Newly graduated nurses are entering the work force and finding that they have neither the practice expertise nor the confidence to navigate what has become a highly dynamic and intense clinical environment burdened by escalating levels of patient acuity and nursing workload. This research used qualitative methods to build on and mature aspects of the new nurse's transition experience into acute care. The theory of transition presented in this article incorporates a journey of becoming where new nursing graduates progressed through the stages of doing, being, and knowing. The whole of this journey encompassed ordered processes that included anticipating, learning, performing, concealing, adjusting, questioning, revealing, separating, rediscovering, exploring, and engaging. Although this journey was by no means linear or prescriptive nor always strictly progressive, it was evolutionary and ultimately transformative for all participants. The intense and dynamic transition experience for these newly graduated nurses should inspire educational and service institutions to provide preparatory education on transition as well as extended, sequential, and structured orientation and mentoring programs that bridge senior students' expectations of professional work life with the reality of employment.

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Discussion is focused on the oppressive context in which hospital nursing continues to be situated and explores the ideological, structural, and relational aspects of domination that continue to surface in the work experiences of novice as well as seasoned nurses. Suggestions for addressing the issues that plague the acute care environment are integrated throughout the article, and a detailed framework of empowerment for this nursing context is offered.

Aim This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. Background The provincial government of Saskatchewan, Canada, implemented a multimillion‐dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. Methods This qualitative exploratory study employed semi‐structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. Results Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. Conclusion The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. Implications for Nursing Management Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.