The Lived Experience of New Graduate Nurses DQ
The Lived Experience of New Graduate Nurses DQThe Lived Experience of New Graduate
Nurses DQAll questions must be answered in bullet format with rationale provided.Sample
and settingWas the group or population of interest adequately described? Were the setting
and sample described in sufficient detail?Was the best possible method of sampling used to
enhance information richness?Was the sample size adequate? Was saturation
achieved?Summary assessmentDo the study findings appear to be trustworthy- do you have
confidence in the truth values of the result?Does the study contribute any meaningful
evidence that can be used in nursing practice or that is useful to the nursing
discipline?ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSThe Lived
Experience of New Graduate Nurses Working in an Acute Care Setting James A. McCalla-
Graham, PhD, RN; and Jennie C. De Gagne, PhD, DNP, RN-BC, CNE abstract The high attrition
rate of graduate nurses will exacerbate the current nursing shortage as Baby Boomer
nurses (born between 1946 and 1964) retire, negatively affecting the quality of patient care
and increasing employer costs. The purpose of this phenomenological study was to explore
the lived experiences of new graduate nurses employed in an acute care setting in
southwest Florida. This information provides further guidance to nurse educators as they
develop curricula, graduate nurses to transition into professional practice, and create
strategies to increase retention. Ten participants who were traditional students in generic
baccalaureate nursing programs, selected through purposeful and snowball sampling, were
interviewed via open-ended questions. Using Colaizzi’s classic phenomenological method of
data analysis and NVivo 10 software, three overarching themes emerged—knowledge,
skills, and environment— which were interpreted in relation to graduates’ lived experience.
Recommendations include implementation of innovative initiatives that address new
graduates’ experience and increase retention. J Contin Educ Nurs. 2015;46(3):122-128. I n
the United States, the demand for nurses is growing faster than the supply. The Lived
Experience of New Graduate Nurses DQThe U.S. population will grow by 18% during the
period of 2000-2020, which will significantly increase the demand on the health care
system (Health Resources and Services Administration, 2002). The current shortage of
qualified nurses in the health care system makes this increase problematic. The problem
gets worse with the increased turnover of graduate nurses from the clinical practice
environment. Gradu- 122 ate nurses are first exposed to professional practice in the acute
care clinical setting, which continues to be the primary setting for treatments of complex
illnesses with the use of innovative technology (Hodges, Keeley, & Troyan, 2008). Thus, it

becomes necessary to maintain a significant number of qualified graduate nurses to satisfy
the growing need of the U.S. health care system. Educators can use the lived experience of
graduate nurses as a catalyst to them in their role transition (Halfer & Graf, 2006), given
that such knowledge may be considered the missing component in nursing education in
helping them bring about changes in behavior. The understanding derived from exploring
the lived experiences of graduate nurses, especially during the first 12 months, may provide
educators with relevant data to develop curriculum activities suited to the clinical learning
environment. The data may also provide ideas on how teaching and mentoring practices in
the clinical practice environment can enhance the graduate nurses’ confidence. Thus,
analysis of the lived experience of graduate nurses in the acute care clinical practice
environment is of vital importance to the understanding of professional longevity and
preparedness to practice in their workplaces. By 2018, new RN positions will increase to
518,500, which is a 22% increase in the size of the RN workforce Dr. McCalla-Graham is
Instructor, Jersey College School of Nursing, Tampa, Florida; and Dr. De Gagne is Assistant
Professor, School of Nursing, Duke University, Durham, North Carolina. The authors have
disclosed no potential conflicts of interest, financial or otherwise. Address correspondence
to James A. McCalla-Graham, PhD, RN, Instructor, Jersey College School of Nursing, 3625
Queen Palm Drive, Tampa, FL 33619; e-mail: jgraham@jerseycollege.edu. Received: July 29,
2014; Accepted:The Lived Experience of New Graduate Nurses DQNovember 3, 2014
doi:10.3928/00220124-20150220-17 Copyright © SLACK Incorporated (U.S. Bureau of
Labor Statistics, 2009). However, this projection does not consider the additional need
created by graduate nurses who left the acute care setting for jobs other than nursing.
Kovner et al. (2007) found that 13% of newly licensed RNs changed their primary jobs
within 1 year of employment, and 37% believed they were ready to change jobs. The
attrition of graduate nurses from the acute care clinical practice environment is likely to
exacerbate the already untenable U.S. nursing shortage. Previous research has shown that
the rate at which new graduate nurses leave the clinical practice environment is
unsustainable, particularly considering the challenges faced by the health care industry, as
the aging population of Baby Boomers in this country is approaching retirement (Cowin &
Hengstberger-Sims, 2006). Recent literature includes studies on the lived experiences of
new graduate nurses in the clinical practice environment and the type of these graduates
need to enable them to transition smoothly into professional practice (Dyess & Sherman,
2009; Gill, Deagan, & McNett, 2010). Choudhry et al. (2007) argued that U.S. emergency
departments in acute care hospitals have difficulty meeting the demands of patients who
use the facilities as their primary source of health care. This situation poses special
challenges to new graduate nurses, whose initial exposure to professional practice occurs in
the acute care clinical environment (Hodges et al., 2008). The challenges for new graduate
nurses include the intense work environment, the use of advanced medical technology in
the clinical environment, the increased patient acuity in hospitals, and the sudden transition
from the educational to the service setting (Halfer & Graf, 2006). The high rate of turnover
negatively affects quality patient care and also results in increased costs to employers
(Flinkman, Leino-Kilpi, & Salantera, 2010). The cost associated with nurses’ turnover
averages $65,000 per nurse, which comprises the refilling of the vacancies, the arrangement

for new hires, and the loss of organizational productivity (Jones, 2008). One of the leading
factors in the high turnover of graduate nurses is work-related stress (Duffield, Roche, Blay,
& Stasa, 2011; Yeh & Yu, 2011). An effective transition strategy can potentially reduce the
new nurses’ stress level and invariably contribute to their decision to remain in the clinical
practice environment beyond the time at which they might otherwise retire. Exploring
graduate nurses’ experiences may potentially benefit the development of curriculum and
continuing education, which incorporates work experience in teaching and learning. The
Lived Experience of New Graduate Nurses DQHence, the purpose of this phenomenological
study was to explore the lived experiences of new graduate nurses The Journal of
Continuing Education in Nursing · Vol 46, No 3, 2015 employed in an acute care clinical
setting in southwest Florida. METHOD Study Design Descriptive phenomenology was used
for this study. Informed consent was obtained from each participant and included the study
purpose, procedure, risks, and benefits. The research question was: What are the lived
experiences of new graduate nurses in their first 12 months in the acute care clinical
practice environment? This classic phenomenological approach, which has its beginning in
the disciplines of philosophy and psychology, seeks to understand and explain the lived
experiences of a group of people and the meaning they ascribed to their experiences (Polit
& Beck, 2004). It serves the purpose of generating new knowledge or adding to the existing
body of knowledge related to the phenomenon under study. By definition, this research
paradigm emphasized the interpretation of text, discourse, and meaning. Sample and
Setting Approval to conduct the study was obtained from the university’s institutional
review board. The inclusion criteria for this study were nurses currently practicing in the
acute care clinical settings and having been employed and experienced in the clinical area
for up to 12 months. Exclusion criteria were nurses who had worked as licensed practical
nurses or licensed vocational nurses, or who were licensed by endorsement. The initial
sampling was done through the selection of two participants via purposeful sampling and
then proceeded to snowball sampling, in which the researcher asked participants to identify
others to become members of the sample. A total of 10 participants were selected through
this process. All participants were located and employed in multiple acute care clinical
practice environments in southwest Florida. Participants were purposively selected based
on their professional experience as graduate nurses and inclusion criteria only, not on their
affiliation to a particular hospital. The interviews were conducted in a private setting that
was mutually convenient. Each interview lasted for approximately 45 to 60 minutes. A
demographic questionnaire was provided to the participants for completion at the end of
each interview. The participants were traditional students in generic baccalaureate nursing
programs, ranging in age from 22 to 56 years, including seven women and three men, and
representing two of the three major health care corporations in southwest Florida. The
Lived Experience of New Graduate Nurses DQAll of the participants except for one held
positions in other fields prior to working in health care. 123 Data Collection The data for
this study were collected from participants via open-ended questions. A pseudonym was
assigned to each participant to provide anonymity. The interview protocol and guide were
developed and reviewed by nursing experts in the field of nursing education and were
evaluated for construct and content. A written topic guide, consisting of 11 questions, was

used to ensure that all questions relevant to the phenomenon being studied were covered.
The interviews began with a general question, allowing the participants to verbalize their
experiences as they related to the phenomenon under study. The interview questions
enabled the subquestions to be answered. The interviews were digitally recorded and then
loaded into a computer and transcribed verbatim using computer-assisted qualitative data
analysis software (CAQDAS). Tape recordings of the interviews ensured that the entire
verbal encounter was captured to provide complete data for analysis. Data Analysis and
Verification Using Colaizzi’s (1978) classic phenomenological method of data analysis, the
written descriptions of the new graduate nurse experiences were broken down into
meaningful units derived through the identification of themes. In addition, NVivo10
software was used to facilitate the coding process. The CAQDAS program helped with
unstructured data, such as audio, to enhance decision making. It also helped to track ideas
and steps, as well as the use of annotations to jot down one’s thoughts and create memos to
capture detailed observations, and used links to attach codes with similar themes together.
These themes were then interpreted to provide answers to the research question related to
the lived experience of the participants. The next step was to take each of the themes
identified, code them, and compare each individual interview with other interviews in the
study. After the major topics were identified through chunking—taking individual units of
information and incorporating them in a group—each unit was reviewed for connections
among participants. Finally, the transcribed and coded units were used to describe the
structure of the experience as related to the phenomenon. After the data were analyzed,
interviewees reviewed the transcripts to validate the content, give feedback, and ensure
that the themes portrayed their experiences. This process involved debriefings and
discussions with study participants by providing them with the analyzed research data for a
final validation step. RESULTS The results were summarized according to the major topics
of the interview: knowledge, skills, and environ124 ment related to working in an acute
care setting as new graduate nurses. The themes that emerged from the analysis of the data
were explained in narratives and described in detail through participants’ quotes.
Knowledge The Lived Experience of New Graduate Nurses DQThe general consensus of the
research participants indicated that nursing school provided basic knowledge for the
neophyte nurses, but it did not actually prepare them to function effectively in their first 12
months in the acute care clinical learning setting. Many of the participants expressed the
view that nursing school did not adequately prepare them for their current roles and
responsibilities. It was the expressed conviction of some of the nurses that nursing school
focused on enabling the student to pass the national licensure examination. The participants
commented on the need to have worst-case scenarios as part of their clinical rotation that
would have helped in acquiring the requisite knowledge and broad-based background
necessary to function effectively and safely in the practice setting. Some of these comments
are as follows: • I do think that we were prepared very well, when it came to medications
and procedural knowledge…kind of like the books, as far as book smarts go, I think that the
nursing program that I went through did a good job with book smarts…. I may not have
known how to do some things, or I may not have known the actual procedural part, but
having the background knowledge helped an awful lot. • I feel that nursing school gave me

the essential knowledge obviously to pass the NCLEX exam, which is the basically the test as
to whether you have the basic knowledge….