Background. The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients. Purpose. This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients. Methods. Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method. Findings. From 21 articles, four categories of challenges were identified: “reasoning and decision-making,” “using knowledge and skills in practice with clients,” “the context of service provision,” and “managing caseload and priorities.” “Having self-doubt” was a theme that pervaded the data. Implications. New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.

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Introduction New graduate occupational therapists’ experiences of learning to make paediatric intervention decisions within hospital settings are unexplored. New graduates commonly find clinical decision-making challenging. Previous research has predominantly evaluated support programs designed to assist their transition to practice. Exploring new graduates’ experiences working in hospital settings is important because they are common employers of new graduates and typically provide substantial support. Method A case study approach enabled exploration of the experiences of four new graduate and perspectives of four experienced occupational therapists working in an Australian paediatric hospital. Data were collected through semi-structured interviews, informal discussions, observations and review of documents. Inductive analysis was used to identify codes and themes within the data. Findings New graduates reported substantial access to workplace supports and resources to inform their intervention decisions. However, the immediacy with which occupational therapists needed to respond to referrals impacted new graduates’ ability to consistently access available supports. They were acutely aware of needing to manage clinical risk and actively sought informal support for making intervention decisions. Conclusion Providing opportunities to seek informal support on an ‘as-needs’ basis was most important for assisting new graduates to obtain reassurance that they were making safe, high-quality intervention decisions.

Introduction: New graduates commonly experience challenges making client-related decisions. Current occupational therapy literature has predominantly focused on new graduates’ general experiences of commencing practice and experienced clinicians’ perceptions of clinical decision making. This study aimed to explore new graduate occupational therapists’ experiences of learning to make intervention decisions in paediatric practice. Methods: A case study approach enabled exploration of the experiences and reflections of 18 new graduate and eight experienced occupational therapists working in three paediatric service delivery contexts—private practice, acute hospital and non-government settings. Data were collected using semi-structured interviews, observations, informal discussions, review of documents and reflective journal entries. Similarities and differences across the three cases were examined. Results: Contextual influences, including time pressure, clinical risk and self-expectations, shaped new graduates’ experiences of learning to make intervention decisions. These influences impacted new graduates’ access to common support mechanisms, such as informal discussions with colleagues, formal workplace supervision and shared workplace resources, and prompted them to draw on supports and resources external to the workplace.  Conclusions: Understanding the contextual influences that shape new graduate allied health practitioners’ experiences of learning to make intervention decisions assists professional bodies, workplaces and universities to better target the training and support provided to new graduates to ensure that their intervention decisions promote positive client outcomes. Furthermore, the research findings can increase new graduates’ understanding of both workplace and external support mechanisms that assist clinical decision making and the possible impact of high self-expectations on their decision-making experiences.

Background. Challenges with clinical decision-making are common among new graduate occupational therapists. There is limited research exploring their experiences of learning to make intervention decisions. Purpose. To explore new graduates’ experiences of learning to make intervention decisions in pediatric private practice. Method. A case study approach, involving a range of data sources, explored the experiences of 11 new graduates and three experienced occupational therapists working in Australian private practices. Data were analyzed using inductive thematic analysis. Findings. Themes pervading new graduates’ decision-making experiences were: “being seen as capable and competent,” “similar and familiar,” and “specialist versus generalist positions.” Contextual influences contributed to new graduates utilizing their support networks and personal experiences in addition to workplace supports. Implications. It is vital to balance private practice business demands with opportunities for new graduates to engage with experienced occupational therapists and professional communities of practice to assist their learning to make intervention decisions.