Experience of New Graduate Nurses Feeling Not Ready for Professional Role on Completing Nursing Degree

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Experience of New Graduate Nurses Feeling Not Ready for
Professional Role on Completing Nursing Degree
Systematic Review Assessment

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Table of Contents
Abstract............................................................................................................................................3
Chapter One: Introduction...............................................................................................................5
1.1 Background:................................................................................................................................5
1.2 Rationale .....................................................................................................................................8
1.3 Research question .......................................................................................................................8
1.4 Aim.............................................................................................................................................8
Chapter Two: Methods...................................................................................................................10
2.1 Research Design........................................................................................................................10
2.2 Eligibility criteria......................................................................................................................10
2.3 Search strategy..........................................................................................................................11
2.4 Information Sources..................................................................................................................12
2.5 Studies Selection........................................................................................................................14
2.6 Quality Assessment ...................................................................................................................15
2.7 Data Extraction and Synthesis of results ...................................................................................16
Chapter Three: Results...................................................................................................................17
3.1 Study Selection..........................................................................................................................17
3.2 Study Characteristics ................................................................................................................17
3.3 Quality Assessment ...................................................................................................................24
3.4 Synthesis of Results ...................................................................................................................26
Chapter Four: Discussion...............................................................................................................29
4.1 Summary of Findings ................................................................................................................29
4.2 Critical Discussion.....................................................................................................................30
4.3 Strengths and Limitations .........................................................................................................32
4.4 Implications...............................................................................................................................33

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Abstract
Background
Most research focuses on new nursing graduates' unreadiness or incompetence, but none has
examined the problem's extent. Educational planners and scientists must create an informed and
productive workforce to meet expanding health needs. First, describe problem areas to incoming
nurses and other employees. Transitional support programs and new graduates' positive and
negative experiences are critical for nursing employment retention. This research intends to
investigate the problem's dimensions and scope to help develop an effective nursing curriculum.
Aim
The aim of this project was to examine the experience of new graduate nurses who feel not ready
for professional nursing role on completion of their pre-registration degree programme. This
study used qualitative research using a systematic review methodology.
Methods
CINAHL, Embase, Google Scholar, and PubMed have all been used to find literature-based
insight conducted from 2011 and 2022 written in the English language. All of the papers were
sent to the Critical Appraisal Skills Program (CASP), which employed critical appraisal to
evaluate them further. The findings are collected into a collection that includes implications and
an interpretation of those implications that were researched and described utilising descriptive
synthesis analysis.
Results
Students could focus on patient care because they know the facilities. New graduates felt like
valuable ward team members because they could find knowledge and clinical resources. Student
lacked confidence and dreaded invasive procedures. Many nurses lacked confidence in managing
more patients. Capstone didn't improve practise preparedness. Students felt unprepared for their
placement, according to statistics. High staff expectations, 'an extra set of hands,' and mentors
dismissing student practise papers were difficulties. Students were confident in their abilities,
found the research. Vocational high school graduates and nurses felt most prepared. Training
boosts confidence. Strong academics, bad clinical abilities.

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Conclsuion
A nursing school was enhanced by examining new graduates' positive and negative experiences.
First-year nurse turnover boosts workload and staffing. Uncertainty impedes therapy. Global
news discusses grads' job-search struggles. Individual practise is required before graduation.
Graduates find careers via undergraduate and clinical study. This research examined rookie
nurses' autonomy. Due to education and training gaps, graduate nurses and senior nursing
students lack confidence. Modernize healthcare and nursing. Short- and long-term nursing
commitment is affected by transition. Employers must train new RNs. Students gain real-world
exposure through clinicals.

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Chapter One: Introduction
Chapter Introduction
This chapter focuses on providing a context for the study for the dissertation's main body. It
includes everything essential to get the reader up to speed on research project, from the
background and emphasis of study, to research questions or objectives, the argument planned to
make and so on.
1.1 Background:
The information and skills that nurses acquire during their studies are dependent on the training
and education they receive (Graf et al., 2020). Curriculum is important in terms of establishing
values, goals, and teaching materials. Because of increasing changes in healthcare setting, new
methods of caring, shorter inpatient care periods, technological advancement, and increasing
chronic diseases, the ideal training is when related faculties produce nurses who can demonstrate
appropriate medical services and improve the quality of patient care (Patterson et al., 2017). The
primary goal of nursing education is to produce trained and efficient nurses. Nursing training
begins in the classroom and extends to clinical practise. One of the most important difficulties
facing the educational system is failure to accomplish specified educational goals. According to
several studies, nursing graduates who are the result of the nursing school system lack the
requisite skills to provide high-quality services when they first begin working (Murray et al.,
2018).
Graduate nurses are supposed to have sufficient knowledge, clinical reasoning skills, personal
characteristics, and high professional and ethical practise standards to accomplish the activities
that a competent nurse is expected to perform in real-life settings (McNelis et al., 2019). Prior to
the transition of nursing education to hospitals, students in traineeship programmes spent the
most of their hospitalization periods, becoming an essential share of the hospitals' regular
procedures, attaining wide clinical experiences and becoming a dynamic share of nursing staff
(Croxon et al., 2018). Many doubts have been raised about the job preparedness of new nursing
graduates, with healthcare facilities claiming that graduates do not receive adequate clinical
experience and education before entering the workforce. Healthcare organisations want new

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nursing graduates to be able to 'hit the ground running,' which may be unrealistic for
inexperienced nurses. This dispute, however, continues to rage across the world (Bennett, 2017).
New graduate nurses' first year of practise is sometimes hectic and stressful as they try to employ
newly obtained abilities, offer great patient care, and 'fit in' (Cantlay et al., 2017). Importantly,
the first year of practise is also a period of substantial attrition, with literature reporting rates of
up to 27%. These issues have influenced the establishment of new graduate programmes,
sometimes known as transitional programmes, throughout the world to increase clinical
performance, new graduate nurse professional growth, and retention. The influence of workplace
stress, uncivil conduct, and burnout on the retention of new graduate nurses has been shown in a
recent research (Wiersma et al., 2020). However, how to effectively support immigrant transition
in acute care settings is still a work in progress. Although the literature agrees that a supportive
organisational environment (both on the ward and at the organisational level) is required for the
successful and safe integration of new graduate nurses, several authors have detailed the
perceptions and experiences of new graduate nurses and how they change over time (Thomas
and Mraz, 2017). Another research highlighted the process of immigrant nurses being socialised
into organisations, often known as 'onboarding,' during which time they get the information,
attitudes, and behaviours needed to perform well and acclimate to their new work environment.
However, growing patient understaffing and acuity have been proven to have a deleterious
influence on this process, which is worsened in certain circumstances by fear of failure (Graf et
al., 2020).
The transition from nursing student to registered nurse is described as a "process that begins with
an end, progresses through a time of bewilderment and distress, and culminates in a new
beginning" (Thomas and Mraz, 2017). While they were first thrilled and excited, their experience
as freshly graduated registered nurses soon turned into perplexity, anxiety, disillusionment,
uncertainty, and inadequacy. Due to new responsibilities and tasks, they feel insecure,
vulnerable, unskilled, and inadequate. Nursing students have more responsibilities than newly
graduated registered nurses. They had problems managing administrative abilities, decision-
making, a heavier caseload, and increasing patient acuity (Brandt et al., 2017). Coworkers and
superiors who expect them to 'hit the ground running' with their new duties and job performance
compound the situation. Additionally, freshly graduated registered nurses face a conflict between

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their idealistic vision of nursing and the realities of professional practise. The practicing
environment, and therefore their transition experience, may be confusing, overpowering, and
intimidating (Schuelke and Barnason, 2017).
These feelings contribute to a bad transition, which can lead to professional unhappiness and job
disenchantment. As new registered nurses acclimate to their professional identity and
relationships, they experience personal stress (Hawkins et al., 2019). Newly graduating
registered nurses must first leave their comfort zone, which was a sheltered school setting. Then
they must practise in a new working environment, which requires more accountability and
obligation. Freshly graduating registered nurses were stressed by unanticipated responsibilities
reflecting increasing obligations and accountabilities. Ever-increasing pressure makes them
doubt their ability. Despite their intellectual assurance upon graduation, they worry about using it
in real life (Ankers et al., 2018).
In the workplace, freshly graduated registered nurses are also confronted with a knowledge and
skill competency gap between what they already know and what their healthcare organisations
anticipate of them, which is difficult to bridge (Ares, 2018). This adds to their already high level
of anxiety as they struggle to cope with the additional accountability and obligations that have
been placed on them. Their need for socialisation or 'fitting in' to the new workplace and culture
is also a priority for them; in other words, they want to be accepted and acknowledged by
coworkers. Through this training-to-practice mismatch, patients may get subpar treatment and
new nurses may exhibit less than optimal performance (Whitmore et al., 2018). Training and
clinical practise are viewed as distinct experiences in the nursing profession. When it comes to
expectations for students, educational educators and clinical nurses may have conflicting views.
Nursing practise may eventually be threatened as a result, making it more difficult for nurses to
practise their profession (Walker et al., 2017). Nursing students should be taught in such a way
that they achieve a foundational level of competency and clinical safety. Clinical training
efficiency in nursing undergraduate programmes had not been sufficient, and nurses had not been
adequately prepared for the changing health care contexts, according to an assessment of the
textbooks (Innes and Calleja, 2018).

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1.2 Rationale
Despite the fact that most research in this area have addressed unpreparedness or lack of
competence among new nursing graduates, none of them have defined the scope of the problem.
Because the process of teaching and training nurses is costly, it is critical that educational
planners and scientists in this profession take steps to build a competent and productive human
workforce capable of responding to the changing health demands of the community. In this
regard, identifying and characterization of problem dimensions from freshly graduating nurses
and other associated employees might be the first step toward solving the problem. Given the
consequences for nursing workforce retention, it's critical to look at the efficacy of transitional
support programmes and the elements that influence new graduate experiences, both positive and
negative. Through the absence of systematic review research in this sector and the need to fill the
knowledge gap, this study intended to conduct a systematic review to assess the dimensions and
breadth of the problem to contribute to the planning and revision of an effective nursing
curriculum.
1.3 Researchquestion
 What are the positive and negative experiences of new graduate nurses feeling
unprepared for professional role on completion degree following the PEO framework?
P Participants New graduate nurses
E Exposure Professional nursing
O Outcomes Positive and negative experiences of new graduate nurses feeling
unprepared for professional role on completion degree
1.4 Aim
The aim of this project was following:
 To examine the experience of new graduate nurses who feel not ready for professional
nursing role on completion of their pre-registration degree programme

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Chapter Summary
This chapter covered background of topic, rational to choose a specific topic, aims, research
questions based on PEO framework in order to provide a strong back support to the dissertation.

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Chapter Two: Methods
In this chapter, we'll take a look at how literature reviews work as a research strategy.
Sophisticated review is a family of research methods that examines the reasoning and procedures
employed in the various approaches, utilising examples from current reviews to illustrate the
differences. There includes a discussion of the differences between aggregative and configurative
techniques as well as resources for additional research.
2.1 ResearchDesign
Qualitative research is done to learn about a group. This study used qualitative research using a
systematic review methodology because it gives crucial product design information, such as
behaviour patterns, application scenarios, and customer requirements. Qualitative research
details participants' thoughts, perceptions, and feelings and analyses their behaviours. Depending
on your research method and interpretation, you can look at human experience from different
angles. The researcher's philosophical approach was reflected in the systematic review.
Qualitative research methodologies are influenced by the researcher's attitude and ideas, past
research on a topic, the investigation's aims and objectives, and participant personality.
Qualitative research uses interpretative and naturalistic methods to uncover people's thoughts,
decisions, and feelings about a particular experience. Systematic review, especially
phenomenological research, might emphasise study participation.
2.2 Eligibility criteria
Before beginning the research evaluations, it is important to decide the inclusion and exclusion
criteria. Inclusion criteria are all of the requirements that a study must meet to be accepted.
Exclusion criteria are circumstances that disqualify research. Thousands of search results must
be validated. Defined exclusion criteria make screening more efficient. In this research,
following inclusion and exclusion criteria were followed:
Inclusion Criteria Rationale
 Studies conducted from 2011 and 2022  To find latest and most up-to-date data
and evidences

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 Written in the English language  To find easily understandable data for
everyone
 Studies published in impact factor and
peer reviewed journals
 To find authentic and reliable data
Exclusion Criteria Rationale
 Studies conducted before 2011  To avoid out dated and old data and
evidences
 Written in other than English language
and translated
 To avoid difficulty in understanding
and biasness
 Studies published in other than peer
reviewed journals
 To avoid untruthful and false data
2.3 Searchstrategy
A well-designed search is the review's most crucial part. It retrieves most research to check
eligibility and inclusion criteria (Han et al., 2018). Quality of search affects process entities and
information. The systematic literature review, which is commonly considered as the gold
standard for defining evidence-based practice, is increasingly being utilized to inform policy
choices and future research directions (Martin et al., 2020). Because systematic reviews utilize
systematic approaches to eliminate bias and improve rigor in selecting and synthesizing the best
available information on a given subject, their results are more reliable than those of other types
of reviews (Ho et al., 2019). As a result, when looking for evidence, it's critical to try to discover
all relevant research and consider them for inclusion in the review. When looking for proof, it's a
good idea to start with a few basic searches to try different search keywords and combinations of
terms. A good search method is both sensitive and particular: a sensitive search will bring up
relevant research, while a precise search will exclude studies that aren't relevant (Zhu et al.,
2018). Overly sensitive searches may capture all essential research, but it may need labor-
intensive vetting of extraneous studies during the study selection step. Overly narrow searches
will provide fewer results, but there is always the chance that essential research may be missed.

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There are several ways to find related research articles for a review and classify critical
documents (Busetto et al., 2020). Keywords are search terms used in the title and abstract of a
reference. According to the research theme, same keywords were used to obtain reliable and
authentic study data. Boolean operators were employed to test topic titles and search terms. The
literature was examined in the current study using computerised databases available at the
university library. Academic journals can be searched using computerised tools or by hand.
2.4 Information Sources
Information and investigators experts looking for relevant references for a systematic review
(SR) should search numerous databases and employ extra approaches to ensure that they find all
relevant literature on the topic of interest (Strijker et al., 2020). For locating reports of
randomised controlled trials, the Cochrane Handbook suggests using at least Cochrane Central,
MEDLINE, and, when accessible, Embase. The use of numerous databases has some drawbacks
(Dźwigoł, 2019). Because field codes and proximity operators change throughout interfaces, it is
difficult for searchers to transfer a search strategy into numerous interfaces and search syntaxes
(Ahn and Kang, 2018). Variations in thesaurus terms between databases add still another layer of
complexity to the translating process. It is also time intensive for reviewers, who must scan more
titles and abstracts, many of which are likely irrelevant. In addition, database access is frequently
limited and only available via membership (Cypress, 2018).
In this study, CINAHL, Embase, Google Scholar, and PubMed have all been used to find
literature-based insight studies. The snowballing approach is also known as hand-based or
manual searching. In addition to electronic databases, manual searches used references or
bibliographies. Keywords are search keywords in a reference's title and abstract. Different
keywords were used to acquire reliable and legitimate data. Boolean operators were employed to
test topic titles and search terms. The literature was combed through using the keywords listed in
the table 2.1.
Table 2.1 Keywords and databases hits for searched studies
Keywords Databases Hits

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Newly graduate nurses
OR
Fresh nurse graduates
AND
Nursing experiences
AND
Nursing professional role
AND
Nurses feeling not-ready
for profession
AND
Nurses’ completion degree
CINAHL 43
OR
AND
Nursing experiences
AND
AND
for profession
AND
Embase 34
OR
AND
Nursing experiences
AND
AND
for profession
AND
Google Scholar 17,500
OR
AND
PubMed 1248

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Nursing experiences
AND
AND
for profession
AND
2.5 Studies Selection
The studies were examined to see if they fulfilled the study's exclusion and inclusion
criteria. Examining abstracts for relevance and implications was part of finding relevant
studies. Articles were chosen based on their abstracts, which suggested that they were
based on original research. A total of 13,487 papers were searched across many databases
at the outset of the investigation. Due to duplication, 7,563 research were deleted, leaving
5,924 studies. Using the title, abstract, and keywords, and the full-text when applicable,
2327 papers were excluded, yielding 3597 results. 1117 studies were excluded after a
review of the references. Furthermore, 2363 studies were eliminated owing to poor study
designs, such as conference papers, comments, and articles with missing data, with just
eight publications remaining. PRISMA has shown the entire procedure in figure 2.1.

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Figure 2.1. PRISMA Flow diagram of study selection process
2.6 Quality Assessment
All of the papers were sent to the Critical Appraisal Skills Program (CASP), which employed
critical appraisal to evaluate them further. The process of picking the most relevant papers based
on research criteria is known as critical assessment. The CASP qualitative research checklist was
employed. The credibility and relevance of research publications are assessed using a set of 10
questions. When completing the checklist questions, ethical issues were considered, suggesting
that the research was appropriate for the study's objectives. Triangulation is a feature of a
successful article that improves the results' reliability and trustworthiness while retaining
conflicting opinions. It defined reflexivity practises, ethical issues, and qualitative methodology.
To be relevant to the subject and to meet the expectations of the researcher. The study's academic
values are demonstrated by the researcher's queries concerning reflexivity. Responding to

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concerns is essential for guaranteeing the validity of the findings and preventing researcher bias.
All qualitative research participants are made aware of the final purpose for their involvement to
ensure the validity and reliability of their opinions.
2.7 Data Extraction and Synthesis of results
Data gathered for systematic reviews should be accurate, thorough, and available for future
revisions of the study and for data sharing. Methods utilized for these choices must be
transparent. They should be chosen to reduce human error and biases (Valverde-Berrocoso et al.,
2020). Common with execution of the selection process, it is preferred that data extractors are
from complementary fields, for example a topic area specialist and a methodologist. It is crucial
that everyone participating in data extraction has familiarity utilizing the form (Akhter et al.,
2019). If the form was created by someone else, obtains necessary training. Evidence in favour
of duplicate data extraction comes from numerous indirect sources. Training of data extractors is
meant to acquaint them with the review topic and procedures, the data collecting form or data
system, and challenges that may emerge during data extraction (Lê and Schmid, 2022).
In this systematic review, irrelevant content was eliminated during the screening of abstracts and
entire articles. To help in distinguishing between conflicting points of view, accurate references
have been meticulously assembled. A study of a small number of published papers was carried
out using a systematic data gathering approach. A study is defined by the names of the authors,
the dates of publication, the main research phase, and the kind or total number of medical cases.
The sources, besides any potential conflicts of interest, are also stated. The findings are collected
into a collection that includes implications and an interpretation of those implications that were
researched and described utilising descriptive synthesis analysis.
Chapter Summary
In this chapter, a discussion of research design, eligibility criteria of selecting studies, search
strategy, information sources including digital databases, searching ways, process of studies
selection, quality assessment of included studies, data extraction and synthesis of results have
been discussed in a configurative manner.

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Chapter Three: Results
It is possible to convey the results of systematic reviews in several ways. In this chapter, results
from the many research included in this systematic review were presented qualitatively along
with defining the characteristics of chosen studies and summarising the findings.
3.1 Study Selection
This literature review aimed to report the current knowledge of new graduate nurses' readiness
for professional role. To achieve this, the results of selected studies have been summarized in the
table below (Table 3.1). There were two quantitative surveys (Usher et al., 2015; Woods et al.,
2015), two mixed-methods (Guner, 2015; Woo and Newman, 2020), two descriptive studies
(Watt and Pascoe, 2013; Missen et al., 2015), one qualitative (Morrell and Ridgway, 2014), and
one phenomenological study (Wiersma et al., 2020) included in this research. A table 3.2 with
the scores of all selected research has been produced, confirming the accuracy and high quality
of the studies included.
3.2 Study Characteristics
Table 3.1 Characteristics of selected studies and summary of outcomes
Authors,
Date
Aim Methodology Sample Results
(Watt and
Pascoe,
2013)
To find out
how graduate
nurses felt
about their
readiness for
practise.
Interpretive
descriptive
design.
There were 10
new nursing
graduates in
the last year of
nursing
school.
Since students were
already familiar
with the training
facility, they were
able to concentrate
more on providing
quality patient care.
The new grads
were able to feel

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like a productive
member of the
ward team since
they knew how to
access information
and clinical
resources needed
for care.
(Usher et al.,
2015)
To compare
nursing
students'
opinions of
confidence
and readiness
for practise
before and
after
completing a
capstone
course.
Quantitative
survey study
Two cohorts
of third-year
nursing
students. Pre-
capstone
cohort
(n = 113) and
post-capstone
cohort
(n = 54).
Both sets of
students were
apprehensive about
conducting invasive
treatments and
lacked self-
assurance in their
professional
identities. In
addition, both
groups felt less
confidence in their
ability to deal with
the growing
number of patients
assigned to them.
After the capstone
subject, feeling
prepared for
practise did not
improve
considerably.

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(Morrell and
Ridgway,
2014)
Assessing
student
nurses'
opinions of
their
readiness for
final practise
placement
and
identifying
the elements
that helped
or hindered
readiness.
Qualitative study 8 nurses
during their
final
placement
The students did
not feel properly
prepared for their
placement. The
utilisation of 'an
additional pair of
hands,' mentors
treating student
practise
documentation as
irrelevant, and high
staff expectations
were among the
issues emphasised.
Mentorship is
important,
especially students
who believe they
lack information,
and those who feel
unsupported and
anxious.
(Güner,
2015)
To determine
the readiness
of final year
nursing
students
Mixed-methods 1804 students
at their final
year
Students were
confident in their
ability to succeed in
the workplace.
People who had
already graduated
from a vocational
high school or were

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employed as nurses
reported feeling the
most prepared.
Attendees who had
received enough
training felt more
confident. Findings
from focus group
interviews
indicated that
students were
confident in their
academic
knowledge, but
lacked clinical
abilities.
(Missen et
al., 2015)
To find out
what the
programme
coordinators
of graduate
nursing
programmes
think about
the job
preparedness
of their
students.
Descriptive
Interview based
study
16 graduate
nursing
coordinators
from
healthcare
facilities
The study found
that nursing
graduates face a
number of
difficulties as they
prepare for practise,
including a lack of
clinical skills,
difficulties
communicating
with patients, and
difficulties
transferring from
school to work.

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(Woods et
al., 2015)
To find out
what 3rd-
year nursing
students
think about
their
readiness for
practise
during their
final
semester
Quantitative
survey approach.
235 registered
nursing
students of 3rd
year
There was a large
majority of pupils
that felt ready to
practise. Younger
nursing students
indicated higher
degrees of self-
confidence.
Participants in a
simulation feel
more confident and
prepared. Expanded
placements, more
use of simulation
for clinical skills
practise, smaller
clinical skills, class
numbers, and
contemporary
equipment were
some of the areas
that needed to be
improved upon.
(Woo and
Newman,
2020)
To examine
the
experiences
of freshly
minted
registered
nurses as
mixed-methods 30 nurses This study found
that nurses'
transition
experiences may be
broken down into
three categories:
personal,

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they made
the transition
from nursing
student to
registered
nurse.
professional, and
organisational.
These three
categories are
intertwined to
provide a holistic
picture of nurses'
transitions. This
investigation
confirms the
existence of a gap
between theory and
practise. For this
reason, educational
institutions, the
healthcare industry
and government
agencies must work
together more
closely to identify
and address the
variables that affect
students' ability to
successfully
transition to the job.
(Wiersma et
al., 2020)
To
investigate
new graduate
nurse's
transition to
Phenomenological
study
Two focus
groups
Study provided
primary challenges
that new nurses
face throughout the
transition process

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practise and
the impact of
their
education on
their
preparedness
to practise.
and recommends
strategies for
educating and
successfully
transitioning them
into professional
practise. The
findings of this
study provide a
starting evidence
foundation for other
educators in both
academic and
clinical settings
who are interested
in assisting new
graduate nurses in
making a successful
transition to
practise.

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3.3 Quality Assessment
Table 3.2 CASP Tool Appraisal Score
Authors Was
there a
clear
statement
of aims
of
research?
Is a
qualitative
methodology
appropriate?
Was the
research
design
appropriate
to address
the aims of
research?
Was the
recruitment
strategy
appropriate
to the aims
of
research?
Was the
data
collected
in a way
to
address
the
research
issue?
Has the
relationship
between
researcher
and
participants
adequately
considered
Have the
ethical issues
been taken
into
consideration?
Was the
data
analysis
sufficiently
rigorous?
Is there a
deer
statement
of
finding?
How
valuable
is the
research?
Score
Watt and Pascoe
(2013)
+ + + + + + + + + + 10/10
Usher et al.
(2015)
+ + + - + + + + + + 9/10
Morrell and
Ridgway (2014)
+ + + + + + + + + + 10/10
Guner (2014) + + + + + + + + + + 10/10

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Missen,
McKennaand
Beauchamp
(2015)
- + + + - + + + - + 7/10
Woods et al.
(2014)
+ + + - + + + + + + 9/10
Ming et al.,
(2019)
+ + + + + + + + + - 10/10
Gretchen
Wiersma et al.,
(2020)
+ + + + + + - + + + 9/10

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3.4 Synthesis of Results
In the last several decades, the nursing profession has grown significantly as nurses have been
given more and more responsibility in the healthcare industry. Nursing care for the ill is now a
more difficult notion, especially in light of modern healthcare systems, technological advances,
physical science, and pharmacology that need a high degree of intellectual ability for simple
nursing chores. When new nurses enter the workforce, they must be able to communicate
effectively and deliver safe nursing care. Because of these and other factors, such as rapidly
evolving medical practises, a growing reliance on evidence-based medicine, and rapid advances
in information systems and healthcare technology, the need for nurses who can work
independently in a variety of contexts is becoming more pressing. A new generation of nurses
must be critical thinkers and able to practise safely and autonomously because of the rising
demands in healthcare.
Watt and Pascoe (2013) performed an interpretative descriptive research to determine how newly
graduated nurses felt about their readiness to practise. Students were able to focus more on
giving superior patient care since they were already familiar with the training facilities. Because
they knew how to access information and clinical resources, the new graduates were able to feel
like contributing members of the ward team. Usher et al., (2015) used a quantitative survey to
assess nursing students' confidence and preparation for practise before and after taking a
capstone course. It was discovered that both groups of students were fearful of performing
invasive treatments and lacked confidence in their professional identities. Furthermore, both
groups lacked confidence in their abilities to manage the increasing number of patients allocated
to them. Feeling prepared for practise did not improve significantly after the capstone subject.
Morrell and Ridgway (2014) performed a qualitative research to analyse student nurses'
perceptions of their preparedness for final practise placement and to identify the factors that
aided or hampered their readiness. The students did not feel adequately prepared for their
placement, according to the findings. High staff expectations, the use of 'an extra pair of hands,'
mentors considering student practise paperwork as unnecessary, and the use of 'an extra set of
hands,' were among the difficulties raised. Mentorship is critical for students who believe they
are lacking in knowledge and who feel unsupported and frightened. Guner (2015) used a mixed-
methods approach to assess final-year nursing students' preparedness. Students were confident in

27
their abilities to excel in the profession, according to the study. Those who had already
completed a vocational high school or worked as nurses said they felt the most prepared. Those
who had gotten adequate instruction felt more assured. Students were confident in their academic
knowledge but lacked clinical competence, according to focus group interviews.
Studies looked at how well new nursing grads were prepared to practise in the real world. These
studies found that a number of individuals rated their early work experiences as terrifying and
underlined their sentiments of poor self-confidence when confronted with scenarios requiring
problem-solving, decision-making and leadership abilities. Participants' lack of self-confidence
was linked to their lack of faith in their abilities and, in some cases, their inability to acquire the
skills necessary to provide safe nursing care. Graduating into a new work environment quickly,
not having enough theoretical preparation to practise in real clinical circumstances, feeling
socially isolated in clinical areas, and the general quality of clinical environments were all
blamed for these experiences. The preparedness of first-year nursing students to enter the
workforce has also been studied. In these surveys, the majority of students thought they
possessed the necessary knowledge to begin their professional careers. However, they lacked the
confidence in their clinical talents and skills that would be required of them in the workplace.
Missen et al., (2015) performed a descriptive interview with graduate nursing programme
coordinators to learn what they thought about their students' employment readiness. Nursing
graduates experience a variety of challenges as they prepare for practise, according to the report,
including a lack of clinical skills, issues connecting with patients, and transitioning from school
to work. Woods et al., (2015) performed a quantitative survey to determine how 3rd-year nursing
students feel about their preparation for practise during their final semester. The vast majority of
students were eager to begin practising. Self-confidence was higher among nursing students who
were younger. In a simulation, participants feel more confident and prepared. Some of the areas
that needed to be addressed were expanded placements, better use of simulation for clinical skill
practise, smaller clinical skills, class numbers, and modern equipment.
Woo and Newman (2020) used mixed approaches to explore the experiences of new RNs. This
study indicated that nurses' transition experiences are personal, professional, and organisational.
These three categories interact to show nurses' changes holistically. This study indicates a

28
theory-practice divide. Educational institutions, the healthcare sector, and government agencies
must work together to identify and solve problems affecting students' career transition. Wiersma
et al. (2020) studied new graduate nurses' transition to practise and the influence of their
education on their preparation. The study identifies the main obstacles novice nurses experience
and suggests ways for training and transferring them into professional practise. This study's
findings can help academic and clinical instructors help new graduate nurses make a smooth
transition to practise.
It was Watt and Pascoe's goal to examine the attitudes of graduate nurses in Australia about their
readiness to practise after completing their last nursing degree. Participants in the research were
first-year BSN graduates. The study found that participants' readiness to practise was favourably
connected with the introduction of high-quality clinical experiences. The preparedness and
competence of senior student nurses to practise were examined in another Australian study by
Usher et al. before and after the inclusion of a Capstone subject of 240 clinical training hours at
the conclusion of their studies. For this study, researchers surveyed preregistration nursing
students in two cohorts, one of which was simply required to complete a capstone course.
It was also found that freshly minted registered nurses were unable to adjust to their new
professional identity. To put it another way, it was because their previous student environment
had protected them from real-world practise. Since their new jobs as registered nurses were more
difficult and had more serious repercussions than they had previously realised or experienced as
nursing students, their stress was worsened by this knowledge. The lack of information and
expertise they believed they lacked was also cited as a source of stress in the study. Their lack of
clinical skills and the capacity and confidence to handle additional tasks, such as dealing with
patients/relatives, medical officials and interpreting laboratory and diagnostic investigation data,
were also cited as reasons for their lack of experience.
Chapter Summary
Study selection, results synthesis, and qualitative definitions and summaries of selected studies
were all covered in this chapter.

29
Chapter Four: Discussion
Results and interpretations of findings are presented in this chapter, which also explored the
ramifications of the findings, admits their limits, and provides suggestions. To support the
conclusion, arguments were given in a systematic manner.
4.1 Summary of Evidence
This systematic review was conducted to assess the positive and negative experiences of new
graduate nurses feeling unprepared for professional role on completion degree to contribute to
the planning and revision of an effective nursing curriculum. The high rate of new graduate nurse
turnover during their first year of practise is causing staffing issues and a significant increase in
the workload of nurses. The total quality of healthcare is jeopardised by the nursing workforce's
insecurity. As a result, recognising new graduates' problems in making a smooth transition into a
professional career has piqued international interest. To achieve a stable nursing workforce,
nursing students must graduate equipped to practise safely and independently before moving into
professional settings. More emphasis should be placed on undergraduate education and clinical
experiences, which are critical in assisting new graduates in adjusting to their new jobs in real-
world situations. This study looked into the characteristics that influence new nursing graduates'
preparedness to practise safely and autonomously after completing their school. Due to the
disparity in educational preparation and clinical training experiences, several studies have found
that graduate nurses and senior nursing students lack confidence in their ability to practise. While
transition is viewed as a vulnerable time, the nursing profession, and more importantly, the
healthcare sector as a whole, is under pressure to better understand and manage the transition
process. This is because the quality of the transition experience is critical not only to newly
graduated registered nurses' capacity to offer safe and effective patient care, but also to their
short- and long-term commitment to the nursing profession. This necessitates greater
coordination between educational institutions and health-care business partners to effectively
train and assist newly graduated registered nurses before to and throughout their transition.
Clinical rotations, because nursing is a practise profession, are a type of apprenticeship training
that allows students to apply classroom ideas to clinical practise, preparing them well for

30
transfer. The significant themes were (1) focus of newly graduate nurses on patient care with
proper facilities, (2) making ward team with proper knowledge and clinical resources, (3) lack of
confidence and dreaded invasive procedures in managing patients, (4) unprepared for
professional placement, (5) high staff expectations and mentors’ dismissing student practise, (6)
highly prepared vocational nursing graduates as training boosts confidence.
4.2 Critical Discussion
According to the findings, students lacked a clear sense of their professional selves. This
phenomenon may be due to the quality of students' clinical experiences rather than the capstone
subject. When students had good clinical experiences, their self-esteem soared. Similar to this, a
research by Haruzivishe and fellow found that students' preparedness for clinical placements was
improved when they had mentors who were capable of guiding them (Haruzivishe and
Macherera, 2021). The authors outlined a number of ways to help students prepare for practise,
including encouraging mentors to help students improve their documentation abilities and
providing students with the assistance and direction they need to learn and develop their clinical
skills. It is important that students be not used as an additional pair of hands during clinical
placements (Harrison et al., 2020).
According to the findings of current research, the planning and delivery of high-quality clinical
experiences is essential in helping new graduates adjust to their new roles. Precepting
undergraduate students in the hospital environment and organisational culture is enhanced when
they work closely with authorised nursing preceptors also reported in a previous research
(McKitterick et al., 2021). In addition, regular supervision and assistance of new graduates will
help them learn the clinical skills they need to succeed in the field. Similar outcomes reported by
Jarden and fellows that nursing preceptors and academic staff have a tight working relationship,
which fosters pride in students as members of the nursing team (Jarden et al., 2021). Several
educational methods are recommended in the present research to increase students' preparedness
to practise when they get a job. Reflective and problem-based learning techniques are used.
Students can study and reflect on their clinical training experiences with other students while
being guided by nursing professors or a preceptor in this style of learning.

31
Students' critical thinking and problem-solving abilities are honed through problem-based and
reflective learning. As a result, students gain a greater sense of self-efficacy and responsibility
for their education through this form of learning. Davies et al., (2021) reported similar results
that preserving a conducive learning environment for nursing students by providing enough
supervision throughout clinical rotations. Students can become the bridge gap between theory
and practise in nursing if they get adequate guidance from experienced preceptors (Davies et al.,
2021). Helping students bridge the theory-practice gap requires timely assistance, appropriate
feedback, and student interaction in actual and challenging clinical settings. To ensure that
students receive high-quality clinical experiences, academic programmes and healthcare
institutions must work together to plan and communicate effectively (Jones et al., 2021). A
strong collaborative link between nursing programmes and clinical areas is stressed to bridge the
theory-practice divide for nursing students. Nursing students benefit from the relationship and
ongoing collaboration between nursing programmes and healthcare providers. Oducado also
documented that, only when students are given adequate assistance and direction in real-world
clinical situations can classroom and simulation lab learning become really active (Ubas-
Sumagasyay and Oducado, 2020).
There was a significant turnover rate among new graduate nurses in their first year of
employment due to healthcare facilities' high expectations. While new nurses are being
employed and trained, Eklund and fellows reported contrasting results that the high rate of new
nurse turnover has led to various staffing issues and a significant rise in nurses' workload
(Eklund et al., 2021). Understanding new graduates' and older students' difficulties in
transitioning into their professional roles has been of worldwide concern because of the volatility
of the nursing workforce and its impact on patient care and safety. Sagita and Kaihlanen in 2020
reported parallel results that, for the sake of a stable nursing workforce, it is imperative that
nursing students graduating from college are prepared to practise safely and independently
before entering the industry (Sagita et al., 2020). Pre-graduation education and clinical
experiences are critical for new graduates to adjust to their new crucial responsibilities in real-
world situations, according to the research (Kaihlanen et al., 2020).
Through the mismatch between what healthcare facilities want of new nurses and what schools
should teach them, nursing students struggled academically and clinically (Ericson and

32
Zimmerman, 2020). Through the assumed gap in students' preparedness, a better relationship
between hospitals and educational institutions to monitor and coordinate clinical experiences was
advocated. Another research looked at the preparedness of nursing students to practise,
respectively, in nursing education programmes (Dudley et al., 2020). According to the findings,
students with more clinical experience scored higher on post-tests than students with less clinical
experiences. Evans et al. observed almost similar findings that nursing preceptors and new
graduates were dissatisfied with students' academic preparation and their capacity to operate after
graduation in their study to assess the strengths and flaws of transition to practise programmes.
Walker and Campbell also looked at the link between graduates' first-year job experience and
their preparation for the workforce. The study found that graduates' clinical competency was
critical to achieving successful employment outcomes. Anxiety and lack of self-confidence were
shown to be linked to the graduates' lack of exposure to clinical experiences throughout their
training.
4.3 Strengths and Limitations
Only a single site and one data collecting method were used in Watt and Pascoe (2013).
Reflection on their last year of study was requested. There is a possibility that this led to an
increased sense of contentment. Only one site's data was used in Usher et al., (2015). An
increased response rate might be attributed to survey takers who were enthusiastic about the
subject. A lack of training chances or a lack of self-assurance may have kept pupils from
practicing the methods listed. Only one location was surveyed in Morrell and Ridgway's (2014)
study. Extensive replication is needed, taking into account many higher education institutes
(HEIs). It is possible that the findings of Güner's (2015) study may be influenced by cultural and
practise variations between nations. The research by Missen et al., (2015) was conducted only in
one Australian state. As a result, the results may not be applicable to other fields. A total of 16 of
the 54 graduate nurses who applied for the research decided to participate. People who did not
engage in the study may have different views. To generalise the data, only 48 percent of
participants in Woods et al (2015)'s study responded. Only one rural university was represented
among the participants, therefore their views do not necessarily represent the views of students in
other parts of Australia. The response rate of 48% in Woo and Newman (2020) may have
reduced the generalizability of the results. Only one rural university was represented among the

33
participants, therefore their views do not necessarily represent the views of students in other
parts of Australia.
4.4 Implications
To accomplish their clinical learning objectives, nursing faculty should encourage nursing
students to have an engaged and positive learning attitude during all clinical assignments.
Education providers should not be held completely accountable for newly graduated registered
nurses who are "job-ready" (Terry et al., 2021). The expectation put on freshly graduated nurses
by the healthcare industry that they would become skilled practitioners during their transition is
unrealistic. Nursing instructors should also warn nursing students that education programmes
cannot equip them for all of the skills they will need once they begin practicing (Labrague and
De los Santos, 2020). To avoid reality shock, creating such understanding will better prepare
nursing students emotionally and mentally for what to expect throughout their transition to newly
graduated nurses. Clinical experiences are the cornerstone of nursing education because they
offer students with the necessary learning opportunities to practise nursing skills and solidify
information in real-world situations. Many of the criteria discussed in this analysis have an
impact on graduates' preparation to work in clinical settings (Lao et al., 2021).
Academic preparation, a lack of high-quality clinical training experiences, and clinical preceptor
assistance are among these problems (Davies et al., 2020). Students' capacity to interact and
create a feeling of belonging in real-life clinical settings is harmed by a lack of adequate
connections between educational institutions and healthcare facilities. Nursing schools must
actively seek input from the healthcare industry to adapt and align its prescribed curriculum to
suit current clinical needs and core skill proficiencies necessary in today's practise environments
(Morgan et al., 2020). Nursing schools may want to explore adding more simulation-based
learning training hours to their curriculum. Stimulation-based training involves exposing nursing
students to a variety of real-life clinical settings and teaching them how to handle them in a safe
but realistic learning environment. Faculty might collaborate with the healthcare industry to
create actual case scenarios as part of the curriculum to better prepare students for job in real-
world clinical settings (Ottrey et al., 2021).

34
Nursing schools and the healthcare industry should collaborate to see if there is a way to position
nursing students in designated specialist units where they are either interested or will be allocated
to work in the future (Stoikov et al., 2022). This chance might be part of, or the entire term of,
their last clinical placement before graduation. This might be viewed as one project of
curriculum revision aimed at facilitating the consolidation of basic skills while also taking into
account the fact that other specialised talents not taught at the pre-registration level require
additional time (Murray et al., 2020). It is also critical for the healthcare business to be more
aware of the degree of knowledge and skills possessed by freshly graduated nurses, to adopt
reasonable expectations of their capabilities, and to provide better support for their requirements.
It is critical for nursing management to push for a more pleasant transition environment that
promotes the psychological well-being of freshly graduated nurses. Nurse managers at the unit
level are looking for more targeted transition programmes that account for and respond to the
requirements of freshly graduated nurses (McLeod et al., 2021). As a result, it improves the job
satisfaction of freshly graduated nurses, resulting in a smooth transition and retention and safe
and high-quality patient care.
Chapter Summary
In this chapter, summary of findings and interpretations are presented along with critical
discussion of the findings, strengths and limitations, and suggestions. Implications to practice
and knowledge were also given for future work.

35
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