Review
Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies

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Abstract

Objective

This systematic review describes the experiences of the orientation into nursing of newly graduated nurses.

Design

Systematic review.

Methods

Data was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC (ProQuest). Qualitative, peer reviewed, original studies published in English, Swedish or Finnish before February 2016 and exploring newly graduated nurses’ experiences of the nursing orientation process were included. The studies were selected by screening titles, abstracts and full texts and the quality of the studies was assessed by two researchers independently. Data was analysed using content analysis.

Results

Thirteen studies were chosen for the review. Newly graduated nurses’ orientation experiences were divided into four main categories: experiences related to orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation and suggestions for changes based on orientation experiences. The findings establish that the orientation and the preceptor have a great impact on how newly graduated nurses experience the start of their career. Often, newly graduated nurses wish to continue their relationship with their preceptor after the orientation period.

Conclusions

Results bring together both the positive and negative aspects that newly graduated nurses relate as regards their current orientation programmes. Attention needs to be paid to the variation and imbalance in the quality of orientation programmes and preceptors. A more formal form of mentorship needs to be developed further.

Introduction

Nurses exiting the nursing profession have raised concerns internationally. The European Commission has estimated that in 2020, there will be a shortfall of 970,000 employees in healthcare and 590,000 of those will be nurses (Sermeus and Bruyneel, 2010). The intention to exit nursing is most common among young, newly graduated nurses (Goh et al., 2015, Rudman et al., 2010, Salminen, 2012). According to studies, 36% of 24–29-year-old nurses (Flinkman et al., 2008) and 37% of under 35-year-old nurses (Salminen, 2012) had thought about exiting nursing at least once in a month.

Exiting nursing has been noticed to be connected to dissatisfaction with the orientation (Flinkman et al., 2013, Laschinger, 2012) and to follow simultaneous changes that are happening in levels of depression symptoms (Rudman and Gustavsson, 2011) and burnout (Rudman and Gustavsson, 2011, Rudman et al., 2014). Almost every fifth newly graduated nurse reported having very high burnout levels and among other things, the feeling of being poorly prepared for nursing is a sign of developing burnout (Rudman and Gustavsson, 2011). In this review, newly graduated nurses include those who have less than three years’ experience in professional nursing as a nurse. The first three years of working at the same job or doing similar tasks is important for growing as a competent nurse (Benner, 1984). Newly graduated nurses need more support for competence development (Lofmark et al., 2006, Yeh and Yu, 2009) as well as wellbeing at work (Tastan et al., 2013, Yeh and Yu, 2009), because they suffer from fatigue, feel dissatisfaction (Missen et al., 2014, Tastan et al., 2013) and have greater stress (Yeh and Yu, 2009).

Orientation is one way to improve newly graduated nurses’ wellbeing (Park and Jones, 2010), self-assurance, competence (Scott et al., 2008) and satisfaction with the profession (Scott et al., 2008, Tastan et al., 2013), and therefore also turnover rates (Missen et al., 2014). Orientation is defined as the activity where someone is familiarised with something (Oxford Dictionary of English, 2016) and the purpose of the orientation is to ease the transition process from student to qualified nurse, increasing both competence and commitment (Beecroft et al., 2001). In this review, the orientation of newly graduated nurses was understood as an aid for newly graduated nurses to become assured providers of good and safe patient care. The duration, structure and content of orientations vary between workplaces (Rush et al., 2013, Scott et al., 2008). Many newly graduated nurses have the opportunity to be preceptored during their orientation, but this is not the case in all workplaces (Rush et al., 2015). Preceptor is a term used for staff members who work as role models for newly graduated nurses and facilitates the transition process by giving guidance and helping with prioritising (Myrick and Yonge, 2002). Preceptorship is often confused with the term mentorship. The principal difference between these terms is, that preceptorship is a short-term process during the orientation, whereas mentorship is a longer-term process during the whole work career. Preceptorship is for new staff members while mentorship is for all staff members. (Firtko et al., 2005.) Some organisations offer rotations in different clinical areas or wards during the orientation. (Malouf and West, 2011).

Newly graduated nurses’ orientation has been recognised as an important area in wellbeing at work and development as a competent nurse. There are systematic reviews of newly graduated nurses’ experiences and expectations related to the transition from student to newly qualified nurse (Higgins et al., 2010, Whitehead and Holmes, 2011) as well as the connection between orientation programmes and newly graduated nurses’ job satisfaction (Lin et al., 2014), orientation programmes’ impact on newly graduated nurses’ clinical decision-making and leadership skills (AL-Dossary et al., 2014).

A broader perspective is needed to gain a deeper understanding of how newly graduated nurses have experienced the orientation so as to develop the orientation based on newly graduated nurses’ needs. As far as we know, there is no systematic review of qualitative studies concerning newly graduated nurses’ experiences of orientation. Therefore, the aim of this review was to describe the newly graduated nurses’ experiences of the orientation in nursing. The research question was: What kind of orientation experiences do newly graduated nurses have in nursing?

Section snippets

Search strategy

This systematic review of qualitative studies was conducted according to guidelines from the Centre for Reviews and Dissemination (CRD, 2009) and Joanna Briggs Institute User guide (JBI, 2014). Data was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC (ProQuest) in February 2016. No limit for publication year was set. Searches from PsycARTICLES and ERIC were combined so that results from both databases were obtained with one search. Search strategies, terms and

Description of studies

Of the 13 studies chosen for this systematic review, six were conducted in the USA (Delaney, 2003, Glynn and Silva, 2013, Moore and Cagle, 2012, Morales, 2014, Spiva et al., 2013, Zinsmeister and Schafer, 2009), three in Australia (Evans et al., 2008, Lea and Cruickshank, 2005, Ostini and Bonner, 2012), one in Oman (Al Awaisi et al., 2015), one in Japan (Gregg et al., 2011), one in Ireland (Hollywood, 2011) and one in Canada (Patterson et al., 2013). The number of the newly graduated nurses as

Discussion

A systematic review was conducted to reach the aim of this review, which was to describe newly graduated nurses’ experiences related to the orientation in nursing. Four main categories, experiences related to the orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation; and suggestions for changes based on the orientation experiences, were created to explain this phenomenon as it was portrayed by newly graduated nurses in those thirteen

Acknowledgment

We would like to thank the information specialist Sirpa Grekula from the University of Oulu for giving such enriching guidance.

References (53)

  • K.L. Rush et al.

    Best practices of formal new graduate nurse transition programs: an integrative review

    Int. J. Nurs. Stud.

    (2013)
  • E.S. Scott et al.

    New graduate nurse transitioning: necessary or nice?

    Appl. Nurs. Res.

    (2008)
  • P. Thabault et al.

    Describing a residency program developed for newly graduated nurse practitioners employed in retail health settings

    J. Prof. Nurs.

    (2015)
  • Y. Zhang et al.

    The effectiveness and implementation of mentoring program for newly graduated nurses: a systematic review

    Nurse Educ. Today

    (2016)
  • P.C. Beecroft et al.

    RN internship outcomes of a one-year pilot program

    J. Nurs. Adm.

    (2001)
  • P. Benner

    From Novice to Expert: Excellence and Power in Clinical Nursing Practice

    (1984)
  • Centre for Reviews and Dissemination (CRD)

    Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care

    (2009)
  • C. Delaney

    Walking the fine line: graduate nurses’ transition experiences during orientation

    J. Nurs. Educ.

    (2003)
  • J.B. Duchscher

    A process of becoming: the stages of new nursing graduate professional role transition

    J. Contin. Educ. Nurs.

    (2008)
  • S. Elo et al.

    The qualitative content analysis process

    J. Adv. Nurs.

    (2008)
  • J. Evans et al.

    The strengths and weaknesses of transitional support programs for newly registered nurses

    Aust. J. Adv. Nurs.

    (2008)
  • A. Firtko et al.

    Understanding mentoring and preceptorship: clarifying the quagmire

    Contemp. Nurse

    (2005)
  • M. Flinkman et al.

    Young registered nurses’ intention to leave the profession and professional turnover in early career: a qualitative case study

    ISRN Nurs.

    (2013)
  • Y.S. Goh et al.

    Profiling nurses’ job satisfaction, acculturation, work environment, stress, cultural values and coping abilities: a cluster analysis

    Int. J. Nurs. Pract.

    (2015)
  • M.F. Gregg et al.

    Newly licenced nurses’ experiences in rotational training programs in Japan

    J. Contin. Educ. Nurs.

    (2011)
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