related challenges for
graduate nurse and implemented many initiatives or professional support programs to enable
nurse to effectively address challenges in practice. Education directed at eliminating incivility
and bullying is some example of continuous efforts to create positive work environment for
nurses. Based on new graduate nurse’s complain on incivility, zero tolerance policy has also
been implemented in many organization to foster behaviour change and promote culture change
(Dwyer & Revell, 2016). The implementation of the orientation program is also a positive
element that can not only provide them with stability but also lead to reduced workload
perception and anxiety.
Search strategy:
To search for relevant research literature according to the research aim, the search was
initiated in CINAHL and PubMed databases. The keywords to be used during literature
searching were taken from the following research questions:
What are the factors that influence a new graduate nurse’s transition into professional practice?