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Concililsartical-Newlylicensednurseresiliencyandinterventionstopromoteresiliencyinthefirstyearofhire-Anintegrativereview

Concililsartical-Newlylicensednurseresiliencyandinterventionstopromoteresiliencyinthefirstyearofhire-Anintegrativereview

153The Journal of Continuing Education in Nursing · Vol 50, No 4, 2019

Newly Licensed Nurse Resiliency and Interventions to Promote Resiliency in the First Year of Hire: An Integrative Review Lisa Concilio, MSN-ED, RN, CCRN; Joan Such Lockhart, PhD, RN, CNE, ANEF, FAAN; Marilyn H. Oermann, PhD, RN, ANEF, FAAN; Rebecca Kronk, PhD, MSN, CRNP, CNE, FAAN; and James B. Schreiber, PhD

The nursing shortage has been a long-standing problem in the United States and spans eight decades (National League for Nurses, 2017). Newly licensed nurses (NLNs) are graduate RNs who have passed the National Council Licensure Exam-RN (NCLEX-RN®) and are employed for the !rst time in the role as a professional nurse. NLN turnover has been reported in recent years to a”ect patient safety and com- pounds the global nursing shortage (Boamah & Las- chinger, 2015; Bradbury-Jones, 2015; Kovner, Brewer,

Fatehi, & Katigbak, 2014; Spence Laschinger, Zhu, & Read, 2016; #omas & Kellgren, 2017; World Health Organization, 2017). #e American population is liv- ing longer with chronic diseases and expanding disabili- ties; more well-prepared RNs are needed as health care is ever-advancing and technology is at the forefront to help solve health care problems and improve quality of life (Academy of Medical-Surgical Nurses, 2018; Ghe- breyesus, 2018; National Academy of Medicine, 2017; Reinhard, 2014).

PROBLEM IDENTIFICATION AND SIGNIFICANCE #e American Association of Colleges of Nursing

(2017) reported that 1.2 million RN positions will be vacant between 2014 and 2022 and that approximately 700,000 nurses will retire or leave the workforce by 2024. Cline, La Frentz, Fellman, Summers, and Brassil (2017)

abstract Background: Lack of resiliency contributes to grow-

ing dissatisfaction among newly licensed nurses (NLNs) and often leads to clinical errors and job resignations. Method: An integrative review synthesized current re- search investigating NLNs’ resiliency within their first year of hire and interventions that may affect their re- siliency. Results: Key database searches (2008 to 2018) yielded 16 studies. Insufficient resiliency among NLNs has been correlated with intentions to leave current jobs and decreased job satisfaction. Residency pro- grams, well-prepared preceptors, and peer support promoted NLN resilience and enhanced patient safety. Lack of coworker support has led to NLNs’ intentions to leave their current jobs or the profession entirely. Conclusion: NLN turnover has been interpreted to be an outcome of poor NLN resilience. The first year of practice is stressful and affects NLNs’ mental health and cognitive reasoning, thereby risking patient safe- ty. Resiliency should be measured using a resiliency scale rather than turnover rates. [J Contin Educ Nurs. 2019;50(4):153-161.]

Ms. Concilio is PhD Student, Dr. Lockhart is Professor and MSN Nurs- ing Education Track Coordinator, Dr. Kronk is Associate Professor, and Dr. Schreiber is Professor of Epidemiology/Statistics, Duquesne University School of Nursing, Pittsburgh, Pennsylvania; and Dr. Oermann is !elma M. Ingles Professor of Nursing, Duke University School of Nursing, Dur- ham, North Carolina. Ms. Concilio is also Lecturer and Clinical Instructor, School of Nursing, San Diego State University, San Diego, California.

!e authors thank Dr. Jane Brannan, EdD, Professor of Nursing, Ken- nesaw State University, Kennesaw, Georgia, for her content expertise and support. !e authors also thank David Nol”, MLS, AHIP Head, Research Engagement, Health Sciences/STEM Initiatives, Assessment Coordinator Gumberg Library, Duquesne University, Pittsburgh, Pennsylvania, for on- going support.

!e authors have disclosed no potential con#icts of interest, “nancial or otherwise.

Address correspondence to Lisa Concilio, MSN-ED, RN, CCRN, Lec- turer and Clinical Instructor, School of Nursing, San Diego State Uni- versity, 10006 Maya Linda Rd. #5207, San Diego, CA 92126; e-mail: conciliol@duq.edu.

Received: August 13, 2018; Accepted: October 22, 2018 doi:10.3928/00220124-20190319-05

 

 

154 Copyright © SLACK Incorporated

reported that training one NLN may cost a health care system $60,000 to $96,000; therefore, increasing NLN resiliency is imperative to maintain patient safety and is a !nancial priority. NLNs experience immense stress, leading to a state of shock while transitioning to practice (Duchscher, 2009) and resulting in burnout and turn- over (Laschinger et al., 2016; Pfa”, Baxter, Jack, & Ploeg, 2014). Dyrbye et al. (2017) de!ned burnout as a syndrome characterized by emotional exhaustion that leads to poor performance and an attitude that is contrary to caring. Nurse burnout has led to sta$ng shortages and increased turnover rates, which has resulted in the use of physical re- straints, patient falls, and the formation of pressure ulcers (Aiken et al., 2014; Robert Wood Johnson Foundation [RWJF], 2012).

Resiliency has been identi!ed as a key factor in manag- ing the stress of nursing work–life, bu”ering burnout, and positively in%uencing NLNs’ intentions to stay their cur- rent jobs (Chesak et al., 2015; Cope, Jones, & Hendricks, 2016; Delgado, Upton, Ranse, Furness, & Foster, 2017; Reyes, Andrusyszyn, Iwasiw, Forchuk, & Babenko-Mould, 2015). Mudd (2016) stated that the concept of resiliency is elusive and a closer examination of resiliency is needed in order to decrease burnout and decrease turnover. With- out resiliency or ways to cope with the emotional stressors and workplace adversities (Delgado et al., 2017), nurses (including NLNs) may develop inconsistent thoughts, be- liefs, and values that will render them unsafe for practice and increase intentions to leave their jobs (Hart, Brannan, & De Chesnay, 2014; Stephens, 2012; Tahghighi, Rees, Brown, Breen, & Hegney, 2017). #is article describes an integrative review of the literature that examined NLNs’ resiliency within their !rst year of hire and interventions that a”ect their resiliency.

EXPLORING THE CONCEPT OF RESILIENCE IN NURSING

#e youngest generation of nurses are the most likely group of nurses to lack the protective factors of resilien- cy and leave the profession within the !rst year of hire (Flinkman, Isopahkala-Bouret, & Salanterä, 2013; RWJF, 2014). Resilience assists a nurse’s psyche to cope with the negative consequences of workplace stress (Fletcher & Sarkar, 2013). Stressors encountered by nurses in health care organizations include an increasing aging population, growing numbers of patients with chronic illnesses, and an aging nursing workforce (American Association of Col- leges of Nursing, 2017). To overcome these organizational and systemic stressors, nurses have been remediated to provide excellent customer service and uphold standards of care; yet, these approaches have not addressed the afore- mentioned stressors or bolstered nurses’ resilience (Insti-

tute of Medicine, 2014; Spence Laschinger et al., 2016; Wonder, York, Jackson, & Sluys, 2017).

A resilient nurse receives information and acts on it to safeguard patients and advocate for their needs (Sieg, 2015). Resiliency is the ability to command psychomotor skills (the ability to perform tasks and communicate cor- rectly and in a timely manner) and cognitive-behavioral skills (cognitive re-framing, mindfulness, compassion, and emotional intelligence) in order to perform success- fully while stressed (Academy of Medical-Surgical Nurses, 2018; McAllister & Lowe, 2011). In this article, we pro- vide current knowledge on the concept of NLN resilience during the !rst year of hire because the lack of resiliency causes nurses to act in a manner that is contrary to caring. As dissatisfaction builds, it leads to an increase in errors and contributes to NLNs leaving their current jobs (Ga- briel, Diefendor”, & Erickson, 2011; Hart et al., 2014). #erefore, a need exists to understand NLN resilience during the !rst year of hire.

PURPOSE AND SPECIFIC AIMS #e purpose of this integrative review is to summarize

and synthesize NLN resiliency and interventions used to promote NLN resiliency within the !rst year of hire in an e”ort to guide future research in this area. Although resilience has been widely studied in nurses (Delgado et al., 2017; Hart et al., 2014; Stephens, Smith, & Cherry, 2017) and nursing students (Stephens, 2012, 2013), few studies have examined NLN resilience. #is integrative review explores the past literature to describe factors as- sociated with a lack of resiliency or its protective factors and to investigate approaches that increase NLN resil- iency. #e following speci!c aims guided this integrative review: t� What is the state of NLNs’ resiliency within their !rst

year of practice? t� What are the contributing factors that promote or hin-

der NLNs’ resilience? t� What are the outcomes associated with NLNs’ resil-

ience or lack of resiliency? t� What are the current interventions or strategies used to

build protective factors of resilience that lead to NLNs’ intention to stay at their current jobs?

t� What tools have been used to measure NLNs’ resiliency and have been correlated with intentions to leave jobs?

METHOD An integrative approach by Whittemore and Kna%

(2005) guided this review of the literature. #is model included !ve stages (problem identi!cation, literature search, data evaluation, data analysis, and presentation) to enhance accuracy and ensure a thorough search.

 

 

155The Journal of Continuing Education in Nursing · Vol 50, No 4, 2019

Literature Search A systematic process was used to review the pri-

mary studies of qualitative and quantitative research designs (Whittemore & Kna%, 2005). #e process of conducting an integrative review is to provide an unbi- ased review of the literature. To retrieve relevant litera- ture, searches were conducted with the assistance of a health science librarian using the Cumulative Index to Nursing and Allied Health Literature (CINAHL®) and PubMed® databases and restricted to English-language articles published from January 2008 to May 2018. #e following subject headings were used to retrieve articles that included descriptions about NLNs: newly licensed nurses, resiliency, and intention to leave. #e Boolean operators AND and OR were used to com- bine these terms with newly licensed nurse* and nurs* (Table A; available in the online version of this arti- cle). Inclusion criteria included (a) the topic addressed resilience or protective factors leading to resilience in NLNs; (b) study participants were NLNs within their !rst year of practice; (c) any research design was used; (d) the studies were conducted in the United States; and (e) publication was between January 2008 and May 2018. #e review excluded nonresearch publications, gray literature, and publications that did not address the inclusion criteria.

A total of 789 articles were identi!ed from CINAHL and PubMed using the initial search terms; 56 duplicates were removed, resulting in 733 publications. As shown in the PRISMA %ow diagram (Figure 1), 570 articles were removed based on their abstracts, which did not meet the inclusion criteria. Next, 163 articles were re- trieved for full-text evaluation; 147 of these were exclud- ed as they did not meet the inclusion criteria, leaving 16 articles that comprised the !nal sample for this review (Anderson, Linden, Allen, & Gibbs, 2009; Bontrager, Hart, & Mareno, 2016; Clark & Springer, 2012; Cline et al., 2017; Clipper & Cherry, 2015; Fiedler, Read, Lane, Hicks, & Jegier, 2014; Fink, Krugman, Casey, & Goode, 2008; Gill, Deagan, & McNett, 2010; Hodges, Keeley, & Troyan, 2008; Hodges, Troyan, & Keeley, 2010; Kramer et al., 2013; Li, Early, Mahrer, Klaristenfeld, & Gold, 2014; Martin & Wilson, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009; Pellico, Brewer, & Kovner, 2009). #ere was no follow-up with authors to retrieve additional information.

Sample studies included qualitative (n = 8), quantita- tive (n = 5), and mixed-methods (n = 3) designs. Quali- tative studies used case study (n = 2), phenomenological (n = 3), and grounded theory analyses (n = 3). Quantita- tive studies were nonexperimental (n = 5) and included causal-comparative (n = 1) and descriptive analyses (n =

4). Mixed-methods studies used sequential, exploratory designs (n = 3).

Data Evaluation #e data evaluation stage used a methodological ap-

proach to appraise the quality of each publication (Whit- temore & Kna%, 2005). Each quantitative study was evaluated and categorized based on its quality of evidence and recommendation level for practice using the GRADE (Grading of Recommendations, Assessment, Develop- ment, and Evaluations) Guideline Criteria for Appraising Quality of Evidence (Schünemann, Ahmed, & Morgan, 2011); for qualitative studies, the GRADE-CERQual Con!dence in the Evidence from Review of Qualitative Research (Lewin et al., 2018) was used. Qualitative stud- ies were evaluated using GRADE-CERQual and catego- rized using a systematic approach to increase transparency in the appraisal process. Four components were used to evaluate qualitative studies: methodological limitations, coherence, adequacy of data, and relevance. Publication bias is also important and was considered in the appraisal of qualitative evidence and placed as a !fth criterion. Elev-

Figure 1. Graphical representation of the flow of citations reviewed. Adapted from “Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, and D.G. Altman, 2009, Physical Therapy, 89, pp. 873-880. Copyright 2009 by Moher et al. Adapted with permission.

 

 

156 Copyright © SLACK Incorporated

en studies were rated as moderate to low quality (quali- tative, n = 8; mixed-methods, n = 3) and the remaining !ve quantitative studies were rated moderate to very low quality.

A matrix was created to track key data extracted from each study using the following subheadings: author, pub- lication year, design, sample population, setting, purpose/ aims, variables, instruments, and the quality appraisal (Table B; available in the online version of this article). Evidence was recorded as high, moderate, low, or very low (Table B). Observational designs were noted using ++, and experimental studies were noted using ++++ (Lewin et al., 2018; Ryan & Hill, 2016).

Data Analysis During data analysis, primary studies were organized,

categorized, summarized, and integrated into a conclu- sion about the research problem of each study based on (a) NLNs’ resiliency within the !rst year of practice, (b) contributing factors of NLNs that promote or hinder re- silience, (c) the outcomes associated with NLNs’ resilience or the lack thereof, (d) methods found to build resilience in NLNs, and (e) an examination of the tools that have been used to measure NLNs’ resiliency and correlated with intentions to leave their jobs. Results were synthesized us- ing a consistent, correlative method to identify patterns and relationships, create themes, draw conclusions, and provide a comprehensive summary (Whittemore & Kna%, 2005).

RESULTS Presentation of data is the !nal stage of an integrative

review, which exhibits detailed evidence from each sample study (Whittemore & Kna%, 2005). #e presentation also includes a synthesis of sample studies based on the review’s purpose and aims.

Description of Sample All 16 sample studies were published in the United

States and distributed from 2008 to 2017; most studies (n = 3) were published in 2009, and none were published in 2013. Studies were published in nine di”erent journals, and more than one study was included in the Journal of Nursing Administration (n = 4), !e Journal of Continuing Education in Nursing (n = 3), and Nursing Outlook (n = 3).

A wide range of sample sizes existed by study designs: qualitative studies (7 to 612 participants); quantitative (51 to 558 participants); and mixed-methods (7 to 434 participants). Both male and female NLNs were included as study participants in half of the studies, with female NLNs comprising the majority of study participants, ranging from 83.4% to 94.2%. #e percentage of male

NLNs included as study participants ranged from 5.8% to 16.6%. Conversely, the remaining half of the studies did not disclose participants’ gender. Reported age ranges of participants varied among studies, with most NLNs rang- ing from 21 to 25 years; two studies repeated mean ages of 33 and 33.4 years; and one study reported a median age of 38.6 years. Other studies reported diverse age ranges: 18 years or over (n = 1); 21 to 50 years (n = 1); 20 to 25 years (n = 1); and younger than 30 years (n = 1).

Only four studies reported the participants’ race/eth- nicity. Caucasian was the highest group represented (n = 4, 54.7%) followed by Black (n = 4, 13.6%), Latino (n = 3, 6.1%), and Asian (n = 2, 16.7%). Study settings were mainly inpatient care settings in medical centers and hos- pitals across the United States.

NLN Resiliency Literature published over the past decade revealed that

NLNs’ resiliency must be fostered for NLNs to remain at their current jobs. Insu$cient resiliency among NLNs has been correlated with intentions to leave current jobs, turnover, and decreased job satisfaction. According to the sample studies (n = 14), most NLNs want to leave their jobs due to dissatisfaction with nursing work and/or their work environments (Anderson et al., 2009; Bontrager et al., 2016; Clark & Springer, 2012; Cline et al., 2017; Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al., 2010; Kramer et al., 2013; Li et al., 2014; Martin & Wil- son, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009; Pellico et al., 2009).

Factors That Promote or Hinder NLN Resiliency Residency programs and coworker support were re-

ported to enhance NLNs’ intentions to remain in their current jobs and the nursing profession. Residency pro- grams speci!cally designed to address the needs of NLNs positively a”ected NLN resiliency (Anderson et al., 2009; Cline et al., 2017; Fiedler et al., 2014). #e protective fac- tors of resilience that emerged among the sample studies were social support (Clipper & Cherry, 2015; Fiedler et al., 2014; Hodges et al., 2008; Li et al., 2014; Martin & Wilson, 2011), group cohesion (Anderson et al., 2009; Bontrager et al., 2016; Gill et al., 2010; Li et al., 2014), well-prepared preceptors (Bontrager et al., 2016; Clip- per & Cherry, 2015), relationship-based care practices (Clark & Springer, 2012; Clipper & Cherry, 2015; Fink et al., 2008; Kramer et al., 2013; McCalla-Graham & De Gagne, 2015; Olson, 2009; Pellico et al., 2009), organi- zational support (Fiedler et al., 2014; Fink et al., 2008; Olson, 2009), and plentiful clinical support (Fink et al., 2008).

 

 

157The Journal of Continuing Education in Nursing · Vol 50, No 4, 2019

NLN resiliency decreased when NLNs experienced verbal abuse from physicians and incivility among other sta” nurses (Kramer et al., 2013; Martin & Wilson, 2011; Olson, 2009; Pellico et al., 2009). #eir inability to meet expectations of preceptors, unengaged preceptors, and de- creased support when making errors also hindered NLNs’ con!dence and job satisfaction which, in turn, negatively a”ected their resiliency (Gill et al., 2010; Li et al., 2014).

Outcomes Associated With NLN Resiliency Positive Outcomes. NLN resiliency, which has been in-

ferred as NLNs who want to stay in their jobs (McAllister & Lowe, 2011), improves empathy toward patients, job engagement, augmented teamwork, enhanced ability to perform tasks, boosted con!dence, adaptability, and im- proved clinical reasoning. All these outcomes of resiliency assist in closing the preparation–practice gap and enhance patient safety (Fink et al., 2008; Martin & Wilson, 2011; Olson, 2009).

Negative Outcomes. #e most common outcome as- sociated with poor NLN resiliency cited in the nurs- ing literature is high turnover (Anderson et al., 2009; Bontrager et al., 2016; Clark & Springer, 2012; Cline et al., 2017; Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al., 2010; Kramer et al., 2013; Li et al., 2014; Martin & Wilson, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009; Pellico et al., 2009). Second, a lack of support from preceptors, sta”, physicians, and other NLNs increases NLNs’ intentions to leave their jobs or the profession entirely (Anderson et al., 2009; Li et al., 2014; Martin & Wilson, 2011; Olson, 2009). Finally, poor resiliency decreases an NLN’s capability to work in a team setting (Bontrager et al., 2016; Clark & Springer, 2012; Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al., 2010; Kramer et al., 2013; Mar- tin & Wilson, 2011; Pellico et al., 2009). Teamwork is the cornerstone of patient care delivery as clinicians col- laborate and use enhanced communication to bene!t patients to attain mutual goals (World Health Organiza- tion, n.d.). As NLN resiliency decreases, so does patient safety.

Methods to Build Resiliency and Decrease Turnover

Nurse residency programs have been reported to build NLN resiliency and decrease turnover or the intention to leave a job (Anderson et al., 2009; Bontrager et al., 2016; Clark & Springer, 2012; Cline et al., 2017; Fiedler et al., 2014; Fink et al., 2008; Gill et al., 2010; Kramer et al., 2013; Li et al., 2014). Residency programs coordinate group learning and utilize a buddy system approach to

on-the-job learning; residency programs were reported to increase socialization, which Dyer and McGuinness (1996) reported is a protective factor of resiliency. Eleven of the sample studies concluded that collegial relation- ships, social support, and professional acculturation were formidable and essential to cope with stress of a chaotic, foreign, and challenging work environment (Anderson et al., 2009; Bontrager et al., 2016; Fiedler et al., 2014; Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al., 2010; Li et al., 2014; Martin & Wilson, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009). Hodges et al. (2010) and Fiedler et al. (2014) de- scribed NLNs building comradery with others to negate feelings of inadequacy as method to protect themselves from the daily assault of stress and self-doubt. Addition- ally, Martin and Wilson (2011) described NLNs forming caring groups to enhance collegial relationships; these supportive groups helped to decrease feelings of doubt and stress experienced during their transition from aca- demia to practice.

Measuring Resiliency and the Outcomes #is integrative review presents studies that correlated

resiliency using satisfaction surveys, evaluations of precep- tor e”ectiveness, and intention to leave surveys to best un- derstand the reasons why NLNs leave their jobs. Table C (available in the online version of this article) outlines the tools used in sample studies (n = 8) to evaluate strategies to build NLN resiliency (Anderson et al., 2009; Bontrager et al., 2016; Clark & Springer, 2012; Cline et al., 2017; Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al., 2008; McCalla-Graham & De Gagne, 2015). Studies did not evaluate patient outcomes while measuring NLN satisfaction or intention to leave. Yet, Gill et al. (2010) explored NLNs’ work perspectives to gauge nursing qual- ity by using the 10-item abbreviated version of the Na- tional Database of Nursing Quality Indicators (NDNQI) (reliability coe$cient = .91; Taunton et al., 2004). #e NDNQI was correlated with intentions to leave one’s job, yet the majority of the participants (n = 7) in this study intended to leave their current job despite indicating they were satis!ed. #e same !nding was reported by Clark and Springer (2012), in which NLNs expressed intentions to leave their jobs despite being satis!ed with the care they delivered (n = 37).

DISCUSSION An iterative process of examining each sample study to

identify patterns, themes, noting intervening factors, and relationships between variability (Whittemore & Kna%, 2005) was done to clarify, summarize, and synthesize what is known about the phenomenon of resiliency in NLNs,

 

 

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within the !rst year of hire, in an e”ort to guide future research in this area.

First, the concept of NLN resiliency is not well un- derstood as NLN turnover has been interpreted to be an outcome of poor NLN resiliency. Second, the expec- tation of NLNs is to take on new responsibilities and overcome numerous challenges to integrate themselves into a practice environment that stresses teamwork; this belief is so overwhelming that it negatively a”ects NLNs’ mental health. #ird, these feelings drain NLNs, which, in turn, can cause cognitive and emotional la- bility and a”ect clinical reasoning, a clear and present danger to patient welfare. Finally, resiliency should be measured using a resiliency scale, as the decision or in- tention to leave one’s job is not a surrogate to determine NLN resilience.

A growing body of research indicates NLNs’ attri- tion is increasing at an alarming rate, despite residency programs assisting in their transition to help them as- sume professional responsibilities for which they may be unprepared (Clark & Springer, 2012; Cline et al., 2017; RWJF, 2014). Nurse incivility among sta”, in- cluding NLNs, occurs due to the high-stakes climate and coworkers’ ine”ective communication skills (Las- chinger, Wong, Regan, Young-Ritchie, & Bushell, 2013). A paradox ensues as NLNs believe they would be cared for by caring professionals in a caring environ- ment (Hart et al., 2014; Hodges et al., 2008; Marine, Ruotsalainen, Serra, & Verbeek, 2006; Martin & Wil- son, 2011; Pariyo, Kiwanuka, Rutebemberwa, Okui, & Ssengooba, 2008).

Implications for Practice, Policy, and Research #e implications for this integrative review provide

information to hospital educators and administrators re- garding the trends and needs of NLNs and adds a new perspective on workforce readiness in an e”ort to pro- mote patient safety. Nursing research has used a positiv- ist approach to assess NLN resiliency, a philosophy that has not advanced nursing science in this area. Millennials (ages 22 to 37) (Dimock, 2019) comprise the majority of newcomers to the nursing workforce and have the high- est attrition rate among any generation that has entered the nursing profession (RWJF, 2014). #erefore, nurse researchers must apply a social constructivist approach, as there is much to learn about the Millennial generation in the workplace (Veesart, 2018). A social constructivism approach encourages a participant’s own interpretation of the situation to better understand the meaning of their experience (Dahnke & Dreher, 2010). #is sociological lens may help researchers, managers, and educators evalu- ate NLN resilience as a truth created by their own per-

ceptions rather than through job satisfaction surveys or intention to leave scales. #e American Academy of Nurs- ing Policy agrees there is a need to build NLNs’ resilience (Goode, Glassman, Ponte, Krugman, & Peterman, 2018) to mitigate the negative e”ects of stress and encourage in- tention to stay at their !rst job is paramount. Research regarding low-cost, social support strategies to encourage NLNs’ motivation and engagement in nursing is needed to garner patient safety.

Limitations Several limitations existed among the sample studies

that may result in the !ndings not being applicable to each NLN’s experience during their !rst year of hire or to their abilities to build resiliency. For example, detailed information was not provided regarding sample char- acteristics such as age in nine studies (Anderson et al., 2009; Clark & Springer, 2012; Fink et al., 2008; Hodges et al., 2008; Kramer et al., 2013; Li et al., 2014; Martin & Wilson, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009). Additionally, there was minimal represen- tation of men in all sample studies, as well as a poor representation of ethnic/racial diversity. Various prac- tice settings among the studies limited generalizability of the !ndings as the settings included medical centers, hospitals, and specialty units (i.e., oncology). Each set- ting used di”erent ways to orient NLNs and participants faced varying types of experiences, which may not repre- sent all NLNs’ experiences when transitioning into their !rst jobs.

#e designs of the 16 sample studies were primar- ily surveys or qualitative interviews. One study did not report the reliability and validity of the instrument used (Anderson et al., 2009). Researchers did not directly mea- sure participants’ resilience in any of the sample studies yet inferred that participants’ resilience was low if they intended to leave their jobs. #is ambiguity may have led to a lack of di”erentiation among the search terms, as turnover and intention to leave have been correlated with resilience. However, strategies that encourage group cohe- siveness, managerial involvement, and adequately prepare preceptors for what Duchscher (2007, p. 23) referred to as the “transition shock” period may increase resiliency and decrease intentions to leave (Anderson et al., 2009; Bon- trager et al., 2016; Clark & Springer, 2012; Cline et al., 2017; Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al., 2010; Kramer et al., 2013; Li et al., 2014; Martin & Wilson, 2011; McCalla-Graham & De Gagne, 2015; Olson, 2009; Pellico et al., 2009; RWJF, 2014). Despite these e”orts, NLN attrition rates continue to rise each year.

 

 

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CONCLUSION #is integrative review provides pertinent informa-

tion to researchers, managers, educators, and health care administrators about the concept of NLN resiliency. De- creased resiliency threatens patient safety. NLNs expressed di$culties feeling con!dent, which, in turn, a”ects profes- sional development—a factor that is crucial to preparing a competent workforce. A supportive sta” of nurses and physicians who are empathetic to the challenges NLNs face during the !rst year of hire is a proven facilitator of NLN resiliency; these supportive attributes increase NLN job engagement, con!dence, and enhances team building skills. Additionally, resilience may be an indicator of prac- tice readiness, a vital key to motivate and retain NLNs.

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Table A Search Terms by Databases Used in the Literature Search

Database Search Term Headings Used: Newly Licensed Nurse, Leaving within First Year, and Resiliency

No. of Titles and Abstracts

CINAHL search terms

( (“Newly licensed nurse*” OR (MH “New Graduate Nurses”) OR ((MH “Nurses+”) OR nurse*) AND (MH (“Internship and Residency) OR MH (“Transitional Programs) OR MH (“Employee Orientation) OR MH (“Preceptorship))) ) AND ( (MH “Personnel Retention”) OR (MH “Personnel Turnover”) OR Retention OR Turnover OR Attrition OR Quit OR Stay OR “Negative Nurse Outcomes” OR “Intention to Leave” OR “Intention to Quit” OR (MH “Intention”) OR (MH “Personnel Attitudes”) OR (MH “Motivational factors for turnover intention”) OR (MH “Professional Identity”) OR (MH “Locus of control”) OR (MH “Negative Patient Outcomes”) OR (MH “Willingness to leave”) OR Manpower OR “Motivational factors” OR “Psychosocial Factors” OR “negative patient outcomes”) AND ( (MH (“Adaptation, Occupational”) OR (MH “Avoidance (Psychology)” OR (MH “Coping”) OR (MH “Cultural Safety”) OR (MH “Disengagement”) OR (MH “Disruptive Behavior”) OR (MH “Hardiness”) OR (MH “Job Satisfaction”) OR (MH “Optimism”) OR (MH “Reality Shock”) OR (MH “Self-Efficacy”) OR (MH “Social Adjustment”) OR (MH “Stress Disorders, Post-Traumatic+”) OR (MH “Stress, Occupational”) OR (MH “Support, Psychosocial”) OR (MH “Symptom Distress”) OR (MH “Symptom Distress”) OR (MH “Vulnerability”) OR “Nurse Shock” OR “Occupational Adaptation” OR “occupational shock” OR “personal identity disturbance” OR “Post- Traumatic Stress Disorder” OR “Professional ident*” OR “psychological capital” OR “Reality Shock” OR Coping OR Optimis* OR Protective factors OR PTSD OR Resiliency) OR (MH “Motivation”) OR (MH “Psychological Factors”) OR (MH “Occupational Coping”) OR (MH “Shared decision-making”) OR (MH “Workplace empowerment”) OR (MH “growth mindset”) OR (MH “Prevention and Control”) OR (MH “Occupational Commitment”) OR (MH “Professional commitment”) OR (MH “Controlled Motivation”))

397

PubMed search terms

(((( “Emotional Adjustment”[Mesh]) AND “Sense of Coherence”[Mesh] OR “Resilience, Psychological”[Mesh] OR “Adaptation, Psychological”[Mesh] OR “Problem Behavior”[Mesh] OR “disruptive behavior”[tiab] OR “disruptive behavior”[ot] OR “Job Satisfaction”[Mesh] OR “Absenteeism”[Mesh] OR

392

 

 

Note. CINAHL = Cumulative Index to Nursing and Allied Health Literature.

“Presenteeism”[Mesh] OR “Optimism”[Mesh] OR “Self Efficacy”[Mesh] OR “Social Adjustment”[Mesh] OR “Stress Disorders, Post-Traumatic”[Mesh] OR “Social Support”[Mesh] OR “Nurse Shock” [tiab] OR “Occupational Adaptation” [tiab] OR “occupational shock” [tiab] OR “personal identity disturbance” [tiab] OR “Post-Traumatic Stress Disorder” [tiab] OR “Professional identity” [tiab] OR “Professional identities”[tiab] OR “psychological capital” [tiab] OR “Reality Shock” [tiab] OR Coping[tiab] OR Optimis*[tiab] OR “Protective factor” [tiab] OR “Protective factors” [tiab] OR PTSD[tiab] OR Resiliency[tiab] OR “Nurse Shock” [ot] OR “Occupational Adaptation” [ot] OR “occupational shock” [ot] OR “personal identity disturbance” [ot] OR “Post-Traumatic Stress Disorder” [ot] OR “Professional identity” [ot] OR “Professional identities”[ot] OR “psychological capital” [ot] OR “Reality Shock” [ot] OR Coping[ot] OR Optimis*[ot] OR “Protective factor” [ot] OR “Protective factors” [ot] OR PTSD[ot] OR Resiliency[ot] OR “Motivation”[Mesh] OR “psychology” [Subheading] OR “Decision Making”[Mesh] OR “Prevention and Control”[Subheading]))) AND ((Quit[ot] OR Quit[tiab] OR retention[ot] OR Retention[tiab] OR Stay[ot] OR Stay[tiab] OR Turnover[ot] OR Turnover[tiab] OR “Personnel Turnover”[Mesh] OR “Personnel Loyalty”[Mesh] OR Retention[tiab] OR Retention[ot] OR Turnover[tiab] OR Turnover[ot] OR Attrition[tiab] OR Attrition[ot] OR Quit[tiab] OR Quit[ot] OR Stay[tiab] OR Stay[ot] OR “Negative Nurse Outcomes”[tiab] OR “Negative Nurse Outcomes”[ot] OR “Intention to Leave”[tiab] OR “Intention to Leave”[ot] OR “Intention to Quit”[tiab] OR “Intention to Quit”[ot] OR Manpower[tiab] OR “Motivational factors” [tiab] OR “Psychosocial Factors” [tiab] OR “negative patient outcomes” [tiab] OR Manpower[ot] OR “Motivational factors” [ot] OR “Psychosocial Factors” [ot] OR “negative patient outcomes” [ot]))) AND ((“Newly licensed nurse”[tiab] OR “Newly licensed nurse”[ot] OR “Newly licensed nurses”[tiab] OR “Newly licensed nurses”[ot] OR “New Graduate Nurse”[ot] OR “New Graduate Nurse”[ot] OR “New Graduate Nurses”[ot] OR “New Graduate Nurses”[ot] OR “Novice nurse” [tiab] OR “Novice Nurse”[ot] OR “Novice nurses” [tiab] OR “Novice Nurses”[ot] OR “Newly licensed nurse*”[tiab] OR “New Graduate Nurses”[ot] OR “Novice nurse” [tiab] OR “Novice Nurses”[ot] OR (“Nurses”[Mesh] OR nurse*[tiab] OR nurse*[ot]) AND (“Internship, Nonmedical”[Mesh] OR “Inservice Training”[Mesh] OR “Preceptorship”[Mesh]))

Total no. of citations including duplicates

789

 

 

T able B

Sum

m ary of F

indings from R

esearch Studies (N =

16) __________________________________________________________________________________________________________ A

uthor/year D

esign/M ethod

Sam ple population/ Purpose, A

im s, Findings A

ppraisal R ating/

Setting V ariables, and Q

uality of E vidence

Instrum ents using G

R A

D E

or G

R A

D E

-C E

R Q

ual

 

_____________________________________________________________________________________ A

nderson et al. (2009)

m ixed m

ethods/ sequential exploratory

90 new graduate

nurses, gender and ethnicity not reported/interactive nurse residency

Purpose: to com pare

perceived job satisfaction and em

ployee engagem

ent of new

graduate nurses com

pleting an interactive nurse residency. A

im s: to m

easure job satisfaction and engagem

ents perceptions of new

nurses after com

pleting interactive residency m

odules and to test the environm

ent nursing satisfaction survey. V

ariables: change for nurse residency –

Q ualitative results

revealed 2 them es

(protective factors of resiliency em

erged): w hat

satisfied nurses (patients, patient outcom

es, and team

w ork) and w

hat did not satisfy nurses (staffing/scheduling, lack of team

w ork,

M D

disrespect). Q

uantitative results: “A

fter the nurse residency sessions and 1 year later, the quantitative findings on the H

alfer-G raf

survey revealed that the nurse residents

+ +

⨁ ◯ ◯ ◯

R

isk of bias: T here

w ere lim

itations in detailed design as the outcom

e w as not

confidently determ

ined as the tool’s psychom

etrics w

ere not discussed. T

here w as no

discussion about the H

alfer-G raf Job/W

ork E

nvironm ent N

ursing Satisfaction Survey other than stating it w

as reliable and valid as previously stated in previous studies. M

ost inform ation w

as stated from

studies at

 

 

im plem

entation of a 2- day interactive nurse residency. Instrum

ents: H alfer-

G raf Job/W

ork E

nvironm ent N

ursing Satisfaction Survey (psychom

etrics not reported)

significantly perceived that they w

ere able to perform

their job, identify resources, understand perform

ance expectations, accom

plish w ork

tasks, and m anage

the dem ands of the

job effectively” (p. 168). A

n interactive learning environm

ent assists new

graduate nurses in job satisfaction and em

ployee engagem

ent. M ost

valuable strategy w

as em ail

com m

unication as a form

of support (a protective factor of resiliency).

low or unclear risk of

bias. T his denotes

serious risk of bias, dow

n grade one level (R

yan, 2016). Inconsistency: the sam

ple w as from

one cohort of new

graduate nurses and one period in tim

e. T

his denotes som e

inconsistency and a dow

ngrade of one point is recom

m ended

(R yan, 2016).

Indirectness: the author answ

ered the question of w

hether this particular cohort w

ere satisfied and engaged by using interactive residency m

odules. Im

precision: C

onfounding variables w

ere not discussed as to other reasons to the 4%

increase of new

graduate nurse retention w

hen com

pared to past years. T

here w as not

 

 

enough inform ation to

detect a precise estim

ate of the effect (interactive residency m

odules on new

graduate satisfaction and job engagem

ent). Publication bias: N

ot detected, Journal of N

ursing A

dm inistration has

various studies of size and design.

B ontrager et

al. (2016) quantitative/ descriptive, prospective, cross- sectional

84 new ly licensed

registered nurses enrolled in a residency program

. 5.8% of

participants w ere m

ale. 66.7%

participants w

ere C aucasian, 17.9%

w

ere black, 3.6%

L atino, and 7.1%

A

sian.

Purpose: to understand how

preceptor role effectiveness and group cohesion affect N

L N

s’ satisfaction and intent to stay. A

im s: W

hat w ere the

relationships am ong

preceptor role effectiveness, group cohesion, and job satisfaction am

ong N

L N

s? W hat w

ere the relationships am

ong preceptor role effectiveness, group cohesion, job satisfaction, and

H igh levels of

intention to stay at job w

as perceived by nurses due to the role of preceptors, job satisfaction, and group cohesion (protective factor of resiliency). Preceptors that are effective ensure a quality orientation and can help socialize a new

nurse and encourage job satisfaction. G

roup cohesion w as

found to be vital to increase feelings of

+ +

⨁ ⨁ ◯ ◯

R

isk of bias: T ool

psychom etrics w

ere reported and C

ronbach D scores

show ed reliability and

validity. T he

tools/scales w ere

justly chosen to predict the outcom

e level. Inconsistency: the sam

ple w as not

discussed regarding units w

orked on or shift w

orked. T he

ability to exam ine

 

 

intent to stay am ong

N L

N s?

V ariables: D

V :

preceptor role effectiveness, group cohesion, and job satisfaction Instrum

ents: Preceptor R

ole E

ffectiveness Scale, N

urse Job Satisfaction Scale, Intent to Stay Scale.

value, reduce burnout, stress and anxiety. G

roup cohesion is im

portant to reduce transition shock and intention to stay.

changes during the orientation period w

as not discussed. D

oubtful that there are large variations in the degree to w

hich the outcom

e is affected, no dow

ngrade if on the basis that it does not seem

to be an issue. Indirectness: T

here w

as evidence of indirectness as the outcom

e w as assessed

at only one period in tim

e w hich lim

ited the ability to exam

ine changes. T

he evidence that w

as found w

as m ore

restrictive than the review

question and m

ay not directly answ

er the review

question, “W hat w

ere the relationships am

ong preceptor role effectiveness, group cohesion, and job satisfaction am

ong N

L N

s? W hat w

ere the

 

 

relationships am ong

preceptor role effectiveness, group cohesion, job satisfaction, and intent to stay am

ong N

L N

s?” D ow

ngraded one point as som

e indirectness exists. Im

precision: good correlation w

ith prim

ary studies, no im

precision detected. Publication bias: N

ot detected, T

he Journal of C

ontinuing E

ducation in N ursing

has various studies of size and design.

C lark &

Springer (2012)

qualitative/ case study m

odel

37 new graduate nurses

in a nurse residency program

across m any

specialty areas/ northw

estern U S

15.6% of participants

w ere m

ale. T he

ethnicity of participants w

as not reported.

Purpose: to exam ine

the lived experience as new

nurses to assess the level of job satisfaction during the first year of practice. A

im s: 1. H

ow do new

graduate nurses describe their typical w

orkday? 2. W

hat are the m ost

satisfying aspects of

T hem

es that em

erged: learning to w

ork in chaos, feeling valued, stress of the unknow

n, life-long learning, and preserving the profession. Preceptors and staff are vital to enhancing job satisfaction and

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: Prim ary

studies revealed conflicting evidence regarding the lived experiences of new

nurses. W

e are confident that the findings in this study reflect this sm

all

 

 

the new graduate

nurses’ nursing? 3. W

hat are the m ost

concerning aspects of the new

graduate nurses’ practice? 4. W

hat educational topics do new

graduate nurses w

ant to know m

ore about? 5. W

here do the new

graduate nurses see them

selves practicing nursing in the future? V

ariables: D V

: job satisfaction Instrum

ents: open- ended questions

com m

itm ent to

nursing. Support (protective factor of resiliency) w

as m

entioned to im

prove job satisfaction. T

he stress of life-long learning w

as divided into sub- them

es that included dealing w

ith incivility, adapting to change, and stress m

anagem ent.

Participants described being valued by colleagues as a m

ajor contributor to job satisfaction. O

rganizations can help new

nurses feel valued by using relationship-based care and increasing collegial relationships as w

ays for enhancing satisfaction and feelings of com

petence. Som e

sam ple’s lived

experience as it did represent w

hat w as

found in prim ary

studies discussed. R

elevance: N ew

nurses are experiencing a new

environm

ent and w ay

to function yet one of the research questions asked about educational topics they m

ay w ant to

know m

ore about. T

he prem ise of being

“new ” and the chaos

this brings, it seem s

contrary and not relevant to pursue this aim

. N ot applicable to

the context specified in describing the lived experience of a new

nurse; dow

ngraded one point. C

oherence: T here is

good fit betw een the

data from the prim

ary studies and the review

findings. A

dequacy of data: T

here is good

 

 

participants stated preceptors w

ere unsupportive and disinterested and this decreased job satisfaction. T

his also increased stress and decreased new

nurses’ ability to w

ork in team s.

am ounts of data

supporting the review

finding and this aligns w

ith prim ary studies

about the lived experiences of new

nurses. Publication bias: N

ursing O utlook has

published diverse studies designs w

ith various sam

ple sizes.

C line et al.

(2017) Q

uantitative/ descriptive, retrospective analysis of 10 years of residency data

First stated over 1,000 participants’ data w

ere analyzed then table show

ed 558 new nurses

w ithin 12 m

onths of hire/residency program

in a cancer center w

ithin the U S 8.9%

w

ere m ale participants.

Percentage of C

aucasian participants w

as 36% , B

lack 21.6%

, L atino 12.2%

, A

sian 26.3% .

Purpose: to present a 10-year retrospective review

of outcom es

from an internally

developed nurse residency program

A

im s: an analysis of

an internally developed residency program

on the developm

ent of new

nurses. V

ariables: “custom

ized” nurse residency program

at one cancer care center and w

as “enhanced” over tim

e, sim ulation w

as

Scores in support declined over the course of the residency program

w

hich decreased professional satisfaction. T

he C

asey-Fink scores revealed participants’ stress levels w

ere low

during this residency program

, this is not consistent w

ith prim ary studies

or new ly licensed

nurses’ experiences in the literature. T

he authors suggested that findings

+ +

⨁ ◯ ◯ ◯

R

isk of bias: there w

ere lack of details in the design and execution as the residency program

over tim

e had m any

changes. Inconsistency: there w

as little understanding of the outcom

es from this

longitudinal study and how

the data supported the outcom

e that residency program

s assist in new

nurse

 

 

also added through the years. Instrum

ents: C asey-

Fink G raduate N

urse E

xperience Survey, institutional retention m

etrics

developed in this “custom

” residency program

em

phasized that a program

just about entry to practice can com

fort new nurses

and prom ote

confidence (protective factor of resiliency) w

hich w

ill lead to positive retention.

job satisfaction and therefore retention. Indirectness: applicability of this custom

ized residency program

(undetailed) did not help reader to understand the phenom

enon of new

nurse retention or the ability to enhance dealing w

ith stress or adversity (resilience). Im

precision: there is a large am

ount of inadequacy due to the levels of stress reported and the confounding variables such as the possibilities of financial stress due to the level of support the hospital m

ay have offered participants as opposed to the actual stress of the job. Publication bias: yes, this study w

as m ost

likely published due to the positive findings that a residency program

 

 

 

can possibly influence new

nurse retention.

C lipper &

C

herry (2015)

quantitative/ descriptive, com

parative

59 participants/ gender and ethnicity w

ere not specified

Purpose: to describe the im

plem entation

and evaluation of a preceptor developm

ent program

and its effect on the new

graduate nurse’s transition to practice and m

easure first- year turnover. A

im s: to assess new

nurses’ perceptions of their transition and preceptors betw

een 2 groups of preceptors (one group trained in a structured and w

ell- developed program

: details w

ell explained, and the other group w

as untrained). V

ariables: ID : new

nurses w

ithin the first year of hire. D

V :

perceptions of transition to practice betw

een 2 groups of preceptors. T

rained

T he study evaluated

the effectiveness of a preceptor program

by m

easuring perceptions of transition to practice and 1

st year retention of 2 groups of form

er nurse graduates and the other group w

as those that did not participate in structured training. N

ew graduates have

m ore positive

perceptions regarding safe care giving and have a slightly better retention rate than those w

ho did not have a structured new

graduate program

. Preceptors need to address them

es of socialization (protective factors

+ +

⨁ ⨁ ◯ ◯

R

isk of bias: Possible lim

itations in the design – obviously w

ell-trained preceptors w

ould better understand the needs of new

nurses and help m

itigate the stress of transition, but the study did not reveal reasons for consistent turnover or new

nurse dissatisfaction during the first year of hire. It w

as clear from

previous literature that a w

ell prepared and trained preceptor w

ill decrease transition shock, but still not a big change in new

nurse retention. Inconsistency: the findings w

ere consistent w

ith the

 

 

preceptors and untrained preceptors. Instrum

ents: 16-item

investigator developed surveyed based on the attributes of transition shock theory w

as used to obtain data regarding new

nurse perceptions of the transition process and the effectiveness of their preceptors.

in resiliency) in order to build confidence and foster good relationships to build form

s of support. N

ew nurses that had

trained preceptors expedited to a higher level of practice faster than the untrained preceptor cohort. It w

as anticipated that those that w

ere in the cohort of untrained preceptor w

ould stay at the organization due to lack of confidence and that w

as not the case. C

onfidence w as

found to directly im

pact patient outcom

es positively and increase w

hen new

nurses had a good relationship

phenom enon of new

nurses during the first year of hire. Indirectness: inform

ation in this study w

as not very applicable to understanding new

nurse turnover or how

transition shock m

itigation strategies can decrease turnover. Im

precision: inadequate am

ount of data regarding new

nurse confidence, the support a new

nurse receives, and the intention to leave first job. Publication bias: N

ot found. T

he Journal of C

ontinuing E ducation

in N ursing publishes

m any types of studies

that reveal positive and negative findings such as this study.

 

 

w ith his or her

preceptor. T his also

w as correlated w

ith the new

nurse having a safer practice than those w

ith an ineffective preceptor.

Fiedler et al. (2014)

quantitative/ descriptive

51 new nurses in a

residency program

(m ost w

ere second degree students) on diverse units/ m

edical center in the M

idw est,

a U H

C /A

A C

N

program . G

ender and ethnicity of participants w

ere not specified.

Purpose: to determ ine

w hat influence a

nurse residency program

has on long- term

outcom es

including turnover, career satisfaction, and leadership developm

ent. A im

s: 1. describe the long- term

(beyond the 1st year of em

ploym ent)

turnover rates of N R

P graduates, 2. exam

ine the long-term

career satisfaction of N

R P graduates

beyond the 1st year of em

ploym ent,

and 3. explore long- term

leadership developm

ent of N

R P graduates

beyond the 1st year of em

ploym ent.

T he long-term

outcom

es of a nurse residency program

have benefits to the organization and individual turnover rates low

er than the national average of 14.7%

(1.5-3 years after the residency program

. T

he literature review

in this study points out that w

ithin 6 m onths,

residents noticed decrease job satisfaction, yet at the end of the year, significant increase in satisfaction resulted. Support (protective factor of resiliency) from

the

+ +

⨁ ◯ ◯ ◯

R

isk of bias: D

etected. U sing one

instrum ent, w

hich m

easures satisfaction to evaluate turnover lim

ited the execution of the study and other data or qualitative factors w

ere m issed

for reasons or intentions to leave. Inconsistency: D

etected. Sam ple size

w as sm

all, it w as

diverse yet getting in touch w

ith participants that have left but filled out the survey w

as difficult and possibly lead to inconsistencies w

ith results.

 

 

V ariables: IV

: A A

C N

residency program

. D

V ’s: career

satisfaction, leadership developm

ent, hospital com

m ittee

involvem ent,

certification status, pursing an advanced degree. Instrum

ents: M

cC loskey/M

ueller Satisfaction Scale (M

M SS) has 8

subscales: extrinsic rew

ards, scheduling satisfaction, fam

ily/w ork balance,

cow orkers,

opportunities for social contacts, professional responsibilities, praise/ recognition, and control/responsibility.

organization, m

anagers, and recognition leads to satisfaction and w

ell as good collegial relationships. Peer support w

as ranked as a m

ajor com

ponent of nurses’ job satisfaction.

Indirectness: N one

detected as the applicability is reasonable as residency program

s are supportive and foster new

nurses’ careers, therefore increased retention is very probable. Im

precision: D

etected. D

issatisfaction results in turnover yet the tool w

as m easuring

satisfaction and that w

as assum ed the

reason for turnover, m

ore investigation regarding w

hat led to dissatisfaction w

ould have been m

ore helpful in understanding if a residency program

, over years, affects retention rates alone. Publication bias: N

ot detected. T

he Journal of N

ursing A

dm inistration

publishes pilot studies w

ith negative results

 

 

and also larger sam ple

sizes.

Fink et al. (2008)

m ixed m

ethod/ sequential exploratory

434 graduate nurse residents in the U

niversity H

ealthSystem

C onsortium

/A A

C N

nurse residency program

at 12 academ

ic hospital sites. G

ender and ethnicity of participants w

as not specified.

Purpose: T o evaluate

if qualitative responses to C

asey- Fink G

raduate N urse

E xperience Survey

could be analyzed quantitatively to easily analyze new

nurses’ experiences during a post B

SN

nurses residency program

. A

im s: 1. to analyze

the qualitative voices of the resident respondents to determ

ine if com

m ents could

further enrich the quantitative data and 2. to determ

ine if analysis of the them

es m ined from

the qualitative data could be used to convert the open- ended questions on the C

asey-Fink G

raduate N urse

E xperience Survey

“T he results of this

qualitative analysis perm

itted further revisions of the C

asey-Fink G

raduate N urse

E xperience Survey.

T hem

es identified from

data analysis of the 3 top skills difficult to m

aster at each period, and the 5 open-ended questions asked on the original survey, w

ere of sufficient strength to convert these item

s to m

ultiple-choice form

at. T he one

open-ended item

that the authors retained w

as the final survey question that asked residents to com

m ent on their

experiences” (p.347). N

ew nurse

stressors w ere

+ +

⨁ ⨁ ◯ ◯

M

ethodical lim

itations: D etected.

T he design and

execution of the study w

as to use a quantitative tool to gather qualitative data and revision of the tool w

as suggested. R

elevance: T he body

of evidence from

prim ary studies

supported review

findings that is applicable to the context specified in the review

questions. C

oherence: T here is a

clear fit betw een the

data from prim

ary studies and the review

findings, yet the sam

ple is hom

ogeneous, dow

ngraded 1 point. A

dequacy of data: T

here is a good

 

 

into quantitative questions for ease of test adm

inistration and analytic procedures. V

ariables: D V

s: role changes, lack of confidence, w

orkload, fears, orientation issues. IV

: residency program

w

ithin the first year of hire. Instrum

ents: C asey-

Fink G raduate N

urse E

xperience Survey. Q

ualitative data outcom

es w ere

gathered via open ended questions from

the author.

issues w ith skills

over a period of tim

e, they w ere not

getting easier. T his

w as attributed to

constant preceptor assistance and lack of being able to perform

skills independently during com

plex patient cases. W

ork/life balance w

as a m ajor stressor

and im pacted the

ability to function at the job. B

eing able to com

m unicate w

ith M

D s (a protective

factor of resiliency) and organize their w

orkload w ere

barriers to transitioning into their new

role w hich

reflected K ram

er et al. (2013) and H

alfer and G raf’s

(2006) results.

am ount of qualitative

data to represent the hom

ogeneity sam ple.

Publication bias: N ot

detected. T he Journal

of N ursing

A dm

inistration publishes pilot studies w

ith negative results and also larger sam

ple sizes. Q

uality increased by 1 point due to all plausible residual confounding factors dem

onstrated an effect.

 

 

C om

m unication

from m

anagem ent

and the desire to be a part of the unit’s culture w

ere pointed out to be a m

uch- needed support. T

he top 3 m ost

satisfying aspects of graduate nurse residents’ w

ork environm

ent included as follow

s: support, cam

araderie, and caring for patients. “T

here is not enough socialization in the residency program

. B ecom

ing a new

nurse in a new

environm ent is

difficult’’ (p.347).

G ill et al.

(2010) cohort study using m

ixed m ethods/

sequential exploratory

7 participants/ inpatient care areas at L

evel 1 traum

a center. 7.7%

participants w ere m

ale. T

he ethnicity of

Purpose: to investigate the expectations, perceptions, and satisfaction of graduate nurses after

N ew

graduates are fairly satisfied. T

w o

them es em

erged: establishing relationships and learning the job.

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: N ot

detected as the

 

 

participants w as not

specified. 6 and 12 m

onths of em

ploym ent.

A im

s: to describe new

graduates during the first year of practice. V

ariables: D V

: perceptions regarding the first year of practice such as social support, stress, professional values Instrum

ents: 10-item

abbreviated version of the N

ational D

atabase of N ursing

Q uality Indicators

(N D

N Q

I) revised survey for R

N s w

hich is a series of statem

ents relating to the nurses’ perceptions of their w

ork. It has been show

n to be both reliable. “A

t the com

pletion of the final interview

, graduate nurses w

ere asked to com

plete a brief three-item

survey on intent to leave. Individuals

Strong tie to prim

ary studies that states group cohesion (a protective factor of resiliency) and satisfaction can increase the ability to stay at one’s job and in nursing. A

t the end of the 12-m

onth study, m

any graduates considered leaving their until and the organization, but few

participants thought of leaving the profession entirely.

prim ary studies are

reflected in the review

findings. R

elevance: T he study

w as relevant. T

he body of evidence from

prim ary studies

supported the review

finding and is applicable to the context of new

nurse graduates and the aim

s of the study. C

oherence: T he study

w as coherent, and the

findings w ere a fit

betw een the prim

ary studies and the review

finding. A

dequacy of data: T

here w as adequate

data supporting the review

finding but the sam

ple w as very

sm all.

Publication bias: T

here is no detection of publication bias as results revealed perceptions and w

ere not deem

ed as positive or negative.

 

 

w ere asked to

indicate how often

they contem plated

leaving their unit, the organization, or the profession of nursing on a 5-point L

ikert scale” (p. E

13).

H odges et

al. (2008) qualitative: phenom

enological m

odel/ exploratory

11 new nurses/

southeastern U S and

had experience betw

een 12 and 18 m

onths. 9% of

participants w ere m

ale. T

he ethnicity of participants w

as not specified.

Purpose: T o explore

the nature of professional resilience in new

B

SN nurses in the

acute care setting and to extrapolate pedagogical strategies that can be developed to support resilience and career longevity. A

im s: to explore the

existence and social structure of professional resilience am

ong practicing nurses to evolve a m

iddle range theory to explain the relationships of constructs w

ithin the concept.

N ew

nurses spend a significant am

ount of tim

e learning their place in the social structure and need positive experiences to feel they are a part of the w

ork environm ent.

R esilience is needed

to ensure new nurse

self-protection, risk taking, and m

oving forw

ard w ith

reflective know

ledge of self. T

hem es that

em erged w

ere learning the m

ilieu (developing confidence and skills), discerning fit (accepted by the culture), and

+ +

⨁ ⨁ ◯ ◯

M

ethodical lim

itations: N ot

detected as prim ary

studies revealed sim

ilar findings. R

elevance: the study is relevant due to its context to the aim

w

hich explored professional resilience and as a protective factor, social support. C

oherence: it is clear that social support is needed to be professionally resilient, yet it w

as not coherent regarding how

to garner social support to ensure the

 

 

V ariables: D

V :

experiences of social support of new

nurses. Instrum

ents: open- ended questions

m oving through

(recovering from

stress and identifying those they can trust in order to develop protective factors against w

ork-life issues). Participants noted significant am

ount of adapting that m

ust take place to be accepted socially and also the disparity betw

een academ

ics and practice. T

his distressed new

nurses as they actualized the discrepancies. N

ew nurses’

em otional energy is

consum ed by

cognitive w ork;

resilience is necessary for such w

ork in order to grow

from

adversity.

developm ent of

resiliency, dow

ngraded a point. A

dequacy of data: T

here is an adequate am

ount of data but is from

a sm all sam

ple yet does reflect current findings regarding the phenom

enon of new

nurse resilience. Publication bias: T

here is no detection of publication bias as results revealed perceptions and w

ere not deem

ed as positive or negative.

 

 

C onstruction of a

new nurse’s social

identity w as found

to be im portant to

create their professional identity.

H odges et

al. (2010) qualitative: grounded theory/ descriptive

19 new and

experienced B SN

nurses w

orking in direct patient care (9 participants w

ere 11 to 18 m

onths in practice)/southeast U

S- m

ultiple levels of m ed

centers and hospitals. N

o gender or ethnicity of participants w

ere specified.

Purpose: to explain how

B SN

acute care nurses understand, adapt to, and negotiate challenge and change in acute care settings in the context of social and structural features and career persistence. A

im s: to understand

career persistence in B

SN acute care

nurses and create a m

iddle range theory to place into practice to encourage career resilience. V

ariables: nurses spanning 11 m

onths – over 5 years. Instrum

ents: open- ended questions

T he central them

e w

as building professional resilience, w

as noted to be the central social process. V

erifying fit: participants stated incongruent personal principles and values regarding nursing practice and incom

patibility w ith

the environm ent

(the environm ent

does not m atch their

strengths). Stage setting: how

to protect one’s self and form

relationships in

+ +

⨁ ◯ ◯ ◯

M

ethodical lim

itations: D etected

as the studied w as

com posed of new

nurses (w

ithin 11-18 m

onths of practice to those w

ith 5 or m ore

years). T hat is a large

breath of experience to find out about nurse’s resilience as the stress of a new

job tests one’s resilience and those that have overcom

e adversity are know

n as resilient. D

ow ngraded

one point. R

elevance: G ood

relevance as the concept of an ever- changing health care

 

 

order to feel secure and supported (protective factors of resiliency). O

ptim izing the

environm ent:

seeking activities that help one attain professional goals. T

he key to understanding professionalism

of nurses is to understand one’s social group.

arena is obvious, career resilience is a characteristic one needs to stay in the career. C

oherence: T he data

aligns to the prim ary

studies. A

dequacy of data: T

he data is com ing

from a sm

all population of different ages and tim

e fram es w

ithin their careers (18 m

onths to over 5 years), dow

ngraded one point. Publication bias: M

ost likely this study w

as published because of its “sensibility” regarding recom

m endations to

help nurses stay engaged w

ith their w

ork life and w ork

environm ent,

dow ngraded one

point.

 

 

K ram

er et al. (2012)

qualitative: grounded theory/ exploratory

82 participant interview

s w ere done.

A t the tim

e of interview

ing, 71% (n =

236) of the 330 N L

N s

w ere betw

een 9 and 12 m

onths post hire/local M

agnet hospitals. G

ender and ethnicity of participants w

ere not specified.

Purpose: to elicit from

new nurses and

experienced nurses on clinical units w

ith very healthy w

ork environm

ents, the com

ponents and strategies of nurse residency program

s and effective in new

nurse integration into professional practice. A

im s: W

hat N R

P com

ponents and strategies do N

L N

s and clinical nurses practicing on clinical units w

ith V ery

H ealthy W

ork E

nvironm ents

(V H

W E

) identify as effective in N

L N

transitioning and integrating into professional practice? V

ariables: D V

s: delegation, prioritization, conflict resolution w

ere used to construct the interview

schedule and as the basis for selection of

First them e w

as about delegation. Second them

e w as

about prioritization. T

hird them e w

as about getting w

ork done. Fourth them

e clinical autonom

y and how

to m ake

the right decisions. T

ext m essages to

M D

s to relay info and data w

as citing as an effective com

m unication

technique in hospitals. Fifth them

e: constructive conflict resolution. Sixth: feedback to restore self- confidence (a protective factor of resiliency). R

esults of this study support the recom

m endation

that developm ent of

tw o-stage,

T ransition plus

Integration, N R

Ps are no longer an

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: D etected.

Interview s w

ere conducted w

ith 2 or 4 new

nurses and experienced nurses (contam

ination possible as responses m

ay not have been as genuine if nurses w

ere alone) in each of the units and w

ere interview

ed by various hospital unit educators. D

ecreased one point. R

elevance: V ery

relevant as learning about w

hat creates a healthy w

ork environm

ent can help prepare a strong w

orkforce and good transition experience is very desirable for organizations. C

oherence: Som e

hospitals had clinical coaches and others did not, this m

ay have

 

 

participant observations. Instrum

ents: open- ended questions

option but a necessity. T

hese N

R Ps need to have

clearly differentiated goals, com

ponents, expected role perform

ance, and rites of passage.

affected participants’ responses and experiences lim

iting generalizability yet since all program

s w

ere enrolled at hospitals w

ith residency program

s greater than 3 years, and since not every hospital has coaches, the sam

ple size w as

large enough to represent the population of those in residency program

s. A

dequacy of data: T

here is adequate data to support the finding that residency program

s are preferred w

hen transitioning to first year of practice. Publication bias: findings w

ere not positive or negative, therefore none detected.

L i et al.

(2014) quantitative, correlational/ descriptive,

A convenience sam

ple of 251 nurse residents (0-3 m

onths of w orking

Purpose: T he purpose

of the study exam

ined protective

“O rganizational

com m

itm ent

+ +

⨁ ⨁ ◯ ◯

 

 

 

predictive

on a pediatric unit in L

os A ngeles, C

A ).

7.9% of participants

w ere m

ale. Percentage of C

aucasian participants 30.3%

, B

lack 0.8% , L

atino 2.4%

, and other ethnicities w

ere not reported.

factors that m ay

decrease burnout and increase job satisfaction in a nurse residency program

over 3 m

onths. G roup

cohesion optim izes

practice w hereas

organizational com

m itm

ent helps to create an intention to stay at current job (p. 96). A

im : to determ

ine w

hether factors such as group cohesion and organizational com

m itm

ent w ould

be protective and m

oderate the association betw

een stress exposure and posttraum

atic stress sym

ptom s and other

negative nurse outcom

es w hich

w ould create positive

ones. V

ariables: D V

s: stress, com

passion, satisfaction, group cohesion, and

w as not found to

protect nurse residents from

negative nurse outcom

es, it did play an im

portant role in prom

oting job satisfaction” (p. 95). “R

esults confirm

ed previous findings that stress exposure and PT

SD

sym ptom

s have serious im

plications for a range of affective outcom

es for new

resident nurses” (p. 95). Inform

ation w as

provided about the relationships that group cohesion and negative nurse outcom

es have and that establishing a relationship in a group can serve as a protective factor in helping bounce back from

negative nurse outcom

es like burnout and com

passion fatigue.

R isk of bias: sam

ple bias due to convenience sam

pling and collection of inform

ation w as not

reliable and only at one hospital, one type of floor. Inconsistency: findings w

ere consistent w

ith other findings w

ithin the context of group social support decreases the adverse effects of stress. Indirectness: Findings w

ere applicable to the context of the study. Im

precision: relevant only to one hospital on one floor, dow

ngraded one point. Publication bias: not likely as findings w

ere neither positive or negative.

 

 

organization com

m itm

ent. Instrum

ents: L ife

E vents C

hecklist good reliability, PT

SD C

hecklist C

ivilian V ersion,

C om

passion Satisfaction and Fatigue T

est, N urse

Job Satisfaction Scale, G

roup C

ohesion Scale, and O

rganizational C

om m

itm ent Scale

 

**Social support could also im

pact how

nurses respond to stress (p. 97).

M artin &

W

ilson (2011)

qualitative/ interpretive phenom

enology, descriptive

7 new nurses w

ithin the first year of practice w

ho participated in an intensive transition program

designed as a com

ponent of an orientation program

to ease new

graduates into nursing practice on various m

edical/surgical units/ purposive convenience sam

ple. 14% of

participants w ere m

ale. Percentage of C

aucasian participants w

as 85.7% , B

lack

Purpose: to exam ine

the lived experience of new

ly licensed R

N s in their first year

of practice in a hospital setting. A

im s: to extract the

m eaning and

understand from the

hum an experience,

new nurses, during

their first year of hire. V

ariables: D V

: experiences of new

nurses during their first year of hire.

T hem

es: real nurse w

ork, guidance, transitional processes, institutional context, and interpersonal dynam

ics. “T he

cum ulative effects

of socialization, skill acquisition, and stress on new

nurses indicate that research is needed to answ

er questions regarding recruitm

ent, retention, and job

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: som ew

hat detected as convenience sam

ple w

as used to recruit sam

ple yet fram ew

ork for the study m

atched the purpose and aim

s for this study. R

elevance: the findings are very applicable to the context of new

nurse experiences.

 

 

14% , there w

ere no other ethnicities reported. (purposive: the researcher deliberately selects subjects m

ost know

ledgeable about the issue under study.)

Instrum ents:

interview questions

satisfaction” (p. 21). C

aring of the profession vs non- caring w

ithin the profession is posed as an argum

ent for a new

orientation objective – possibly the form

ation of a “caring group” (better know

n as support group). “Professional acculturation is a com

plex process that requires tim

e to navigate. T

he success of the process is often dependent upon the degree of perceived support the new

ly licensed R

N

receives” (p.22). R

elationships are required to adapt to the stress of starting nursing. C

ollegial relationships w

ith all nursing staff and M

D s, and ancillary

staff m atters to new

nurses.

C oherence: good

coherence w ith

previous studies of professional acculturation and struggle to create a professional identity w

hile transitioning to practice w

hich is deem

s extrem ely

stressful. A

dequacy of data: findings aligned w

ith K

ram er’s sem

inal w

ork (1974), R eality

Shock, and reconfirm

ed via D

uchscher’s w ork on

Transition Shock Theory. Publication bias: none detected as the study did not report positive or negative findings.

 

 

M

cC alla-

G raham

&

D e G

agne (2015)

qualitative: phenom

enological/ exploratory

10 participants, using a purposive, snow

ball sam

pling/southw est

Florida, m ost w

ere experiencing their second career. G

ender and ethnicity w

ere not specified.

Purpose: to explore the lived experiences of new

graduate nurses em

ployed in an acute care setting. A

im s: to best

understand new

graduate nurses’ experiences in the acute setting V

ariables: D V

: acute care setting in the first year of hire. Instrum

ents: 11 open- ended questions

Participants stated that nursing school did not prepare them

for current roles or responsibilities and that the goal of nursing school w

as only to assist the new

grad in passing the N

C L

E X

. “T he

findings suggest that the graduate nurses thought that if they developed good coping skills, the acute care clinical setting m

ight be less stressful for them

” (p. 125). Participants also stated they w

ere very overw

helm ed

by the w orkload and

that positive reinforcem

ent helped m

itigate this stress.

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: none detected as the findings reflected sim

ilar findings as prim

ary studies, there w

ere very little issues, other the sam

pling m

ethod, in the w ay

the study w as

designed/ conducted. R

elevance: the findings w

ere relevant and the extent of the body of evidence from

the prim ary

studies supported and is applicable to the context of the new

nurse shortage phenom

enon occurring w

ithin the first year of practice. C

oherence: T he

researchers discussed a clear fit betw

een the data from

prim ary

 

 

studies and the review

findings. A

dequacy of data: there w

as rich data and the am

ount to support the findings w

ere adequate. Publication bias: none detected as the results are neither positive or negative influencing the preference to publish.

O lson

(2009) qualitative/ exploratory, interpretive, phenom

enological, longitudinal

12 participants/ purposive sam

ple of 2 groups of new

graduates: 6 B

SN and 6

A D

N nurses – full tim

e staff nurses at the tim

e of data collection. 16.6%

of participants w

ere m ale. E

thnicity of participants not specified.

Purpose: to understand the experience of new

ly licensed nurses from

their perspective. A

im s: to understand

m illennial, novice

nurses’ experiences throughout the first year of practice V

ariables: D V

: new

nurse experiences Instrum

ents: open ended interview

s at 3, 6, and 12 m

onths

T hem

es that em

erged: being in unfam

iliar surroundings w

hich seem

ed confusing and overw

helm ing

because they had spent lim

ited tim e in

acute care as students. A

fter a year, participants expressed fear about being oriented to a different place. T

he second them

e, “out of the blue,” w

hich are the “never to be forgotten” experiences – so

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: lim itation

regarding sm all

sam ple yet findings

w ere analyzed w

ell, and researcher dem

onstrated a good ability to reflect on participants’ experiences to create com

m on them

es that are applicable to the phenom

enon of new

graduate experiences. R

elevance: Prim ary

studies support the

 

 

chaotic and the difficulty of trying to keep up – this w

as relayed to researchers as feelings of helplessness, guilt, and extrem

e sadness as novices coped w

ith death or a m

edical error for the first tim

e. T he third

them e: finding m

y voice, this w

as a description of novices’ relationships w

ith preceptors, M

D s,

and other staff m

em bers. Feeling

w elcom

ed and confronting incivility w

ith other nurses w

ere crucial to feeling successful in the transition. T

he fourth them e

w as “am

I ok?” O

btaining feedback, trust w

ith know ing

som eone w

ould tell them

they w ere

doing som ething

findings and it is applicable to m

illennial, novice nurses’ and their intentions to do everything really w

ell regardless of how

foreign som

ething is and the need for im

m ediate attention

and feedback to continually grow

and learn. C

oherence: there is a good fit betw

een the prim

ary studies and the findings in this study. A

dequacy of data: the quantity and degree of richness in prim

ary studies support the review

findings. Publication bias: D

oubtful due to neither positive or negative results w

ere shared, only reported experiences of a sam

ple of new nurses.

 

 

w rong w

as very im

portant to participants as they expressed great anxiety regarding m

aking m istakes.

T he acute setting is

very unfam iliar, and

socialization can assist w

ith the stressful adjustm

ent w

hich m akes it

difficult to grow and

continue to learn. M

illennials w ant

nurturing, attention, and continuous feedback w

hich places an extensive value on social support (a protective factor of resiliency).

Pellico et al. (2009)

qualitative: case study m

odel/ descriptive

612 participants in 12- 18 m

onths of practice /stratified sam

pling in m

etropolitan m idsize

areas in the U S

w orking inpatient.

E thnicity and gender of

participants not specified.

Purpose: “T he

purpose of this article w

as to explore the perceptions of 612 N

L N

s’ nascent experiences as reflected in their com

m ents provided

in a national survey

“5 them es w

ere discovered. “C

olliding expectations” describes conflicts betw

een nurses’ personal view

of nursing and their

+ +

⨁ ⨁ ⨁ ◯

M

ethodical lim

itations: this w as

secondary findings from

a parent study and there w

ere no lim

itations in the

 

 

that sought to gain a better understanding of the w

ork life of N

L N

s” (p. 194). A

im s: to understand

N L

N ’s w

ork-life experiences. V

ariables: m ultiple

areas across the U S

Instrum ents: 16-page

survey w ith 207

item s.

lived experience. “T

he need for speed” describes the pressure related to a variety of tem

poral issues. “Y

ou w ant

too m uch”

expresses the pressure and stress N

L N

s feel personally and professionally. “H

ow dare you”

describes unacceptable com

m unication

patterns betw een

providers. “C hange

is on the horizon” suggests optim

ism

for the future as N

L N

s speak of transform

ing the system

s w here care

is provided (a protective factor of resiliency). T

his content analysis reveals that the w

orking environm

ent w here

N L

N s begin their

design of the findings of the prim

ary studies. R

elevance: the findings are applicable to the context specified to explore perceptions of new

nurses’ w ork life.

C oherence: T

here is a good fit betw

een the data from

the prim ary

studies and the findings yet prim

ary studies did not reveal any m

ention of w

anting to change new

nurses’ experiences as stated in the review

of findings in this study. A

dequacy of data: the data underlying a review

finding are rich and com

e from

different num bers of

participants per study. Publication bias: doubtful as the results w

ere neither positive or negative but reported the

 

 

career is in need of reform

” (p. 194). experiences of participants.

N ote. N

L N

= new ly licensed nurse; ⨁

⨁ ⨁ ⨁

= high; ⨁

⨁ ⨁ ◯

= m

oderate; ⨁ ⨁ ◯ ◯

= low

; ⨁ ◯ ◯ ◯

= very low ; +

+ =

observational design; +

+ +

+ =

experim ental study.

 

 

T able C

Tools U

sed in Studies to D eterm

ine N LN

R esiliency or P

rotective F actors of R

esiliency Study

T ool

N L

N O

utcom es R

eflecting N L

N R

esiliency A

nderson, L

inden, A

llen, &

G ibbs (2009)

T he H

alfer-G raf Survey (validity/reliability not reported)

(H alfer &

G raf, 2006) and open-ended questions

C om

pared job satisfaction and em ployee

engagem ent after com

pleted 2-day interactive residency m

odules w hich assisted N

L N

s to perform

job, identify resources, and job expectations. M

ost valuable strategy to satisfy N L

N s w

as em ail

com m

unication as a form of support, follow

ed by positive patient outcom

es and team w

ork.

B ontrager,

H art, &

M

areno (2016)

Preceptor R ole E

ffectiveness Scale (reliability coefficient = .75) (R

auen, 1974); G roup C

ohesion Scale (reliability coefficient = .81) (H

inshaw &

A tw

ood, 1983); N urse Job

Satisfaction Scale (overall internal consistency reliability coefficient = .88) (H

inshaw &

A tw

ood, 1983); and Intent to Stay Scale (reliability coefficient = .85) (K

im , Price,

M ueller, &

W atson, 1996)

 

Preceptors, job satisfaction, and group cohesion w

ere found to be im portant to reduce transition

shock and intention to leave.

C lark &

Springer (2012)

O pen-ended questions

L earning the w

ork flow , feeling valued, preceptors,

and cow orkers enhanced satisfaction and

com m

itm ent to the profession and the ability to w

ork in a team

.

C line et al.

(2017) C

asey-Fink G raduate N

urse E xperience Survey: the section

on com fort and confidence (C

ronbach = .78). T

he next section consists of 5 factors, nam

ely, support ( = .90),

patient safety ( = .79), stress (

= .71), com

m unication/leadership (

= .75), and professional

A custom

ized residency program m

ay im prove

N L

N s’ experiences as they enter practice w

hich increases confidence and m

ay lead to intention to stay at current job.

 

 

satisfaction ( = .83) (C

asey, Fink, K rugm

an, & Propst,

2004) and institutional retention m etrics

C lipper &

C

herry (2015)

16-item investigator developed survey assessing the

attributes of transition shock to obtain N L

N perceptions and

effectiveness of their preceptors (C ronbach

= .954) (D

uchscher, 2009)

N L

N s w

ere m ore positive regarding practices and a

slightly better retention rate w hen a structured

preceptor program w

as provided.

Fiedler, et al. (2014)

M cC

loskey/M ueller Satisfaction Scale (C

ronbach = .94)

(M ueller &

M cC

loskey, 1990) R

esidency program s can low

er turnover rates yet at 6 m

onths, job dissatisfaction decreased yet at 12 m

onths satisfaction increased.

Fink et al. (2008)

C asey-Fink G

raduate N urse E

xperience Survey (C ronbach

= .89) (C asey et al., 2004) and open-ended questions

C onstant preceptor assistance increased N

L N

satisfaction.

G ill, D

eagan &

M cN

ett (2010)

10-item abbreviated version of the N

ational D atabase of

N ursing Q

uality Indicators (reliability coefficient = .91) (T

aunton et al., 2004) and open-ended questions

E stablishing relationships and learning the job

positively affected N L

N satisfaction. D

espite positive results, som

e N L

N s considered leaving the

organization but few stated they thought of leaving

the profession.

H odges,

K eeley, &

T

royan (2008)

open-ended questions D

eveloping confidence by learning skills, being accepted by others, and recovering from

stress because of the academ

ic/practice disparity w as

found im portant for N

L N

s to build professional identities and a social connection in order to adapt and negotiate career stress.

H odges,

T royan, &

K

eeley (2010)

open-ended questions T

he practice environm ent does not m

atch N L

N

strengths. Feeling supported is key and establishing a social group is necessary to develop career persistence.

K ram

er et al. (2013)

open-ended questions D

elegation, prioritization, accom plishing w

ork, clinical autonom

y, effective clinical decision-

 

 

m aking, constructive conflict resolution, and

restoring self-confidence are im portant factors to

prom ote N

L N

professional practice.

L i et al.

(2014) L

ife E vents C

hecklist (reliability > .50, test-retest

reliability r = .82) (G ray, L

itz, H su, &

L om

bardo, 2004), PT

SD C

ivilian C hecklist (internal consistency

= .94, test- retest reliability r = .88) (W

eathers, L itz, H

uska, & K

eane, 1991), C

om passion Satisfaction and Fatigue T

est (test produces three subscales: com

passion satisfaction, burnout, and C

F/ST S. E

ach scale show s good internal consistency in

this sam ple (α = .87, .90, and .87) (Stam

m , 2002), N

urse Job Satisfaction Scale (

= .90) (M ueller &

M cC

loskey, 1990), G

roup C ohesion Scale (

= .89) (B yrne &

N elson, 1965),

and O rganizational C

om m

itm ent Scale (

= .89) (Porter, Steers, M

ow day, &

B oulian, 1974)

 

R elationships and social support can buffer stress

and com passion fatigue.

M artin &

W

ilson (2011)

open-ended questions Socialization, the ability to perform

skills, and collegial relationships help to garner job satisfaction and retain N

L N

s.

M cC

alla- G

raham &

D e

G agne (2015)

open-ended questions N

L N

s reported m ore training needed for coping

skills to deal w ith stress.

O

lson (2009) open-ended questions

T he overw

helm ing w

ork atm osphere confused N

L N

s as w

ell as new experiences not encountered w

hile in nursing school translated into feelings of helplessness. Inabilities to speak w

ith M D

s and not know

ing w ho to trust verified extensive social

support and continuous feedback are needed in m

illennial N L

N s the first year of hire.

 

 

 

Pellico, B

rew er, &

K

ovner (2009)

open-ended questions Poorly understood N

L N

expectations, the expectations for N

L N

s to perform quickly, and

incivility am ong clinicians inform

s organizations and leaders that the w

ork environm ent needs reform

. N

ote. N L

N = N

ew ly licensed nurse.

 

 

R eproduced w

ith perm ission of copyright ow

ner. F urther reproduction prohibited w

ithout perm ission.

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