We investigated the challenges final-year nursing students (FYNSs) and first-year registered nurses (FYRNs) face as they transition to nursing practice in Lebanon. Our purpose was to understand the challenges of transition from the perspective of FYNS and FYRNs. We conducted focus group discussions with FYNSs and FYRNs recruited from four leading universities. Thematic analysis identified an unexpected paradox that has implications for quality of nursing care and retention of graduates. While humanoids are marketed to communicate empathically with patients, FYNSs in Lebanon struggle to resist becoming robots.

Transitioning to practice is challenging for baccalaureate nursing students. In baccalaureate nursing programs, the process typically begins in the junior year. A Successful transition depends on how well students apply their developing knowledge during clinical placements. A cross-sectional, multisite, qualitative study was conducted at four universities in Greater Beirut, Lebanon. In total, 35 junior baccalaureate students participated in audio-recorded focus group discussions. Thematic analysis was used to analyze the data. Three themes were sufficient to summarize the students experiences: “being unprepared,” “learning unexpected lessons,” and “taking responsibility.” Three subthemes, revising expectations, discovering divergence, and self-monitoring, were used to clarify the unexpected lessons students learned during clinical placements and how students responded. “Loving nursing and protecting yourself,” making the most of every day, and doubting future readiness were subthemes within the “taking responsibility” theme. Students troubled by nursing practices that diverged from their expectations monitored themselves to avoid falling into poor practices and kept track of the nursing procedures they performed. Only by taking responsibility for their learning, could students develop the competencies they will need as registered nurses. Faculty, clinical instructors, hospital administrators, nurse managers, and registered nurses need to do more to support students to take control of their learning.

The aim of this study was to identify the challenges graduates from three of Lebanon's leading universities face as they transition from the role of student to first year registered nurse. Focus group discussions and one joint interview were conducted with 16 first year registered nurses transitioning to practice in university medical centers in Greater Beirut. Thematic analysis was used to summarize the challenges faced by the graduates. Initially, three descriptive themes were used to summarize the data: classroom learning, workplace realities, and "wanting a life". Together the three themes indicted that classroom instruction of baccalaureate nursing students in Lebanon raises expectations for ideal practice that cannot be realized in clinical units with high workloads and nursing shortages. As a result, first year registered nurses are made to feel unwelcome unless they compromise their values and adapt quickly to the pace of work. The three initial themes were revised deductively from the perspective of ego-identity theory to explain the relationship between transitioning to nursing practice and identity formation in late adolescence and early adulthood. If the pressures of identity formation are not addressed, first year registered nurses in Lebanon will be at risk for acquiescing to task-centered practice, abandoning bedside care for administrative roles, or leaving nursing. The evidence for this conclusion will interest nursing faculty, hospital administrators, nurse leaders, registered nurses, physicians, and nursing students.