FOR PROFESSIONALS currently employed in health care, geopolitical distinctions are arguably no longer adequate benchmarks for predicting critical shortages in human resources. Where once existed some stability of regular progression in professional development and affordance for increasing health care standards, there now is a significantly disrupted workplace where progressive technologies and clinical complexity outpace the capabilities and priorities of institutions chronically undervaluing human capital.1–3 A unifying, worldwide realization of the dire state of nursing has been exposed by the pandemic state of health care, with significant impacts on nurses and those new to the profession in particular.4–7
Within this article, precipitating factors of the current experience for newly graduated nurses (NGN/s) will be discussed, focusing on how adapting evidence-informed methods of support for NGNs can be applied today, with significant potential for reducing attrition and increasing job satisfaction. Professional role transition (PRT) underwent pivotal examination in the years following the now seminal Robert Wood Johnson/Institute of Medicine Future of Nursing Report,8 wherein nurse residency programs were recommended throughout the United States as a cost-effective means of reducing NGN turnover. Recent reports suggest that a single bedside RN turnover is estimated to cost US $46 000, with 270 US hospitals reporting in 2021 that more than 30% of staff attrition was in employees with less than 1 year's tenure.9 Despite historical professional transition programs for NGNs, evidence continues to suggest that PRT is a tumultuous experience for many NGNs, with transition shock motivating possible outcomes of burnout and attrition if not recognized and mitigated.10 This article will conceptualize the behaviors and experiences one can expect from NGNs embedded within the varying stages of transition; this process situates residency and other support programs within practice environments of increasing workplace chaos and complexity. Finally, a novel approach to NGN support will be discussed through its historical iterations to its current state, wherein holistic, realistic, and multimodal supports are offered to emerging professionals in an accessible online format. Nursing is buckling under internal and external pressures, and though the professional crisis for nurses is not experienced solely by the new practitioner, providing NGNs with comprehensive systems of support is crucial for both retaining and building capacity for the future of the profession.11–13
SITUATING NEW GRADUATE TRANSITION
Presently, about half of the registered nursing workforce in Canada and the United States is older than 45 years,2 with projected nurse shortages reaching 120 000 by 202614 and furthered by the expectations of continued aggressive external agency and international recruitment.15 Quality health care depends upon an understanding of what constitutes a quality nursing work environment and the commitment of resources to support such an environment. Despite correlations between a shortage in quality nursing human resources and public health risk,16,17 demands for full-time nursing professionals continue to exceed the rate at which NGNs are graduating from educational institutions.
The long-term, complex composite of market, technological, and societal influences has eroded the ability to respond to cyclical changes in the need for nurses.18 Pervasive societal disrespect, workplace discrimination and racism, disregard for the human needs of nurses, inappropriate utilization of nursing knowledge, a focus on fiscal management rather than quality work environments, and attractive alternatives to hospital nursing are primary contributors to the current acute care nursing workforce deficiencies.12,19–26 A foundational report of nursing workforce trends in 5 countries (Canada, the United States, England, Scotland, and Germany) showed strikingly consistent symptoms of distress suggestive of fundamental problems in the design of nursing work; inadequate staffing quotas available to cope with elevated acuity and census figures; increases in worker absenteeism and subsequent escalating costs of nursing care provision; qualitative evidence of health care administrations that are out of touch with the voices of struggling nurses; and reports of an increased tendency for younger nurses to show greater willingness to leave their hospital jobs.27 Although no such other study has been conducted to date, evidence related to evolving postpandemic practice context reveals concerning workforce vulnerabilities.28 Compounding these data are reports claiming that the majority of NGNs who begin practicing as professional nurses in a hospital setting plan to change their place of employment or leave the nursing profession within the first 2 years.14,29–33 Given the tremendous stressors experienced by NGNs and their senior counterparts during the recent pandemic, and considering the human resource shortages escalating globally as a result, there is an undeniable urgency to understand our resource gaps and how to fill them.34
The movement of NGNs between institutions or out of the profession altogether has been primarily attributed to the following factors:
- Emotional exhaustion secondary to increasing professional demands, workloads, and powerlessness to effect change.
- Horizontal violence and discrimination.
- A plummeting professional self-concept and self-confidence within NGNs, including the impact of the same on their professional motivations.
- Pivoting practice environments (ie, rapidly changing unit demographics, increases in workload stress, and suboptimal staffing) that demand unusual flexibility in NGN practices.
- Institutional change implemented without meaningful nurse consult or consideration.
- Undergraduate educational and employment institutions that were required to make tremendous alterations to their knowledge transfer approaches (ie, pivot to online, virtual, and simulation teaching frameworks) due to COVID-distancing restrictions, rendering graduates inadequately prepared for “real”-world practice.
Insufficient professional transition integration programs exist that could mitigate the challenges faced by NGRNs in practice. These include undergraduate curricula on transition preparation, seasoned novice nursing mentorship and preceptorship programs, NGN internships or residencies, transition facilitator roles or other initiatives that offer NGN advocacy, and extended workplace orientations.
Although the most overt cost of the loss of nursing human resources to employers may be seen in the replacement of exiting nurses, an even greater cost may well be a threat to the health of the public as a whole.35,36 Increased patient morbidity and mortality rates are a natural consequence of new and experienced nurse burnout that is secondary to inadequate staffing, bullying from senior practitioners, and the job dissatisfaction and moral dissonance of the practicing nurse.23–26,37 Near-miss research clearly warns of the dangers of expecting NGNs to practice without access to experienced colleagues for clinical collaboration and leadership.37 Finally, limited human resources and the need of care contexts to frequently pivot in care prioritization and “response” to ongoing public health challenges (ie, COVID-19) dictate the immediacy of implementing creative programs that support role appropriation to optimize performance throughout all scopes of nursing practice. To comprehend what supportive programming may look like for the NGN, it is essential to consider the journey from historical conceptualizations of PRT to the current understandings of what is experienced by NGNs today.
THEORETICAL UNDERPINNINGS OF NURSING THE FUTURE
The body of work that frames and grounds the Nursing The Future (NTF) support initiative represents the extensive and comprehensive PRT study and research of Dr Judy Duchscher spanning more than 2 decades (1998-2022). The intent of Duchscher's program of research and grassroots work has been to continue to examine, build upon, and mature aspects of the NGN transition experience such that an accurate overall representation of this experience and the processes encompassed within it can be confidently applied by the scholarly community. The purpose of such application is to provide representative support for this experience and to advance the dialogue around the issues inherent in the new nurse's initial professional role adjustment.
If we are to not only recruit and retain NGNs but also motivate and inspire future generations of our profession, then we must come together in creating a strategic plan that can reflect and address evolving challenges that NGNs face when being formally introduced into their professional community. It is this collective effort that has the potential to yield transformative change within the discipline for while the initial PRT of the NGN is itself a unique stage in their professional journey, it should also be considered a magnified reflection of the realities all nurses face on a daily basis. As such, the evolving transition experience of the NGN has the potential to unite and advance the entire profession by making visible the contemporary challenges and triumphs of the whole nursing community.
The substantive NGN transition theory presented here constitutes only one element of the overall socialization process of the new nursing professional. Larger, metatheoretical frameworks of transition transcend time, demographic context, and individual nuances. Duchscher's theory, being substantive, speaks only to the experience of NGNs at the interface of their student-practitioner lives (post “orientation” to the workplace and up to 12 months of professional practice). Although Duchscher's work has resonated remarkably well anecdotally with experienced nurses making role transitions within the profession (ie, from direct-care nurse to nursing educator) and has been identified as congruent with the initial role transitions of professionals from other health care disciplines (ie, social workers, pharmacists, physicians, dieticians), the theory is not claimed to be evidentiary outside of the NGN.
Furthermore, it is not enough to simply understand what NGNs experience during their journey from student to practitioner; the transition to professional practice is only the first step in their ongoing professionalization as nurses. But Duchscher believes that it is by seeking to understand the lived experience of the NGNs that we become aware of the challenges they face not only as nurses but also as individuals within social, economic, political, developmental, cultural, physical, professional, and institutional (workplace and education) contexts. It is the authors' hope that through this deep understanding, we can develop and expand our postpandemic socialization and professionalization processes to optimize the nursing profession and, consequently, the quality of health care we are able to offer our communities.
Along her 20+ years of journey in this topic area, Duchscher claims that the most unanticipated but undoubtedly the most fulfilling outcome of her work in this area has been the gentle but persistent “voice” of the NGN that has insisted on being heard. It has been clear through the process of her research, study, and ongoing grassroots work with NGNs that far too many of them still experience role stress, moral distress, discouragement, and disillusionment during the initial months of their introduction to professional nursing practice, particularly in acute care settings. Duchscher's work with thousands of graduates and those who support them spans Canada, the United States, Australia, and Asia. This work has revealed a staged, mostly progressive, and nonlinear process of role transition whereby they explore, discover, engage, separate, critique, embrace, endure, and most ultimately thrive in their newly established professional nursing practice.
Although elucidating a theoretical construct that can help us understand the NGN experience is the obvious academic outcome of her work, Duchscher asserts that the narration of the NGN stories of transition, as told through the shared experiences of all the NGNs with whom she has had the privilege of interacting has truly transformed her:
This body of work has been, in many ways, the most illuminating, clarifying and crystallizing experience that I have ever had. Perhaps the compelling nature of their collective story is that it poignantly illustrates a proverbial “coming of age” and as such, resonates in some way, at some level, with all of us. There is the excited anticipation of arriving at a long-awaited and hard-earned goal to realize, as in this case that “it's just a job, like every other job” you've ever had. While embarking on a professional life has its empowering and encouraging moments, it is often revealed to be more reality than romanticized fiction—more bee than honey. This account reflects the age-old adage that “all is not as it seems” or, more to the point what we “dreamed”; it is a story about growing up (J. E. B. Duchscher, written communication, September 2022).
DUCHSCHER'S TRANSITION THEORY
The generation of this emerging theory arises out of an evolving 25-year program of research encompassing qualitative and mixed-methods studies in the area of NGN transition, an ongoing contemporary literature review of the transition experience of the NGN,38–42 and several decades of working directly with NGNs in transition. Duchscher's initial study, conducted in 1998, consisted of a 6-month phenomenological exploration of 5 NGNs navigating their initial introduction to professional practice. The second study, conducted in 2001, extended over a period of 12 months and was an exploration of the experiences of 4 new graduates and 5 seasoned nurses. These graduates were studied as they integrated into an emergency department environment immediately after graduating from a Canadian undergraduate BScN nursing program. The third study was conducted by Dr Leanne Cowin out of Australia. Duchscher was asked to complete a retrospective analysis of the qualitative data collected in this 3-part study examining graduate nurse self-concept and retention plans. In her doctoral work of 2007, Duchscher explored the transition journey of 15 NGNs for more than 18 months. For this study, she employed a generic qualitative approach to data collection, using a grounded theory process to guide the ongoing analysis and interpretation of the emerging data. Initial semistructured interview templates were created for the 1, 3, 6, 9, 12, and 18-month data collection periods based on her previous program of research on new graduate transition. These instruments were then modified as the data emerged. In addition, participants completed preinterview questionnaires and submitted monthly journals detailing their experiences. Finally, focused group discussions, informed and guided by prior interviews, journaling data, and her ongoing study were conducted during identical time periods with a separate group of participants originating from the same nursing program. A dynamic interplay between inductive and deductive processes permitted a fluid movement between data analysis and further data acquisition.
In September of 2011, Duchscher engaged in a research study to explore the initial PRT of accelerated degree nursing graduates (those graduating with a baccalaureate in nursing after having acquired a nonnursing degree prior to entry into their nursing program). As well, in the summer of 2011, Duchscher embarked on an international study of men transitioning to professional practice as nurses. The findings that emerged from these studies were subsequently integrated into the overall theoretical constructs of Transition Shock and the Stages of Transition. Upon Duchscher's return to academia in 2017, provincial and national consultations for NGN education and practice support frameworks were undertaken, leading to 2 further studies. Both studies were initiated in 2018-2019, with the first focused on exploring the impact of a nurse residency program on the experience of transition for NGNs in Australia and utilized her Professional Role Transition Risk Assessment Instrument, a 61-item quantitative tool constructed from the 4 foundational elements of her transition shock model (roles, responsibilities, relationships, and knowledge). The second study explored the socialization experiences of NGNs moving from the culture of education to the culture of practice; this research sought to understand how a structured mentorship approach framed in the Stages of Transition and Transition Shock models would influence the NGN's journey into practice.
TRANSITION SHOCK
Transition Shock was the initial core variable to take shape from Duchscher's evolving data, and it did so with dramatic persistence. Although Duchscher clarifies that she did not set out to rewrite Dr Marlene Kramer's42 reality shock theory, the unrelenting presence and significance of her findings granted her the confidence to move forward, albeit with a cautious sense of clarity and a deep level of conscience, to empower the development of this idea. The theoretical construct of transition shock focuses on the antecedents (aspects of the new graduate's roles, responsibilities, relationships, and knowledge) that both motivate and mediate the intensity and duration of the experience and qualify the early stage of PRT for the NGN. The detail Duchscher offers in relation to these antecedents is intended to facilitate a more comprehensive use of the model by identifying multiple root issues and events through which the transition experience might be further understood and supported. This work expands on Kramer's42 theory by demonstrating that the NGN engaging in a professional practice role for the first time is confronted with a broad range and scope of physical, intellectual, emotional, developmental, and sociocultural changes that are both expressions of and mitigating factors within the experience of transition. These factors may be further aggravated by unfamiliar and changing personal and professional roles and relationships as well as unexpected and enhanced levels of responsibility and accountability that students are unable to be afforded during their education. Further to this, the current assumption underlying the contemporary transition experience is that NGNs will be able to apply clinical knowledge to a new context of practice that may be as yet untried, may be contextually unrecognizable to the novice practitioner, or may be simply unknown. An impressive finding and one that serves as a core variable in the experience of transition shock is the “surprise” expressed by participants as they move into new professional workplace roles. The predominance of this variable reveals an inadequacy in the preparation of senior students for the reality of the transition experience. Furthermore, the extent of the struggle to adjust to their new reality, and the fact that while the experience qualitatively changes over time but does not necessarily abate until graduates are into approximately their 8th month of transition, suggests that insufficient orientation and support exist for many new professionals in the workplace. Elucidating and then edifying the stages of role transition that occur for the NGN during the initial 12 months of their introduction to professional practice was an emerging finding that indeed emanated fluidly from both a theoretical and representative (ie, model) perspective.
STAGES OF TRANSITION THEORY
The Stages of Transition theory incorporates a journey of becoming where NGNs progress through the stages of doing, being, and knowing. The initial 3 to 4 months of the NGNs' journey is an exercise in adjusting and adapting to, as well as accommodating, what they find in the realities of their new work, professional and personal life worlds. For the NGN, there is little energy or time to lift their gaze from the very immediate issues or tasks set before them, and their “shock” state demands a concerted focus on simply “surviving” the experience without revealing their feelings of overwhelming anxiety or exposing their self-perceived incompetence. The second stage of PRT encompasses the next 4 to 5 months of the NGNs postorientation period and is characterized by a consistent and rapid advancement in their thinking, knowledge level, and skill competency. As this period progresses and the NGNs gain a comfort level with their professional roles and responsibilities, they are confronted by inconsistencies and inadequacies within the health care system that serve to challenge their somewhat idealistic pregraduate notions of the profession. An increased awareness of the divergence between their professional self and the enactment of that self in their new role motivates a reflective retreat from personal and professional interactions; Duchscher coined this as the “transition crisis” component of the second stage of PRT. The primary task for these graduates at this stage is to make sense of their role as a nurse relative to other health care professionals and to find a balance between their personal and professional lives.
The third and final stage of evolution for these nurses during the initial 12 months of their careers is focused on achieving a separateness that both distinguishes them from the established practitioners around them and permits them to reunite with their larger community as professionals in their own right. With an increase in both familiarity and comfort in their nursing roles, professional responsibilities, and relationships with coworkers, the NGNs have the time and energy to begin a deeper exploration and critique of their professional landscape, making visible the more troubling aspects of their sociocultural and political work environments.
Likely fed by a residual exhaustion from prior stages, the NGN may express a growing dissatisfaction with shift work, the conditions of their work environment, and their relative powerlessness to effect change within that environment. For some, this may simply be a case of adjusting to the work world for the purpose of achieving a sense of job satisfaction. For others, sacrificing particular professional expectations and aspirations and conceding to what they perceive as inadequacies in the system within which they will spend their life working is terminally demotivating and inspires a search for alternate avenues of professional fulfillment (eg, changing employment, leaving the province and country, making plans to return to school, or disengaging from and exacting a distinct separation between work and home life). The whole of this journey encompasses ordered processes that included anticipating, learning, performing, concealing, adjusting, questioning, revealing, separating, rediscovering, exploring, and engaging. Although this journey is by no means linear or prescriptive, nor always strictly progressive, it is evolutionary and ultimately transformative. Further to this, it can be assumed that ongoing but transient regressions will be experienced by the graduates. These alterations in progression may be precipitated by the introduction of (a) new life events, (b) complex personal or professional relational situations, or (c) unfamiliar or complex practice situations or contexts.
Building on the certainty that all NGNs will undergo at least some form of PRT, we should ask ourselves why NGNs continue to have these experiences in isolation, with many possibly never realizing the normalcy of their experience or being made aware of potential supports. Arguably, the initial “keep your head down” stage of PRT does not lend itself to NGNs locating additional supports, as they simply strive to survive each shift. As the NGN progresses, their perspective might include a need to demonstrate levels of independence not matched by their novice skills and therefore additional help is not sought out. As such, it appears that support for the transitioning nurse must come from an external source.
NURSING THE FUTURE
This section provides the historical framework of NTF from 2004 to 2014, offering insights into the impetus behind the birth of this initiative and shares how NTF evolved to its current rendition. During its initial tenure as a Canadian registered nonprofit organization, NTF was successful in (a) establishing the presence of peer support resources for NGN in provinces throughout Canada, (b) creating a Web site that served as a conduit for contemporary evidence and knowledge sharing related to the topic of PRT for the NGN, and (c) hosting North America's only annual conference for knowledge sharing and capacity building around the topic of PRT for NGNs.
From its conception in 2003 and inception in 2004, NTF spread quickly throughout Canada, driven primarily by a partnership between Duchscher; senior provincial nursing leaders in both education and the health care sector committed to preparing, transitioning, integrating, and stabilizing NGNs; and teams of regional senior students and NGNs. Although the introduction of a membership/chapter model worked initially, the logistics of this approach proved unsustainable. Six years after its inception, and utilizing the base annual funding received from the Saskatchewan Ministry of Health, NTF moved to a more consultative platform. Regions interested in establishing networks of NGN transition support were guided and supported by NTF over a period of months. Sustainability was attainable through this model as it allowed NTF to work with regional NGNs and develop transition content experts within the region's own network.
During the second phase of NTF (2010-2014), Duchscher, along with a leadership team consisting of senior students and NGNs from across Canada, mentored provincially based student/NGN/senior leadership cohorts as they sought to develop regional New Graduate Transition Facilitation Networks (NGTFN). These NGTFNs were based on a guided mentorship relationship between regional NGN-evolving leaders, regionally established nursing leaders committed to growing capacity in young aspiring leaders, and members of the NTF leadership team. Duchscher, alongside NTF's national leadership director (Kandis Harris, currently the Academic Chair—Saskatchewan Collaborative Bachelor of Science in Nursing [SCBScN], School of Nursing, Saskatchewan Polytechnic, Regina, Saskatchewan), and at least 1 other NTF leader traveled to provinces who had made requests for consultation to grow their regional NGTFN. Preparatory meetings were held by distance, including participation in exercises focused on orientating both senior nursing leadership and NGN leaders to transition theory and the challenges of PRT for NGNs. This preparation occurred over a period of several months prior to the leaders coming together for an NTF-guided face-to-face induction workshop. The workshop facilitated discussion of issues related to NGN transition and culminated in the development of a sustainable regional model that could educate and support the process of PRT for local NGNs.
After its inception in 2004, NTF established professional and organizational intents, created a vision statement and mandate, secured a visual and virtual identity, and cultivated relationships and partnerships with regional, provincial, and national professional associations. In March 2005, NTF became a registered nonprofit organization with Industry Canada, maintaining that status until 2014. During its tenure, NTF was the only non–employer-based platform in Canada's history devoted to NGN PRT. Nursing The Future hosted an annual international conference on the Workplace Integration for New Nurses, published a quarterly newsletter, established an online discussion network, and evolved a dynamic professional resource Web site for its members. In 2012, Duchscher published her initial book on her evolving theory, making it available on the NTF Web site and using it as the framework for knowledge development of all NGN leaders in the organization.
Because of the strength of the evidence-informed resources framing the organization, NTF's commitment to increasing the awareness of the transition experience for NGNs and developing resources to support that experience was an invaluable resource to Canada's NGNs. Collaboration with provincial and national health care and nursing communities resulted in a doubling of NTF's base membership between September 2007 and 2008. By 2010, membership in NTF comprised more than 1000 nursing students, new nursing graduates (LPN, RPN, and RN), seasoned practitioners, nursing educators, and leaders from across Canada. In recognition of the impact of this organization on the nursing community at large, Duchscher was awarded the 2008 Mu Sigma Chapter of the Sigma Theta Tau Honor Society of Nursing Community Leader Award and the 2009 Saskatchewan Health Excellence Award (SHEA) for Leadership.
Along with its primary objective of providing a portfolio of resources to support the role transition of NGNs into the health care system, the second primary objective of NTF was to grow leadership capacity in young nursing professionals across the country. To that end, NTF evolved its new graduate leadership team (NGLT) to a cohort of 39 NGN leaders from across western Canada. In October 2008, NTF established a New Graduate Leadership Model that decentralized decision-making capacity to regional NGN leaders. Select NGN leaders were appointed to a regional NGLT that worked directly with NTF's executive director and national leadership director.
Over its initial 10-year tenure, NTF represented both urban and rural health care contexts and served the broad range of practice areas where NGNs enter professional practice; NTF committed to being a resource developed “by NGNs for NGNs.” Nursing The Future received significant financial support from the Saskatchewan Ministry of Health, allowing it to continue its national influence by building on NGN initiatives already established in each province. During its tenure, NTF received financial endorsements and conference sponsorship monies from the Saskatchewan Institute of Applied Science and Technology, the University of Saskatchewan, the Regina Qu'Appelle Health Authority, the Saskatoon Regional Health Authority, SUN, the Prince Albert Parkland Regional Health Authority, the Canadian Patient Safety Institute, Sun Country Regional Health Authority, Keewatin Yatthe Regional Health Authority, Mamawetan Churchill River Regional Health Authority, Five Hills Regional Health Authority, Heartland Regional Health Authority, Sunrise Regional Health Authority, Prairie North Regional Health Authority, and the Nightingale Nursing Group Inc. These valued members of Saskatchewan's health care community displayed both insight and vision as they lent their support to an initiative that rapidly established itself as the premier professional support network for NGNs in Canada. As of September 2008, the NTF support network extended throughout every province in Canada with local and regional health authorities contributing financial support to the establishment of provincial NGTFN (see previously).
SUPPORT RESOURCE OVERVIEW
A Transition Support Guide for NGNs, referred to as a “survival guide” by the NGLT, was developed in 2006 to address professional and developmental issues related to making a successful transition from student to professional practitioner. The manual was updated in 2012 with grounding in the growing base of contemporary global evidence and framed by Duchscher's program of research and grassroots work that generated the model of Transition Shock and the theory of the Stages of Transition. Additional resources within the new publication provided tips on issues such as understanding and enhancing intra- and interprofessional work relationships, dealing with shift work, managing conflict in the workplace, connecting with professional organizations, and creating a professional career path. This publication was included as a resource for all NTF members.
Bridge Clubs were established where NGNs met face-to-face with other NGNs to discuss nursing and health care issues, find support for their professional transition to and work within the health care sector, and engage in ongoing educational development through dialogue with invited local community nurses and nursing leaders. Nursing The Future introduced the concept of Bridge Clubs during Welcome to Practice Events,* with subsequent meetings serving as mentoring networks for NGNs. In addition, the Bridge Club meetings were a source of capacity building for NGNs as invitations were extended to seasoned practitioners to share their own experiences and knowledge on a variety of salient topics related to nursing practice. Health region staff responsible for regional mentorship/preceptorship programs were encouraged to link with Bridge Club coordinators as a means of offering support to their regional NGNs. The most successful of these initiatives occurred in the larger urban health regions. Support for networking, the sharing of experience around workload planning, clinical judgment and decision making in practice, the transfer of tacit knowledge between novice and seasoned nursing professionals, and the general socialization of NGNs to the profession that occurred during the Bridge Club forums made these forums attractive to senior nursing leaders. Nursing The Future considered taking steps to enhance the collaboration with managers and educators in providing employed NGNs with ongoing formalized peer support by NTF graduate leaders. It was felt that Bridge Club meetings could consist of mentoring between more advanced NGNs (>12 months of practice experience) already employed within institutions and recent graduates for the purpose of providing education about the transition experience and offering creative strategies for dealing with common transition issues.
The original Web site was updated in 2008 with a comprehensive platform that offered access to information on nursing issues and regional professional resources from each province, as well as linkages to educational, research, and practice supports intended to foster growth and engender support for advancing NGN practice. The expanded Web site included the availability of multitopic discussion boards and weekly LIVE Chats for both NGN and senior health care leaders, linkages with a wide variety of professional nursing Web resources, opportunities for NGNs to voice their professional concerns regarding their transition experience, and a platform for recommending strategies to address these concerns. A Web-based membership database was also developed that allowed for the tracking and managing of NGN data. The capacity to access NGNs via an online platform was felt to be a rich source of connection between industry, education, professional organizations, government stakeholders, and NGNs that could inform evolving employment trends and issues.
An annual WINN†-NTF collaborative conference was offered for 10 consecutive years in provincial regions that spanned the country. This educational forum offered NGNs an opportunity to explore, discuss, and work through issues inherent in the transition stages with other new and recently graduated nurses, as well as nursing leaders and professional transition experts from across the country. Plenary and concurrent sessions consisted of evidence-based topics related to NGN transition. Challenges such as anticipating the stages and phases of professional transition, dealing with threats to self-confidence, developing a professional self-concept, addressing and resolving conflict in the workplace, and initiating and managing a career were all presented. The conference agenda grew significantly over the years, attracted an international audience, and featured renowned international keynote speakers including Suzanne Gordon, Dr Marlene Kramer, Tilda Shalof, Dr Mary Ferguson-Paré, Dr Marlene Smadu, Dr Leanne Cowin, and Sister Elizabeth Davis to name a few. Both podium and poster presentation platforms were offered and Duchscher's Transition Shock and Stages of Transition constructs were used to frame the content and process of the conference. Planners of the conference were committed to offering initiatives and strategies that empowered the individual NGN as well as fostered collaborative and unifying relationships between NGNs, their seasoned practice colleagues, health care leaders, and ministries of health and advanced education, as well as professional organizations and unions. A new graduate planning subcommittee consisting of NTF leaders and NGNs from the host province's health authority coordinated all student and NGN-specific content, developing and delivering workshops on issues targeted at NGN conference attendees.
Development of leadership capacity in NGNs as a means of professional succession planning became a significant mandate of NTF during its latter years. The senior student and NGN leaders chosen for this organization were mentored in the development of their leadership strengths through monthly reflective dialogue with the executive director and face-to-face leadership development workshops each year. All NTF leaders completed and submitted extensive journals on subjects relating to the development of their leadership character, program initiation, writing and oral presentation, and work ethic. All leaders accepted an organizational portfolio (eg, Bridge Clubs, Graduate Liaison, Annual Conference) for which they were responsible to submit monthly updates on progress made and challenges addressed. Senior NGN leaders were advanced in their level of responsibility relative to more junior NGN leaders in the organization and peer mentoring between leaders was strongly encouraged and organizationally facilitated. Meetings between the executive director and the NGLT were held primarily based on the needs of the leaders and the demands on NTF resources.
As an organization that relied on the infusion of senior nursing students and NGNs annually to maintain its contemporary voice, NTF faced the ongoing and significant challenge of how to address the expected turnover in NGN leaders. Ongoing interviewing and the appointment of potential successors to vacated NGN leadership positions were an oversight role of the executive director but a shared responsibility among each level of NGN leadership within the organization. The regeneration of the leadership team through the secondment and the development of young leadership protégés were made possible through the collaborative funding efforts of cross-provincial health regions and provincial ministries of health. An NTF liaison position within all provincial chapter councils for the Canadian Nursing Students' Association was secured during the 2009 CNSA National Assembly Meeting. This provided an avenue for securing aspiring student leaders, and NTF was contracted to deliver PRT Workshops annually at the CNSA National Convention and General Assembly 2010-2014.
From 2005 to 2011, in the spring of each year, all NGN leaders were brought together for a 2-day NTF Leadership Development and Organizational Strategic Planning Retreat. The objectives of this retreat were to develop the public-speaking skills of the NGN leaders, consolidate a consistent organizational message, and rehearse therapeutic ways to respond to challenging NGN transition scenarios. Additional outcomes of these retreats included enhancing the NGN leaders' time management skills and advancing their knowledge of contemporary PRT theory. In May 2009, 32 NGN leaders (including students and graduates from practical, registered, and psychiatric nursing programs) from Saskatchewan, Alberta, British Columbia, and Manitoba came together for a special leadership development session. With workshops on professionalism, conflict and communication strategies, transition theory, and dynamic approaches to leadership, these young leaders saw themselves stretched, challenged, validated, and embraced for the unique and exceptional leadership qualities they were bringing to the discipline. During its initial tenure and up to 2014, when Duchscher stepped away from the initiative to pursue other goals, the national NTF NGLT had responded to more than 200 requests to address issues related to NGN transition at local, regional, provincial, national, and international meetings, workshops, and conferences. There was no doubt that NTF had advanced the contemporary knowledge of PRT, embedded a comprehensive understanding of what constituted appropriate NGN transition support in both nursing education and the health care sector, and did this through developing leadership capacity in aspiring young scholars across Canada.
During the years of NTF's original iteration (see part 2 for an outline of NTF's current platform), international interest in NGN PRT was being built through the impetus of the RWJF/IOM Future of Nursing (2010) report. Prior to this report, little existed in terms of supportive programming standards, particularly due to the investment required in such programs. When the depletion of our nursing human resource started to escalate, and it became evident that investment in supporting nurses through their transition offset the tremendous attrition-associated costs of losing NGNs to workplace disconnects, there was a significant unfolding of exploration and development in NGN transition programming. Numerous international health care authorities, educational institutions, and government entities sought out Duchscher's transition support framework in building their residency programs. Unfortunately, workplace challenges continued to grow and were outmatched by the supports being offered.
In the absence of NTF, 2014-2020 Canada's NGN transition support landscape was significantly reduced. Equally during these years, global health care challenges continued, with evidence of toxic workplace cultures and escalating losses of nursing's seasoned clinical expertise. Nurses were increasingly expected to engage in advanced care technologies and graduates were showing interest in career mobility over long-term institutional commitment, especially with increasing options for out-of-country specialty practice upon graduation. Clinically, patients were being regularly offered procedures from which their recovery times were significantly decreased, and patient turnover and resource centralization increased. New nursing graduates were now encountering the normal process of professional transition but within a context of growing turnover of staff nurses and inadequate or insufficient transitional support programs. In the following article of this series, NGN supports will be discussed as they can be applied to the contemporary nursing landscape, exploring the impacts of COVID-19 and global health care trends.
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