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TransitionExperienceSatisfaction

xplore new graduates' experiences of entering the nursing workforce in NSW,tors that impact on their transition to the workforce, satisfaction and likelihood

Nurse Education Today 34 (2014) 150156

Contents lists available at ScienceDirect

Nurse Educa

j ourna l homepage: wwTransition towork has been the focus of concern in Australia since thetransfer of nurse education to the tertiary sector in the 1980s. The newgraduate nurse's ability to assimilate into aworkforce, workplace and cul-tural milieu is challenged by an environment of constant change andcomplex organisational and social dynamics. Understanding the com-plexity of health care and health workforce issues that impact on newgraduates is essential to maintaining the future workforce and a positiveand productive workplace environment. In this paper we report the nd-ings of a study conducted in New South Wales (NSW), Australia that in-

The body of literature examining new graduates' experiences, rang-ing across 30 years, is large and diverse. Researchers, both qualitativeand quantitative, have been particularly interested in transition to pro-fessional practice, socialisation, satisfaction and review of transitionprogrammes. The nature of new graduates' experiences in their rstyear of employment has been shown to have signicant impact ontheir future career directions. It is well reported that often these experi-ences are stressful and unsatisfying (Madjar et al., 1997; Chang andHancock, 2003; Beecroft et al., 2007; Wilson et al., 2008; Spencevestigated new graduate nurses' experiencenursing workforce.

Corresponding author at: School of Health, Armidale,0249469630, +61 0457714528(mobile).

E-mail addresses: vicki.parker@hnehealth.nsw.gov.amichelle.giles@hnehealth.nsw.gov.au (M. Giles).

0260-6917/$ see front matter 2012 Elsevier Ltd. Alldoi:10.1016/j.nedt.2012.07.003BackgroundIntroductionrience.Conclusion: There is an urgent need to develop and test a range of evidence based approaches that will bothempower 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.have a signicant impact on their future career directions. It is well reported that often these experiencesare 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 professionaldevelopment (mean 3.37) but job satisfaction was rated lower (mean 2.91). Qualitative ndings from focusgroups and survey comments revealed a number of key factors impacting on the experience of transition fornew graduates. These are; the nature of the workplace environment, the level and nature of support availableto 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-Keywords:New graduates

Background: The nature of new graduates' experiences in their rst year of employment has been shown to

of retention.Article history:Accepted 6 July 2012

Aims: This study aimed to eAustralia, and to identify facNew graduate nurses' experiences in thei

Vicki Parker a,d, Michelle Giles b,, Gena Lantry b, Maa University of New England, Australiab Centre for Practice Opportunity and Development, Hunter New England Area Health Distrc School of Nursing and Midwifery, University of Newcastle, NSW, Australiad Hunter New England Health, Australia

s u m m a r ya r t i c l e i n f oof becoming part of the

NSW, 2351, Australia. Tel.: +61

u (V. Parker),

rights reserved.rst year of practice

ret McMillan c

Australia

tion Today

w.e lsev ie r .com/nedtLaschinger et al., 2010). This is concerning given the critical shortageandmaldistribution of the nursing workforce in many countries. Issues,in relation to attracting and retaining nurses in theworkforce have beena 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, concernsin relation to the adequacy of under-graduate education/preparation(Kelly and Ahern, 2008), a decline in the public image of nursing as a

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151V. Parker et al. / Nurse Education Today 34 (2014) 150156career, 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 theworkforce are numerous and complex. The difculties of reconciling thedisparity between idealised 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 tomeet the bureaucratic mandate, whilst maintaining a sense of profes-sional integrity.

These tensions, in addition to the well documented problems ofexcessive workloads, variable degrees of organizational and pro-fessional support, and negative workplace cultures, have all beenextensively 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 theprimary contributor to turnover amongst nurses, with consistent asso-ciations between intention to leave and actual turnover beingwell 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 newgraduate nurses is reported as the most vulnerable time during whichthey formulate decisions about their intent to commit to the professionand/or their organization (Beecroft et al., 2006; Lavoie-Tremblay et al.,2008; Scott et al., 2008; Price, 2009).Manynewnurseswill change clinicalareas or leave the profession altogether during this period (Kovner et al.,2007; Park and Jones, 2010) with as many as 50% of new nurses leavingtheir rst job within a 12 month period (Wineld et al., 2009).

There is abundant evidence to suggest that intern, preceptorand 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 supernumerarysupport, extent of clinical exposure and autonomy in early practice, andassociated funding have not been dened or rigorously examined(Zizzo and Xu, 2009). Whilst variable approaches allow for facilities totailor their programmes based on local needs, the prevailing sentimentin 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, new graduate nurses are employed across public and privatesectors. Those employed in the public sector are recruited into new grad-uate support programmes, usually for a period of 12 months with place-ment in at least two different clinical areas. On completion of the newgraduate programme graduates apply for positions in areas offeringemployment.

The Study Aim

This study aimed to explore new graduates' experiences of enter-ing the nursing workforce. In particular, we sought to identify factorsthat impact on transition to the workforce, new graduate satisfactionand likelihood of retention.

Methods

The study was conducted using a mixed method cross sectionaldesign incorporating quantitative and qualitative approaches. Thequantitative 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 werecollected concurrently via survey and focus groups. The protocolwas reviewed and approved by the Hunter New England Health Re-

search Ethics Committee.Data Collection

Participants were drawn from the cohort of newly graduated nurseswho were recruited as registered nurses in the NSW public sector in2008. The required target sample for the on line surveywas 300or greaterbased on the overall target population of 1604. Newgraduateswere invit-ed to participate in the survey via postal mail outs and email.

The survey, developed from a review of the literature included ques-tions related to demographics, current employment, prior nursing expe-rience, the nature of current employment, the nature of the initialrecruitment 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 andmodied from a survey developed by Hegney andMcCarthy (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 Likertscale. To assess content validity expert reviewwas sought from 15 nurs-ing clinicians and educators. Itemswere then added, deleted ormodiedbased on the information gathered from all sources.

Focus group questions related to the transition experience in terms ofsupport, expectations, workload, relationships, intention to stay and ca-reer opportunities. Participation in focus groups was sought across sixsites in metropolitan and rural NSW. Fifty-ve new graduate nurseswho gave informed consent participated in seven focus groups (610per group) of between 60 and 90 min duration. One rural focus groupwas conducted via video conferencing.

Data Analysis

Quantitative survey data were analysed using SPSS. Differences inscores were compared using contingency table analysis, with chi-squared and analysis of variance using KruskalWallis to identify variablespredicting differences using a signicance level of 0.05. The rating scaleitemswithin the surveywere combined to derive several factors; recruit-ment satisfaction, level of support, job satisfaction, job experience and jobcondence. Factor analysis conrmed groupings and further reliability ofresponseswas assessed using Cronbach Alpha scores for each item group.Values of 0.7 or better were obtained.

Qualitative survey data were coded and themed to inform low levelinference qualitative description (Sandalowski, 2010). Focus group tran-scripts were coded and categorised according to themes and the researchquestion by individual researchers and then compared and revised forconsistency. Representativeness and auditability were ensured throughgrounding and reporting the ndings through reference to excerptsfrom 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 secondlanguage (ESL), with Chinese language as the most common. Thosewith ESL were signicantly proportionally higher in metropolitanareas (40%, rural 8%, pb0.01). Distribution of respondents across areahealth districts was representative of the larger cohort. Seventy-threepercent (n=207) of respondents had prior experience in nursing(Table 1) and half of these had greater than 2 years experience. Seventysix percent were in full-time positions at the time of responding to thesurvey. The majority (77%) were employed in a metropolitan area and84% of those currently employedworked 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 mentalhealth than their female counterparts.

Themajority of respondents (92%)were employed in one of their four

preferred clinical areas and males (92%) were more likely than their

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Although most respondents (63%) reported that they had been allo-catedmentors only 41% of respondentswere satisedwith their relation-ships and 32% responded that they were dissatised. The highest level ofsatisfactionwaswith nursing colleagues and 61% of respondents reportedthat they were satised with this relationship.

Expectations

Respondents were asked whether they experienced clarity about jobdescription and responsibility. In general new graduates were clearabout their roles and responsibilities, however they were less clearabout what others expected of them. A signicant number (26%) of re-spondents indicated that they did not have, or were not sure whetherthey had the necessary information to carry out their job. Twenty twopercent felt that theywere unable tomeet their own expectations. Stresslevels associated with role expectations were rated high to extreme by45% of respondents with no difference identied across gender or inESL groups.

Retention and Intention

Of concern, was the number of respondents who indicated that they

Table 1Survey respondent education and prior nursing experience.

Highest education in another profession Survey respondentsn 224

NSW cohortn 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 282Yes 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)

152 V. Parker et al. / Nurse Education Today 34 (2014) 150156female counterparts (84%) to receive their rst preference. Mostly re-spondents (79%) were not required to relocate their residence to takeup their new graduate position, however relocation was signicantlyhigher in those working in rural areas (pb0.01). Respondents wereasked to rate their level of satisfactionwith 12 individual items associatedwith their recruitment process. Between 8% and 15% of respondentsreported some level of dissatisfactionwith themajority of the recruitmentitems, however 45% reported dissatisfaction with feedback on interviewperformance. 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 new graduates either formally throughnew graduate 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 havingdesignated 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 predominantlyon support from other new graduates, 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 through to very supportive) they received for their profession-al development from the organisation as a whole, management, othernurses and other professions. Other nurses were rated the most support-ive with 60% of respondents reporting that they felt supported by thisgroup. Other professions were rated the least supportive with only 40%of respondents feeling supported by this group. These 4 itemswere 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 inrural facilities and in males but these differences were not signicant.

Table 2Structured support offered to new graduates.

Formal supports Mean (days) Median Range

Facility orientation 3 3 014Ward orientation 2 1 028Supernumerary on ward 4 2 084Education days 5 4 045What was the length of the programme(months)?

12 124

How many rotations were in the programme? 3 09How many days were supernumerary in eachrotation?

5 1100intended 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 stayfor 5 years or greater, 32% were unsure how long they would stay, with3% 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 noposition or were unsure about whether they would have one. Of these8.4% indicated that they denitely had no position at the time of survey.

In relation to intention to pursue further studies, most (85%) werekeen to continue with their formal education. Most of those who planto study are planning to do graduate certicates in speciality areas, themost 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 werecondent in meeting others' expectations (74%), in their own

Table 3Survey respondent's retention and intentions.

How long do you intend to stay in nursing? %

Have already left nursing 1Less than 2 years 3Between 2 and 5 years 9Between 5 and 10 years 12Greater than 10 years 43Unsure/undecided 32

In what area of practice do you see yourself working in the next 3 years? %

Medical nursing 10Surgical nursing 10Mixed medical/surgical 8Critical care 15Emergency nursing 13Perioperative 7Midwifery 5Aged care 2Rehabilitationdisability 2Mental health 10Family and child health 4Community health 2Other 13

occasions, as long as the staff numbers were correct, it didn't matter

Meeting Expectations

153V. Parker et al. / Nurse Education Today 34 (2014) 150156performance (80%) and their ability to perform competently (85%).However, they also described their work as an RN as emotionallychallenging (93%) and their workload as heavy (94%) and physical-ly demanding (93%). Not surprisingly, 77% of respondents agreedthat work stress is high. Only 30% of respondents rated nursing mo-rale as good, 37% were neutral and 33% disagreed, 47% agree thatmorale is deteriorating. However, the statement that there is alack of teamwork and support from colleagues was rejected byhalf of the respondents.

Only 48% of respondents agreed with the statement that the work-place is well equipped (42% disagreement, 29% neutral). Nursing as acareer with high status was not supported by the majority (43% dis-agreement, 34% neutral). However, most agreed (63%) that careerprospects are good. Fifty-seven percent agree that nursing work isvalued by the community, whilst only 35% agree that nursing workis valued within the health system.

The statement that skill and experience are not rewarded wassupported 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 theirvalues at work (30% neutral, 47% disagreement). The above 17 itemswere combined to derive an overall mean job experience score of only2.81 (median 2.82).

Satisfaction

Respondents were asked to rate their level of satisfaction for 7 jobrelated items ranging from 1 very dissatised to 5 very satised.Only 47% of respondents were satised with education opportunitiesand 41% with career development and encouragement. Rural respon-dents rated lower levels of satisfaction with educational opportunitiesand 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 theyreceived in their roles, whilst 32% were satised with their choiceover their own work practice. Respondents were least satised withworkload (20%), work life balance (19%) and pay rates (20%). These 7items 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 GraduateNurses

Being a new graduate was described as challenging, stressful anddifcult. Stress, particularly in the early months was often due tohaving to manage routines and workload, anxiety about giving med-ications and dealing with the particular challenges associated withclient 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 oftransition 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 innursing.

Negotiating Workplace Culture

For participants, a positive workplace culture was one in whichthere is an explicit commitment to them as beginning practitionersand new staff members, where this commitment is matched by thecapacity to full the promises made to them in relation to supportand learning opportunities and where they would be treated with re-

spect and courtesy. Whilst there were many reports of such positiveParticipants' perceptions of various clinical contexts were colouredby the expectations placed on them, their perception of the reasonable-ness of expectations and their ability to perform to the level of expecta-tion. Patient loads of nine to eleven were reported as common, alongwith the expectation to supervise junior staff. In someareas, particularlygeneral medical surgical areas the workload and level of expectationplaced on themwere seen as unreasonable and at times unsafe. Themo-rale amongst staff in these areas was often seen as low with high levelsof stress and burnout.

We were expected to perform and provide care like other nurses thathad been there for 20 years! Same amount of patients, and some-times the most difcult ones because no-one wanted them, and thenyou would get in trouble for not having completed all the necessarytasks by the end of the day shift. Focus group 4

Becausework and rostering practices differ acrosswards, beginning ina new ward was often like starting all over again. Expectations often dif-about the skill mix.Survey comment

Asking for help was often difcult when new graduates could seethat other staff members were also overwhelmed with work. Dealingwith negative circumstances was easier when there were at least asmall number of supportive staff. If new graduates felt they couldlearn and grow in spite of the difculties they felt that the experiencewas worthwhile.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 handwas disappointing, demoralizing and difcult.

It was disappointing to continually meet with nurses who were notsupportive towards new graduates and their learning needs. Oftenthe whole ward experience could be changed by the continued poortreatment by a very small number of Senior RNs. They underminecondence you have developed in your own practice and make youfeel like an ineffective member of the team. Focus group 4

New graduates frequently encountered horizontal violence in theworkplace during their transition year. In many instances, the violencewas perceived as systematically directed at them as new graduates,others believed in the main that it was a feature of an individualperson'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 aslearners were in competition with the need to staff wards and providecare to patients. They describe being viewed as a number to ll rostergaps, with little regard for their level of knowledge, experience oranxiety.

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 manyfered and it was often not easy to nd the necessary helpful information.

mano-wo

154 V. Parker et al. / Nurse Education Today 34 (2014) 150156deterred by lack of interest from senior colleagues, they reportedywould have beneted fromconstructive feedback about their perfor-nce. Often the only feedback they received was based on the fact thatone was complaining and no major mistakes had been made. TheyMany believed that because they received very little feedback fromothersthey had to rely on their own assessment of their performance, to be openand ask questions even when others appeared unreceptive or unhelpful.Their condence grew as time went on as they gathered skills andbegan to understand the cultural milieu.

Understanding what was expected of me, something that I foundchallenging at times. Sometimes it was confusing because some staffwould expect one thing and others would expect different, especiallybeing new to an area each rotation. But by the end of each rotation, Iwould feel condent. Survey comment

The Importance of Support and Feedback

Most newgraduates believed theywould bemorewelcomed and bet-ter supported. They also expected to have more choice about where theywould work during their rotations and on completion of their new grad-uate year. All believed theywould bewell supported through their 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 stillbelieved that structured support was important along with feedbackand encouragement.

I had no contact with any coordinators or mentors unless I soughtthem out and they were not too busy with other work to help me.

Survey comment

I rarely worked with onward mentors, which was disappointing assupport 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 reluctantorthePrior experience in nursing did provide the opportunity to understandsome of the dynamics of workplace culture and helped new graduates toidentify 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 couldmake 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 newcircumstances and able to accommodate varying expectations of them.Roles are poorly dened, haphazard at best! Job descriptions are ofassistance but are often outdated. Lot of time is wasted trying to fath-om very simple procedures which are not written anywhere butstored 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 ultimatelyenjoyed their transition period. The ability of these individuals to tran-scend these negative inuences appears, in part, to be related to how re-silient theywerewithin the context, and towhat extent they utilised theiremotional intelligence to sustain and make the most of a sometimes lessthan favourable situation.uld have preferred some encouragement and genuine interest intheir 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 everyoneto get the placement options that they request. Whilst some see lackof choice as problematic, others expressed a view that often the rota-tions that they didn't choose were the ones they enjoyed most. Lackof choice may not be a bad thing under such circumstances. Whatwas concerning for all was the possibility of nding themselves in aplacement that they really disliked for a protracted period of time.

I was asked onmore 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 wasplaced 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 theprogrammes, pathways and opportunities available to new graduates.Participants consistently reported differences between speciality andgeneral medical/surgical areas. Speciality areas have more educators,more senior staff, more medical and other professional support and bet-ter developed newgraduate programmes that are co-ordinated by desig-nated staff. They often have extended orientation programmes andsecond year programmes for those who are chosen to stay. Further, inthese areas new graduates are unlikely to be expected to perform be-yond their level of knowledge and experience and more likely to begiven quarantined supernumerary time. It is not surprising that morenew graduates intend to stay in these areas.

In contrast many new graduates in medical and surgical wards andin 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 sucha specialty area, they appreciate that you're not going to know every-thing and I found them much more supportive and that's been reallygood and I'm really really enjoying it. Focus group 4

The large differences that exist across contexts challenged new gradu-ates to consider carefully where they would work in the future. Somewere fortunate enough to be able tomatch their preferenceswith awork-place climate that suited their individual needs and capacities. Othershowever, reported making the decision to pursue a non-preferred areaof nursing in order to work in a climate that was positive, where theworkloadwasmanageable andwhere therewas support and opportunityfor their professional development.

Whilst many new graduates have ongoing positions a signicantnumber 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 itparticularly difcult to understand when they work in an environmentwhere it is frequently difcult to nd enough staff to ll rosters acrossshifts. For those who are unable to relocate, pursuing work in an areathat doesn't interest them may be their only option. They are worriedthat if this happens they may be restricted in their future employmentprospects 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 ndemployment elsewhere. I am extremely fearful I may have to move toa different area so I can gain employment at a facility that will con-tinue to develop my clinical skills.Survey comment

graduates to stay. A similar programme is warranted in rural areas, one

large enough to meaningfully examine the experiences of specicsub-groups such as those from rural settings and culturally and linguis-

155V. Parker et al. / Nurse Education Today 34 (2014) 150156Further, employment policies and practices that have seen increasednumbers of short term contracts are worrying to those who really needfull time employment.

Discussion

The ndings of this study support those of many other studies thathave examined new graduate experience (Beecroft et al., 2007; Changand Hancock, 2003; Chang et al., 2005; Parry, 2008; Roberts et al.,2004; Wilson et al., 2008). They are also consistent with studies thathave identied problems associated with workplace culture and poormorale in nursing generally (Scott et al., 2008; Cho et al., 2006;Duchscher, 2008). By far the biggest issue identied by participantswas the discrepancy between the amount and quality of support theybelieve they required and the amount and quality of support they re-ceived. This study highlights the inconsistency in application of andcommitment to support initiatives across facilities and even fromward to ward in the same facility.

In linewith previous studies (Madjar et al., 1997; Heslop et al., 2001;Wineld et al., 2009) this cohort described their experience of transi-tion into theworkforce as stressful, draining, demanding, both physical-ly and emotionally, and personally challenging. Not only do graduateshave to learn to perform adequately but also need to make major ad-justments in their personal lives.

The degree towhich new graduates experienced horizontal violenceresulting from poor staff attitudes, together with unfair treatment asso-ciated with rostering, deployment andworkloadwas also of major con-cern. Overall they suggested that their experience would be improvedthrough the provision of sustained genuine support, reduced work-loads, less expectations in terms of excessive responsibility early intheir rst year, fairer treatment by senior staff, fairer rosters, greaterchoice of placement options and critical constructive feedback ontheir performance. In rural areas the experience could be improvedthrough better communication and information, together with greateraccess to support, particularly through resources that are relevant inthe rural context. Further, in line with recommendations of previousstudies (Lea and Cruickshank, 2007; Kelly and Ahern, 2008), schoolsof nursing need to better prepare graduates to deal with the culturaltensions and social interactions that will impact them in their initialperiod of employment.

The reporting of negative workplace culture with frequent episodesof horizontal violence is consistent with other studies conducted overthe 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 manynew graduates become quickly aware of the negative culture and havelearnt how to negotiate a comfortable albeit, in some cases a transientposition, for themselves. This study supports the ndings of SpenceLaschinger et al. (2010) that new graduates are less likely to be bulliedwhen they have access to workplace empowering structures such as;access to information, resources, support, opportunities to learn andgrow, job discretion and strong working alliances.

The ndings of this and other studies suggest that the pressure onnew graduates is high, along with expectations for them to be workready (Wolff et al., 2010; Kelly and Ahern, 2008). Yet the support theyreceive in the main is inadequate, leaving some feeling compromised,dissatised and frustrated by a system that is reportedly in desperateneed of their skills and commitment to stay in nursing. In relation tothe presence or otherwise of supportive mechanisms made availablefor the new graduate nurse transitioning into the workplace there wasresounding consensus around the absolute need and priority of havingdesignated new graduate nurse educators/co-ordinators, who are ac-cessible and responsive to the unique needs of the transitioning newgraduate nurse. It would appear that the presence of these supportivepositionsmitigates to some degree the organizational deciencies asso-

ciated with unproductive mentor and other collegial relationships andtically diverse backgrounds. Further studies are needed to understandthe nature of transition for those possibly at risk groups.

Conclusion

The factors that impact on the experience of transitioning of newgraduate to the workplace are complex and integral to challenges thatconfront nurses and health care generally. There were many reports ofrewarding, enjoyable experiences, where new graduates were wel-comed and encouraged and supported in their learning. However,therewere alsomany stories of discontent. Discontentwas 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 new graduates 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, particularlysenior colleagues. Their transition is to a large degree a personal journeyof 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 evidencedbased approaches that will both empower nurses (new graduates andexperienced nurses) and embed systematic approaches that enable eq-uitable and contextually relevant stewardship of newgraduates into thethat engages new graduates in a positive experience of rural nursingand understands their motivations for wanting to work in rural contexts.

Limitations of the Study

Although general invitations to attend focus group meetings weredisseminated via the on line survey and through nurse educators and/or new graduate co-ordinators, there remained an inherent bias ofonly reaching nurses employed at host sites, and further, only thosewho were on duty at the time. Hence, a bias toward hospital employednew graduate nurses was inevitable. More extensive geographicalspread 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 sizewas notinconsistent provision of orientation and supernumerary days. Theoverwhelming view by new graduates that support is most effectivewhen available from work colleagues highlights the need for invest-ment in ward level supportive strategies. Further studies that identifyparticular contextual factors that impede success with a view to the de-velopment of programmes and processes that engage ward staff andnew graduates in sustainable supportive relationships are needed.

New graduate satisfaction with their new graduate experience seemsto be largely contingent on the collective capacities of individuals, wards/units and organisations to engagewith themand to support their learningand their gradual assumption of the full expectations and responsibilitiesof a RN. There seems to be an expectation that they should and will beready from day one. Regardless of expectations, reasonable or otherwise,the larger issue ofmajor concern to participants was they often perceivedthemselves 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 bettersupported is imperative. Given that lack of support and unrealistic expec-tations is due primarily to relatively lower numbers of senior experiencednurses, the development of career pathways that support the develop-ment of highly skilled practitioners in these areas may encourage newprofession into the future.

Acknowledgment

The study was sponsored and funded by the Nursing andMidwiferyOfce of NSW Health.

No conict of interest has been declared by the authors.

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New graduate nurses' experiences in their first year of practiceIntroductionBackgroundThe Study Aim

MethodsData CollectionData Analysis

ResultsSupportExpectationsRetention and IntentionWorkplace Perceptions and ImpactSatisfactionFactors that Impact on Transition to the Workforce for New Graduate NursesNegotiating Workplace CultureMeeting ExpectationsPrior Experience and AttributesThe Importance of Support and FeedbackDifferences Across Contexts

DiscussionLimitations of the StudyConclusionAcknowledgmentReferences