Early Solo Flight: Integrating Perspectives of Transition to Practice in New Graduate Nurses

Background:A widely acknowledged transition-to-practice gap exists for new graduate nurses (NGNs) as they begin working as registered nurses (RN) in the United States. Attempting to bridge this gap, acute care hospitals often offer structured internship or residency programs. Many researchers have focused on the first several months of NGN experience when they are paired with a preceptor, but few studies focus on NGNs after their active precepting ends and when they are working independently. A review of the available literature suggests these newly independent nurses are experiencing high levels of stress, low levels of job satisfaction, and are at high risk for job turnover. Turnover is costly to employers and causes an interruption in the nurse's journey to role competence. In order to intervene, more information is needed about their experience in early independent practice. No studies have been conducted on the perceptions of nurse managers regarding newly independent nurses or on the perspective of nursing students regarding the time it takes to transition to practice or achieve role competence.

Methodology: Three studies focused on transition to practice were conducted. In the first study, phenomenology was used to explore the lived experience of 15 NGNs working independently in acute care settings during their fourth to eighth month of work experience. In the second study, phenomenology was used to explore the perceptions of 5 nurse managers regarding NGNs working independently in acute care settings. In both of these studies, individual, one-time, semi-structured interviews lasting from 30 to 60 minutes were conducted and analyzed for reoccurring themes. The third study used a mixed-methods approach to explore undergraduate nursing students' perceptions of transition to practice.

Results and Recommendations: From the interviews with new graduate nurses four major themes emerged from the data: feeling overwhelmed, the importance of relationships, finding my flow, and being a good nurse. Although they are working independently, NGNs in their 4th to 8th month of practice continue to experience knowledge insecurity and emotional distress. They need support from experienced colleagues, educators, and managers to help them provide high quality care to patients as they navigate the continued challenges of becoming an RN with experience. Nurse managers in this sample identified NGN strengths during this time of early independent practice that include continued eagerness to learn and desire for connectedness with their unit and co-workers. Nurse managers believed that at this stage of practice NGNs are "not done yet" in the process of transition and see themselves as needing to provide continuing support to these new nurses during this potentially vulnerable time of practice. Of interest is the idea that undergraduate nursing students' perceptions of the time needed to transition to practice are not congruent with the reality of the estimated year theorists believe is needed to achieve role competence. Applications for nurse educators in academia and hospital-based settings will be offered. Limitations of the study and implications for future research will be discussed.