New graduate nurses' experiences in their rst year of practice

Vicki Parker
a, d
, Michelle Giles
b,
, Gena Lantry
b
, Margaret McMillan
c
a
University of New England, Australia
b
Centre for Practice Opportunity and Development, Hunter New England Area Health District, Australia
c
School of Nursing and Midwifery, University of Newcastle, NSW, Australia
d
Hunter New England Health, Australia
s u m m a r y a r t i c l e i n f o
Article history:
Accepted 6 July 2012
Keywords:
New graduates
Transition
Experience
Satisfaction
Aims: This study aimed to explore new graduates' experiences of entering the nursing workforce in NSW,
Australia, and to identify factors that impact on their transition to the workforce, satisfaction and likelihood
of retention.
Background: The nature of new graduates' experiences in their rst year of employment has been shown to
have a signicant impact on their future career directions. It is well reported that often these experiences
are stressful and unsatisfying.
Methods: A mixed method cross sectional design was used combining quantitative and qualitative ap-
proaches. Data was gathered by online survey and focus groups.
Results: A total of 282 new graduates, aged 21 to 54, responded to the online survey (response rate 24%).
Overall, respondents were satised with their recruitment process (mean 3.54) and support for professional
development (mean 3.37) but job satisfaction was rated lower (mean 2.91). Qualitative ndings from focus
groups and survey comments revealed a number of key factors impacting on the experience of transition for
new graduates. These are; the nature of the workplace environment, the level and nature of support available
to new graduates, together with their propensity to learn and adapt to workplace cultures and to accommo-
date their own expectations and the expectations of others, and to a lesser degree, the amount of prior expe-
rience.
Conclusion: There is an urgent need to develop and test a range of evidence based approaches that will both
empower nurses and embed systematic approaches that enable equitable and contextually relevant steward-
ship of new graduate nurses into the future.
2012 Elsevier Ltd. All rights reserved.
Introduction
Transition to work has been the focus of concern in Australia since the
transfer of nurse education to the tertiary sector in the 1980s. The new
graduate nurse's ability to assimilate into a workforce, workplace and cul-
tural milieu is challenged by an environment of constant change and
complex organisational and social dynamics. Understanding the com-
plexity of health care and health workforce issues that impact on new
graduates is essential to maintaining the future workforce and a positive
and productive workplace environment. In this paper we report the nd-
ings of a study conducted in New South Wales (NSW), Australia that in-
vestigated new graduate nurses' experience of becoming part of the
nursing workforce.
Background
The body of literature examining new graduates' experiences, rang-
ing across 30 years, is large and diverse. Researchers, both qualitative
and quantitative, have been particularly interested in transition to pro-
fessional practice, socialisation, satisfaction and review of transition
programmes. The nature of new graduates' experiences in their rst
year of employment has been shown to have signicant impact on
their future career directions. It is well reported that often these experi-
ences are stressful and unsatisfying (Madjar et al., 1997; Chang and
Hancock, 2003; Beecroft et al., 2007; Wilson et al., 2008; Spence
Laschinger et al., 2010). This is concerning given the critical shortage
and maldistribution of the nursing workforce in many countries. Issues,
in relation to attracting and retaining nurses in the workforce have been
a major concern for policy makers, both within Australia and interna-
tionally (Cowin, 2002; O'Brien-Pallas et al., 2006; Cho et al., 2006).
These concerns are in response to cyclical nursing shortages, concerns
in relation to the adequacy of under-graduate education/preparation
(Kelly and Ahern, 2008), a decline in the public image of nursing as a
Nurse Education Today 34 (2014) 150156
Corresponding author at: School of Health, Armidale, NSW, 2351, Australia. Tel.: +61
0249469630, +61 0457714528(mobile).
E-mail addresses: vicki.parker@hnehealth.nsw.gov.au (V. Parker),
michelle.giles@hnehealth.nsw.gov.au (M. Giles).
0260-6917/$ see front matter 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2012.07.003
Contents lists available at ScienceDirect
Nurse Education Today
j our nal homepage: www. el sevi er . com/ nedt
career, and the increasing demands of reformed health care environ-
ments (Cowin, 2002; O'Brien-Pallas et al., 2006; Cho et al., 2006).
The challenges associated with beginning practitioners entering the
workforce are numerous and complex. The difculties of reconciling the
disparity betweenidealised role conceptions and actualized role con-
ceptions, reported as reality shock, give rise to nursing role conicts
(Duchscher, 2009; Feng and Tsai, 2012). Nursing role conict and asso-
ciated role ambiguity impact on the beginning practitioners' ability to
meet the bureaucratic mandate, whilst maintaining a sense of profes-
sional integrity.
These tensions, in addition to the well documented problems of
excessive workloads, variable degrees of organizational and pro-
fessional support, and negative workplace cultures, have all been
extensively reported as being major determinants of job dissatisfaction
(Cowin, 2002; Hegney and McCarthy, 2000; Hegney et al., 2002;
Roberts et al., 2004; Tourangeau et al., 2006; Lea and Cruickshank,
2007; Wilson et al., 2008). Job dissatisfaction is widely regarded as the
primary contributor to turnover amongst nurses, with consistent asso-
ciations between intention to leave and actual turnover being well doc-
umented (Forsyth and McKenzie, 2005; Simmons, 2008; Takase et al.,
2006; Tourangeau, et al., 2006).
The transition period, (the rst 12 to 24 months of practice) for new
graduate nurses is reported as the most vulnerable time during which
they formulate decisions about their intent to commit to the profession
and/or their organization (Beecroft et al., 2006; Lavoie-Tremblay et al.,
2008; Scott et al., 2008; Price, 2009). Many newnurses will change clinical
areas or leave the profession altogether during this period (Kovner et al.,
2007; Park and Jones, 2010) with as many as 50% of new nurses leaving
their rst job within a 12 month period (Wineld et al., 2009).
There is abundant evidence to suggest that intern, preceptor
and mentor programmes are successful in supporting new gradu-
ate nurses in their rst year of employment (Nelson, et al., 2004;
Santucci, 2005; Beecroft et al., 2006), however, the exact composi-
tion of programmes, in terms of duration, degree of supernumerary
support, extent of clinical exposure and autonomy in early practice, and
associated funding have not been dened or rigorously examined
(Zizzo and Xu, 2009). Whilst variable approaches allow for facilities to
tailor their programmes based on local needs, the prevailing sentiment
in the literature is that they require revision in relation to consistency,
efcacy and transparency and more research is needed using more ob-
jective and reliable outcome measures (Edwards et al., 2011).
In NSW, newgraduate nurses are employed across public and private
sectors. Those employed in the public sector are recruited into newgrad-
uate support programmes, usually for a period of 12 months with place-
ment in at least two different clinical areas. On completion of the new
graduate programme graduates apply for positions in areas offering
employment.
The Study Aim
This study aimed to explore new graduates' experiences of enter-
ing the nursing workforce. In particular, we sought to identify factors
that impact on transition to the workforce, new graduate satisfaction
and likelihood of retention.
Methods
The study was conducted using a mixed method cross sectional
design incorporating quantitative and qualitative approaches. The
quantitative core component of the study was supplemented by qual-
itative methods to enhance description and provide explanation
(Morse and Niehaus, 2009). Quantitative and qualitative data were
collected concurrently via survey and focus groups. The protocol
was reviewed and approved by the Hunter New England Health Re-
search Ethics Committee.
Data Collection
Participants were drawn from the cohort of newly graduated nurses
who were recruited as registered nurses in the NSW public sector in
2008. The requiredtarget sample for the online survey was 300or greater
basedonthe overall target populationof 1604. Newgraduates were invit-
ed to participate in the survey via postal mail outs and email.
The survey, developed froma reviewof the literature included ques-
tions related to demographics, current employment, prior nursing expe-
rience, the nature of current employment, the nature of the initial
recruitment process, the nature of transition to the workforce, employ-
ment intentions, career aspirations, condence in practice, job experi-
ence and job satisfaction. The satisfaction items were derived and
modied froma survey developed by Hegney and McCarthy (2000). Re-
spondents were asked to rate their level of agreement, level of con-
dence or level of satisfaction with a statement using a 5 point Likert
scale. To assess content validity expert reviewwas sought from15 nurs-
ing clinicians and educators. Items were then added, deleted or modied
based on the information gathered from all sources.
Focus group questions related to the transition experience in terms of
support, expectations, workload, relationships, intention to stay and ca-
reer opportunities. Participation in focus groups was sought across six
sites in metropolitan and rural NSW. Fifty-ve new graduate nurses
who gave informed consent participated in seven focus groups (610
per group) of between 60 and 90 min duration. One rural focus group
was conducted via video conferencing.
Data Analysis
Quantitative survey data were analysed using SPSS. Differences in
scores were compared using contingency table analysis, with chi-
squared and analysis of variance using Kruskal Wallis to identify variables
predicting differences using a signicance level of 0.05. The rating scale
items within the survey were combined to derive several factors; recruit-
ment satisfaction, level of support, job satisfaction, job experience and job
condence. Factor analysis conrmed groupings and further reliability of
responses was assessed using Cronbach Alpha scores for each itemgroup.
Values of 0.7 or better were obtained.
Qualitative survey data were coded and themed to inform low level
inference qualitative description (Sandalowski, 2010). Focus group tran-
scripts were coded and categorised according to themes and the research
question by individual researchers and then compared and revised for
consistency. Representativeness and auditability were ensured through
grounding and reporting the ndings through reference to excerpts
from within each and across all the focus groups.
Results
A total of 282 new graduates responded to the online survey (24%
response). Respondents ranged in age from 21 to 54 years (mean 29)
and 85% were female. Thirty ve percent reported English as a second
language (ESL), with Chinese language as the most common. Those
with ESL were signicantly proportionally higher in metropolitan
areas (40%, rural 8%, pb0.01). Distribution of respondents across area
health districts was representative of the larger cohort. Seventy-three
percent (n=207) of respondents had prior experience in nursing
(Table 1) and half of these had greater than 2 years experience. Seventy
six percent were in full-time positions at the time of responding to the
survey. The majority (77%) were employed in a metropolitan area and
84% of those currently employed worked in an acute public health facil-
ity, predominantly in medical and/or surgical wards (41%), critical care
(16%), mental health (10%) and emergency nursing (9%). A higher per-
centage of male respondents were working in critical care and mental
health than their female counterparts.
The majority of respondents (92%) were employed in one of their four
preferred clinical areas and males (92%) were more likely than their
151 V. Parker et al. / Nurse Education Today 34 (2014) 150156
female counterparts (84%) to receive their rst preference. Mostly re-
spondents (79%) were not required to relocate their residence to take
up their new graduate position, however relocation was signicantly
higher in those working in rural areas (pb0.01). Respondents were
asked to rate their level of satisfaction with 12 individual items associated
with their recruitment process. Between 8% and 15% of respondents
reportedsome level of dissatisfactionwiththe majority of the recruitment
items, however 45% reported dissatisfaction with feedback on interview
performance. The 12 items were combined to derive an overall satisfac-
tion with recruitment with a mean of 3.64 (median 3.75).
Support
The type of support offered to newgraduates either formally through
newgraduate programmes or in the clinical area varies markedly, partic-
ularly in relation to the amount of orientation, education and supernu-
merary time (Table 2).
Ninety-one percent (n=213) of respondents reported having
designated new graduate programme coordinators and 63% (n=144)
had designated mentors or preceptors. Respondents said they relied pre-
dominantly on other registered nurses (85%) and clinical nurse educators
(71%), however some participants (21%) reported relying predominantly
on support fromother newgraduates, enrolled nurses, assistants in nurs-
ing and medical ofcers. Most sourced support from a range of staff.
Respondents were asked to rate the level of support (very un-
supportive throughto very supportive) they receivedfor their profession-
al development from the organisation as a whole, management, other
nurses and other professions. Other nurses were rated the most support-
ive with 60% of respondents reporting that they felt supported by this
group. Other professions were rated the least supportive with only 40%
of respondents feeling supported by this group. These 4 items were com-
bined to derive an overall level of support for professional development
(mean 3.37, median 3.5) and was rated lower in respondents located in
rural facilities and in males but these differences were not signicant.
Although most respondents (63%) reported that they had been allo-
cated mentors only 41% of respondents were satised with their relation-
ships and 32% responded that they were dissatised. The highest level of
satisfactionwas withnursing colleagues and 61%of respondents reported
that they were satised with this relationship.
Expectations
Respondents were asked whether they experienced clarity about job
description and responsibility. In general new graduates were clear
about their roles and responsibilities, however they were less clear
about what others expected of them. A signicant number (26%) of re-
spondents indicated that they did not have, or were not sure whether
they had the necessary information to carry out their job. Twenty two
percent felt that they were unable to meet their own expectations. Stress
levels associated with role expectations were rated high to extreme by
45% of respondents with no difference identied across gender or in
ESL groups.
Retention and Intention
Of concern, was the number of respondents who indicated that they
intended to leave or were uncertain as to whether they will stay in nurs-
ing. Ten percent of all respondents indicated they intend to pursue a ca-
reer outside nursing. Fifty-ve percent indicated their intention to stay
for 5 years or greater, 32% were unsure how long they would stay, with
3% intending to stay less than 2 years (Table 3).
At the completion of their new graduate year the majority of respon-
dents (81%) had secured a position, 19% indicated that they either had no
position or were unsure about whether they would have one. Of these
8.4% indicated that they denitely had no position at the time of survey.
In relation to intention to pursue further studies, most (85%) were
keen to continue with their formal education. Most of those who plan
to study are planning to do graduate certicates in speciality areas, the
most popular choices being critical care (19%), medical/surgical nursing
(18%), emergency care (13%) and midwifery (12%).
Workplace Perceptions and Impact
The majority of the respondents (85%) reported that they were
condent in meeting others' expectations (74%), in their own
Table 1
Survey respondent education and prior nursing experience.
Highest education in another profession Survey respondents
n 224
NSW cohort
n 1604
No prior qualications 44% (98)
Degree/masters in another profession 33% (75)
Other (TAFE, grad cert, diploma) 23% (51)
Prior experience in nursing before graduating n 282
Yes 73% (207) 76% (1218)
AIN only 42% (118) 70% (840)
EN/EEN 14% (40) 22% (264)
Personal carer (PC) 5% (14) 8% (102)
EN, AIN and PC, RN in another country 12% (34)
Table 2
Structured support offered to new graduates.
Formal supports Mean (days) Median Range
Facility orientation 3 3 014
Ward orientation 2 1 028
Supernumerary on ward 4 2 084
Education days 5 4 045
What was the length of the programme
(months)?
12 124
How many rotations were in the programme? 3 09
How many days were supernumerary in each
rotation?
5 1100
Table 3
Survey respondent's retention and intentions.
How long do you intend to stay in nursing? %
Have already left nursing 1
Less than 2 years 3
Between 2 and 5 years 9
Between 5 and 10 years 12
Greater than 10 years 43
Unsure/undecided 32
In what area of practice do you see yourself working in the next 3 years? %
Medical nursing 10
Surgical nursing 10
Mixed medical/surgical 8
Critical care 15
Emergency nursing 13
Perioperative 7
Midwifery 5
Aged care 2
Rehabilitationdisability 2
Mental health 10
Family and child health 4
Community health 2
Other 13
152 V. Parker et al. / Nurse Education Today 34 (2014) 150156
performance (80%) and their ability to perform competently (85%).
However, they also described their work as an RN as emotionally
challenging (93%) and their workload as heavy (94%) and physical-
ly demanding (93%). Not surprisingly, 77% of respondents agreed
that work stress is high. Only 30% of respondents rated nursing mo-
rale as good, 37% were neutral and 33% disagreed, 47% agree that
morale is deteriorating. However, the statement that there is a
lack of teamwork and support from colleagues was rejected by
half of the respondents.
Only 48% of respondents agreed with the statement that the work-
place is well equipped (42% disagreement, 29% neutral). Nursing as a
career with high status was not supported by the majority (43% dis-
agreement, 34% neutral). However, most agreed (63%) that career
prospects are good. Fifty-seven percent agree that nursing work is
valued by the community, whilst only 35% agree that nursing work
is valued within the health system.
The statement that skill and experience are not rewarded was
supported by 39%, 30% neutral and 31% disagreed, whilst 45% of respon-
dents agreed that autonomy is encouraged, with only 15% disagreeing.
Twenty-three percent agreed that they have to compromise their
values at work (30% neutral, 47% disagreement). The above 17 items
were combined to derive an overall mean job experience score of only
2.81 (median 2.82).
Satisfaction
Respondents were asked to rate their level of satisfaction for 7 job
related items ranging from 1 very dissatised to 5 very satised.
Only 47% of respondents were satised with education opportunities
and 41% with career development and encouragement. Rural respon-
dents rated lower levels of satisfaction with educational opportunities
and career development and encouragement (p=0.029) than metro-
politan respondents. Equal numbers of respondents expressed satisfac-
tion and dissatisfaction with the personal praise and recognition they
received in their roles, whilst 32% were satised with their choice
over their own work practice. Respondents were least satised with
workload (20%), work life balance (19%) and pay rates (20%). These 7
items were combined to derive a job satisfaction mean score of 2.91
(median 2.85) and results were signicantly higher in the ESL group
(mean 3.08, p=0.03).
Factors that Impact on Transition to the Workforce for New Graduate
Nurses
Being a new graduate was described as challenging, stressful and
difcult. Stress, particularly in the early months was often due to
having to manage routines and workload, anxiety about giving med-
ications and dealing with the particular challenges associated with
client groups (older people with dementia, people with drug depen-
dence and/or mental health problems, physically heavy patients).
Factors reported to have signicant impact on the experience of
transition for new graduates were the nature of the workplace envi-
ronment, the level and nature of support available to new graduates,
together with their propensity to learn and adapt to workplace cul-
tures and to accommodate their own expectations and the expecta-
tions of others, and to a lesser degree, their prior experience in
nursing.
Negotiating Workplace Culture
For participants, a positive workplace culture was one in which
there is an explicit commitment to them as beginning practitioners
and new staff members, where this commitment is matched by the
capacity to full the promises made to them in relation to support
and learning opportunities and where they would be treated with re-
spect and courtesy. Whilst there were many reports of such positive
environments, there were more that described lack of commitment,
minimal support, unreasonable expectations and workload, and hor-
izontal violence.
In spite of having some prior knowledge of the problems associat-
ed with workplace disharmony in nursing, experiencing it rst hand
was disappointing, demoralizing and difcult.
It was disappointing to continually meet with nurses who were not
supportive towards new graduates and their learning needs. Often
the whole ward experience could be changed by the continued poor
treatment by a very small number of Senior RNs. They undermine
condence you have developed in your own practice and make you
feel like an ineffective member of the team. Focus group 4
New graduates frequently encountered horizontal violence in the
workplace during their transition year. In many instances, the violence
was perceived as systematically directed at them as new graduates,
others believed in the main that it was a feature of an individual
person's attitude and poor morale.
They can be very territorial and instead of teaching the new grad, it be-
comes easier to pick on them for doing everything wrong. I've been bul-
lied, told not to look up drugs ..//.. because I was wasting time.
Focus group 4
Many participants described a situation where their needs as
learners were in competition with the need to staff wards and provide
care to patients. They describe being viewed as a number to ll roster
gaps, with little regard for their level of knowledge, experience or
anxiety.
I did not feel that I had the correct level of knowledge to be in the po-
sition on most days. I felt very unsupported by management on many
occasions, as long as the staff numbers were correct, it didn't matter
about the skill mix.
Survey comment
Asking for help was often difcult when new graduates could see
that other staff members were also overwhelmed with work. Dealing
with negative circumstances was easier when there were at least a
small number of supportive staff. If new graduates felt they could
learn and grow in spite of the difculties they felt that the experience
was worthwhile.
Meeting Expectations
Participants' perceptions of various clinical contexts were coloured
by the expectations placed on them, their perception of the reasonable-
ness of expectations and their ability to performto the level of expecta-
tion. Patient loads of nine to eleven were reported as common, along
withthe expectationto supervise junior staff. Insome areas, particularly
general medical surgical areas the workload and level of expectation
placed onthemwere seenas unreasonable andat times unsafe. The mo-
rale amongst staff in these areas was often seen as low with high levels
of stress and burnout.
We were expected to perform and provide care like other nurses that
had been there for 20 years! Same amount of patients, and some-
times the most difcult ones because no-one wanted them, and then
you would get in trouble for not having completed all the necessary
tasks by the end of the day shift. Focus group 4
Because work and rostering practices differ across wards, beginning in
a new ward was often like starting all over again. Expectations often dif-
fered and it was often not easy to nd the necessary helpful information.
153 V. Parker et al. / Nurse Education Today 34 (2014) 150156
Roles are poorly dened, haphazard at best! Job descriptions are of
assistance but are often outdated. Lot of time is wasted trying to fath-
om very simple procedures which are not written anywhere but
stored in people's heads. Survey comment
Prior Experience and Attributes
Within the cohort studied, there were individuals that despite en-
countering negative workplace experiences, ourished and ultimately
enjoyed their transition period. The ability of these individuals to tran-
scend these negative inuences appears, in part, to be related to how re-
silient they were withinthe context, andto what extent they utilisedtheir
emotional intelligence to sustain and make the most of a sometimes less
than favourable situation.
Prior experience innursing did provide the opportunity to understand
some of the dynamics of workplace culture and helped newgraduates to
identify and where possible avoid difcult staff and negative situations.
However, the ability to adapt seemed to be most contingent on the indi-
vidual capacity of new graduates themselves to assess staff and circum-
stances and to negotiate a position for themselves where they could
make the most of the situation.
If I had been younger there is no way I would have been able to tol-
erate the nastiness towards new grads. It's a food chain issue.
Survey comment
Being exible meant that new graduates were able to adapt to new
circumstances and able to accommodate varying expectations of them.
Many believedthat because they receivedvery little feedback fromothers
they had to rely ontheir ownassessment of their performance, to be open
and ask questions even when others appeared unreceptive or unhelpful.
Their condence grew as time went on as they gathered skills and
began to understand the cultural milieu.
Understanding what was expected of me, something that I found
challenging at times. Sometimes it was confusing because some staff
would expect one thing and others would expect different, especially
being new to an area each rotation. But by the end of each rotation, I
would feel condent. Survey comment
The Importance of Support and Feedback
Most newgraduates believed they would be more welcomed and bet-
ter supported. They also expected to have more choice about where they
would work during their rotations and on completion of their new grad-
uate year. All believed they would be well supported throughtheir partic-
ipation in a new graduate programme.
Many participants reported feeling disappointed when the sup-
port promised to them did not eventuate. Whilst many felt comfort-
able asking questions and seeking support for themselves they still
believed that structured support was important along with feedback
and encouragement.
I had no contact with any coordinators or mentors unless I sought
them out and they were not too busy with other work to help me.
Survey comment
I rarely worked with onward mentors, which was disappointing as
support was greatly needed!! Survey comment
Although, many of the participants felt strongly about their own re-
sponsibility and need to pursue help if necessary and to not be reluctant
or deterred by lack of interest from senior colleagues, they reported
they wouldhave benetedfromconstructive feedback about their perfor-
mance. Often the only feedback they received was based on the fact that
no-one was complaining and no major mistakes had been made. They
would have preferred some encouragement and genuine interest in
their performance. It would have helped with their condence and re-
duced the stress they experienced from not knowing how others per-
ceived their performance.
Participants in the main accept that it is not possible for everyone
to get the placement options that they request. Whilst some see lack
of choice as problematic, others expressed a view that often the rota-
tions that they didn't choose were the ones they enjoyed most. Lack
of choice may not be a bad thing under such circumstances. What
was concerning for all was the possibility of nding themselves in a
placement that they really disliked for a protracted period of time.
I was asked on more than three different occasions, by three different peo-
ple what I wanted, and I was just placed where they were short staffed.
Survey comment
I only got one rotation in an area of my choice. The others I was
placed in by the facility. Despite this I have gained from all place-
ments and enjoyed each placement. Survey comment
Differences Across Contexts
There is a great deal of variation and inequity associated with the
programmes, pathways and opportunities available to new graduates.
Participants consistently reported differences between speciality and
general medical/surgical areas. Speciality areas have more educators,
more senior staff, more medical and other professional support and bet-
ter developednewgraduate programmes that are co-ordinatedby desig-
nated staff. They often have extended orientation programmes and
second year programmes for those who are chosen to stay. Further, in
these areas new graduates are unlikely to be expected to perform be-
yond their level of knowledge and experience and more likely to be
given quarantined supernumerary time. It is not surprising that more
new graduates intend to stay in these areas.
In contrast many new graduates in medical and surgical wards and
in rural areas have little or none of these resources and opportunities.
I would frequently leave an hour late and I'd still be nishing things
..//.. and then I moved to Emergency and I found that because it's such
a specialty area, they appreciate that you're not going to know every-
thing and I found them much more supportive and that's been really
good and I'm really really enjoying it. Focus group 4
The large differences that exist across contexts challenged newgradu-
ates to consider carefully where they would work in the future. Some
were fortunate enoughto be able to matchtheir preferences witha work-
place climate that suited their individual needs and capacities. Others
however, reported making the decision to pursue a non-preferred area
of nursing in order to work in a climate that was positive, where the
workloadwas manageable andwhere there was support andopportunity
for their professional development.
Whilst many new graduates have ongoing positions a signicant
number are wondering what their future holds. Participants were sur-
prised and disappointed about what they perceived as the lack of trans-
parency in relation to the availability of ongoing positions. They nd it
particularly difcult to understand when they work in an environment
where it is frequently difcult to nd enough staff to ll rosters across
shifts. For those who are unable to relocate, pursuing work in an area
that doesn't interest them may be their only option. They are worried
that if this happens they may be restricted in their future employment
prospects because of loss of skills and minimal experience.
There is currently a hiring freeze on and I have no idea what will hap-
pen after my contract. No-one is really sure except I may have to nd
employment elsewhere. I am extremely fearful I may have to move to
a different area so I can gain employment at a facility that will con-
tinue to develop my clinical skills.
Survey comment
154 V. Parker et al. / Nurse Education Today 34 (2014) 150156
Further, employment policies and practices that have seen increased
numbers of short term contracts are worrying to those who really need
full time employment.
Discussion
The ndings of this study support those of many other studies that
have examined new graduate experience (Beecroft et al., 2007; Chang
and Hancock, 2003; Chang et al., 2005; Parry, 2008; Roberts et al.,
2004; Wilson et al., 2008). They are also consistent with studies that
have identied problems associated with workplace culture and poor
morale in nursing generally (Scott et al., 2008; Cho et al., 2006;
Duchscher, 2008). By far the biggest issue identied by participants
was the discrepancy between the amount and quality of support they
believe they required and the amount and quality of support they re-
ceived. This study highlights the inconsistency in application of and
commitment to support initiatives across facilities and even from
ward to ward in the same facility.
Inline withprevious studies (Madjar et al., 1997; Heslop et al., 2001;
Wineld et al., 2009) this cohort described their experience of transi-
tion into the workforce as stressful, draining, demanding, bothphysical-
ly and emotionally, and personally challenging. Not only do graduates
have to learn to perform adequately but also need to make major ad-
justments in their personal lives.
The degree to whichnewgraduates experienced horizontal violence
resulting frompoor staff attitudes, together with unfair treatment asso-
ciated with rostering, deployment and workload was also of major con-
cern. Overall they suggested that their experience would be improved
through the provision of sustained genuine support, reduced work-
loads, less expectations in terms of excessive responsibility early in
their rst year, fairer treatment by senior staff, fairer rosters, greater
choice of placement options and critical constructive feedback on
their performance. In rural areas the experience could be improved
through better communication and information, together with greater
access to support, particularly through resources that are relevant in
the rural context. Further, in line with recommendations of previous
studies (Lea and Cruickshank, 2007; Kelly and Ahern, 2008), schools
of nursing need to better prepare graduates to deal with the cultural
tensions and social interactions that will impact them in their initial
period of employment.
The reporting of negative workplace culture with frequent episodes
of horizontal violence is consistent with other studies conducted over
the last 10 years (Lea and Cruickshank, 2007; Spence Laschinger et al.,
2010). However, there are still many examples where the staff is sup-
portive and new graduates feel valued. There is evidence that many
new graduates become quickly aware of the negative culture and have
learnt how to negotiate a comfortable albeit, in some cases a transient
position, for themselves. This study supports the ndings of Spence
Laschinger et al. (2010) that new graduates are less likely to be bullied
when they have access to workplace empowering structures such as;
access to information, resources, support, opportunities to learn and
grow, job discretion and strong working alliances.
The ndings of this and other studies suggest that the pressure on
new graduates is high, along with expectations for them to be work
ready (Wolff et al., 2010; Kelly and Ahern, 2008). Yet the support they
receive in the main is inadequate, leaving some feeling compromised,
dissatised and frustrated by a system that is reportedly in desperate
need of their skills and commitment to stay in nursing. In relation to
the presence or otherwise of supportive mechanisms made available
for the new graduate nurse transitioning into the workplace there was
resounding consensus around the absolute need and priority of having
designated new graduate nurse educators/co-ordinators, who are ac-
cessible and responsive to the unique needs of the transitioning new
graduate nurse. It would appear that the presence of these supportive
positions mitigates to some degree the organizational deciencies asso-
ciated with unproductive mentor and other collegial relationships and
inconsistent provision of orientation and supernumerary days. The
overwhelming view by new graduates that support is most effective
when available from work colleagues highlights the need for invest-
ment in ward level supportive strategies. Further studies that identify
particular contextual factors that impede success with a viewto the de-
velopment of programmes and processes that engage ward staff and
new graduates in sustainable supportive relationships are needed.
Newgraduate satisfaction with their newgraduate experience seems
to be largely contingent on the collective capacities of individuals, wards/
units andorganisations toengage withthemandto support their learning
and their gradual assumption of the full expectations and responsibilities
of a RN. There seems to be an expectation that they should and will be
ready from day one. Regardless of expectations, reasonable or otherwise,
the larger issue of major concern to participants was they often perceived
themselves as unsafe practitioners in some situations.
Given the negative experience of many new graduates in non-
speciality areas, examination of ways in which these areas can be better
supported is imperative. Given that lack of support and unrealistic expec-
tations is due primarily to relatively lower numbers of senior experienced
nurses, the development of career pathways that support the develop-
ment of highly skilled practitioners in these areas may encourage new
graduates to stay. A similar programme is warranted in rural areas, one
that engages new graduates in a positive experience of rural nursing
and understands their motivations for wanting to work in rural contexts.
Limitations of the Study
Although general invitations to attend focus group meetings were
disseminated via the on line survey and through nurse educators and/
or new graduate co-ordinators, there remained an inherent bias of
only reaching nurses employed at host sites, and further, only those
who were on duty at the time. Hence, a bias toward hospital employed
new graduate nurses was inevitable. More extensive geographical
spread was limited by time restraints, distance and cost. However,
these biases are mediated to some extent by the widespread distribu-
tion of survey responses, across all area health districts and metropoli-
tan and rural areas within NSW.
Whilst the sample is broadly representative, the sample size was not
large enough to meaningfully examine the experiences of specic
sub-groups such as those fromrural settings and culturally and linguis-
tically diverse backgrounds. Further studies are needed to understand
the nature of transition for those possibly at risk groups.
Conclusion
The factors that impact on the experience of transitioning of new
graduate to the workplace are complex and integral to challenges that
confront nurses and health care generally. There were many reports of
rewarding, enjoyable experiences, where new graduates were wel-
comed and encouraged and supported in their learning. However,
there were alsomany stories of discontent. Discontent was largely relat-
ed to the absence of expected support in a workplace context that re-
quired more of them than they felt able to provide. Consequently,
some newgraduates were stressed about their safety as care providers,
overloaded by excessive responsibility and physical work and emotion-
ally tested by the treatment they received from colleagues, particularly
senior colleagues. Their transition is to a large degree a personal journey
of learning to negotiate the workplace culture, building skill and con-
dence over time.
There is an urgent need to develop and test a range of evidenced
based approaches that will both empower nurses (new graduates and
experienced nurses) and embed systematic approaches that enable eq-
uitable andcontextually relevant stewardshipof newgraduates into the
profession into the future.
155 V. Parker et al. / Nurse Education Today 34 (2014) 150156
Acknowledgment
The study was sponsored and funded by the Nursing and Midwifery
Ofce of NSW Health.
No conict of interest has been declared by the authors.
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