entry into nursing an ethnographic study of newly qualified nurses taking on the nursing role in a...

Hindawi Publishing CorporationNursing Research and PracticeVolume 2012, Article ID 690348, 7 pagesdoi:10.1155/2012/690348

Research Article

Entry into Nursing: An Ethnographic Study of Newly QualifiedNurses Taking on the Nursing Role in a Hospital Setting

Mari Skancke Bjerknes1 and Ida Torunn Bjørk2

1 Faculty of Nursing, Oslo and Akershus University College, Pilestredet 52, N-0167 Oslo, Norway2 Department of Nursing Science, University of Oslo, Postboks 1153, Blindern, 0318 Oslo, Norway

Correspondence should be addressed to Mari Skancke Bjerknes, [email protected]

Received 3 July 2012; Accepted 30 August 2012

Academic Editor: Maria Helena Palucci Marziale

Copyright © 2012 M. S. Bjerknes and I. T. Bjørk. This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work isproperly cited.

The transition from student to working nurse has long been recognized as challenging. This paper presents the findings of researchinto the opportunities and limitations encountered by newly qualified nurses when taking on the nursing role. The study hadan ethnographic design. Observation, interviews, and document analysis were used to gain insight into nurses’ daily work fromthe perspective of recently graduated nurses. Thirteen nurses were monitored closely during their first year in a hospital settingin Norway. These new nurses generally entered the field with empathy for their patients, enthusiasm for the profession, andreadiness to learn more about being a good nurse. However, their more experienced colleagues seemed to neither respect nornurture this attitude. The new nurses experienced heavier responsibilities than expected, fragmentation of patient care, andstressful interactions with colleagues. The lack of a supportive work environment and role models increased the new nurses’experience of overwhelming responsibility in their daily work situations. The nurses learned to cope the hard way, despite theorganizational culture, not because of it. Adjusting the profession’s expectations of new nurses, and offering good role models andmore comprehensive support programmes, would markedly ease the transition for new nurses.

1. Introduction

The transition from student to working nurse has long beenrecognized as difficult and has attracted the attention ofresearchers for decades [1–5]. Various studies have shownthat new graduates are inadequately prepared for their role asnurses, and they are ineffectually oriented to the work place[6–8]. The nursing discipline and nurse education are cur-rently experiencing the compound pressure of expectations,which may lead to deteriorating conditions for nursingpractice. The clinical field, under increasing pressure to beprofitable, efficient, and effective, is demanding educationprogrammes that produce graduate nurses who are workready from day one [9]. Professional discussions of the deter-iorating conditions for nursing as a caring profession havealso cited the apparent movement among nurses away fromboth a wish for human contact and a willingness to comfortthe sick and suffering for its own sake [10, 11]. Such studiesindicate that the conditions for nursing remain challenging

in terms of increased pressure in the work environment andnew nurses’ readiness and willingness to care for patients.This situation inspired us to investigate empirically how newnurses are taking on the nursing role in hospitals.

2. Background

Until the 1980s, nurse education in many Western countrieswas based predominantly on an apprenticeship model, inwhich student nurses were salaried members of the nursingwork force in hospitals [12–14]. The three-year programmein schools of nursing had no formal academic recognition. Inthe early 1990s, major reforms in many countries redefinedboth the process and the product of nurse education.The aim was to equip student nurses with the necessaryknowledge and skills to assume the role of graduates, and toachieve academic recognition [6, 15, 16]. Efforts to improvethe quality of study programmes and subsequent nursingpractice led to a shift towards research-based teaching.

2 Nursing Research and Practice

However, this drift towards academia seems to have gonetoo far, resulting in complaints about weak practical skillsand the lack of caring abilities among recently trained nurses[17, 18].

New nurses’ qualifications cannot be viewed solely interms of education policy and reform. Changes in the organ-ization and delivery of health care have a great impact onnurse education. The current nursing culture in hospitalwards is characterized by a stronger treatment culture andgreater demands for efficiency than in previous years [19].In all Western countries, several reforms have led to higherstress levels in hospital wards, more specialized medicaltreatments and technologies, and shorter patient stays [6, 7,20]. A related factor in Norway is that the health-care systemhas undergone substantial organizational changes in the past10–15 years [21].

It is evident from the literature that new nurses do notexperience a supportive practice environment and regularlyencounter unrealistic expectations [8, 22]. Boswell andWilhoit [23] found that nurses may need as long as oneyear after graduation to feel competent. Many health-careorganizations have introduced mentorship strategies as a wayof increasing work readiness, minimizing the effects of realityshock, and reducing graduate nurse attrition [8, 22]. Kramer[1] used the term “reality shock” in nursing to describehow school-bred values conflict with work-world values, aconcept based on the foundational tenets of culture shock.Reports of this transition in nursing have proliferated inrecent years [5, 7, 16, 19, 24]. The term “transition” refersto the processes of learning and adjustment that a new staffmember undergoes to acquire the skills, knowledge, andvalues required to become an effective member of the health-care team [7, 25]. This process involves shifting from oneset of expected positional behaviours to another in a specificsocial system: it incorporates a socialization process or “ritesof passage,” in which the graduates absorb and adopt thelanguage, culture, and rules of the work place. In a Canadianstudy, Duchscher [16] emphasized that it was the qualityof the transitional experience that was likely to influencegraduate nurses’ self-confidence and retention in nursing.That study provided insight into the socialization process ofnurses by asking them to reflect on their first six months inthe profession. A clear conflict emerged between the nurses’desire to deliver good nursing and their lack of competence,time, and energy to do so.

The expectations encountered by new graduates inNorway today are usually the same as those from before the1990s, despite the changes in nurse education and in the con-tent and context of hospital nursing. Graduates are offeredsome form of orientation programme, usually lasting two orthree weeks. Although the content varies, these programmespredominantly focus on patients’ diagnoses, hospital rou-tines, and medical treatments characteristic of the ward [26].Graduates in hospitals are supposed to have a mentor amongthe clinical nursing staff, who provides some support duringthe first four or five months in the ward. However, becauseof the hectic clinical setting, new nurses spend much of theirtime on their own [27].

Research conducted into this transition using qualitativemethodologies has investigated the nature of the transitionprocess and the values of new nurses [16, 24], but littleattention has been given to the reality of new nurses’clinical practice. Missing from the literature is an insider’sperspective on new nurses’ experience when they take onthe nursing role in a hospital setting. Knowledge of newgraduates’ experiences in their daily work situations shouldhelp improve understanding of the challenges they face intheir role as nurses [28]. In this paper, we present the findingsof a study that focused on the question: What opportunitiesand limitations do newly qualified nurses encounter whentaking on the nursing role?

3. Methods

3.1. Design. An ethnographic design was used, drawing uponobservations, interviews, and the analysis of documents.This was a qualitative design, monitoring the nurses intheir encounters with colleagues, physicians, and patients inclinical situations. The combination of different data sourcesis often highly productive, and the resulting analysis andfindings can be more complete when a number of differentinformation sources are used to explore a question [29].

3.2. Sample and Setting. The setting was one gynaecologicaland one orthopaedic ward of equal size (30 beds) in aNorwegian university hospital, during one year of fieldwork.A meeting was held to give the participants and theircolleagues information about the study. Written informationwas also distributed to all new nurses in the wards. For nursesto be included, they had to have been qualified for aboutthree months when the study started. Although the sampleselected was a convenience sample, it was also purposeful,because the participants were ideal in terms of having someexperience of being a new nurse. The sample comprised 13new graduates; all were women, in their early to mid-twenties(mean age 25 years), and from Norwegian backgrounds.

3.3. Data Collection. The nurses were monitored throughobservation and interviews in the context of the wards.Reflection notes written by the new graduates about theirwork and caring experiences were included as data. The re-searcher (MSB) observed the nurses’ activities at meetings,in staff rooms, in patient rooms, in ancillary rooms, in thetea room, and in the corridors at different times during theday and evening. The nurses were followed individually. Nosingle period of observation exceeded four hours. The nurses’shifts provided the starting points and the structure of thefieldwork. During observations, the researcher wore the sameuniform as the nurses in order to merge into the setting andmake it easier to be accepted as a natural participant in theward. Observational notes were written out in full immedi-ately after each period of observation so that no valuableinformation would be lost or forgotten. The recordedinterviews were transcribed during the research process.

3.4. Trustworthiness of the Data. We followed the guidelinesof Lincoln and Guba [30] for establishing the trustworthiness

Nursing Research and Practice 3

of data. To establish the credibility of the data, the informantswere encouraged to share their perspectives on differentsituations with the researcher. The informants were alsoasked to read through some of the transcripts, and they wereencouraged to comment on their accuracy, correct them asrequired, and provide supplementary explanations if they feltit was appropriate. Although we acknowledge the criticismsconcerning participant checking [29], we felt that theparticipants themselves should establish the validity of theinterpretations. The dependability of the analysis requiredsufficient arguments and documentation in the text so thatthe reader could follow the analysis. Finally, the study fulfilsthe criterion of confirmability when its findings can beapplied to contexts beyond the study situation [30].

3.5. Data Analysis. The analysis proceeded in parallel withthe data collection, as the researchers read through thetranscripts repeatedly. Initially, the task was to find conceptsthat would make sense of the data. According to Benner [31],the nurses’ world can never be delineated completely, becausealthough it is historical, contextual, and multifaceted, it canonly be grasped in finite, situated terms. We followed theprinciple of analysing abundant data on a few informantsand have provided “thick descriptions” [32]. The mainanalysis was performed after the end of the year of fieldwork.For this purpose, we relied on a set of analytical techniques[33]. The process started with quite open questions, forexample, What do new graduates do? What are they talkingabout? With whom are they cooperating? We wished to createnew ways of looking at the nurses’ work in order to interpreteveryday situations with a higher degree of abstraction. Inthis process, more specific questions developed, consistentwith themes such as the nurse’s responsibility or “beingbusy.” Other themes increased in importance as they recurredin the nurses’ actions and statements. The different datasources were compared for one nurse and across the 13nurses. We searched for similarities and contrasts in the waysin which the individual and the group as a whole experiencedtheir relationships with colleagues and patients in differentsituations.

3.6. Ethical Considerations. The study was approved by thehospital research ethics committee. Informed consent wasobtained from each participant before data collection com-menced. The participants were assured that any data abouttheir participation would be treated confidentially. Becausethe researcher was an external person, with no employmentlinks to the hospital, the participants could feel free tobe honest in dialogues about their work and their workenvironment. The participants were informed that they werefree to withdraw from the study at any time without anyexplanation. According to common practice, the nursesalways asked the patients’ permission to bring a researcherinto their rooms.

4. Findings

In this section, the two central findings are presentedfrom the perspectives of Tina and Kari. Their experiences

represent typical challenges that the nurses reportedthroughout the entire body of material. The remaining find-ings give voice to all the nurses in the study.

4.1. Taking Care of Patients. “The patients in the ward havemany complex diseases and they need regular observationday and night,” Tina told me as I followed her down thecorridor. In one room, a young woman lay with her eyesclosed and her face towards us. Tina quietly approached thebedside and bent down, whispering: “Are you awake? CanI get you something to drink?” The patient only gruntedin reply and did not open her eyes. Her face was paleand she had a kidney bowl on her chest holding someabsorbent tissue. While looking at the intravenous catheterand checking the intravenous injection, Tina kept an eye onthe patient’s face. She stood there for some minutes. Aftera period of silence, the patient replied, “My mouth is dry,so perhaps just a swallow.” A glass of fresh water was onthe bedside table, and Tina carefully supported the patientand helped her take a small mouthful. The patient swallowedsome water and spat out the rest. “Just a small swallow,yes, that’s good,” Tina said. After helping the patient into acomfortable position, Tina said that she would be back againsoon. On the way out, I noticed a soft light in the singleroom, a glow from the lamp beside the bed, positioned insuch a way that it would not bother the patient. I asked Tinaabout this patient afterwards, and she told me that the patienthad a serious disease, hyperemesis gravidarum, which meantthat she was constantly sick with nausea and vomiting. Thepatient would have to stay in bed for months or possiblyfor her entire pregnancy, and she was not supposed tohave anything to drink or eat. “I really feel sorry for thispatient, so young and being so sick day after day,” she said.Later in the afternoon, and in between phone calls and herresponsibilities for other patients, Tina slipped in to seethe young pregnant woman. “I must not disturb her,” shewhispered to me. “I have to follow up and see if she is allright, and whether she has vomited.” She helped the patientand offered her a special moisture stick in a glass of iced waterto cleanse her mouth, which would give her a sense of tastingwater. Tina’s caring and sensitive attitude when taking careof the patient was in marked contrast with her much moredetermined and brisk manner of walking as soon as she wasback in the corridor.

Involvement in patient situations gave Tina an opportu-nity to be close to a person who had complex care needs.Tina experienced herself and her competence in caring indifferent ways. She used her knowledge and empathy tosupport the young pregnant woman “just enough” so thatthe patient would feel taken care of. The patient received thenecessary rest and relief from her nausea and vomiting. Tinawas pleased because she felt that she had displayed the clinicalskills required for the medical treatment, while at the sametime comforting and calming the patient. She experiencedbeing responsible for the care of a patient. She was also awarethat being responsible for a number of patients at the sametime generated a kind of anxiety within her. She said thatthis was particularly so when she did not have enough timefor all her patients during a shift: “On night duty, I have got


more time for the patients. I can be there when the day-time’shectic rhythms are not in force any more. And no one caresif I spend a long time with one patient.”

4.2. Role of a Team Leader. Kari said she had started to feelmore secure in her position, but that acting as a team leaderwas still an overwhelming responsibility. On one particularday, she was responsible for seven patients with her team.This included all the hands-on work, such as medications,wound care, and many quite specialized procedures. After theearly morning report, she sat down to look through trays ofpaperwork, talk to secretaries, fetch laboratory results, andcheck physicians’ orders and medications. I could hear Kariand two other nurses in the staff room talking about the“stress of getting an overview”, while they were waiting forthe physician’s round. Kari looked confused, and I asked ifthere was something special about today. “No,” she said, butthe physician coming to perform the doctor’s round wouldbe late. Then, why did she persist with the paperwork forso long? When I asked Kari about this afterwards, she toldme that the paperwork concerned the need for getting theessential data about the patients. She added that she wasreluctant to begin the patients’ morning care if she was goingto be interrupted in the middle of these activities, and thatit was often difficult to finish an assignment that had beenstarted. “In the middle of giving a bed bath to one patient,I often have to leave the patient to give another patientpremedication or join the physician’s rounds. I feel this isshowing disrespect for the patients.”

Finally, it was Kari’s turn to follow the physician. Thephysician seemed busy, barely greeting Kari before he headedfor the first patient’s room. Kari almost had to run to catch upwith him. At the first patient’s bedside, the physician askedKari about the records and started to explain the details ofthe disease to the patient. It was obvious that the patient didnot understand it all. Kari attempted to add something, butthe physician turned away and attended briefly to the otherpatient in the room, before leaving. Kari followed, but shestopped by the first patient’s bed to say, “I will come back, andwe can talk more.” By the time she was back in the corridor,the physician was already in the next room; he finishedhis whole round in five minutes. Kari asked the doctorquestions about medications and rehabilitation but foundthe answers unsatisfactory. After the round, Kari preparedsome medications, and then she went to visit two patients,checking their intravenous lines and some dressings. Sheasked the patients how they were feeling, and she seemedto create good relationships with the patients. Back in thecorridor, she told me that she would have no time to followup the patients this morning as she had planned, apart fromtalking with the patient who looked worried after receivingthe physician’s information. At the end of the day, I askedKari about her working relationships with the physicians.She told me that they were not always like that “some arequite friendly, but for the most part, cooperating with themis frustrating.” Then, she blurted out: “It is all too muchrunning after them—on our time.”

In Kari’s case, it was clear that the situation required bal-ance between attending to the patients’ needs and acquiring

the necessary overview before the physician’s round. At thesame time, she had learned to recognize and take intoaccount patients’ particular illness-related problems, andhow to communicate her observations to the physician. Theexperience of being the team leader gave Kari the opportunityto learn what can only be mastered in practice. Despite thedifficulties of her situation, Kari felt satisfied when she hadmade sure that the patients were satisfied, and when, as teamleader, she had “got everything done, written the reports,ordered the blood tests, and signed patients out and arrangedfor social workers and physiotherapists, and everything elsethat has to be done.”

4.3. The Challenge of Being Responsible. The new nurses wereunprepared for the myriad of feelings provoked by thisresponsibility while trapped in administrative routines; theyhad not been aware of the extent of the work load and itsconsequences for the quality of their care. One nurse, whoconsidered herself well acquainted with the ward from herstudent days, noticed a marked difference between being astudent and bearing the responsibility of being a nurse. Shesaid that “the main difference between training and beingon the job is in fact the responsibility.” This responsibilityincluded making independent decisions, especially duringevening and night shifts. The new nurses had high expec-tations of their own capabilities and felt that they shouldbe able to handle difficult situations. However, there wasa discrepancy between their perceptions of their own skillsand knowledge and their actual ability to draw on these toassume the responsibility required. This discrepancy was asource of stress on busy days. One nurse wrote in a narrativethat she was very much aware that there would be a lotof responsibility, “but I feel there’s even more. I feel thatit’s more and more like nursing on an acute ward as far asthe responsibility is concerned.” Many of the patients in thegynaecological ward were women close to their own age, withserious and sometimes life-threatening diseases. When askedto discuss this, the nurses said that the responsibility wasdifficult when there were time constraints and “you feel thatyou do not have the resources you need, or the energy itselfand the knowledge to tackle what is expected of you. Then itgets tough, and that happens quite frequently.”

4.4. Excitement of Learning More. Despite the conflict be-tween patient care and administrative tasks, the new nurseswere enthusiastic about learning to do their job well. Formany of them, a positive aspect of working in a surgicalward was the variety in their work: this was one of themain reasons that they had begun their careers in a hospital.One nurse was pleased because she had learned that she“wanted to be an angel, but also that this is where it’s allhappening”. She added: “I want the best of both worlds, tomean something to the patients, but also to learn more.”Another nurse said “That’s perhaps what gives most of themeaning to being a nurse, that’s what we work for.” Shetold me about a time when she was happy because a patienttold her in the morning that the painkiller she had givenhim had helped and that he had slept well for the rest ofthe night. In such situations, the nurses felt they had done


a good job. They seemed to want intimacy—to be there forthe patients—but they also wanted excitement. They foundit exciting to learn more about technical procedures and tomanage new situations with the patients, especially whenthey could concentrate on what they were doing withoutinterruption.

4.5. Lack of Guidance. The general impression derived fromthe data was that the new nurses experienced little support orhad few opportunities to discuss the challenging situationsthey encountered in their work. Problems that requiredpractical solutions were given precedence. The bustle inthe wards meant that conversations often took place inpassing, for example, on the way to the morning care routine.The new graduates’ relational experiences with the patientsreceived little attention, and the patients’ situations were onlyrarely the subject of discussion in the care environment.

Resolving the conflict inherent in scheduling and orga-nizing their attention to patients was a challenge for the newnurses, and the fragmentation of their work left them feelingthat their more experienced colleagues neither understoodnor respected their ideas about nursing. The level of supportfor the new graduates in this respect varied; for some, it wasnegligible. Any organized supervision that was available wasear marked for the more senior nurses. One nurse said “Ifthere’s anyone who needs guidance, it’s us, the newcomers.If only we could talk more with the experienced nurses,then there would be some guidance at least.” Although thequality of mentorship varied, it was perceived as useful whenit “included opportunities to work together, formal meetingsand completion of paperwork.” The most readily availablesupport was given by the other nurses in the team; suchsupport often involved a mix of informal input, such asdiscussing a shift before going home, and more structuredsupport, such as help filling out a critical-incident statement.The new nurses seemed to have developed a defensiveattitude in response to this “busyness” and lack of support:“You just get on with your job as part of the system. There’snot much else we can do.” Although each graduate nurse wassupposed to have a mentor for the first three or four months,the system did not work well because their shifts were notcoordinated.

5. Discussion

The empirical findings of this study both conflict and concurwith other relevant research findings. Our study showed thatthe new nurses were keenly aware of their patients’ needsand wanted to give them the best care possible, and thatthey were concerned about creating good relationships withtheir patients. This patient-centred caring was also observedin Duchscher’s [16] study, in which it was associated withincreased knowledge. However, when Rognstad et al. [11]studied students’ educational and occupational motivations,they found a high degree of self-centredness. The studentswere described as typical representatives of the “what’s init for me” generation, whose main concern was to fulfiltheir own wishes and needs. Tveit [34] moderated thisimpression in her study. She found that nursing students

had an ambivalent attitude: they were motivated towardsnursing because they wanted to help the sick, but at thesame time, helping others increased their self-understandingand accentuated their own importance. In this respect, Tveitencourages us to perceive self-centredness among studentsand new nurses as a potential strength. As in the studies ofboth Tveit [34] and Maben et al. [24], the new nurses in ourstudy wanted to make a difference to their patients.

The nurses’ positive energy and interest in improvingtheir skills did not seem to be fully exploited, or valued bytheir more experienced colleagues. Maben et al. [24] foundthat their participants’ attempts to put their ideals into prac-tice were often hindered by processes designated “organi-zational sabotage” and “professional sabotage.” Professionalsabotage included a lack of support and poor nursing rolemodels. Organizational sabotage included time pressuresand excessive work loads. Our findings confirm the presenceof this bureaucratic aspect in the work place. The newnurses were sometimes anxious about whether they couldmeet the profession’s expectations, especially when they wereresponsible for a large number of patients, and particularlyon days when they were team leaders. Whereas existingstudies have described anxiety (fear of making mistakes) anda desire for ongoing feedback among new nurses [16, 35, 36],the nurses in our study did not seem to worry constantlyabout making mistakes. They felt a lack of energy andknowledge and wanted support, but they seemed to managethe challenge of assuming responsibility. As team leaders, thenurses experienced different styles of physician cooperation,and felt that they were in an insecure position because thephysicians seemed to expect the nurses to be ready for themat any time. This finding confirms those of Duchscher [16],Dyess and Sherman [8], and Martin and Wilson [5], inthat the new nurses in their studies frequently experiencedless than ideal communication with physicians. The lack ofprofessional confidence that new nurses feel in challengingsituations can be heightened when another professional isbrusque or expresses displeasure [8]. However, as Leeveret al. [37] pointed out, the collaboration between nurses andphysicians in a hospital is crucial to the care of individualpatients.

Although the nurses in our study did not directly confirmthe findings of Kramer [1] in terms of “massive transition,”there was a perceptible “psychological shift,” which seemedto mark the adjustment from being a student to becominga staff nurse. This adjustment was mainly associated withthe recognition that “the main difference between trainingand being on the job was the responsibility,” in that thenew nurses had become answerable for all their decisionsin practice, a factor also identified by Maben and Clark[38] and Dearmun [39]. The new graduates wanted tomanage, despite the difficulties, and they, therefore, acceptedwork loads and responsibilities that could provoke feelingsof stress. In an effort to conform to the implicit valueof being seen to be doing a good job and to “play theorganizational game,” the nurses became aware of the impor-tance of “appearing to be busy” [40], which they oftenmanifested in their manner of moving briskly through thecorridors. According to Lindberg-Sand [41], this aspect of


“reality shock” can be understood as a profound transitionexperience. She suggested that new nurses’ experiences ofresponsibility are interwoven with the aspect of time, so thatthe feeling of being responsible increased in tandem withthe speed with which the nurses fulfilled their duties. Inthis context, the new graduates in our study seemed to haveadapted to the implicit requirement to be efficient in orderto avoid trouble and to earn the respect of their leader andother staff members. Unacknowledged value conflicts androle ambiguities may lie behind the unrealistic expectationsheld by senior nurses. Ellerton and Gregor [35] and Mabenet al. [24] described an incongruence between the personalvalues of new graduates and the established values in clinicalpractice settings and questioned the effect on nurses of nothaving the energy or capacity to realize their ideal of nursing.These conflicting expectations emerged clearly in our studyand illustrate the pressures felt by new nurses. According toDuchscher and Cowin [4], the primary challenge for newnurses lies in their struggle to construct a new professionalsense of self-confidence that fuses the ideals of their educa-tion with the realities of their practice context.

The new nurses in our study were attracted to a jobwith possibilities for excitement, and for them, working ina surgical ward was about learning more. They saw the jobas giving them an opportunity to take care of patients and tolearn how to be a good nurse. However, it became apparentthat there was no support tailored to their individual learningneeds, leading to a dissonance between the support andsupervision that they felt they needed. As recent graduates,they had expected that the more experienced nurses wouldprovide guidance as they developed their clinical skills, assistthem with decision making, and help them meet theirpatients’ needs and the organizational requirements of thehospital. These findings are consistent with previous studies[5, 24, 36]. Wenger [42] argues for an interaction betweenthe nurses’ participation in practical work and a dialogueabout this work. It is through practice that students and newgraduates can work and form opinions about that work. Ourfindings support Olson’s conclusion [36] that collegialityis highly valued by new nurses today, and that mutuallysupportive and empathetic relationships with colleagues playan important role in how well new nurses adapt to the cultureof nursing [5].

5.1. Methodological Considerations. This study explored theperceptions and experience of the reality of practice among13 new graduate nurses in a Norwegian hospital. Althoughsmall, the sample provided an opportunity for observation,in-depth interviews, repeat interviews, and ongoing journalreflections, all of which enriched the study. The questionsaddressed to the informants were constructed during thefieldwork, and they should be recognized as coming fromwithin the author’s personal and professional paradigm ofthought. This subjectivity indirectly instilled a conceptualbias in the fieldwork process, although rigorous attemptswere made to ensure that the informants directed the type ofdata collected. The context of the two surgical wards differed,but this issue was not addressed in this study. However,

incorporating these contextual differences would not haveincreased the validity of the data.

All data were collected by the main author. At the timeof the study, the author had been a practising acute-carenurse for five years and had previous involvement as a nurseeducator. As in all qualitative research, the author’s practiceexperience necessarily influenced both the process and thecontent of the study. This is a strength of the study, because itoffers an insider’s perspective on the views of new graduates.

6. Conclusions

The research presented in this paper shows that newly gradu-ated nurses are likely to enter nursing practice with empathyfor their patients and enthusiasm for their profession.However, this potential in new nurses and their readiness tolearn seem to be hindered by organizational and professionallimitations, including time pressures and a lack of support.For a transition to be optimal, it must take place in a well-structured ward, with a supportive environment character-ized by initiatives that will meet the needs of new nursesduring their first year of practice. Such initiatives shouldinclude support that extends beyond clinical orientationand basic unit-specific mentoring programmes. The workexperiences of new nurses provide substantial informationabout improvement opportunities at the ward level. Thesefactors have an important impact on new nurses’ workpractices and on future nurse retention. Further researchin this area is required to explore the experience of beingconstrained within the professional nursing role, the kinds offeelings this issue engenders in newly graduated nurses, andthe effects on their future careers.

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