Background: The transition period from student to newly qualified nurse where nurses are adjusting to their new role and consolidating their knowledge and skills can be stressful. It is a time when many newly qualified nurses are left feeling inadequately prepared. A variety of strategies to ease the transition process have been reported, which aim to increase confidence, competence, sense of belonging of new graduates, improve recruitment and retention and reduce turnover costs.
Objectives: To synthesise the best available evidence on the effectiveness of support strategies and interventions aimed for newly qualified nurses.
Methods: A comprehensive search was undertaken on major electronic databases to identify both published and unpublished studies from 2000 to the present date. Reference lists of retrieved papers were searched and authors contacted. Only quantitative studies published in English language were considered.
Methodological quality and data extraction: Two reviewers independently assessed methodological quality and extracted data from the included studies. A third reviewer resolved any disagreements through discussion.
Data synthesis: The review did not identify comparable Randomised Controlled Trials (RCTs), and as such meta-analysis of the data was not appropriate. The data extracted from the included studies were synthesized into a narrative summary.
Results: Thirty three studies were included in the review: RCT (1), Quasi-experimental (3) and observational/descriptive studies (29). Countries of origin were: USA (25), Australia (4), England (2), New Zealand (1) and Thailand (1). Studies were categorised according to the type of programme or support strategy provided: nurse internship/residency programmes (14) and graduate nurse orientation programmes (7), preceptorship (4), simulation (3) and mentoring (2), final year nursing students transition programs (2) and externship (1).
Outcomes were categorised as being important to the employer (recruitment, retention, turnover rates, competence, confidence and costs), or to the new graduate (stress and anxiety reduction, job satisfaction, knowledge/skills acquisition, critical thinking and interpersonal skills, confidence and professional nursing behaviours).
The range of outcomes reported across the studies made it difficult to report firm conclusions. A general increase in level of confidence was noted, along with reduction in stress and anxiety. Some success in relation to increases in knowledge, critical thinking and levels of job satisfaction were reported. A number of studies reported a V shaped pattern (initial high levels, dipping at 6 months and then reverting to baseline levels) for autonomy, job satisfaction, and professional transition. Research relating to improvements in retention and reduction in turnover was generally poor.
Implications for Practice
The overall impact of intervention programmes appears positive, irrespective of the intervention. This may suggest that it is the organisation's focus on new graduate nurses with support from colleagues that is important. .Mentors/preceptors need to be adequately prepared for the role.
Implications for Future Research
Future research should build on the strengths and limitations of the current studies. A lack of experimental studies means there is commonly little control over other variables that might influence the outcome. There is a need for larger studies using more objective and reliable measures.