How graduate nurses adapt to individual ward culture: A grounded theory study

Abstract

Aim:To increase understanding of strategies graduate nurses use on a day-to-day basis to integrate themselves into pre-existing social frameworks.Background: Being a graduate nurse and transitioning from a novice to beginner in the first year of clinical practice is stressful, challenging and overwhelming due to steep learning curves and adjusting to working in professional environments. How graduate nurses socially adapt and fit into ward cultures is a hurdle to successful transition and can be difficult. Design:A qualitative constructivist grounded theory methodology was used. Methods: Seven adult, Registered Nurses were recruited using a purposive sampling technique. Participants were undertaking a graduate nurse transition programme, in one of two acute care, adult public hospitals in South Australia. Data collection conducted in 2016 used individual interviews consisting of open-ended questions in an unstructured format. Transcripts were transcribed verbatim. Data analysis processes included initial and focused coding, theory building, memo-writing and theoretical sampling.Results: Three main categories: self-embodiment and self-consciousness, navigating the social constructs and raising consciousness, supported by subcategories describe the main strategies graduate nurses use to facilitate adaptation into complex clinical environments and ward cultures. Subsequent concept and theory development explains how graduate nurses find the social and professional balance to fit in. Conclusions:Understanding the graduates' adaptation strategies can inform improvements in graduate nurse transition programmes. Facilitating and enhancing graduate nurse adaptation is the precursor in creating more resilient nurses ready to face the challenges that exist in today's work environments.

The development of nurses’ foundational values

“…39,40 During this period, graduates are contextualising their personal–professional values while orientating themselves into the new workplace milieu. 41 The findings of this study are similar to current literature that highlights the significant role professional transition plays, especially in nursing graduates developing their competencies and confidence. 39 However, graduate nurses who are working in a complex and challenging environment are vulnerable, as they are exposed to many aspects of the environment that affect their overall well-being.…”

New graduate registered nurses’ experiences with psychological safety

“…To experience psychological safety, new graduate registered nurses must feel like credible members of the clinical team. In addition to fitting into the workplace culture (Feltrin et al, 2019), participants wanted their peers to accept them as competent, trustworthy clinicians. New graduate registered nurses build credibility they demonstrate to themselves and others that they can handle clinical situations appropriately.…”

“…Unfortunately, difficult experiences with transitioning to practice is an international phenomenon that, for decades, has posed significant challenges to new graduate registered nurses (Duchscher 2009; Edwards, Hawker, Carrier, & Rees, 2015; Missen, McKenna, & Beauchamp, 2014; Rush, Janke, Duchscher, Phillips, & Kaur, 2019). As new graduate registered nurses try to navigate their new workplace culture, they notice which behaviours (and individuals) are accepted within the culture and which are not (Feltrin, Newton, & Willetts, 2019). New graduate registered nurses’ desire to fit in (Hawkins, Jeong, & Smith, 2019b), frequently coupled with a lack of confidence (Hawkins, Jeong, & Smith, 2019a), makes new graduate registered nurses more likely to adopt behaviours perceived as culturally acceptable (Hunter & Cook, 2018).…”

Success Factors of Adaptation of Newly Graduated Nurses: A Scoping Review

“…Self-embodiment and self-awareness are key strategies used by graduate nurses to develop and t into social groups, thus facilitate adaptation into complex clinical environments and ward cultures [53]. New nurses need to demonstrate their ability to master nursing practices and give positive impressions to their seniors [27].…”

“…Nurses are considered to be more resilient by taking control of their own learning and management of situations [39]. New nurses who have strong sense of identity and ability, are good at managing feelings and balancing emotions are more able to shake off negative attitudes and unprofessional incidents [53]. Eliminating unhealthy cultures in an organisational structure, by proposing culture-speci c habitual preceptorship education, is encouraged in organisations.…”