Literature Review

Different qualitative studies have been conducted with the aim of offering a better understanding of the challenges that nurses undergo during the transition period. Transition refers to the passing from one stage to another. In this case, the term ‘transition’ is used to refer to the passage from students to a registered nurse. The transition is an important process in ensuring and allowing the students to put into practice the skills they have acquired during the study period.

Practice-Theory Gap

Cheery (2016) conducted a longitudinal study that sought to shed more light on the existing gap in theory practice. More attention was placed on the bureaucratic processes and the corresponding impacts on the sharing of information. The study indicates that nursing problems are not just restricted to the United Kingdom but are also evident in other countries. While the transition to a nurse is subjective of the learning processes, it is worth noting that it can be overwhelming and subject the concerned persons to great levels of stress. Studies indicate that there is a huge gap between practice and theory. While the transition is crucial, Cherry (2016) infers that the process is marked by many challenges that affect the competency levels of nurses. During the transition process, nurses are exposed to different environments and often register some challenges in getting along with new members. The situation is common in settings where there is the failure to offer onboarding or clinical supervisions. Consequently, new nurses are exposed to a stressing environment and also find it challenging to execute complex tasks. Another common problem during the transition period is the lack of communication and leadership skills that are required to smoothly interact with diverse people. The transition from a learning nurse to a registered nurse requires that the concerned persons are adequately prepared to deal with the new environment and professional duties.

During the course of nursing duties, every nurse experiences a transition that sees an equal change in work descriptions, duties, and responsibilities. In the case of students, assuming complex and new nursing duties can be overwhelming. Contrary to the school settings where students are in a protected environment, working in hospital surroundings often comes with many pressures that may prove to stress many nurses. Cherry (2016) explains that nurses often lack the needed support services to go through transitions smoothly. The study indicates that many cases of nurse transitions are marked by stress and dissatisfaction levels. In extreme instances, some fresh nurses give up and quit their nursing jobs.

Walsh (2015) conducted a study that employed comparative and descriptive design that is equally accompanied by a questionnaire. The study sought to determine the nurse experiences in six months after graduating from nursing school. The objective of the study was to determine the stress that the nurses go through while working in acute care hospitals. The researchers developed the Case-Fink Nursing Graduate Experience; it was revised and piloted to effectively determine the nurses’ experiences. The nurses were evaluated during the first three months, after six months and after one year. There was an emphasis on determining whether there were similarities in skills and demographic factors.

The convenience sample of 300 nursing staffs was composed form six acute hospitals. The recruitment process was through an appeal to the nurses to take part in the study. There was the use of anonymous data collection procedures which helped uphold the privacy of the participants. The nurses were asked open-ended questions that gave them the opportunity to give their views. Some of the questions involved relationship with other peers, mastering organizational structure, communication, professionalism and confidence in executing their duties. The variety of the participants served as the primary strength of the study as it minimised chances of bias. However, there was a methodological limitation of the sample size as it was challenging to keep track of all persons in hospital settings. The findings of the study held that there is the need to address the topics during the orientation.

There have also been studies that employ the grounded theory methodology. Maben et al (2016) conducted a study that lasted eighteen months that sought to determine what happened to nurses during the transition period. The study had ten participants who had graduated from the same degree program. The study employed the demographic survey method of data collection as well as four interviews. The interviews were conducted at different stages to determine the progress of the nurses in their professions. The research found that the transition process is critical on boosting the confidence level of the new nurses.

It is on this basis that Cherry (2016) conducted a longitudinal study with the objective of exploring the theory-practice gap. The study employed non-probability sampling where n=36. The respondents were from different nursing fields and were required to have worked for at least five months. While one of the pre-qualification requirements was for the nurse to have worked for not less than five months, the post-qualification was ten months and above. There was the use of face-to-face interviews, thus allowing the interviewer to collect diverse data. The responses of the participants were transcribed and tape-recorded.

An analysis of the findings in Cherry (2016) study indicates that while nurses often have strong academic qualifications, they lack the ability to progress their careers due to the deficiency of elaborate transition platforms. Out of the 36 respondents, it is critical to note that 24 nurses asserted that they faced problems in terms of professional skills, change in the environment, and communication difficulties. These factors acted as a hindrance to their abilities to execute services effectively. The findings of the study indicate that there is a mismatch between the skills taught in universities and the requirements in work settings.

Performance Levels

Wong et al (2018) conducted a two-phase perceptive explorer research that sought to compare the performance levels of different nurses during their first year of practice after the transition. Additionally, the study incorporated data during the post-qualification and the pre-registration periods with the objective to determine impacts transition has on the productivity levels of the nurses. Other than the use of the Five-Point Likert Rating Scale, there was the use of closed questions. The closed-ended questions had queries on nursing responsibilities and possible barriers to the smooth execution of duties.

The study had a total of 24 participants, with most of them being female individuals aged not more than 25 years. The research sought to determine whether nurses had been prepared in different subjects and their abilities to address problems associated with the study. While some responded that they had been equipped with communication skills, others argued that they lacked both communication and leadership skills. The group lacking these skills further stressed that it was challenging to engage in teamwork or interact with diverse patients. It is imperative to mention that the delivery of health care services often calls for improved collaboration levels between different health care agencies.

Moreover, many nurses felt that they were not adequately prepared to deal with the problems that are common in the health care sector. Such challenges include ethical dilemmas, communication with diverse people, dynamic working environment, and pressure from leaders. The findings of the study indicate that not all registered nurses in the study were confident of their abilities to handle complex situations. On the contrary, it was evident that they were exposed to stress. They attributed the problem to the lack of clinical supervision that would have served the role of offering the needed guidance to new nurses. The use of the Likert Scale is effective in data collection as it allows participants to express their opinions, thus contributing to the richness of the data. However, the study was limited as it only included nurses from a single district, thus implying that the results may not necessarily reflect the trend across the country.

MacIntyre et al (2015) conducted a Heideggerian hermeneutical phenomenological study with the goal of comparing experiences of nurses in hospital settings to those in schools. The researchers placed attention on some of the measures that have been put in place to promote the transitioning processes. The number of participants was 20, and the researchers employed non-probability purposive sampling method. There was the use of both questionnaires and face-to-face interviews.

The questionnaires were issued through an online platform and allowed for the inclusion of respondents in a wide geographical area. On the other hand, the interviews lasted for thirty minutes and sought to understand challenges that the new nurses faced in the transition period. The study pointed that while many nurses are committed and enthusiastic after graduation, they are often facing the lack of support services, which derails their productivity levels (Rhéaume et al. 2014, 485).

The study infers that there are different types of transitions that nurses tend to undergo. These transitions are health/illness, organisational, situational, and developmental. The study sought to explore the degree of knowledge, skills, and competency levels of nurses in relation to the transition processes. The researchers argue that these factors have both positive and negative impacts on the transition process. The nursing internship is explained as being one of the processes that ensure that new nurses are well-trained to deal with challenges that come with their professions. They are part of hospital orientation programs and, thus, ensure that nurses are aware of the functioning of the health care facilities. Through interviews and analysis of past research, the study found that it is not always the case that nurses are orientated on onboarding services during the transition period.

Wong et al. (2018, p. 30) conducted a quantitative study to investigate the interaction of nurse-to-patient ratio, the workload, and how it is a hurdle to the nursing students in transition. The researchers used the international recommended standard of ratio 1:6 and noted that health care facilities that had two to four times higher than the recommended ratio did not effectively manage the transition. Such hospitals have high workloads that adversely affect career development among the fresh graduates. However, several studies in the literature review are in consensus that nursing trainees encounter numerous challenges during the transition period. In some instances, new professionals quit their jobs if there are no role models to guide them. The occurrence of such incidences explains the rise of nurses’ turnover, especially in developing countries. According to the authors, stress and work dissatisfaction are critical elements that are challenging to the nursing trainees during the transition. Hong Kong is one of the cities that record the highest number of nursing students that quit their jobs at the early stage of transition. In this case, the authors noted that the rate increased from 6% in 2011 to 14.5% in 2013. The situation suggests that there is a need for immediate intervention to enable stakeholders to effectively manage challenges that fresh nursing professionals face during a transition.

Edwards et al. (2015, p. 1257) used methodological checklist that integrated both descriptive and observational studies to critically analyse information in secondary sources on the topic. Two reviewers extracted data from the literature and involved a third party where there were disagreements. Meta-analysis was then used to assess the success level of interventions used. In this case, the chi-squared test results indicated that the studies had a 95% confidence interval that improper management of transition negatively impacted the competence and confidence among nursing students. Stress, however, is directly associated with insufficient preparation for the work environment during the study. It is also attributed to past failures during clinical placements besides little research while in the training institutions.

Hofler and Thomas (2016, p. 133), unlike Edwards et al. (2015), collected primary data to gain insights into core challenges that new nursing graduate students face in transition. The researchers used questionnaires and involved trainee nurses as respondents. They identified the lack of access to experienced mentors, performance anxiety, stress, and fatigue as primary challenges that graduate nurses face as soon as they enter their jobs. However, they corroborate with previous researchers that excessive workload inwards is a critical factor that explains why nursing students find it difficult to adapt to the nursing field, the underlying practices, and responsibilities. The researchers further assert that graduate nurses placed in surgical wards have higher levels of stress compared to their counterparts in other units of the health care facility.

Missen, McKenna, and Beauchamp (2014, p. 4422) used narrative synthesis and systematic reviews to investigate efficiency of transition programs offered in various health care facilities. The researchers analysed this aspect using quantitative studies published in electronic databases from December 2000 to December 2012. As such, they identified 338 studies but selected only 12 that had detailed information on the topic. The researchers used pre- and post-testing techniques. They found that there is a direct association between job satisfaction and the success of the transition approaches used. However, the authors acknowledge that such strategies vary from one nursing student to another, and for this reason, they are appropriately tailored to meet individual needs. One of the plans to enhance the effective management of the transition is formulation of an effective preceptor and mentoring programs.

Kaihlanen, Lakanmaa, and Salminen, L. (2014, p. 422) used the inductive content analysis technique to gain insights into the extent to which mentors guide nursing students. In this case, researchers requested 16 nursing students to write essays on how such personnel assisted them during the transition. The analysis shows that mentors determine how efficiently fresh professionals acquire skills in patient management and clinical skills. From the study, it emerged that three elements define the essence of mentors. These aspects are mentor support, mentor actions, and most importantly, mentor qualities. The authors further acknowledged that preceptor programs play critical roles since they reduce culture shocks among fresh nursing professionals in transition. Consequently, trainee nurses will enhance their professional competence, confidence, and most importantly, gaining of autonomy when handling patients (Banister, Bowen-Brady, & Winfrey, 2014, p. 321).

Limitations

In any participant study, it is crucial to have a good recall. However, there is the view that some of the participants who had negative experiences during their early years in nursing may decline to respond. Additionally, there is the likelihood that nurses may be timid in giving negative information of their employers due to the fear of being reprimanded (Davis et al. 2014). The inability of the study to address possible instances of selection bias can affect the integrity of the results. Some of the factors that ought to be considered include the geographical location of respondents, life experiences, and their background among many other factors that may influence the productivity levels.

Recommendation

During the final year of study, there is the need to introduce some changes in the learning process to ensure that nurses are well-trained to deal with challenges at work settings. The training can cover areas such as communication and leadership. The argument rests on the fact that many nurses are asserted that they lack skills and ability to interact with diverse teams. It is critical to note that the goals of the health care organisation cannot be attained without ensuring that the nurses are adequately trained (Davis et al. 2014).

There is also an emphasis on the need to have safe and quality initiative care for patients. Based on the studies, nurses are often exposed to complex and stressing working environment. In some cases, the situation is compounded by the lack of clinical supervision, thus implying that there is an increased chance of making errors. However, the inability to wholly execute their duties can be addressed by ensuring that they are availed with the right support services and the progress monitored.

On the other hand, nurses can better manage their duties by having a timeline of programs and the support of experienced nurses. It is worth noting that moving to a new work environment may create problems such as communication barriers, cultural differences, and poor understanding of the organisational goals. Clinical facilitators both in hospital settings and the institutions from which students graduated can play the role of offering guidance to learners. Further, they can offer tips on ways to deal with possible setbacks during the transition period. Organisations that have employed this approach have been found to have high productivity levels and reduced stress experienced by the nurses.

Conclusion

From the above-discussed information, it is apparent that there are significant problems faced during the transition period. Numerous studies indicate that nurses are not issued with the right support services, thus making the delivery of their duties complex and distressing. The problems relate to the change in environmental settings, as there is a shift from the school environment to a complex hospital setting (Poynton et al. 2016, 390). Under the new environment, nurses are charged with many responsibilities, and thus they are required to collaborate with diverse teams. However, it is not always the case that they are equipped with skills to deal with work pressure.

The other issue that complicates the transition processes concerns leadership skills of the nurses. There is the indication that nurses lack vital leadership skills that are required in dealing with ethical dilemmas and ensuring that there is a reduction in conflicts. In most settings, nurses are required to interact with a person from diverse settings, therefore increasing the risk of conflicts (Rhéaume, 2014). It further implies that they tend to find it challenging to engage in teamwork. However, leadership skills would ensure that they have the ability to implement organisational policies, take part in teamwork, and successfully transform the health care sector.

On the other hand, an analysis of the productivity of nurses indicates that they exhibit communication challenges. During the first year, the transition problem is compounded by the fact that there are inadequate clinical supervisions. The lack of guidance implies that nurses are exposed to a stressing environment, thus limiting their productivity. In a typical setting, it is expected that they would be availed with guidance and other supervisions services. Not only would they help to deal with the problems during the transition period but also contribute to an improvement in the productivity of employees.

On the other hand, there is the call to have continuous training and learning by nurses. Scholars infer that the health care sector is highly dynamic, and, thus, it is marked by constant changes. These trends often have the effect of making the delivery of health care services complex. In settings where nurses are not trained on a regular basis, there is the danger that they may find it hard to register the intended results. Continued training will improve the skills of nurses and further ensure that there is positive collaboration among the concerned parties. At the hospital setting, close supervision and assigning of senior staffs to monitor the progress of junior nurses can prove to be effective.

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