Introduction
To guarantee high-quality care and the best possible patient outcomes, the area of nursing calls for strong management and leadership abilities. Setting objectives, creating action plans, and inspiring personnel are all nursing leadership and management components. This literature review will discuss the importance of preparation, mentorship, and support to nurses.
The paper will cover the new nurse transition issues, including lack of confidence, competence, critical thinking, problem-solving, and decision-making skills. Finally, the text will explore transition strategies such as transition programs, preceptorship, self-care, and resilience to help new nurse graduates successfully transition into the role of a registered nurse. Through these strategies, nurses can gain the skills, knowledge, and confidence needed to become competent and safe practitioners.
Leadership and management are two distinct but related capabilities that are often necessary for success in the workplace. Leadership involves stimulating and motivating others to reach a shared objective. According to Pishgooie et al. (2018), leaders provide a vision, direction, and enthusiasm to cultivate confidence and cooperation.
Cummings et al. (2021) add that they can stimulate others to strive towards a unified aim and create a team spirit of energy and passion. Management involves using practical abilities to arrange, coordinate, and supervise activities (Pishgooie et al., 2018). Managers are responsible for laying out objectives, formulating plans, allocating resources, and ensuring that tasks and initiatives are completed promptly and within the allocated budget.
One way to distinguish between a leader and a manager is to look at the focus of their roles. Leaders are primarily concerned with people, inspiring and motivating them to achieve a shared goal and creating a positive work environment. Cummings et al. (2021) discovered that managers are focused on processes and systems, ensuring that tasks are completed on time and to a high standard and that all team members operate efficiently.
This is supported by findings by Pishgooie et al. (2018), who claim that each situation is unique and it is difficult to determine which leadership style is better, as the appropriate style will depend on the context of the situation. Pishgooie et al. (2018) and Cummings et al. (2021) agree that a mix of leadership and management styles may be the most effective approach. For example, a leader can set a bold vision and inspire others to action. At the same time, the manager can develop a plan and ensure that it is appropriately implemented.
Themes
Preparing Nurses for the Challenges They May Face
Nursing leaders and managers play a critical role in managing nurses due to the level of responsibility carried. Nurses have varied roles, some of which might require close monitoring. Warshawsky et al. (2020) support this by stating that nurse leaders must adequately prepare those under them to ensure that they perform activities as required. This follows the Self-Efficacy Theory described by AlMekkawi & El Khalil (2020) and Bultsma et al. (2022), where self-efficacy is the belief in one’s ability to complete tasks, which is essential to successful implementation.
Moreover, Hedenstrom et al. (2022) agree by highlighting that proper leadership guides nurses to develop proper self-efficacy, promoting better work performance. For instance, implementing an onboarding curriculum effectively prepares new nurses to embrace their roles. Bultsma et al. (2022) also added that the curriculum increased new nurses’ confidence and enhanced their knowledge of the organization’s policies and procedures. Thus, preparation is key to successful leadership and management in nursing.
Nurse leaders must clearly define expectations and objectives to prepare nurses for their roles properly. According to Pishgooie et al. (2018), nurse leaders should also provide resources, tools, and training to ensure that nurses understand the tasks they will be responsible for. Hedenstrom et al. (2022) agreed that such supportive resources include individual or group training sessions, lectures, seminars, discussions, and other methods. Nurse leaders should also advocate for their nurses’ growth and development (Hedenstrom et al., 2022). Leaders and managers should strive to create a supportive and safe environment where nurses can feel confident in taking initiative and accepting responsibility.
The Social Cognitive Theory (SCT) emphasizes that the learning process is primarily based on the individual’s interactions with the environment. According to Irvine et al. (2019), it is imperative in nursing leadership and management, as it aims to promote positive behavior by preparing nurses for the challenges they may face. It was further discovered by Winqvist et al. (2023) that the learning process is affected by the environment, the individual’s capabilities, and the behavior of those around them per SCT.
However, there are often gaps in how preparation for nursing is addressed. For instance, some nurses lack the necessary experience in specific clinical settings, and some are not adequately trained in communication and patient care skills (Warshawsky et al., 2020). Vuckovic et al. (2019) and Irvine et al. (2019) added that the focus on preparation for nursing often overlooks the importance of the emotional and psychological aspects of the job, such as understanding the stresses of the job and dealing with complex patients and family dynamics. However, leaders could help nurses deal with the challenges to promote positive outcomes among nurses.
Mentorship
The Transitional Support Model (TSM) is an evidence-based model aimed at reducing the stress associated with the transition period for new nurse graduates. According to Davey et al. (2023) and Pishgooie et al. (2018), a supportive environment encourages mentorship and collaboration between new and professional nurses. This is supported by Lyman et al. (2020) and Ibrahim & Sleem (2021), who suggest that nurse mentors provide a safe and secure environment, aid in developing professional autonomy and decision-making, and offer guidance and support with clinical skills. Rush et al. (2019) add that mentorship promotes positive attitudes, proper communication, and interaction among nurses. Thus, mentorship is an essential aspect of the nursing profession.
Mentoring can not only equip nurses with the knowledge and abilities needed to succeed in professional practice but also offer emotional support. Research by Paton et al. (2022), Lyman et al. (2020), and Rush et al. (2019) have revealed that experienced nurses can help less knowledgeable nurses manage the stress and worries related to their nursing careers. This indicates that mentorship is an ongoing process; any nurse can require it at any point in their career.
However, there can be gaps in mentorship depending on a nurse’s experience level and the availability of experienced mentors. For example, Davey et al. (2023) and Luken (2019) claim that nurses may have difficulty finding mentors in their area or lack access to experienced nurses who can provide guidance and support. Additionally, there are inconsistencies in the quality of mentorship, with some leaders being better able to provide guidance and advice than others, as discovered by Luken (2019) and Ibrahim & Sleem (2021). These issues that present as gaps in the analyzed literature need to be addressed to make mentorship more effective for all nurses who require it.
Support
The Experiential Learning Theory (ELT) states that learning results from experiences and reflections. The theory posits that learning comes from experiences and reflections. Research conducted by Irvine et al. (2019) and Labrague & Santos (2020) found that nurses should be given endless chances to gain knowledge and become proficient in a secure, nurturing atmosphere as they continue practicing. Sarkar et al. (2022) and Davey et al. (2023) support this by positing that nurses require enough time and resources to think about their experiences and hone their skills. This helps them overcome their fears and progress fast in gaining the knowledge others have gained over their practice.
The Protean Career Theory (PCT) can guide nurses in their practice by helping them to identify their skills and strengths and to recognize the importance of networking and professional relationships. Redondo et al. (2019) and Luken’s (2019) theory analysis discovered that it can help nurses assess their current situation, identify areas of opportunity, and devise plans to optimize their professional growth and satisfaction. Additionally, the authors added that PCT can enlighten nurses to become aware of the changing nature of the healthcare industry and recognize the need for continued skill development and professional networking to stay relevant and competitive.
The Situational Leadership Theory (SLT) provides a practical framework for leaders to assess the needs of nurses and provide the necessary support and guidance. According to Luken (2019), the leader can maximize the potential of each nurse by acknowledging their unique strengths and weaknesses and providing the correct type of guidance and assistance to facilitate their growth and success in their roles. One gap noted by Cummings et al. (2021), Davey et al. (2023), and Luken (2019) in the caring theme of support is that nurses in a high-stress environment may struggle to provide the same level of support to their colleagues as nurses in a more relaxed setting (Sarkar et al., 2022); Davey et al., 2023). Thus, nurses may not always be aware of the needs of their colleagues or may be reluctant to provide the necessary support due to time constraints or other factors.
Transition
Transition is adjusting to a new situation or environment, which may involve changes in lifestyle, thoughts, beliefs, and behaviors. It can include moving to a different place, starting a new job, or entering a new stage of life, such as marriage, parenthood, or retirement. The first phase of transition is the honeymoon phase, marked by a feeling of excitement and enthusiasm. According to Graf et al. (2020), people typically experience a sense of optimism and excitement when anticipating the future, often accompanied by a surge of energy as they take on fresh opportunities with assurance.
The Reality/Shock phase is the second stage of the transition process. During this stage, individuals must face the reality of their new circumstances. This can lead to feeling overwhelmed, disconnected, and out of place in their new environment (Ibrahim & Sleem, 2021). The unfamiliarity of the situation and difficulty adjusting can lead to confusion and frustration as the individual attempts to find their place and identity. Finally, during recovery, a person slowly acclimates to new surroundings and becomes accustomed to them.
Transition Issues
Lack of Confidence
New nurse graduates often struggle with self-doubt as they adjust to their new roles. This lack of confidence can affect the nurse’s ability to perform the expected tasks and lead to low levels of self-assurance in their capabilities and decisions. Studies have shown that new graduates are often unprepared to transition from nursing school to practice (Labrague & Santos, 2020; Song & McCreary, 2020).
The lack of preparedness can contribute to the deprivation of confidence that new nurse graduates experience. The research conducted by Labrague and Santos (2020) revealed that nurses with little clinical experience before graduating may struggle with feelings of low confidence and being unequipped for the transition into the profession. Therefore, nurse managers can help nurses overcome this by guiding them in decision-making, which could help build confidence in new nurses.
New nurses may struggle with confidence in their ability to perform due to inexperience and pressure from others. This can be heightened by a denial of support from more experienced nurses, who may be too busy to provide guidance, causing the new nurses to feel isolated and uncertain of their capabilities, as analyzed by Calleja et al. (2019). This is supported by Labrague & Santos (2020), who state that support includes mentorship and educational opportunities such as simulation training to help new nurses build their knowledge and clinical skills. Therefore, nurse leaders providing a safe and supportive environment for new nurses to ask questions and discuss patient care issues can help alleviate feelings of insecurity.
It is widely accepted that new nursing graduates often experience low confidence as they transition into the nursing role, and consistency is noted in this concern. According to Woo and Newman (2020), nurses who are not confident in their capabilities are more prone to procrastination, take longer to complete tasks, and make more errors. Woo & Newman (2020) and Labrague & Santos (2020) identify one information gap in this aspect: there is limited research on the level of confidence among new nursing graduates’ experiences during the transition period. This is because it can vary widely, with some feeling very confident and others feeling overwhelmed and lacking in confidence (Labrague & Santos, 2020). The confidence experienced by new nursing graduates is linked to the level of support and guidance they receive from their managers during the transition period, which is another consistency regarding poor confidence in new nurses.
Lack of Competence
The transition from the classroom to the clinical setting can be challenging for new nurse graduates, resulting in a lack of competence in the workplace. Baker (2020) attributes this to inadequate preparation for the transition, lack of experience with the clinical setting, and lack of understanding of the expectations of the role. Moreover, there is also a lack of confidence in the workplace, a lack of a strong support system, and a lack of knowledge of the nursing field (Baker, 2020; Labrague & Santos, 2020). As a result, new nurses may feel overwhelmed and lack the necessary skills and knowledge to be successful in the workplace, leading to a lack of confidence and competence.
One potential cause of incompetence among nurse is inadequate clinical experience during their education. Clinical experiences are essential for nurses to gain the knowledge and skills to offer safe, quality care (Baker, 2020). Additionally, transitioning from classroom learning to the clinical setting can be difficult for students. This can be more challenging when experienced staff members do not provide sufficient support and guidance during clinical placements. Labrague and Santos (2020) add that leaders can resolve this by creating progressive learning programs and experiential opportunities for nurses to keep learning from each other. Therefore, the management can foster competence development among nurses, preparing them for their roles.
Furthermore, recent graduates may be unfamiliar with the policies and procedures of the healthcare organization, which can lead to decreased patient safety and quality of care. Baker (2020) reveals a lack of consistency in the definition of competency and a gap in the evidence-based assessment of competency. Moreover, there is an inconsistency in the approaches to competency assessment and a lack of a unified standard of competency assessment across different healthcare settings (Labrague & Santos, 2020).
Furthermore, there is a lack of research on the impact of competency on patient outcomes and the need to provide adequate support and resources to new nurses during their transition period. Leaders can overcome this by making fair programs where all nurses can practice their skills and get guidance where needed (Woo & Newman, 2020). Moreover, the needs of nurses need to be understood by their leaders in order to be solved from a person-centered perspective.
Lack of Critical Thinking, Problem-Solving, and Decision-Making Skills
New nurses may struggle with applying critical thinking, problem-solving, and decision-making skills professionally due to a lack of experience and training. These abilities are vital to successful nursing, yet many recent graduates are unprepared to handle them in their roles (Cooke et al., 2019). Evaluating a situation from multiple angles and making informed decisions based on evidence is a key critical thinking component. This is supported by İlaslan et al. (2023) and Cooke et al. (2019), who suggest that nurses must be able to analyze a patient’s condition and make sound judgments as to the best course of action. Problem-solving involves recognizing an issue, weighing various solutions, and choosing the most suitable one (İlaslan et al., 2023). Leaders can resolve issues related to these aspects by analyzing data, considering the pros and cons of different courses of action, and then deciding on the best option.
The lack of critical thinking, problem-solving, and decision-making in new graduates is due to a few different factors. Cooke et al. (2019) suggest that nursing education programs tend to be overly focused on the theoretical side of the profession and do not provide enough guidance on applying those concepts in real-world scenarios. This is further supported by İlaslan et al. (2023) and Cooke et al. (2019), who claim that these skills are best honed through real-world experience and practice, which can be challenging to come by for new graduates. According to İlaslan et al. (2023) and Cooke et al. (2019), nurses lack the necessary skills to make sound clinical decisions, which can result in adverse patient outcomes.
However, there is some inconsistency in the literature regarding the best way to address this issue, as Baker (2020) discussed. While İlaslan et al. (2023) suggest that more formal education and training are necessary to equip nurses with these skills, Cooke et al. (2019) presume that more informal on-the-job training and mentorship are the best ways to improve these skills. Nurse leaders can promote this issue by allowing the nurse to present their suggestions on handling different clinical issues to promote their critical thinking and problem-solving skills.
Transition Strategies
Transition Programmes (NETP/NESP)
A successful transition program for new nurse graduates is essential to the success of nursing leadership and management. As Devoe et al. (2021) illustrated, the New Employee Transition Program (NETP) is an effective program that equips new nurses with the skills and knowledge they need to succeed in their positions. This program offers mentorships, educational seminars and workshops, and guidance in understanding and utilizing the healthcare system (Devoe et al., 2021). İlaslan et al. (2023) agree by stating that through the NETP, nurses can build relationships with their peers and learn about their workplace culture and expectations.
Moreover, the New Employee Support Program (NESP) is designed to ease the transition of new nurse graduates into the profession. It provides comprehensive orientation, mentoring, and professional development opportunities to help new nurses develop the skills and knowledge needed to succeed (İlaslan et al., 2023). Participants learn about the healthcare system, communication and teamwork, the nurse’s role in the system, and the laws and regulations of the profession (İlaslan et al., 2023). The NESP also offers support and guidance to ensure new nurses can practice confidently and competently.
However, there is also evidence of gaps in implementing these programs, with some programs lacking sufficient structure, resources, and support. İlaslan et al. (2023) and Cooke et al. (2019) agree that there is inconsistency in the design of these programs, with some programs providing inadequate guidance and mentorship. To ensure the effective implementation of these transition programs, there needs to be more consistency in the design and delivery of the programs and the provision of adequate resources and support.
Preceptorship
Preceptorship is key for new nurse graduates to enter the profession effectively. It involves a new nurse joining forces with an experienced mentor for a personalized learning experience. The preceptor mentors and educates the new graduate (Vuckovic et al., 2019). This approach is advantageous as it enables the new graduate to learn in a safe and supportive atmosphere while guided by an experienced mentor.
According to Woo and Newman (2020), the advantages of having a preceptor for new nurse graduates are manifold. These advantages include improved patient outcomes, greater job satisfaction, better communication abilities, self-confidence, reduced staff turnover, and improved job retention (Vuckovic et al., 2019). The preceptorship experience could also be rewarding for the preceptors, as it provides a chance to strengthen their teaching and management abilities, reflect on their work, and gain fulfillment from supporting others.
There is some inconsistency regarding the overall impact of preceptorship on new nurse graduates. In a study by Woo & Newman (2020), preceptorship did not significantly impact nursing performance, while in another research by Vuckovic et al. (2019), it was found to be beneficial. Furthermore, there is a lack of evidence regarding the long-term effects of preceptorship on new nurses’ performance and career development (Vuckovic et al., 2019). There is also some inconsistency regarding the best practices for preceptorship, as different organizations may have different expectations and approaches (Woo & Newman, 2020). Furthermore, there is a need for more research regarding the impact of preceptorship on different groups of nurses, such as those from diverse backgrounds.
Self-Care and Resilience
New graduates are particularly vulnerable to burnout due to transitioning from student to practitioner. Self-care is “a conscious act of looking after oneself” (Lin et al., 2020) and is essential for maintaining physical and mental health. Self-care strategies can range from simple activities, such as taking regular breaks and getting plenty of sleep, to more complex systems, such as utilizing coping skills or engaging in positive self-talk. Resilience is a crucial strategy for new nurse graduates to transition successfully into the registered nurse role. It is the capacity to adapt and cope with challenging and complex situations (Lin et al., 2020). Resilience is acquired through experience, which occurs over time as nurses engage in more nursing practice.
Self-care and resilience are widely accepted strategies for aiding in the transition period of new nurse graduates. Lin et al. (2020) suggest a lack of consistency in how this strategy is used and gaps in the literature related to its efficacy. Although research has been conducted on the topic, further work is needed to understand the impacts of self-care and resilience on new nurse graduates (Auttama et al., 2021). There also appears to be a need for further research into the best ways to apply these strategies in the post-graduate transition period (Auttama et al., 2021). Thus, self-care is essential in assisting new nurses in transitioning smoothly into their nursing careers.
Leaders and managers have a significant impact in aiding new nurse graduates as they transition into their roles. As Gellerstedt et al. (2019) discussed, managers should offer guidance and mentorship, set clear expectations and goals, offer feedback, and provide the necessary resources and assistance to help new nurses succeed. Moreover, Riegel et al. (2021) claim that leaders should create an atmosphere of openness, collaboration, and responsibility to guarantee that the new nurses receive support and can reach their highest potential.
Managers can help create an atmosphere of respect and cooperation by engaging in conversations with nurses, offering constructive feedback, and listening to their worries (Gellerstedt et al., 2019). They can also build a powerful team of nurses by providing the necessary skills, knowledge, and tools to do their job. Moreover, Auttama et al. (2021) suggest that nurse leaders can offer guidance, educational programs, and support for professional growth. Therefore, nurse leaders are essential, especially in supporting new nurse graduates to thrive in their careers.
Conclusion
In conclusion, the transition period for new nurse graduates is a necessary time to determine their nursing career’s success. New nurses must have adequate resources and support to transition into practice successfully. Transition programs such as the NETP and NESP are essential in providing new nurses with the necessary skills and knowledge to become competent and safe practitioners. In addition, preceptorship, self-care, and resilience strategies can help reduce the stress associated with the transition period and ensure that new nurses are adequately prepared to enter practice.
By implementing these strategies, recent nurse graduates can have the best chance of success in their new roles. At the same time, effective leadership and management in nursing are critical components of ensuring a successful transition process for new nurse graduates. Leaders should provide support and mentorship and foster collaboration and open communication.
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