Factors Affecting Transition of Graduate Nurses: A Literature Review

This literature review examines the challenges and facilitators faced by new graduate nurses during their transition from nursing school to professional practice. The review explores the impact of factors such as professional guidance and training, job satisfaction, effective coping mechanisms, and inter-professional support on the transition process. It synthesizes findings from various studies published after 2013, focusing on the positive and negative influences on graduate nurses' experiences. The review highlights the significance of structured programs, support systems, and coping skills in mitigating stress, enhancing confidence, and improving job satisfaction. It also emphasizes the importance of inter-professional collaboration and the need for organizations to provide resources and guidance to ensure a smooth transition, reduce burnout, and promote successful integration into the nursing profession. The review concludes by identifying key areas for future research and intervention to support graduate nurses and enhance patient care.

Literature Review
Introduction
New graduate nurses often face various challenges and problems during their transition from
nursing school to the workplace. This period may be accompanied by changes in roles and
responsibilities, challenges, and a shift in goals and expectations as one transit to a more
demanding position (Pfaff et al., 2014). Scholars interested in this topic have found that
nurses experience significant changes during their transition from student-based environment
to professional-based environment. Unless one is prepared, there are high chances of
suffering from stress, anxiety, burnouts and fear that affect their physical and mental health
(Laschinger et al., 2016). Although nurses from the largest healthcare professional group in
most healthcare systems around the world, their roles and practices can be very challenging.
Al-Yateem and Docherty (2015) have defined transition as " passing or passage from one
condition, action, or place, to another" or the "development or evolution from one stage, form
or style to another "(p. 36). In a nursing context, a transition is understood as a change
occurring due to moving from school to the workplace. Lack of preparedness and poor
transition issues can lead to lack of job satisfaction that eventually translate to high trnover
rates, low quality services, and adverse health outcomes on recipients in the clinical setting.
Various factors can affect the coping skills of the nurses during the transition According to
Azimian, Negarandeh, and Fakhr-Movahedi (2014), some modifiable factors can affect the
coping skills of a nurse and eventually affect the transition to a professional profssion.
Transition from student to a professional nursing profession is impacted by both barriers and
facilitating factors. According to Phillips et al. (2014), lack of experience and complex
nursing procedure could influence nurses and also induce performance anxiety. However,
according to the study by Dwyer and Revell (2016) a positive attitude towards transition
challenges could influence nursing practice in a positive manner. Therefore, this paper will
focus on providing a review of literature on the existing factors (both positive and negative)
that facilitate or hinder the successful transition of graduate nurses during their transition
period. The review will also collect evidence on how various factors influence patients, their
families, and professional relationship and help them complete service provisions.
Background
Just in any other profession, the transition period presents significant challenge to nurses as
they step into practical career environment. The transition to professional roles could be very
stressful and could lead to negative or positive transition experiences. Most of the studies
have identified the negative aspect of transition, such as the study conducted by Tastan,
Unver, and Hatipoglu (2013) which looked at the transition of new graduate nurses in Turkey
and asserted that some significant negative factors of transition are lack of appropriate
knowledge, lack of experience, a feeling of insufficiency in relation to the skills, leading to
the fear making errors or mistakes and lack of appropriate guidance. This also confirms the
finding of Azimian, Negarandeh, and Fakhr-Movahedi (2014), who argue that transition from
the academic to real world setting could be stressful for the nurses because of their lack of
practical experience in providing complex care.
New student nurses have to cope with the challenge of shifting from student to a staff nurse
in a new environment and hospital setting. For many graduate nurses, this period is clouded

with doubts and challenges in professional requirements and confidence in oneself.
Villanueva et al., (2015) identified that "an individual adjustment to role transition is
complex, and involves personal development as well as interactions with
socialisation/organisational processes and role requirements" (p.49). Therefore, this change
can be very challenging; however, according to Monagle et al., (2018) through effective skills
guidance and support, these stresses can be relived, and the transition period could provide a
better experience to graduate nurses. Some new graduate nurses may feel inefficient or lack
confidence in themselves when handling new tasks and responsibilities, thus affecting their
confidence, perception and attitude towards work as discussed in Al-Yateem and Docherty,
(2015), Brnes (2015), and Monagle et al. (2018).
A qualitative analysis conducted by Maria, Stanley and Mei (2018) has identified that high
stress and reality shock are the main reason that compel nurses to quit their profession in their
first year of practice. Maria, Stanley, and Mei (2018) further explain that both human and
work-related factors have a significant impact on how a graduate nurse transits from a student
to a professional. However, Kumaran and Carney (2014) identified professional guidance as a
positive element that can facilitate successful transition for graduate nurses. A study
conducted by Lin, Viscardi and McHugh (2014) has identified that " the transition from
student to new graduate nurse is marked by both opportunity for professional growth and risk
for burnout and job dissatisfaction" (p.439). Therefore, it is very important to understand
various barriers and facilitators that may impact the transition of new nurses from student to
professional practice with the goal of understanding how these factors may be enhanced or
suppressed to help them.
Aim and Research Methodology
Aim:
To identify the various factors that facilitate or hinder the transition of graduate nurses from
student to professional practice
Method:
A literature search was conducted to explore the electronic database that included Ebsco,
CINAHL Plus, Medline, Cochrane, PsycINFO and World Seach Databases. For every
database, an Individual search was conducted using the appropriate keywords, phrase search
and Boolean operators, Such as 'new graduate nurse', 'nurse transition', 'new graduate nurse
transition', 'nurse transition and coping ', 'transition and professional practice of nurses',
'stress', 'transition and stress', 'nursing stress', 'stress and satisfaction', 'satisfaction in
transition', 'satisfaction and confidence', and 'satisfaction and collaborate working'. In the
electronic search conducted on different databases, 28 articles were selected for the review.
The inclusion criteria consisted of articles published after 2013, were in English, and related
to the objective of this study. All articles published before 2013 or in a language other than
English were excluded. Appropriate filters were used to ensure that all the articles available
were published within a six-year period, and only peer-reviewed studies were included for
literature analysis.
Literature review
Professional guidance and training

Krautscheid (2014) asserted that professionals who provide guidance and training in nursing
accountability and responsibility could help in empowering and improving the confidence
levels of graduate nurses as well as provide positive experiences. Additionally, another study
by Dwyer and Revell (2016) found that most of the graduate nurses’ anxiety and stress are
linked to lack of professional guidance in workplaces. Therefore, Villanueva et al. (2015)
identified that organisations could support the new graduate nurses by offering " structured
preceptor-ship programmes" that reduce stress and anxiety and improve confidence and job
satisfaction. A study conducted by Lin, Viscardi and McHugh (2014) identified that nurse
residency programs could significantly enhance the skills of new graduates. Some of the
areas of focus include enhancing communication with patients and co-workers, critical
thinking, and decision-making in the workplace environment. This program can significant
provide professional guidance to the new graduate nurses that can enhance job satisfaction
and reduce stress.
A study conducted by Sparacino (2016) also identified that guidance and support from
educators can provide a satisfactory and positive transition experience for nurses. However,
the study conducted by Ortiz (2016) identified that the guidance of the professionals during
the transition period is more significant than the guidance provided by the educator before
placement. This is because it helps nurses to cope with various stressors and also helps them
to gain confidence and skills to conduct professional practice effectively. This is because the
guidance and training providing by professionals during the transition phase significantly
improves professional confidence and helps job satisfaction for the healthcare provider as
well as the patient that is receiving the service (Ortiz, 2016) which further helps in improving
work related satisfaction. A study conducting by Dorcy et al. (2016) has identified the
significance of a dedicated education unit in cancer clinics. The researchers found that
ongoing education and guidance provided to new nurse graduates during the transition phase
can improve their critical thinking, equip them with new skills, and empower their
competencies for improved job performance.
Satisfaction and Effective Coping
A study conducted by Hart, Brannan and De Chesnay (2014) informed that satisfaction is a
very important factor that influences the self -efficacy and personal control and also promotes
effective coping with stress and work pressure. A study conducted by Laschinger et al. (2016)
identified the negative consequences of work related stress among nurses during the
transition periods and identified that in result in higher levels of burnout and poor physical
and mental well being among nurses. The study further identified that stress can affect the
ability of nurses to conduct professional practice effectively. Stress can occur due to a lack of
occupational coping self-efficacy, experience and confidence (Labrague & McEnroe-Petitte,
2018). The feeling of being isolated can affect personal skills and resilience, which are
important interpersonal resources that enhance the ability to cope with work related stressor
(Labrague & McEnroe-Petitte, 2018). However, the lack of such interpersonal resources
results in higher stress during transition, causing mental health problems (Read & Laschinger,
2015).
Stephens (2013) also identified the effect of stress and various workplace-related stressors on
student nurses, such as lack of collaboration, lack of learning opportunities, the burden of
care and lack of knowledge. According to a study conducted by Chesak et al. (2015),
effective coping skills among the new graduate nurses are important in improving stress
management skills and their practice during transition. Another study by Pfaff et al. (2014)

had identified that there are various personal (knowledge, coping skills and critical thinking)
and organisational factors (organisational support, inter-professional support and
collaboration) that impact the graduate nurses’ transitional period to a professional practice.
Personal Satisfaction and inter-professional support
Studies have identified that inter-professional collaboration and support from the staff, senior
nurses, professionals and interdisciplinary team is essential helping graduate nurses fit in the
new teams (Yu & Kang, 2016). Job and work-related satisfaction among the graduate nurses
are significantly associated with inter-professional support and collaboration (Yu & Kang,
2016). Therefore, support can be offered and received from a wide range of professionals
within the organisation, who can help in enhancing the personal skills and capabilities of a
new graduate nurses and further improve their work and job satisfaction levels (Pineau Stam
et al., 2015)
one significant example of support is identified by the study of Villanueva et al. (2015) in the
paediatric setting. Villanueva et al. (2015) state that working with young children is very
complex, as children are part of the most vulnerable population and have different physical
and psychological needs than adults. Meyer et al. (2015) have also identified that care
delivery in a paediatric setting requires a family-centred approach, which demands
specialised skills and knowledge from nursing professionals. Therefore, through inter-
professional collaboration and support, such as providing feedback , praise, and debriefing
can significantly improve inter-professional collaboration (Parker et al., 2014) and improve
new graduate nurse's skills and abilities to deliver complex and satisfaction towards their
professional practices (Meyer et al., 2015; Villanueva et al., 2015).
A study conducted by Monagle et al. (2018) provided a quantitative mixed-method analysis
of a reflection exercise. In this study, the authors determined that inter-professional support is
a vital resource for new graduate nurses. Inter-professional support helps nurses to improve
their skills in responding to the complex care needs of patients and empowers nurses with
new abilities that improve their confidence and satisfaction levels (Monagle et al., 2018). The
study conducted by Azimian, Negarandeh, and Fakhr-Movahedi, (2014) concluded that
graduate nurses in Iran were adversely affected by lack of professional support in the
healthcare system. The transitional period has its significant challenges, but unless the nurse
finds moral and professional support, many of them hardly find satisfaction. When graduate
nurses are denied motivational factors in their new environment, they may quit the nursing
career due to lack of job satisfaction. The findings of this study were confirmed by a recent
study of Mansour and Mattukoyya (2018). This study also found that organisational
empowerment, perceived inter-professional support and communication among professionals
are significant enablers that can empower graduate nurses, raise their morale, confidence and
work-related satisfaction. Fealy and McNamara (2015) stated that interdisciplinary support
and collaboration during the transition period could improve resilience and coping in new
graduate nurses.
Findings and Discussion
The finding from this review is that the transition period for graduate nurses can be a positive
experience for nurses that had prepared while at the same time a frustrating moment due to
barriers associated with this phase. The main themes that emerged through the literature were
professional guidance and training (Dorcy et al., 2016; Dwyer & Revell, 2016; Krautscheid,

2014; Ortiz, 2016; Sparacino, 2016; Villanueva et al., 2015; Lin, Viscardi, & Mchugh, 2014),
stress and effective coping (Chesak et al., 2015; Hart, Brannan & De Chaesnay, 2014;
Laschinger et al., 2014; Pfaff et al., 2016; Read & Laschinger, 2015; Stephenens, 2013), and
personal satisfaction and inter-professional support (Azimian, Negarandeh, Fakhr-Movahedi,
2014; Fealy & McNamara, 2015; Mansour & Mattukoyya, 2018; Meyer et al., 2015;
Villanueva et al., 2015).
According to the evidence identified through the comprehensive literature, it can be stated the
transition period can be a moment of positive experience while at the same time a moment of
confusion for graduate nurses. This is mainly because a negative experience during the
transition phase can reduce job satisfaction, and nurses tend to drop out of placement.
Although, the studies were conducted in different countries and different settings, it is
difficult to understand which health setting is more challenging, because the nursing demand
is very high in all settings, such as primary health care, critical care, oncological care and
paediatric care settings. The limitations of the studies are that they are either qualitative
studies or quantitative studies with very sample sizes. Therefore, the generalisability of the
evidence is very difficult. However, future research can be conducted with larger sample
sizes and in different settings to identify more appropriate themes that influence nurse
transition in professional practice.
Conclusion
The findings of the literature have helped in identifying three important themes associated
with influencing the transitional period from graduate to professional practice among new
nurses. These themes are professional guidance and training, effective stress coping,
professional satisfaction and inter-professional support. All the three themes have negative as
well as positive influence over the potential success of a professional nurse. The review has
concluded that further research can be carried out with a large sample size to develop a better
understanding of factors. There is little evidence about the details of the type of support,
training and professional guidance that nurses can receive during transition, as these factors
are influenced by the type of setting. Most research identifies the factors and their influences.