Transition from nursing student to registered nurse is an exciting time for new graduate registered nurses (NGRNs). However, they can confront environments and responsibilities not previously encountered and can experience feelings of vulnerability, insecurity, inadequacy and incompetence. The importance of a positive transition experience cannot be overemphasised because the evidence highlights the extent to which the quality of the transition experience impacts on how well NGRNs assimilate into their new role and workplace. A negative transition experience can potentially manifest as a state of professional dissatisfaction and career disillusionment, and it is during the initial three to six months of the transition period that NGRNs decide to either commit to or abandon the nursing profession. Despite an abundance of international studies, NGRN transition is under-researched in the Singapore context. Consequently, there is a need to gain insight into how NGRNs experience transition in Singapore given the social and cultural differences and the peculiarities of the Singapore nursing and health systems. This paper reports on a study conducted in Singapore, and focuses on the NGRNs’ transition experience of the organizational and professional environments.
PURPOSE
The purpose of this study was to: (i) to explore the experiences of NGRNs in Singapore following their initial 6-12 months of transition from nursing student to registered nurse; (ii) to identify the factors that impacted their transition; and, (iii) to identify potential areas of improvement that could enhance the transition experience.
METHODOLOGY
This study utilised a mixed-method, sequentially phased design (quantitative approach -> qualitative approach). Data were collected in two stages. First, participants (N=30) completed a 42-item questionnaire, a newly constructed instrument that was validated for both face and content validity. This was followed by a focus group with participants who volunteered (N=5). The questionnaire data were analyzed using descriptive statistics to determine the level of response agreement among participants and the focus group data were transcribed verbatim, and analyzed using framework of content analysis to code, aggregate and determine themes.
FINDINGS
The findings from this study reveal that while NGRNs in Singapore are satisfied overall with their transition, they did feel underprepared by the pre-registration education, which increased their stress and intensified their loss of confidence. In addition, they experienced significant organizational and professional obstacles that are unique to the Singapore context. They reported the difficulties they faced in working in less than collegial environments and in unsupportive, oppressive and abrasive organizational cultures compounded by unrealistic expectations of their skills and abilities placed on them by more experienced nurses as well as allied health professionals, medical officers and patients. The existence of ethnically based cliques, a distinct feature of Singapore nursing, caused them to feel outcaste and isolated while their socialization into the organization and learning of various registered nurse responsibilities did not follow a defined program but was determined by the agenda of their managers and assigned preceptors. The stress experienced by NGRNs was intensified by the implications of being bonded (another unique feature of Singapore nursing) and not ‘passing’ a probation period, which for non-Singapore citizens, could lead to repatriation to their home country.
CONCLUSION
This study reaffirms the concept of theory-practice gap, which is a recurrent theme in transition literature. The issues surrounding a theory-practice gap signify the need for educational, industry and regulatory stakeholders to collaborate more closely in all aspects of pre-registration nursing education. However, this study also highlights the need for nurse managers and experienced nurses in health care organizations to monitor and manage uncollegial, hostile and oppressive workplace behaviors that undermine the ability of NGRNs to assimilate into their workplace. This study also highlights the extent to which the impact of preceptorship and orientation on NGRNs’ transition experience in Singapore remains under-evaluated and that there is a need for further research on educational sponsorship and bonding on NGRN experiences of transition in Singapore because it is a unique and significant characteristic of the Singapore nursing and health care systems.