BACKGROUND: Following the COVID-19 pandemic, a community emergency department was facing a staffing crisis with new emergency registered nurse turnover rates as high as 83.3%. There were limited experienced emergency nurses available to train the large number of novice nurses hired to fill vacancies. Based on this, the emergency department needed to restructure the orientation process to better align with evidence-based strategies and available resources.
METHODS: The Seven Steps of Evidenced-based Practice were used to identify the best practices for an orientation program specific to the emergency department. Based on the evidence, a 16-week, competency-based, emergency nurse internship was implemented in the 33-bed community emergency department.
RESULTS: The primary outcome of this initiative was new emergency nurse retention, which demonstrated a statistically significant reduction from 81.8% (pre-intervention) to 11.1% (post-intervention) (P < .001). Additionally, there was an improvement in the scores for each of the 6 healthy work environment standards.
CONCLUSIONS: Based on the outcomes of this initiative, an emergency nurse internship is an effective method to improve emergency nurse competence and retention, contributing to a healthier work environment.

OBJECTIVE: This study aimed to assess the level of core competencies in disaster nursing of New Graduate Nurses (NGNs) and explore its influencing factors.
BACKGROUND: In recent years, the overall frequency of disasters around the world has been on the rise. As the emerging workforce in clinical settings, NGNs play an integral role in future disaster relief efforts. NGNs\' level and influencing impact of core competencies in disaster nursing need to be understood.
METHODS: A cross-sectional design.
METHODS: From June to September 2023, the Core Competencies in Disaster Nursing Scale - General Professional Nurse (CCDNS-GPN), designed according to the CCDN V2.0, was used to collect data from NGNs of six nursing schools and 15 hospitals in Guangdong, China. Descriptive analysis was conducted to examine the scores of core competencies in disaster nursing. Furthermore, one-way analysis of variance and multivariate linear regression analysis were used to explore the influencing factors.
RESULTS: A total of 607 NGNs participated in this study. The scores of CCDNS-GPN of NGNs were 90.23 (SD 15.09) (score ratio: 51.56%), indicating a low level of core competencies in disaster nursing. The highest competency was the recovery (score ratio: 55.00%), while the lowest competency was the communication (score ratio: 45.44%). The predictor for core competencies in disaster nursing of NGNs were male (β = 0.091, p < 0.05), below bachelor\'s degree (β = -0.109, p < 0.05), had received disaster nursing education at school (β = 0.087, p < 0.05), had participated in a disaster rescue drill at school (β = 0.140, p < 0.05), had been to the ICU during internship (β = 0.135, p < 0.05) and had the intention to be a disaster specialized nurse (β = 0.114, p < 0.05).
CONCLUSIONS: The NGNs exhibited insufficient core competencies in disaster nursing in Guangdong, China. Nursing schools and clinical institutions should collaborate and play their respective roles to enhance nurses\' core competencies in disaster nursing, ensuring they can timely, safely and efficiently participate in disaster medical relief efforts.

This article was migrated. The article was marked as recommended. Background The transition experience of new graduate nurses (NGN) is a complex and stressful period of adjustment and adaptation. The transition period is often negative leading to job dissatisfaction and increased intent to leave. Literature concerned with transition experiences of NGNs in the Middle East is lacking, where the educational, healthcare and cultural context are dissimilar to those in the published literature. Aim To explore the transition experiences of Qatari NGNs to inform development of a formal transition to practice program at a specialty hospital. Methods A qualitative case study design was conducted to explore the professional role transition experiences of Qatari NGNs. Data was collected through the Casey-Fink Graduate Experience Survey, and an unstructured focus group. Results Qatari NGNs experienced challenges of professional role adaptation and feeling ill-prepared in terms of competency and job-readiness, resulting in self-doubt, frustration and fear. Desires to fit-in were negatively impacted by language, discrimination and lack of social support, and professional identity development. Conclusions Professional role transition of Qatari NGNs involves a complex interplay of intrapersonal, interpersonal, organizational and cultural factors. Experiences can be enhanced by accessible, nurturing, multi-level social support to facilitate socialization and improve clinical practice competency. Managing expectations by preparing students for transition and providing transitional support during their first year of practice will improve their experience. Duchscher\'s Theory of Transition Shock offers insights into the transition expereinces that can inform this support.

OBJECTIVE: The purpose of this integrative review was to evaluate and synthesize literature published in peer-reviewed journals within the past 40 years addressing moral distress in early career nurses (graduation to five years of experience).
BACKGROUND: Moral distress experienced in nursing education and practice manifests physically and psychologically, leads to workforce burnout and attrition, and compounds the nursing shortage. The transition to practice period is a vulnerable time for student nurses emerging into professional practice. Nurse educators serve a crucial role in the preparation of nurses for the recognition and management of moral distress in their professional nursing practice. A better understanding of the state of the science pertaining to the reports of moral distress in early career nurses is essential.
METHODS: Whittemore and Knafl\'s Integrative Review method and the PRISMA 2020 Checklist were utilized in this integrative review.
METHODS: Five literature databases (CINAHL, ERIC, PsychInfo, PubMed, and Embase) were searched using \'moral distress\' and \'new graduate nurses\' as keywords. Studies were included for English language; qualitative and quantitative research; moral distress focus; years of nursing practice experience collected and analyzed in results or discussion; and all areas of clinical nursing practice, geographic locations, and nursing education levels. Studies were excluded for non-peer reviewed publications; moral distress in the academic setting; and the absence of analysis of years of nursing practice experience in the results or discussion.
RESULTS: Eight primary research reports, published between 2016 and 2022 met eligibility criteria. Research methods were largely quantitative with six countries geographically represented. Acute care healthcare settings had the greatest representation with considerations for the COVID-19 pandemic in two reports. Various formats of four moral distress research instruments were used. Years of nursing practice experience were collected as a mean or category. Inconsistent reports of moral distress in early career nurses were found based on experience, age, or nursing education level.
CONCLUSIONS: Research of moral distress prevalence in early career nurses was an identified literature gap. Varied reports of moral distress in early career nurses indicate a need to further understand this topic contextual to academic and clinical education. Nurse educators can prepare students for experiences of moral distress in their professional nursing practice by implementing teaching strategies that draw upon their diverse backgrounds and experiences. A research and education emphasis on moral distress in early career nurses can promote their transition to practice, support their career progression, and uphold nursing occupational commitment.
CONCLUSIONS: An integrative review of moral distress in early career nurses found inconsistent reports of moral distress in this population and a need for further research.

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.
BACKGROUND: Previous research has raised questions about new graduate nurses\' (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs\' expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.
METHODS: A cross-sectional survey design was used.
METHODS: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.
RESULTS: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit. The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses\' readiness for clinical work, the challenges they perceive, and their needs for learning and support.

Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care.
To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit.
This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two).
Findings related to factors influencing the participants\' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment.
This paper highlights that the registered nurse\'s perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit.
The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses\' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.

UNASSIGNED: Nursing jobs are very complex and stressful, and nurses are demanded to have high competency and soft skills to keep their performance. However, the nursing workload often leads to fatigue, and it will be very challenging for novice nurses. Therefore, they need to be trained in soft skills in order to be able to control their emotion and adapt to the situation. Unfortunately, studies on essential soft skills for novice nurses in Indonesia are scarce; further research on this topic is a necessity.
UNASSIGNED: This study aimed to explore the perception of senior nurses about the essential soft skills for novice nurses during their work adaptation process.
UNASSIGNED: This qualitative study used an interpretive phenomenology approach, which was conducted in a private hospital in Jakarta, the capital city of Indonesia. Data were collected using semi-structured interviews from ten senior nurses selected using a purposive sampling technique. Data were analyzed using Gadamer\'s hermeneutic approach.
UNASSIGNED: Nine essential soft skills were developed for novice nurses during their transition phase from education to practice, including self-control, initiative, caring, self-motivated, hospitality, flexibility, adaptability, analytical skill, and presentation skill.
UNASSIGNED: Findings of this study serve as a basis for developing the soft skills of novice nurses in their clinical practice in hospitals in Indonesia. It is also recommended that soft skills should be included in the nursing education curriculum. However, soft skills are essential for novice nurses to succeed in their adaptation and future career.

OBJECTIVE: This study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion.
BACKGROUND: Simulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses\' ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice.
METHODS: During the winter of 2021-2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis.
RESULTS: The results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding.
CONCLUSIONS: Simulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.

BACKGROUND: The Covid-19 pandemic has significantly impacted organizational life for nurses, with known physical and psychological impacts. New graduate nurses are a subset of nurses with unique needs and challenges as they transition into their registered nurse roles. However, this subset of nurses has yet to be explored in the context of the Covid-19 pandemic.
OBJECTIVE: To explore the experiences of new graduate nurses entering the profession in Ontario, Canada, during the Covid-19 pandemic approximately one year after entering the profession.
METHODS: Thorne\'s interpretive description method was utilized.
RESULTS: All participants identified as completing second entry nursing programs, offering a unique perspective on new graduate nurse transition. Four themes emerged in the data: \'Virtual Didn\'t Cut It,\' \'Go Where You Know,\' \'Picking Up the Pieces,\' and \'Learning When to Say No and Let Go.\' Participants felt ill prepared to enter the profession and were cognizant of the various challenges facing the nursing profession, and how these pre-existing challenges were exacerbated by the pandemic. They acknowledged the need to protect themselves against burnout and poor mental health, and as such, made calculated early career decisions - demonstrating strong socio-political knowing. Half of the participants had already left their first nursing job; citing unmet orientation, mental health, and wellbeing needs. However, all participants were steadfast in remaining in the nursing profession.
CONCLUSIONS: Second entry new graduate nurses remain a unique subset of nurses that require more scholarly attention as their transition experiences may differ from the traditional trajectory of new graduate nurses.

OBJECTIVE: The aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses\' professional competence development after preceptors\' participation in an education intervention.
BACKGROUND: New graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses\' competence, and preceptors and preceptorship could also have significant influence on their competence development.
METHODS: A quasi-experimental longitudinal intervention study.
METHODS: The data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees\' orientation, particularly from new graduates\' point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates\' self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist.
RESULTS: The education intervention aimed at preceptors did not have impact on the intervention group NGRNs\' competence development. There were no statistically significant differences between the groups and effect size remained small.
CONCLUSIONS: The preceptors\' education intervention was not effective enough to develop new graduates\' professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses\' competence development during their early career. Preceptors\' education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments.
BACKGROUND: Retrospectively registered.