The Transition Experience of New Graduate Nurses in the Emergency Department

Abstract

Background: New Graduate Nurses (NGNs) face multiple learning and transition challenges as they start their careers. However, little is known about this experience in the Emergency Department (ED) setting. Aim: The purpose of this study was to explore the experience of NGNs’ transition to nursing practice in the ED, including the intrapersonal, interpersonal, and organizational factors that facilitate or hinder this process. Methods: Guided by the Interpretive Descriptive design, this study included ten NGNs working in EDs in southwestern Ontario, Canada. Participants provided demographic information and completed individual interviews. Data from transcripts were analyzed using reflexive thematic analysis. Findings: Four main themes were generated from this study: (1) the effects of the ED environment, (2) the introduction to practice, (3) the adaptation in practice, and (4) the evolution over time. The experiences of transition were impacted by environmental barriers, such as complex patient workloads, unpredictable patient volume and flow, and short staffing. NGNs’ introduction to practice reflected the barriers and facilitators of their academic and organizational training, and support in the workplace. NGNs lacking preparedness and support for ED practice led to a perceived inability to meet practice expectations and occupational stress. NGNs adapted through interpersonal and occupational resources, workload management skills, and intrapersonal actions and behaviors. NGNs evolved by developing confidence and competence in their practice, and in their professional nursing identity. Conclusion: Factors in the ED environment present unique challenges to NGNs’ experience of transitioning into their first professional nursing role. As staffing issues in the ED persist, NGNs will continue to be hired, despite discrepancies in their practical knowledge and skills. Further education, research, and practice initiatives are needed to support the transition of NGNs to the ED setting.