Implications

• Socialisation processes are needed to enhance role transition and improve the integration of newly qualified nurses (NQNs). A particular emphasis should be placed on fostering social acceptance.

• This study provides a theoretical basis on which an intervention could be generated to minimise NQN stress.

• Future studies investigating stress in NQN should also consider the influence of organisational work factors including staffing levels, skill-mix and workload allocations.

Context

The transition from student to newly qualified nurse (NQN) is a vulnerable time period.1 2 The challenges of increased clinical responsibility and settling into the clinical work environment can increase stress levels and cause some graduate nurses to consider leaving the profession.3 Attrition rates are reportedly high during the initial 3 years’ postqualification.4 High attrition rates are especially concerning when one considers the current global nursing shortage. Frögéli and colleagues5 investigate the relationship between professional socialisation processes and stress in NQNs. Increased understanding of stress antecedents will enable healthcare leaders to develop targeted interventions, which can improve graduate nurse’s transition.

Methods

Frögéli and colleagues5 prospective longitudinal study recruited NQNs following summer 2015 and spring 2016 graduations in Sweden. Participants represented all Swedish healthcare regions. Baseline demographics were collated using an online survey and the study’s sample size was decided using a power calculation. Data collection occurred during the first 13 weeks’ postqualification. Validated surveys evaluating ‘stress’, ‘task mastery’, ‘role clarity’ and ‘social acceptance’ were sent to participants online and data were gathered every other week. Researchers adopted Bolger and Laurenceau’s6 longitudinal data analysis methods.

Findings

During the first 13 weeks as a qualified nurse, there was a trend towards a progressive increase in role clarity and task mastery, and a decrease in stress.5 Decreased social acceptance was also reported.5 While these trends highlight the average NQN transitionary response, some nurses progressed more or less effectively than average. These findings illustrate a potential link between organisational social support and NQN stress, with stress levels reportedly lower in nurses who received increased social support.

Commentary

Professional socialisation and the ‘fitting-in’ process is a source of stress for some NQNs and it has been suggested that NQNs find the process of developing professional identity, role clarity, skill mastery and social acceptance challenging.5 Frögéli and colleagues5 longitudinal study illustrated a trend towards a progressive increase in role clarity and task mastery, and a decrease in stress. Other findings reveal an apparent decrease in social acceptance. The latter findings will concern healthcare managers as NQNs are at high risk of making clinical errors in the initial months’ postqualification and collegial support is necessary to improve patient safety.3 Additionally, poor coworker relations are associated with job dissatisfaction which can contribute to nurse burnout.2 Cumulatively, these findings highlight the need for NQN socialisation processes that enhance role transition and improve integration into the complex clinical working environment. Findings from Frögéli and colleagues5 also provide a theoretical basis on which an intervention could be generated to minimise NQN stress. Future studies investigating stress in NQN should also consider the important influence of organisational work factors including staffing levels, skill-mix and workload allocations.2