Factors Influencing New Graduate Nurse Transition: Literature Review

This literature review examines the factors influencing the transition of new graduate nurses into clinical practice. The introduction highlights the role of nurses, the challenges faced by new graduates, and the significance of a smooth transition. The review covers various aspects, including workplace mistreatment, role transition, stress, and the shortage of nurses. The literature search strategy involved identifying key concepts and relevant databases. Findings reveal that workplace mistreatment, lack of formal orientation, stress, personal and organizational factors, and nurse shortages significantly impact new graduates. The discussion emphasizes the need for supportive environments, mentorship, and further research to address the challenges and facilitate a successful transition for new graduate nurses. The review underscores the importance of addressing these factors to improve the retention and well-being of new nurses and ensure quality healthcare delivery.

Running head: LITERATURE REVIEW 1
Literature Review
Student’s Name
University Affiliation

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Literature Review
 Introduction
The role of nurses in health care settings is to take care of the patients under the supervision of physicians. There are different
kinds of nurses such as a graduate nurse and a registered nurse. The term new graduate nurse refers to nurses or individuals who have
graduated from an accredited nursing program and are taking the next step to becoming a registered nurse (Barnes, 2015). These
graduate nurses are eligible for a temporary permit to work as a graduate nurse. A registered nurse is a licensed nurse who can
professionally work in a healthcare setting. According to (Barnes, 2015), a graduate nurse is a recognized or approved entry-level
nursing education program.
This paper will be specifically be looking at the new graduate and the factors that influence these new graduate’s transition into
practice. A transition is a form of development or evolution or different phases the new graduate nurse goes through as they become a
registered professional nurse. New graduates nurses are affected by different factors that influence their transition into nursing. Such
factors include lack insufficient access to experienced professionals who can play the role of a mentor and bullying. Other factors
include multiple comorbidities higher number of sick individuals with complex conditions in hospital settings and performance
anxiety (Coyne et al., 2016).

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Most nurses are stressed and exhausted especially during the time of transition. Nurses must lead the interprofessional team,
manage patients and also manage relationships with providers and families. Besides, nurses have to care for complex patients and
thus may suffer from nervousness leading to attrition of nursing practice (Sahay, Hutchinson & East, 2015). Also, many hospitals are
receiving many patients with complicated conditions. For example, in the regions of Eastern North Carolina, study shows
disproportionately high rates of obesity, end-stage renal disorders, heart disorders, cancer, and diabetes (Villanueva, 2018). All these
complex conditions are as a result of lack of limited access to preventive care, lack of access to primary care, inadequate funding for
care and socioeconomic problems.
The healthcare settings are experiencing many nurses depart as a result of increased workloads, increased ambulatory
opportunities, declining resources and lack of upward mobility. For this reason, healthcare organizations are challenged to leverage
seasoned staff as mentors to provide directions to new graduates. For millions of years, coaches have been vital to a successful
transition, and lack of these coaches in hospitals makes negatively affects the development of new graduates (Huang, Chen & Chiang,
2016). Institutions should likewise account for generational diversity particularly when setting mentorship programs. Experienced
nurses expect more structure in hospitals and if these needs are not met, turnover will be anticipated. Fatigue is also critical as role
ambiguity is the primary cause of burnout among many nurses (Missen, McKenna & Beauchamp, 2016)
Workplace bullying as a pervasive problem that limits free socialization of fresh nurse graduates (Tennant & Stewart, 2017).
Mostly, nurses bully other with the aim of controlling their work environment. This kind of bullying is as a result of lack of effective

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leadership in healthcare organization, thus the need for an effective leadership. Health care institutions that lacks effective leadership
in their workplace the research has shown that there is grate chances of bullying (Barnes, 2015). This is the promotion of unwanted
unprofessional behavior in our healthcare institutions. Each leader in clinical setting has the obligation to make sure there is viable
working environment for every worker as friendly working environment will ensure support of health and the well-being of all
patients and staffs within the organization. These factors can be problematic to nurse graduate, and when faced by these graduates it
becomes complicated to transition to the workplace successfully.
• Background
Fresh nurse graduate remains to be faced with several challenges that have resulted into their unsuccessful transition in their
clinical practice. Such challenges have made several nurse graduates disappointed thereby exiting from the nursing practice. New
nurse graduates face difficulties that affect their successful transition to practice. Health care institutions, therefore, need to understand
how changes in hospital settings affect new graduate. According to (Tennant & Stewart, 2017), looks at factors influencing the
successful transition of new graduate nurses and possible solutions to successful development.
The demand for nurses as a result admission of many patients with different complications is high. Health care organizations are
under pressure to operate efficiently as a result of increased regulatory oversight and increased consumerism (Gardiner & Sheen,

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2016). This increasing pressure raises the demands of education programs that support nurses to be work ready from the time they
finish their training.
• Literature Search Strategy
Based on the topic, “What are the factors that influence a new graduate nurse’s transition into practice?” I can search its
literature in several step strategies. The first step will be to identify the key concepts and terms within my research question. In this
case, my crucial search concept will include:
Search concept 1 Search concept 2 Search concept 3 Search concept 4
Factors New graduate nurses Transition Practice
Determinants Registered nurse Transformation Application
Nurse practitioner Role transition
Workforce Transition theory
The second step in my literature search strategy will be to select the relevant databases and resources. To ensure a
comprehensive literature search, in this case, I will include several databases such as PubMed, Embase, Cochrane library, Scopus and
web of science. The next step will be to combine my search terms with the Boolean operator. For example, in this case, I will combine

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search will be the new graduate nurse’s transition, graduate nurse transition, and practice, etc. I will then run searches in my selected
databases and resources. After running my searches, I will review and refine the search results.
• Literature Review Findings
. Workplace mistreatment
The first year of fresh nurse graduates has different challenges as the new nurses have high levels of emotion exhaustion
(Laschinger et al., 2016). Besides, being positive about their past experience and commitment, they find themselves unable to prosper
as a result of situational and personal challenges. This makes them to be inefficient in their provision of health care services as a result
of work mistreatment. The findings are that workplace mistreatment is an issue for new graduate nurses thus an issue that requires to
be addressed (Laschinger et al., 2016).
Role transition verses formal orientation
According to (Barnes, 2015), there are multiple factors that are believed to affect the nurse practitioner role transition. There is a
positive correlation between nurse practitioner role transition and a formal orientation (Barnes, 2015). According to the study(Barnes,
2015), most of the registered nurses experience did not explain nurse practitioner role transition and future research is required to find
out more factors that may influence the new graduate nurse transition.

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Stress
The first year of nurse graduates is very stressful as many graduate nurses’ reports reality shock, burnout, gaps in their education
among many other negative influences in their transition in the nursing profession (Ortiz, 2016). There are three main factors
influence the transition from student to experienced professional nurse (Gardiner & Sheen, 2016). These factors include the feeling of
stress which is as a result of nursing roles and responsibilities, the amount of support from the seniors and the significance of feedback
on their performance as nurses (Wong et al., 2018).Basing on the study (Ortiz, 2016), I can suggest that the study is very narrow on its
research, and thus further investigation which is focused on the support and feedback provided to new graduate nurses is required for
the best conclusion.
Personal and organization factors
Factors that affect new graduate nurse transition as they continue to experience challenges in transitioning into their practice have
been identified in (Dwyer & Revell, 2016). The study extracted relevant data from 42 articles and significant values recorded (Dwyer
& Revell, 2016). The paper indicates that a complex interplay between intrapersonal, interpersonal and organizational factors have an
impact on new graduate nurse transition .Therefore from the findings (Dwyer & Revell, 2016) , some of the factors that harm new
graduate nurse transition include interpersonal factors, intrapersonal factors, and organizational factors.

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Shortage of nurses
According to (Wong et al., 2018), there are shortages of nurses in all health care settings thus the study tries to find out the reasons
as to why there are such shortages. The study indicates that new nursing graduates are faced with many difficulties especially in their
first year after graduation (Wong et al., 2018). When faced with these challenges, their psychological health is affected which in turn
influences their perseverance thereby leading to high resignation rate in the healthcare sector. The study (Wong et al., 2018), explores
different challenges these fresh graduates face by selectively interviewing them in Hong Kong. In reference to their findings, lack of
effective communication, change of role support, workload and insufficient knowledge are some of the challenges faced by fresh
graduate nurses (Wong et al., 2018).
A few limitations of the research findings are that the entire participant interviewed were from the same nursing program; thus
the findings may not represent all the new graduates (Wong et al., 2018). Also, the transition period is within the first one year after
graduation, and these participants were pursued at the sixth graduation month after graduation thus the need for follow- up study to
examine if there might be any changes within the transition period (Fair et al., 2016). Furthermore, the findings suggest that the
attitude of all participants was positive thus uncertain if the study was carried across the population (Fair et al., 2016).

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• Discussion
According to (Sahay et al., 2015) review, it implies that the majority of the nursing students feel that support from clinical
settings has an impact on their learning outcomes as reported in most of the studies. Support from healthcare staffs in the clinical
settings can be a source of motivation to graduate nurses as this motivates them as they feel welcome and part of the team (Sahay et
al., 2015). Health care staffs and educators need to recognize that new graduate nurses succeed in an environment where they are
respected and feel part of the team. A supportive environment is critical as it helps to reduce the anxiety levels new graduate nurses
(Hofler & Thomas, 2016). The supportive environment also facilitates the process of socialization where anxiety lessens, and
confidence increases thereby enhancing learning for quality outcomes.
To address the management theory of practice gap on the attitude of experienced nurses educated in modern programs versus
those in traditional programs, further research is needed in the future. Further study is also required on the support and feedback
provided to new graduate nurses and to examine more influencers for new graduate nurses transition (Gorski et al., 2015). Besides,
follow up research is required to examine any changes throughout the transition period as the period of graduation may bring varying
results (Gorski et al., 2015).
There are different challenges or factors influence the transition in nurse graduate. Among these challenges faced by new
nurses, heavy workload seems to be the most challenging issue in reference to (Barnes, 2015). One reason behind the substantial

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outstanding task at hand is that there are dependably a high proportion of medical attendants to patients and less work in the ward.
This is the opposite when you refer to (Barnes, 2015), whereby the international standard ratio of physicians to clients is supposed to
be 1:6. This international standard ratio ensures there nurses do not experience heavy workload thereby ensuring quality health care
delivery to all clients. All professional teams in hospital settings need to work in shifts as this ensures quality services delivery (Bush
& Lowery, 2016). As a result, this result induces stress to new graduate thus delaying their transitional role in their practice.
New nursing graduates reported that knowledge and skills that are learned in nursing schools are very vital but insufficient
(Gardiner & Sheen, 2016). As a result, the lack of confidence when working independently becomes an issue in their transition
practice as they lack experience.
• Conclusion
This paper aims to discover out the possible components that impact new alumni in their transformation. Such factors have
resulted into creation of practice gap between fresh nurse graduates and the experienced nurses in clinical settings (Goode, Ponte &
Havens, 2016). Some of the factors that have led the gap include rapid deployment from nursing school to actual clinical practice,
socialization issues and supernumerary issues (Freeling & Parker, 2015). The findings from the literature reviews supported the
existence of the gap in the clinical settings (Gardiner & Sheen, 2016).

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From the findings of this literature review, one can conclude that socialization, communication, and competency can play a
critical role in ensuring a successful transition of new graduate nurses to registered nurses. The new graduate nurses require enough
experience and transformation to move to the next step of their roles (Gardiner & Sheen, 2016).
The current literature suggests the use of multiple approaches that can help in closing the transition gap (Freeling, & Parker,
2015). With the use of these various approaches, the new graduate nurses can be assisted to transform into an advanced beginner
(Barnes, 2015). For instance, the method used by many employers is the nurse residency program which contributes to increased
retention and decreased stress among the new graduate nurses although the study has provided little data that can support the outcome
of increased competency which can lead to the quality patient outcome.
Without the supportive environment that provides supervision graduate nurses will continue to report high levels of stress.
Therefore adequate support for graduate nurses is required to increase confidence and job satisfaction. Also, as a result of many
research showing that there is bullying in many health care settings that are negatively affecting new graduate nurse transition,
healthcare heads should be aware of the possible occurrence of any unprofessional behavior. The clinical health care settings need
quality care which in turn can be provided by positively transformed new graduate nurses who are confident in providing patient care
(Tuckett et al., 2015). Thus there is a need for increased guidance and training in the workplace to counter interact factors that bring
the transition gap between new graduate nurses and registered experienced nurses (Coyne et al., 2016). In conclusion, the barriers to

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the effective transition of graduate nurses can be improved by removing barriers to practice and care, collaborating, promoting
diversity, improving data and transforming education.

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 Reference List
Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2),
178-183.
Bush, C. T., & Lowery, B. (2016). Postgraduate nurse practitioner education: Impact on job satisfaction. The Journal for Nurse
Practitioners, 12(4), 226-234.
Coyne, E., Rands, H., Gurung, S., & Kellett, U. (2016). I-Kiribati nursing graduates experience of transition from university to
residential aged care facilities in Australia. Nurse education today, 36, 463-467.
Dwyer, P. A., & Revell, S. M. H. (2016). Multilevel influences on new graduate nurse transition: A literature review. Journal for
nurses in professional development, 32(3), 112-121.
Gardiner, I., & Sheen, J. (2016). Graduate nurse experiences of support: A review. Nurse Education Today, 40, 7-12.
Goode, C. J., Ponte, P. R., & Havens, D. S. (2016). Residency for transition into practice: An essential requirement for new graduates
from basic RN programs. Journal of Nursing Administration, 46(2), 82-86.

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Gorski, M. S., Gerardi, T., Giddens, J., Meyer, D., & Peters-Lewis, A. (2015). Nursing education transformation. AJN The American
Journal of Nursing, 115(4), 53-57.
Fair, C., Cuttance, J., Sharma, N., Maslow, G., Wiener, L., Betz, C., ... & Naranjo, D. (2016). International and interdisciplinary
identification of health care transition outcomes. JAMA pediatrics, 170(3), 205-211.
Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: a concept analysis. Journal of advanced
nursing, 72(3), 501-513.
Freeling, M., & Parker, S. (2015). Exploring experienced nurses' attitudes, views and expectations of new graduate nurses: A critical
review. Nurse education today, 35(2), e42-e49.
Hofler, L., & Thomas, K. (2016). Transition of new graduate nurses to the workforce challenges and solutions in the changing health
care environment. North Carolina medical journal, 77(2), 133-136.
Huang, C. C., Chen, J. Y., & Chiang, H. H. (2016). The transformation process in nurses caring for dying patients. Journal of Nursing
Research, 24(2), 109-117.
Laschinger, H. K. S., Cummings, G., Leiter, M., Wong, C., MacPhee, M., Ritchie, J., ... & Young-Ritchie, C. (2016). Starting out: a
time-lagged study of new graduate nurses’ transition to practice. International Journal of Nursing Studies, 57, 82-95.

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Missen, K., McKenna, L., & Beauchamp, A. (2016). Registered nurses’ perceptions of new nursing graduates’ clinical competence: A
systematic integrative review. Nursing & health sciences, 18(2), 143-153.
Ortiz, J. (2016). New graduate nurses' experiences about lack of professional confidence. Nurse education in practice, 19, 19-24.
Sahay, A., Hutchinson, M., & East, L. (2015). Exploring the influence of workplace supports and relationships on safe medication
practice: A pilot study of Australian graduate nurses. Nurse education today, 35(5), e21-e26.
Tennant, K., & Stewart, J. (2017). Graduate Nurses' Perceptions of the Refugee Crisis: A High-Impact Practice.
Tuckett, A., Winters‐Chang, P., Bogossian, F., & Wood, M. (2015). ‘Why nurses are leaving the profession… lack of support from
managers’: What nurses from an e‐cohort study said. International Journal of Nursing Practice, 21(4), 359-366.
Villanueva, J. C. V. (2018). Benevolence: lived experiences of staff nurses. Nurs Palliative Care Int, 1(1), 20-24.
Wong, S. W. J., Che, W. S. W., Cheng, M. T. C., Cheung, C. K., Cheung, T. Y. J., Lee, K. Y., ... & Yip, S. L. (2018). Challenges of
fresh nursing graduates during their transition period. Journal of Nursing Education and Practice, 8(6), 30.

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 Table of Evidence
 Author,
Year &
Country,
Methodology
Study Design & Level of
Evidence
Study
Aim/Purpose
Participan
ts
Interven
tions/
Control
Groups
Outcome
Measures
Findings
Laschinger, H. K.
S., Cummings,
G., Leiter, M.,
Wong, C.,
MacPhee, M.,
Ritchie, J., ... &
Young-Ritchie, C
2016
Canada
Surveys containing
standardized questionnaires
. Descriptive statistics,
correlations, and hierarchical
linear regression analyses
were conducted using SPSS
software.
To investigate
factors
influencing new
graduate nurses’
successful
transition to their
full professional
role
3906
Registered
Nurses
There
were no
control
groups
No outcome
measures
Situational and personal factors explained significant
amounts of variance in new graduate nurses’ job and
career satisfaction and turnover intentions.
Barnes, H.
2015
United States
Sstudy used a descriptive,
cross-sectional survey of
practicing NPs
To examined
factors believed to
affect nurse
practitioner (NP)
role transition
352
participants
at a
national NP
conference
There
were no
control
groups
NP role
transition
was the
dependent
variable.
A positive correlation exists between a formal
orientation and NP role transition.
Gardiner, I., &
Sheen, J. (2016).
Australia
Literature review To gain a greater
understanding of
the experiences of
GNs.
Thirty-six
articles
There
were no
control
groups
The review identified three main themes that influence
the transition from student to registered nurse. These
themes included, 1) feeling stressed and overwhelmed
by nursing responsibilities, 2) the amount of support
from senior nurses and 3) the importance of feedback on
their performance as nurses.
Dwyer, P. A., &
Revell, S. M. H.
(2016).
Literature review To identify factors
that influence new
graduate nurse
transition.
42 articles There
were no
control
groups
No outcome
measures
Complex interplay between intrapersonal, interpersonal,
and organizational factors influence transition
Freeling, M., & manual method of thematic To identify There indicate experienced registered nurses discussed themes

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Parker, S. (2015). analysis experienced
registered nurses'
attitudes, views
and expectations
of graduate nurses
which may create
a barrier for
optimal graduate
nurse
performance.
were no
control
groups
including 'nursing skills', 'inadequate preparation during
academic program', 'attitudes and ward culture' and
'concerns with confidence'.
Tuckett, A.,
Winters‐Chang,
P., Bogossian, F.,
& Wood, M.
(2015).
Qualitative study To explore nurses'
reasons for
leaving the
profession
Sixty six
nurses
No outcome
measures
Lack of support leads to nurse’s job satisfaction.
Wong, S. W. J.,
Che, W. S. W.,
Cheng, M. T. C.,
Cheung, C. K.,
Cheung, T. Y. J.,
Lee, K. Y., ... &
Yip, S. L. (2018).
Hong Kong
Qualitative study To explore the
challenges
encountered by
fresh nursing
graduates during
the transition
period
Eight new
nursing
graduate
No outcome
measures
Workload, lack of knowledge, communication,
expectation, change of role, working atmosphere,
support and a blame/complaint culture are the common
areas of challenges that they encounter in the transitional
period
Coyne, E., Rands,
H., Gurung, S., &
Kellett, U.
(2016).
Australia
Interpretive phenomenology
design
To explore the
experience of
international
nursing graduates
from Kiribati
transitioning into
practice in
RACFs, upon
completion of
their bachelor of
nursing degree
Six nursing
graduates
There
were no
control
groups
Cultural differences is the main challenge faced by the
graduates.

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Bush, C. T., &
Lowery, B.
(2016).
Columbia
Survey To compare NPs
with postgraduate
with NPs without
postgraduate
education
All NPS
with and
without
post
graduate
educated in
38 States
Postgraduate education has a significant positive impact
on NP job satisfaction
Sahay, A.,
Hutchinson, M.,
& East, L.
(2015).
Australia
Exploratory study using
quantitative survey
To explore the
influence of
workplace
supports and
relationships on
safe medication
practice
Recent
graduate
nurses
There
were no
control
groups
Unsupportive workplace relationships were inversely
related to graduate nurse medication errors