A phenomenological exploration of graduate nurse transition to professional practice within a transition to practice program

Abstract

Aim: To explore the experiences of graduate nurses enrolled in a transition program, to gain insight into what graduates experienced as beneficial, as barriers and to seek meaning to the phenomena of transition as experienced within a transition program. Background: A graduate nurse's transition to professional practice is a time of high emotion where graduates leave the familiar grounds of university for the unknown of professional practice. Numerous studies, spanning many decades, have investigated issues regarding transition leading to the development of transition programs to aid the recognised burden. Method: The researchers used principles of hermeneutic phenomenology to explore the language used in semi-structured interviews of seven graduate nurses undertaking a Transition to Professional Practice Program in an Australian metropolitan hospital to investigate the lived experiences of transition within a transition program. Results: Thematic analysis of transcribed interviews revealed that transition from student to professional is a time of many new demands that causes shock and can lead to negative emotions. However, many constructive responses and positive emotions were also present. These responses included positive feelings in the care of patients and of support received by graduates from dedicated educators linked to the transition program and by senior nurses on the ward. Conclusion: Transition to practice is an important stage in the career of a Registered Nurse and the transition issues related by graduate nurses in this study corresponded with issues raised in similar transition literature suggesting that continued work is required. However, the benefits of dedicated staff in aiding transition as expressed by the participants of this study is a positive affirmation of the advantages of graduates being enrolled in a transition program.

Full text

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
Collegian
xxx
(2017)
xxx–xxx
Contents lists available at ScienceDirect
Collegian
journal homepage: www.elsevier.com/locate/coll
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program
Matthew
D.
Ankersa,∗,
Christopher
A.
Bartonb,
Yvonne
K.
Parrya
aCollege
of
Nursing
and
Health
Sciences,
Flinders
University,
GPO
Box
2100,
Adelaide
5001,
South
Australia,
Australia
bDepartment
of
General
Practice,
School
of
Primary
and
Allied
Health
Care,
Monash
University,
270
Ferntree
Gully
Rd,
Notting
Hill,
Victoria,
3168,
Australia
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
19
January
2017
Received
in
revised
form
9
September
2017
Accepted
14
September
2017
Available
online
xxx
Keywords:
Transition
to
practice
Graduate
nurse
Nurse
transition
Shock
Hermeneutic
phenomenology
a
b
s
t
r
a
c
t
Aim:
To
explore
the
experiences
of
graduate
nurses
enrolled
in
a
transition
program,
to
gain
insight
into
what
graduates
experienced
as
beneficial,
as
barriers
and
to
seek
meaning
to
the
phenomena
of
transition
as
experienced
within
a
transition
program.
Background:
A
graduate
nurse’s
transition
to
professional
practice
is
a
time
of
high
emotion
where
gradu-
ates
leave
the
familiar
grounds
of
university
for
the
unknown
of
professional
practice.
Numerous
studies,
spanning
many
decades,
have
investigated
issues
regarding
transition
leading
to
the
development
of
transition
programs
to
aid
the
recognised
burden.
Method:
The
researchers
used
principles
of
hermeneutic
phenomenology
to
explore
the
language
used
in
semi-structured
interviews
of
seven
graduate
nurses
undertaking
a
Transition
to
Professional
Practice
Program
in
an
Australian
metropolitan
hospital
to
investigate
the
lived
experiences
of
transition
within
a
transition
program.
Results:
Thematic
analysis
of
transcribed
interviews
revealed
that
transition
from
student
to
professional
is
a
time
of
many
new
demands
that
causes
shock
and
can
lead
to
negative
emotions.
However,
many
constructive
responses
and
positive
emotions
were
also
present.
These
responses
included
positive
feel-
ings
in
the
care
of
patients
and
of
support
received
by
graduates
from
dedicated
educators
linked
to
the
transition
program
and
by
senior
nurses
on
the
ward.
Conclusion:
Transition
to
practice
is
an
important
stage
in
the
career
of
a
Registered
Nurse
and
the
transi-
tion
issues
related
by
graduate
nurses
in
this
study
corresponded
with
issues
raised
in
similar
transition
literature
suggesting
that
continued
work
is
required.
However,
the
benefits
of
dedicated
staff
in
aiding
transition
as
expressed
by
the
participants
of
this
study
is
a
positive
affirmation
of
the
advantages
of
graduates
being
enrolled
in
a
transition
program.
©
2017
Australian
College
of
Nursing
Ltd.
Published
by
Elsevier
Ltd.
Problem
First
identified
in
1970,
issues
with
the
transition
of
gradates
nurses
from
education
to
practice
persist
to
the
present
day
with
neophyte
nurses
being
overwhelmed
and
feeling
unprepared
by
the
demands
of
clinical
practice.
What
is
already
known
From
a
body
of
work
on
the
subject,
transition
programs
have
emerged
to
aid
the
transition
to
practice.
Transition
programs
offer
graduates
dedicated
support
staff,
educa
tion
days
and
rotation
through
different
clinical
environments.
What
this
paper
adds
∗Corresponding
author.
E-mail
address:
matthew.ankers@flinders.edu.au
(M.D.
Ankers).
This
paper
explores
transitioning
within
a
modern
South
Australian
transition
programs
from
the
perspective
of
people
experiencing
the
phenomena.
The
experiences
of
the
interviewed
graduates
suggested
that
the
benefits
of
the
transition
program
and
dedicated
staff
went
beyond
actual
work
support
to
a
perceived
‘peace
of
mind’
knowing
help
was
available
if
needed.
The
paper
also
suggests
graduates
find
positive
benefits
in
the
care
of
others.
1.
Introduction
and
background
In
1974,
Kramer
developed
the
theory
‘Reality
shock’
which
posited
that
university
instilled
values
conflicted
with
the
real-
world
practice
of
nursing
(Kramer,
1974).
In
Kramer’s
(1974,
p.
3)
work,
shock
is
the
‘social,
physical
and
emotional
response
of
a
per-
son
to
the
unexpected,
unwanted,
or
undesired’
experienced
by
a
graduate
in
response
to
the
reality
of
the
new
responsibilities.
The
http://dx.doi.org/10.1016/j.colegn.2017.09.002
1322-7696/©
2017
Australian
College
of
Nursing
Ltd.
Published
by
Elsevier
Ltd.

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
2
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
work
by
Kramer
established
that
an
issue
existed
with
transition
that
unfortunately
remains
true
in
the
modern
transition
of
nurses
to
practice
(Boychuk-Duchscher,
2012).
The
concept
of
‘reality
shock’
has
more
recently
been
concep-
tualised
as
transition
shock.
As
described
by
Boychuk-Duchscher
(2009),
transition
shock
represents
the
initial
stage
of
role
adap-
tation
for
the
graduate
nurse,
and
like
Kramer’s
reality
shock,
highlights
that
university
teaching
does
not
adequately
prepare
students
for
the
realities
of
nurse
practice.
However,
transition
shock
penetrates
beyond
the
professional
aspects
of
shock
and
con-
siders
the
‘intellectual,
physical,
social,
cultural,
developmental,
spiritual,
emotional
and
economical’
(Boychuk-Duchscher,
2012,
p.
17).
The
duration
of
the
graduate
adjustment
to
practice
is
sug-
gested
by
Boychuk-Duchscher
(2009)
as
one
to
four
months
and
is
reflective
of
Rush,
Adamack,
Gordon,
and
Janke
(2014)
grad-
uates
who
felt
a
greater
need
for
support
in
the
first
one
to
three
months
of
practice.
The
‘shock’
is
attributed
to
nursing’s
‘fast
pace’,
which
is
relatively
unforgiving
to
graduates
with
an
increased
responsibility
not
relatable
to
the
university
experience
that
causes
confusion,
isolation,
anxiety
and
exhaustion
(Boychuk-
Duchscher,
2012).
Research
from
Australia
supports
concepts
found
in
transition
shock
with
graduate
nurses
relating
feelings
of
being
unprepared
for
the
role
of
a
practicing
nurse
following
university
preparation
with
an
associated
range
of
negative
emotions
(Kelly
&
Ahern,
2009;
Levett-Jones
&
FitzGerald,
2005;
Malouf
&
West,
2011).
Similarly,
Mellor
and
Gregoric
(2016)
interview
of
graduates
from
South
Australian
hospitals
related
feelings
of
limited
control
over
the
initial
stage
of
their
professional
role.
A
1984
work
by
Patricia
Benner
titled
‘From
novice
to
expert’
outlined
a
5-tier
framework
of
nursing
competence
that
helps
to
place
the
graduate
nurses
scope
of
practice
in
context.
The
second
tier
of
Benner’s
work
titled
‘advanced
beginner’
can
be
applied
to
the
graduate
in
that
the
new
nurse
can
relate
to
selected
clinical
situations
due
to
a
limited
prior
experience
but
that
the
advanced
beginners
practice
is
still
procedural
in
nature
(Benner,
1984).
The
advanced
beginner
may
complete
tasks
that
are
unnecessary
and
miss
cues
to
more
immediate
concerns
(Benner,
1984).
For
these
reasons,
Benner
(1984)
suggests
that
advanced
beginners
require
support
from
more
experienced
practitioners
and
offers
insight
into
why
neophyte
practitioners
may
become
overwhelmed
in
their
new
role
when
clinical
practice
is
far
from
procedural.
Support
from
experienced
practitioners
can
help
these
advanced
beginners
develop
(Henderson,
Ossenberg,
&
Scott
2015)
and
theoretically
reduce
the
shock
identified
by
Kramer
and
Boychuk-Duchscher.
The
education
of
nurses
in
Australia
moved
from
hospital
based
training
to
university
based
tertiary
education
during
the
1970-80
with
the
last
hospital
trained
nurse
intake
occurring
in
1990
(El
Haddad,
Moxham,
&
Broadbent,
2012;
Levett-Jones
&
FitzGerald
2005;
Phillips,
Kenny,
Esterman,
&
Smith,
2014).
How-
ever,
questions
regarding
the
clinical
readiness
of
tertiary
educated
nursing
graduates
soon
surfaced
(Levett-Jones
&
FitzGerald,
2005).
From
the
late
1980’s,
an
organisation
level
response
to
issues
of
the
‘theory-practice
gap’
(Levett-Jones
&
Fitzgerald,
2005,
p.
41)
resulted
in
transition
programs
to
assist
with
the
graduate
tran-
sition
period
(Levett-Jones
&
Fitzgerald
2005;
Clare
et
al.,
1996
cited
in
De
Bellis,
Longon,
&
Glover,
2001).
However,
early
tran-
sition
programs
were
criticised
as
inconsistent
in
format,
content
and
for
offering
only
minimal
support
for
graduates
that
resulted
in
a
lack
of
confidence
amongst
the
novice
practitioners
(Levett-
Jones
&
Fitzgerald
2005;
De
Bellis
et
al.,
2001).
Modern
programs
in
Australia
employ
preceptors,
nurse
educators,
mentors
and
have
education
days
to
increase
clinical
support,
help
consolidate
skills/knowledge
and
encourage
professional
socialisation
(Missen,
McKenna,
&
Beachamp
2016;
Healy
&
Howe,
2012;
Ostini
&
Bonner,
2012;
Malouf
&
West,
2011).
These
added
components
of
the
mod-
ern
transition
program
help
to
bridge
issues
of
transition
identified
by
Kramer
and
Boychuk-Duchscher
and
acknowledge
the
contin-
ued
need
for
support
identified
by
Benner.
Programs
also
offer
rotation
through
different
clinical
areas
so
graduates
gain
experi-
ences
in
a
variety
of
settings
(Missen
et
al.,
2016;
SA
Health,
2016;
Healy
&
Howe,
2012).
Current
Transition
to
Professional
Practice
Programs
(TPPP)
in
South
Australia
are
run
by
the
Government
of
South
Australia’s
Health
Department
and
consists
of
a
12-month
program
in
a
pub-
lic
hospital,
in
either
a
metropolitan
or
rural
location
(SA
Health,
2016).
Programs
offer
rotations
through
medical,
surgical
or
spe-
cialty
wards
and
are
designed
to
offer
a
supportive
environment
for
graduate
nurses
to
consolidate
skills,
grow
confidence
and
adjust
to
the
new
role
as
a
health
professional
(SA
Health,
2016).
The
TPPP
program
incorporates
theoretical
and
clinical
components
(SA
Health,
2016)
and
have
dedicated
educators
and/or
support
nurses.
Extensive
Australian
research
by
Phillips,
Esterman,
and
Kenny
(2015)
suggests
that
support
of
new
graduates,
especially
in
their
commencing
weeks,
is
key
to
successful
transition.
However,
despite
the
research
transition
programs
in
South
Australia
are
not
compulsory
and
as
government
program
numbers
are
capped,
not
all
graduates
will
apply
or
be
successful
in
receiving
an
offer
(SA
Health,
2016).
The
transition
journey
of
the
graduate
nurse
from
university
to
the
workforce
and
their
development
as
a
professional
remains
a
challenging
period
of
adjustment
for
graduate
nurses
(Henderson
et
al.,
2015;
Boychuk-Duchscher,
2012).
One
critique
of
univer-
sity
education
might
suggest
that
graduate
be
made
more
‘practice
ready’
however,
as
El
Haddad
et
al.
(2012)
relate,
modern
nursing
has
numerous
unique
and
complex
settings
suggesting
preparation
for
all
eventualities
is
an
impossibility.
Transition
programs
exist
as
another
response
to
assist
the
graduate
nurse
in
transitioning
from
student
to
professional.
The
importance
of
the
transition
program
for
graduate
nurses
cannot
be
understated
as
Kramer
et
al.
(2013,
p.
583)
relates
‘(transition
programs
are)
no
longer
an
option
but
a
necessity’.
Though
transition
programs
help
the
graduate
nurse
in
the
adjustment
to
practice,
the
programs
cannot
hope
to
address
all
issues,
and
as
noted
by
Boychuk-Duchscher
(2012,
p.
15),
transition
will
never
‘be
uneventful’.
The
opportunity
to
further
understand
this
impact
was
a
key
motivation
for
this
research,
which
used
the
principles
of
hermeneutic
phenomenology
to
investigate
the
lived
experience
of
transition,
specifically
with
graduate
nurses
enrolled
in
a
transition
program,
from
the
perspective
of
a
recent
graduate
of
the
program
(the
lead
author
[MA]).
The
research
provides
insight
into
the
transition
period
by
exploring
what
graduates
experienced
as
beneficial,
the
barriers
they
encountered
and
to
provide
meaning
to
their
experience
of
the
phenomena
of
transition.
2.
Method
The
research
drew
upon
the
principles
of
hermeneutic
phe-
nomenology
as
outlined
in
the
writings
of
Van
Manen
(1990)
to
investigate
phenomena
and
give
meaning
based
on
how
that
phe-
nomena
is
experienced.
Specifically,
in
this
study
the
principles
of
hermeneutic
phenomenology
were
used
to
explore
and
understand
the
experiences
of
graduate
nurses
participating
in
a
transition
pro-
gram.
Hermeneutics
in
phenomenology
interprets
the
languages
used
by
people
when
describing
their
experiences
of
the
phe-
nomena
of
interest
(Dowling,
2004).
The
researchers
conceptualise
‘transition’
as
the
sum
of
experiences
narrated
by
graduate
nurses
during
their
transformation
from
student
to
professional
as
the
phenomena
of
interest
to
this
study.
The
research
represented
the
lead
authors’
honours
research
project
and
as
a
former
participant
of
the
Transition
to
Professional
Practice
Program,
the
lead
author
had
first-hand
experience
of
tran-
sition.
This
link
between
the
lead
researcher
and
participants
aided

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
3
the
collection
of
data
as
he
was
perceived
as
a
peer
of
the
graduates
rather
than
an
outsider.
His
recent
experience
aided
interpretation
of
the
language
used
by
the
graduates
to
describe
the
transition
journey
because
of
a
shared
experience.
The
honours
supervising
team/co-authors
reviewed
all
stages
of
the
research
including
data
analysis
to
moderate
potential
bias
due
to
the
lead
authors’
con-
nection
to
the
phenomenon.
2.1.
Data
collection
Purposeful
samples
choose
participants
with
in-depth
expe-
rience
of
the
central
issue
(Creswell,
2007;
Patton,
2002).
A
purposeful
sample
of
seven
graduate
nurses
in
the
first
4
to
8
months
of
employment
in
a
Transition
to
Professional
Program
(TPPP)
were
recruited
for
their
ability
to
provide
a
current
and
in-depth
insight
into
the
central
issue
of
transitioning
within
a
transition
program.
Graduate
nurses
were
recruited
from
a
sin-
gle
metropolitan
hospital
in
South
Australia,
via
two
presentation
given
by
the
lead
author
in
July
of
2014
and
via
the
participat-
ing
hospitals
TPPP
team
who
emailed
a
request
for
participants
on
behalf
of
the
research
team.
Graduates
indicated
their
interest
by
emailing
the
researchers
at
which
point
an
introduction
letter,
information
sheet
and
consent
form
were
emailed
to
potential
par-
ticipants
as
well
as
a
request
to
organise
a
time
to
conduct
the
interview.
Of
the
eight
original
responders,
one
interviewee
with-
drew
before
being
interviewed
due
to
time
constraints,
leaving
seven
participating
graduates.
This
study
collected
data
by
a
semi-structured
interview.
The
interview
questions
were
developed
after
a
review
of
transition
literature
so
that
questions
related
to
comparable
qualitative
liter-
ature
regarding
the
experiences
of
transition
including
Australian
research
by
Kelly
and
Ahern
(2009),
Ostini
and
Bonner
(2012)
and
an
American
study
by
Zinsmeister
and
Schafer
(2009).
This
step
established
transition
as
it
appeared
in
published
literature
and
formed
themes
that
guided
question
development
(Minichiello,
Aroni,
&
Hays,
2008).
These
themes
were:
1.
‘The
Experience’
which
asked
graduates
to
describe
a
good,
a
bad
and
a
surprising
nursing
experience
2.
‘Expectation
vs
Reality’
asked
participants
to
describe
the
‘picture
in
their
head’
of
themselves
nursing
on
completion
of
their
degree
versus
the
present
and
also
explored
their
perception
of
university
taught
nursing
in
comparison
to
their
new
practice.
3.
‘Socialisation’
which
explored
the
participant’s
experiences
with
their
colleagues
and
the
transition
program.
Interviews
were
conducted
by
the
lead
author
and
took
place
at
a
location
of
the
participants
choosing.
Prompt
questions
were
asked
throughout
interviews
to
elicit
more
information
and
to
gain
clarification.
Field
notes
were
taken
during
interviews
to
help
recollection
and
to
record
points
of
interest.
Interviews
were
audio
recorded
and
lasted
an
average
of
30
minutes.
The
audio
recordings
were
transcribed
verbatim
and
then
analysed
to
draw
meaning
from
the
experiences
of
the
graduates
on
the
phenomena
of
transition
based
on
the
language
used
to
describe
events.
After
conducting
two
interviews,
the
transcripts
were
read
by
the
co-
authors
to
provide
feedback
on
interview
technique
as
part
of
the
lead
researchers
professional
development.
2.2.
Ethical
considerations
Ethics
approval
for
the
research
was
granted
from
the
South
Australian
Clinical
Human
Research
Ethic
Committee.
Consent
forms
were
signed
after
participants
had
clarified
their
understand-
ing
of
the
study
and
before
any
interview
took
place.
All
identifying
information
of
participants
and
institutes
was
removed
from
the
data
to
maintain
confidentiality
and
participants
were
assigned
a
number
for
reporting
purposes.
2.3.
Data
analysis
Transcripts
were
imported
into
QSR
Nvivo
(Version
10.1.0)
to
aid
the
thematic
analysis.
Data
analysis
followed
the
approach
sug-
gested
by
Creswell
(2014)
where
data
was
read
as
a
whole
to
gain
an
initial
understanding
of
the
interview
content,
and
then
read
through
again
to
identify
phrases
representing
similar
experiences.
These
phrases
representing
similar
experiences,
were
then
coded
to
nodes
as
they
emerged
from
the
data,
which
formed
the
ini-
tial
themes.
This
process
was
completed
for
all
transcripts;
similar
experiences
coded
to
the
same
node
were
then
checked
for
con-
sistency
of
content
(Creswell,
2014).
Nodes,
once
checked,
were
given
titles
and
description
based
on
the
grouped
experiences
within
the
nodes
towards
understanding
those
experiences
as
a
whole
(Creswell,
2014).
Nodes
were
then
printed
and
read
in
full
by
the
research
team
to
further
understand
content,
and
check
that
the
interpretation
of
content
was
accurately
reflected
in
the
descriptions
and
theme
titles.
The
final
themes
were
discussed
with
participants
to
test
the
accuracy
of
interpretation
and
increase
confidence
in
the
results.
3.
Results
3.1.
Participants
and
themes
The
mean
age
of
participants
was
34.8
years
with
an
age
range
of
24–55.
The
sample
had
four
international
participants;
two
had
spent
significant
time
in
Australia.
Of
the
four,
two
had
English
as
a
second
language
and
two
were
from
English
speaking
countries
with
English
as
their
prime
language.
All
participants
studied
at
a
university
located
in
South
Australia.
Analysis
of
the
transcripts
revealed
the
phenomenon
of
transition
could
be
represented
by
four
themes:
Disconnect,
Sink
or
Swim,
Impacts
to
Transition
and
Reducing
Impact
to
transition.
These
are
described
in
turn
below.
3.2.
Theme
one:
Disconnect
Graduate
experiences
regarding
university
education
were
reported
both
positively
and
negatively
within
the
interviews.
However,
a
consistent
theme
observed
within
the
data
was
of
a
disconnect
existing
between
what
was
taught
in
universities
in
comparison
to
what
the
graduates
experienced
as
practicing
nurses.
One
concern
raised
by
approximately
half
the
participants
was
their
universities
focus
on
research:
‘I
didn’t
know
much
about
dressings
or
about
wounds
and
pressure
ulcers
and
things
like
that
whereas
I
know
how
to
research
a
journal
article’.
Participant
2.
The
quote
suggests
the
disconnect
felt
by
participants
whose
university
acquired
academic
skills
did
not
relate
to
their
practical
needs
on
the
ward.
However,
both
Participant
1
and
2
discussed
sur-
prising
themselves
with
knowledge
recalled
from
their
university
education
when
nursing,
which
arguably
were
acquired
through
academic
means.
The
perspective
given
by
Participant
3
on
univer-
sity
teaching
was
that
‘they
do
their
absolute
best
to
prepare
us’
but
Participant
3
stated
also
that
some
university
taught
content
was
hard
to
relate
to
ward
nursing
with
a
number
of
participant’s
sug-
gesting
that
the
teaching
content
could
focus
more
on
the
practical
side
of
nursing.
Participant
6
felt
that
university
prepared
gradu-
ates
for
the
basics
of
care
only
while
both
Participant
4
and
7
felt
universities
taught
‘the
perfect
way’
nursing
should
be
as
related
by
participant
4:
‘It’s
a
nice
way
of
nursing
that
they
want
us
to
nurse
but
I
don’t
think
it
is
the
real
world’.

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
4
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
Graduate
suggestions
for
reducing
the
disconnect
between
uni-
versity
and
professional
practice
included
an
increased
focus
on
practical
skills
as
well
as
increased
exposure
during
their
student
clinical
placements.
3.3.
Theme
two:
Sink
or
swim!
When
graduates
discussed
commencing
on
their
wards
they
related
that
the
pace,
increase
in
responsibility
and
skill
profi-
ciency
required
by
the
new
reality
surprised
and
overwhelmed
them.
Several
graduates
related
that
their
time
and
energy
initially
was
focused
on
just
completing
their
daily
tasks,
to
the
point
that
some
graduates
admitted
to
not
always
listening
to
patients
as
they
were
too
focused
on
completing
tasks.
The
graduates
were
aware
of
the
potential
danger
of
not
listening
to
patients
but
the
pressure
in
their
minds
to
complete
tasks
was
such
that
the
graduate
ignored
patients.
Participant
3
relates:
‘I
wasn’t
taking
any
notice
of
the
big
picture;
it
was
just
sort
of
more
focused
on
getting
the
job
done’.
Graduates
also
reported
not
feeling
like
they
had
enough
time
to
know
enough
about
their
patients,
as
they
clinically
should.
The
change
in
responsibility
from
student
to
professional
was
another
cause
for
distress
as
related
by
participant
3
who
saw
the
change
as:
‘you’re
it,
and
having
to
like
realise,
oh
that
person’s
really
unwell,
but
it’s
not
enough
saying
they’re
unwell,
the
doctors
need
to
know
more
about
what’s
going
on.
.
.but
also
with
that
also
comes
the
responsibility
that
if
you
don’t
act
upon
and
something
happens,
then
that’s
your
fault.’
The
graduate
nurses
felt
that
the
time
between
starting
the
new
job
compared
to
the
first
shift
on
the
ward
with
a
patient
load
was
abrupt.
One
participant
narrated
that
after
two
day’s
hospital
ori-
entation,
one
day
ward
orientation
and
one
supernumerary
shift
it
was
‘bang,
you’re
out
on
your
own’.
Another
concern
reported
by
a
number
of
graduates
was
that
inadequate
ward
orientation
made
adjustment
to
the
ward
harder.
3.4.
Theme
three:
Impacts
to
transition
The
adjustment
to
the
new
reality,
as
already
discussed,
caused
obvious
stress
and
anxiety
for
the
graduate
nurses.
An
example
of
the
potential
impact
of
stress
and
anxiety
is
seen
in
the
self-critical
language
graduate
nurses
used
when
retelling
of
incidents
on
the
wards:
‘I
find
I
make
a
mistake
or
something
–
like
it
hasn’t
been
anything
major
but
you
just
forget
little
things
and
then
someone
will
say
oh
you’ve
forgotten
this.
I
think
oh
they’re
going
to
think
I’m
crap’
Participant
2.
Throughout
the
interviews
examples
of
exaggerated
language,
in
situations
that
arguably
would
not
normally
cause
a
reaction,
could
be
found.
For
example,
when
participants
talked
of
strug-
gling
to
find
the
motivation
to
attend
their
shifts.
Other
experiences
narrated
by
graduates
provided
an
insight
into
the
situations
that
negatively
impacted
their
transition.
For
example,
all
graduate
nurses
interviewed
related
struggling
with
the
attitudes
of
certain
staff
members,
with
some
staff
highlighted
as
difficult
to
approach
or
engage
when
a
question
needed
answering
or
staff
taking
over
care
from
graduates
without
discussion
or
handover.
Another
point
of
concern
for
the
graduate
nurses
was
found
in
the
language
the
participants
used
when
discussing
ward
rota-
tion,
which
was
similar
in
tone
to
when
the
graduates
discussed
commencing
on
the
ward:
‘it
sort
of
knocks
my
confidence
for
a
six
because
I’m
on
a
ward
where
I
don’t
know
where
I’m
going
to
go,
I
don’t
know
the
patients,
I
don’t
know
the
policies
and
procedures
and
it
makes
me
feel
like
you’re
new
again
and
you
don’t
know
what
you’re
doing.
.
.
which
is
useless,
and
it
sort
of
makes
me
feel
like
shit’
Participant
1.
Graduates
also
struggled
when
there
were
significant
changes
to
their
current
wards
due
to
events
like
severe
gastro
outbreak
or
the
introduction
of
electronic
documentation
systems
that
made
the
work
environment
chaotic.
3.5.
Theme
four:
Reducing
impact
to
transition
As
with
situations
that
increased
the
impact
of
transition,
there
are
commonalities
across
the
interviews
that
helped
to
reduce
the
impact
of
transition
for
the
graduate
nurses.
Most
gradu-
ates
reported
being
able
to
identify
staff
on
the
ward
who
were
approachable,
who
would
answer
questions
and
even
offer
advice,
as
suggested
in
this
quote
from
participant
2:
‘after
a
while
you
go
to
particular
people
more
than
others.
.
.
There’s
probably
a
couple
of
nurses
on
my
ward
that
I
would
go
to
if
I
was
having
a
problem’.
Graduates
also
related
positive
encounters
with
doctors
and
coordinators
who
demonstrated
skills
for
the
graduates
or
acknowledged
the
graduate’s
contribution
to
the
team.
Also,
sev-
eral
graduates
used
significantly
more
positive
language
when
discussing
their
work
environments,
in
comparison
to
their
peers
(or
even
the
same
graduate’s
descriptions
of
their
experiences
on
another
ward).
Statements
from
these
graduates
related
that
‘they
looked
forward
to
going
to
work’
and
that
the
graduates
had
made
friendships
that
extended
beyond
the
ward
or
like
this
quote
from
participant
4:
‘the
nurses
on
that
ward
are
amazing
and
yeah
it
was
a
good
environment
to
work
in
–
the
right
nurses’.
A
number
of
graduates
identified
nurses
whose
practice
inspired
them
with
the
graduates
reporting
they
would
like
to
emulate
in
their
future
careers.
All
participants
felt
that
with
time,
they
became
more
confident
in
their
practice
and
as
routine
sunk
in,
they
had
more
time
in
their
day
to
complete
their
work.
Of
interest
is
the
two
mature
aged
graduates
in
this
study
who
both
relate
having
stood
up
for
themselves
in
the
face
of
difficult
situations
(which
is
lacking
in
the
younger
participant’s
narrations),
suggesting
life
experience
is
important
in
coping
with
difficulties
of
transition.
Participants
also
identified
the
care
of
other
in
all
seven
inter-
views
as
a
positive
and
beneficial
part
of
the
graduate’s
new
career.
Participants
narrated
that
when
patients
reacted
gratefully
to
the
care
provided
them,
it
helped
make
the
job
worthwhile.
Participant
2
and
3
expand
this
point
by
relating
that
the
patient
is
not
in
hos-
pital
by
choice
and
the
ability
to
help
them
to
recover
and
leave
the
hospital
was
an
encouraging
part
of
the
job.
In
discussing
care
as
part
of
the
nursing
role,
Participant
2
said:
‘we’re
elective
surgery,
so
usually
we
get
them
[patients]
before
their
surgery
and
they’re
really
nervous
and
you
can
be
there
to
comfort
them
and
that’s
always
quite
rewarding’.
Another
rewarding
aspect
of
care
reported
by
the
participants
was
being
part
of
the
health
team
that
helped
return
people
to
health,
or
being
able
to
support
the
families
for
those
that
did
not
return
to
health.
As
related
by
participant
2
and
3,
patients
were
not
in
hospital
by
choice
and
the
ability
to
aide
their
recovery
and
leave
hospital
was
a
rewarding
aspect
of
the
job.
All
participants
were
positive
when
asked
about
their
TPPP.
Common
terms
used
to
describe
their
experience
of
the
program
were
‘support’,
‘supported’,
‘supportive’
or
‘supporting’
when
talk-

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
5
ing
of
the
TPPP
program
or
its
staff.
Participant
4
felt
an
advantage
of
the
program
was
the
ability
to
‘off
load’
confidentially.
Similarly,
Participant
1
told
of
a
negative
encounter
on
the
ward,
after
the
incident
Participant
1
rang
the
TPPP
coordinator
to
discuss
what
happened,
the
TPPP
coordinator
offered
to
follow
up
on
the
situa-
tion
but
Participant
1
said
‘no’
and
that
they
just
needed
to
‘vent’.
This
ability
to
‘vent’,
‘de-brief’
or
‘off-load’
offered
the
graduate
nurses
an
outlet
for
their
frustration
and
the
support
of
the
TPPP
program
offered
‘peace
of
mind’.
Knowing
that
the
TPPP
team
is
there
to
back
the
graduates
up
in
confronting
situations,
to
advocate
for
them
or
as
Participant
3
simply
stated:
‘they
always
make
themselves
available
so
that
if
you’re
finding
yourself
falling
behind
in
your
patient
load,
patient
care,
then
they
can
actually
come
in
and
help
out’
and:
‘the
TPPP
coordinators
are
very
nice,
they
are
very
supportive,
very
thoughtful,
[they]
visited
me
many
times,
and
they
will
give
me
a
hand
at
the
beginning
of
my
rotation,
the
first
two
months
they
offer
help.
It’s
very
nice,
it’s
very
warm’
Participant
5.
The
last
quote
highlights
the
support
graduate
nurses
are
given
when
commencing
on
the
ward
to
help
the
graduates
settle;
Par-
ticipant
1
described
starting
as
a
nurse:
‘it’s
scary
when
you
first
qualify
and
go
onto
this
ward
going
oh
my
god
I’m
actually
the
RN
now.
The
transition
from
a
student
to
an
RN
is
huge.
It’s
overwhelming
and
you
just
have
to
try
and
stay
positive
and
the
feelings
that
you
have
are
normal
and
that’s
where
the
TPPP
people
come
in
and
say
yep
that’s
perfectly
normal’
As
well
as
aiding
the
graduate
to
adjust
to
their
new
position
the
TPPP
team
is
credited
with
helping
to
retain
the
graduate
in
employment:
‘I
got
plenty
of
support
from
them
so
I
was
really,
really,
happy.
I
would
say
that
without
them
I
don’t
think
I
would
like
to
carry
on’
Participant
6
The
quotes
illustrate
the
importance
of
the
TPPP
program
to
the
graduate
nurses
who,
especially
early
on,
felt
overwhelmed
by
the
transition
to
practice
and
the
support
received
by
TPPP
staff
helped
to
potentially
retain
the
employment
of
the
graduate
nurses.
The
program
also
allowed
graduates
to
de-brief
with
their
peers
on
study
days
and
at
in-services,
which
is
beneficial
as
the
shared
expe-
rience
was
identified
in
the
interviews
as
providing
an
awareness
that
all
graduates
undergo
similar
experiences.
4.
Discussion
The
shared
experiences
of
the
graduate
nurses
in
this
study
por-
trayed
transition
as
a
time
of
many
new
experiences;
so
much
is
new
in
fact
that
a
shock
reaction
was
experienced
due
to
an
over-
load
of
new
experiences.
This
shock
of
the
new
is
seen
during
the
initial
transition
when
graduates
speak
of
being
‘overwhelmed’
and
time
poor
due
to
the
demands
of
all
their
new
responsibilities.
Like
Kramer’s
(1974)
definition
of
shock,
the
term
is
used
in
this
study
to
define
an
emotional
response
to
the
‘unexpected’.
How-
ever,
Kramer
(1974)
talked
of
shock
induced
from
a
difference
in
realities
between
the
university
instilled
values
compared
to
real-
ties
of
nursing
practice.
Traits
of
Kramer’s
shock
were
observed
in
this
study.
However,
the
shock
communicated
by
the
participants
in
our
study
was
also
attributed
to
an
overwhelming
volume
of
new
demands
and
were
comparable
to
Kelly
and
Ahern’s
(2009)
findings
where
graduates
reported
being
unaware
of,
unprepared
for,
or
a
combination
of
both
of
the
demands
of
nursing
when
commencing
as
a
nurse.
This
shock
of
the
new
is
also
seen
when
the
graduate
nurses
rotated
to
a
new
ward
and
were
again
overwhelmed
for
a
time
by
their
new
environment.
Issues
related
to
ward
rotation
were
also
reported
by
Missen
et
al.
(2016),
Malouf
and
West
(2011)
and
Kelly
and
Ahern’s
(2009).
Similarly,
major
changes
in
routine
experienced
on
wards
lead
to
the
re-experience
of
shock.
When
the
new
started
to
become
the
familiar
however,
the
graduate
nurses
in
this
study,
and
as
similarly
reported
in
Mellor
and
Gregoric
(2016)
study,
became
settled
into
their
routine
and
began
to
find
more
time
in
their
day,
and
no
longer
in
the
grip
of
shock.
The
shock
of
new
experiences
is
attributed
by
graduates,
in
part,
to
the
academic
preparation
by
universities
not
matching
the
reality
they
found
in
practice.
The
suggestion
that
univer-
sities
preparation
of
graduates
is
inadequate
is
neither
new
in
the
literature
as
outlined
by
Kramer
(1974)
and
more
locally
by
Levett-Jones
and
FitzGerald
(2005)
Australian
study,
nor
lacking
(for
example
Boychuk-Duchscher,
2012;
Malouf
&
West,
2011;
Kelly
&
Ahern,
2009,
as
well
as
this
research).
Additional
collab-
oration
between
hospitals
and
universities
could
aid
preparation
of
students
for
practice
by
providing
a
focused
classroom
learning
and
practicum
environment.
The
need
for
greater
collaboration
has
been
recognised
by
researchers
such
as
Levett-Jones
and
FitzGerald
(2005)
and
Boychuk-Duchscher
(2012)
who
suggests
that
hospitals
and
universities
working
together
can
best
identify
and
address
issues
of
transition
to
help
ease
nurses
into
professional
practice.
El
Haddad,
Moxham,
and
Bradbent
(2012)
pursues
the
idea
further
in
proposing
that
responsibility
be
shared
between
the
education
provider
and
the
workplace
in
preparing
students
for
practice.
This
suggestion
of
joint
responsibility
might
remove
the
potential
for
blame
around
inadequate
preparation
by
universities
and
unre-
alistic
practice
expectations
of
new
nurses
by
hospitals
if
both
institutes
have
a
stake
in
preparation.
Graduates
within
this
study
also
suggested
that
inadequate
orientation
and
minimal
super-
visory
shifts
when
graduates
first
commenced
made
adjustment
difficult.
Inappropriate
orientation
and
allocation
of
patients
with
complex
acuity
beyond
the
new
practitioner’s
scope
was
noted
by
Phillips,
Esterman,
and
Kenny
(2015)
as
affecting
graduate
confi-
dence
and
engagement.
This
consideration
of
patient
allocation
being
matched
to
the
graduate
nurse’s
initial
ability,
that
slowly
expands
as
the
graduate
nurse
gains
confidence
and
competence
is
explored
in
a
theoreti-
cal
model
of
orientation
by
Phillips,
Esterman,
and
Kenny
(2015).
Similarly,
the
idea
of
a
reduced
patient
load
in
terms
of
both
phys-
ical
numbers
and
actual
patient
acuity
in
the
graduates
initial
two
weeks
is
suggested
by
Missen
et
al.
(2016)
as
giving
the
new
prac-
titioner
time
to
adjust
to
ward
routines
and
develop
confidence.
Patient
allocation
that
matches
ability
would
not
only
help
to
ease
the
graduate
into
practice,
but
also
reduce
the
risk
to
patient
safety
by
not
allocating
beyond
the
graduate’s
ability
to
manage
and
is
theoretically
cost
effective
as
it
requires
minimal
change
to
ward
routine.
As
noted
in
this
study,
the
overwhelmed
graduate
may
not
always
take
in
what
their
patient
is
saying
and
as
related
by
Benner
(1984)
may
miss
cues
to
important
clinical
observations.
It
is
also
worrying
to
observe
the
graduates
talk
of
nurses
who
were
hard
to
engage
when
questions
needed
answering.
As
Benner
(1984)
relates,
‘advanced
beginners’
require
guidance
from
experi-
enced
nurses
to
help
inform
and
improve
their
practice
and
there
exists
a
burden
of
training
and
socialization
of
the
next
generation
that
all
nurses
need
to
bear.
However,
just
as
encouraging
was
the
graduates’
narrations
of
supportive
staff,
not
limited
to
nurses,
who
would
answer
question
and
demonstrate
skills
and
this
unit
level
of
support
was
related
by
Rush
et
al.
(2014)
as
aiding
the
transition
experience.
Additionally,
as
Malouf
and
West
(2011)
found,
gradu-
ate
nurses
reported
sharing
advice
on
other
staff;
who
was
helpful
and
who
was
not,
which
aided
the
graduate
nurses
in
identifying
those
who
could
be
turned
to,
to
help
clarify
their
practice.

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
6
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
The
TPPP
team
was
praised
throughout
the
interviews
as
offer-
ing
support
and
peace
of
mind
for
the
graduate
nurses
who
knew
the
team
were
(mostly)
just
a
phone
call
away.
The
dedicated
TPPP
staff
were
credited
with
helping
graduates
to
understand
that
their
emotions
during
transition
were
(unfortunately)
common
and
that
the
graduate
is
not
alone,
voicing
similar
results
to
Henderson
et
al.
(2015)
graduates
when
discussing
their
preceptors.
The
par-
ticipants
described
how
TPPP
staff
helped
with
tasks
that
initially
seemed
overwhelming
by
aiding
the
graduates
in
patient
care,
or
by
helping
out
if
the
graduate
seemed
busy.
The
understanding
gained
from
graduates
reporting
that
dedicated
staff
provided
sup-
port
either
tangibly
in
person
or
via
a
perception
of
being
available
if
needed,
lends
credibility
to
the
existence
of
the
program.
Indeed,
as
noted
by
Phillips,
Esterman
and
Kenny
(2015),
health
service
support
(along
with
effective
socialisation)
is
suggested
as
key
to
a
successful
transition.
Additionally,
the
transition
program
and
the
presence
of
the
TPPP
staff
helped
fill
the
role
identified
by
Benner
(1984)
of
the
experienced
practitioner
that
can
help
inform
and
improve
the
graduates
practice.
The
transition
program,
vicariously
through
the
TPPP
staff,
also
provided
emotional
support
for
grad-
uates
by
acting
as
a
confident
through
which
frustration
could
be
vented.
Healy
and
Howe
(2012)
suggest
the
ability
of
graduates
to
debrief
with
peers
helped
their
resilience
which
suggests
the
con-
fidential
debriefing
with
TPPP
staff
may
provide
a
similar
outcome
4.1.
Limitations
As
an
exploratory
study,
interviews
allowed
graduates
to
express
their
stories
in-depth
and
relate
details
that
were
impor-
tant
to
them.
The
potential
existed
for
the
stories
to
lose
focus
but
the
semi-structured
interview
style
kept
discussion
relevant
to
the
topic
of
graduate
nursing
and
the
transition
journey.
Further,
given
the
lead
researchers
experience
of
transition,
more
depth
and
focus
was
gained
from
interviews
due
to
the
informed
knowledge
of
the
subject
and
the
creation
of
a
safe
space
for
participants
to
share
their
stories.
The
small
sample
size
and
recruitment
of
participants
from
only
one
public
agency
means
care
should
be
taken
to
gen-
eralise
the
results
to
nurse
graduates
in
other
transition
programs.
However,
all
participants
had
first-hand
experience
of
the
central
phenomena,
which
was
described
in-depth
and
then
confirmed
with
participants
after
analysis
giving
confidence
to
the
quality
of
the
data
and
accuracy
of
the
interpretation.
5.
Conclusion
Transitioning
from
university
to
professional
clinical
practice
remains
a
time
of
considerable
challenges
for
graduate
nursing
stu-
dents.
A
graduate
nurse’s
transition
into
their
professional
role
can
be
an
overwhelming
experience
due
to
the
many
new
demands.
Despite
this,
the
support
graduates
received
from
both
the
tran-
sition
program
and
approachable
senior
staff
eased
the
transition
journey.
The
importance
of
the
transition
program
in
aiding
the
graduate
nurses
in
our
study
cannot
be
overstated
as
all
partici-
pants
praised
the
aid
received
from
the
transition
staff.
Further,
this
study
helped
understand
that
the
benefit
of
transition
programs
exists
beyond
the
aid
received
in
the
clinical
environment
in
the
form
of
in-tangible
knowledge
that
help
is
available
if
needed,
and
this
alone
can
assist
with
transition.
Authors
contribution
to
the
paper
All
authors
have
contributed
to
the
study
including
the
con-
ception,
design,
acquisition
and
interpretation
of
all
data
as
well
as
drafting
and
revision
towards
the
final
version,
which
has
been
accepted
by
all
authors.
Conflict
of
interest
Lead
Author
(MA)
is
a
former
graduate
of
the
Transition
to
Pro-
fessional
Practice
Program
(TPPP)
and
current
employee
of
the
participating
hospital
but
has
no
current
affiliation
with
the
TPPP
program.
Disclosures
This
study
received
research
maintenance
funding
through
Flinders
University’s
College
of
Nursing
and
Health
Sciences.
Acknowledgements
The
authors
would
like
to
thank
the
Transition
to
Professional
Practice
Team
from
the
Southern
Adelaide
Local
Health
Network’s
participating
hospital
for
their
assistance
in
promoting
the
study.
References
Benner,
P.
(1984).
From
novice
to
expert
(1st
ed.).
Menlo
Park,
California:
Addison-Wesley
Publishing
Company.
Boychuk-Duchscher,
J.
(2009).
Transition
shock:
the
initial
stage
of
role
adaptation
for
newly
graduated
Registered
Nurses.
Journal
of
Advanced
Nursing,
65(5),
1103–1113.
http://dx.doi.org/10.1111/j.1365-2648.2008.04898.x
Boychuk-Duchscher,
J.
(2012).
From
surviving
to
thriving
(1st
ed.).
Saskatoon,
Saskatchewan:
Nursing
the
Future.
Creswell,
J.
W.
(2014).
Research
design:
Qualitative,
quantitative
and
mixed
methods
approaches
(4th
ed.).
Thousand
Oaks,
California:
Sage
Publications.
Creswell,
J.
W.
(2007).
Qualitative
inquiry
&
research
design:
Choosing
among
the
five
approaches
(2nd
ed.).
Thousand
Oaks,
California:
Sage
Publications.
De
Bellis,
A.,
Longon,
D.,
&
Glover,
P.
(2001).
The
Enculturation
of
our
nursing
graduates.
Contemporary
Nurse,
11,
84–94.
Dowling,
M.
(2004).
Hermeneutics:
An
exploration?
Nurse
Researcher,
11(4),
30–39.
El
Haddad,
M.,
Moxham,
L.,
&
Broadbent,
M.
(2012).
Graduate
registered
nurse
practice
readiness
in
the
Australian
context:
An
issue
worthy
of
discussion.
Collegian,
20(4),
233–238.
Healy,
M.,
&
Howe,
V.
(2012).
Study
of
Victorian
early
graduate
programs
for
nurses
and
midwives
appendices.
Hawthrone,
Victoria:
Taylor
Nelson
Sofres
Social
Research.
Henderson,
A.,
Ossenberg,
C.,
&
Scott,
T.
(2015).
‘What
matters
to
graduates’:
An
evaluation
of
a
structured
clinical
support
program
for
newly
graduated
nurses.
Nurse
Education
in
Practice,
15,
225–231.
http://dx.doi.org/10.1016/j.
nepr.2015.01.009
Kelly,
J.,
&
Ahern,
K.
(2009).
Preparing
nurses
for
practice:
a
phenomenological
study
of
the
new
graduate
in
Australia.
Journal
of
Clinical
Nursing,
18(6),
910–918.
Kramer,
M.
(1974).
Reality
shock:
Why
nurses
leave
nursing
(1st
ed.).
St
Louis,
U.S.A:
Mosby.
Kramer,
M.,
Maguire,
P.,
Schmalenberg,
C.,
Halfer,
D.,
Budin,
W.
C.,
Hall,
D.
S.,
et
al.
(2013).
Components
and
strategies
of
nurse
residency
programs
effective
in
new
graduate
socialization.
Western
Journal
of
Nursing
Research,
35(5),
566–589.
Levett-Jones,
T.,
&
FitzGerald,
M.
(2005).
A
review
of
graduate
nurse
transition
programs
in
Australia.
The
Australian
Journal
of
Advanced
Nursing,
23(2),
40–45.
Malouf,
N.,
&
West,
S.
(2011).
Fitting
in:
a
pervasive
new
graduate
nurse
need.
Nurse
Education
Today,
31(5),
488–493.
Mellor,
P.,
&
Gregoric,
C.
v.
(2016).
Ways
of
being:
preparing
nursing
students
for
transition
to
professional
practice.
Journal
of
Continuing
Education
in
Nursing,
47(7),
330–340.
Minichiello,
V.,
Aroni,
R.,
&
Hays,
T.
N.
(2008).
In-depth
interviewing
(3rd
ed.).
Missen,
K.,
McKenna,
L.,
&
Beauchamp,
A.
(2016).
Graduate
nurse
program
coordinators’
perspectives
on
graduate
nurse
programs
in
Victoria,
Australia
:
A
descriptive
qualitative
approach.
Collegian,
23(2),
201–208.
Ostini,
F.,
&
Bonner,
A.
(2012).
Australian
new
graduate
experiences
during
their
transition
program
in
a
rural/regional
acute
care
setting.
Contemporary
Nurse,
41(2),
242–252.
Patton,
M.
(2002).
Qualitative
evaluation
and
research
methods
(3rd
ed.).
California:
Sage
Publication.
Phillips,
C.,
Kenny,
A.,
Esterman,
A.,
&
Smith,
C.
(2014).
A
secondary
data
analysis
examining
the
needs
of
graduate
nurses
in
their
transition
to
a
new
role.
Nurse
Education
in
Practice,
14(2),
106–111.
Phillips,
C.,
Esterman,
A.,
&
Kenny,
A.
(2015).
The
theory
of
organisational
socialisation
and
its
potential
for
improving
transition
experiences
for
new
graduate
nurses?
Nurse
Education
Today,
35(1),
118–124.
Rush,
K.
L.,
Adamack,
M.,
Gordon,
J.,
&
Janke,
R.
(2014).
New
graduate
nurse
transition
programs:
relationships
with
bullying
and
access
to
support.
Contemporary
Nurse,
48(2),
219–228.

Please
cite
this
article
in
press
as:
Ankers,
M.
D.,
et
al.
A
phenomenological
exploration
of
graduate
nurse
transition
to
professional
practice
within
a
transition
to
practice
program.
Collegian
(2017),
http://dx.doi.org/10.1016/j.colegn.2017.09.002
ARTICLE IN PRESS
G Model
COLEGN-472;
No.
of
Pages
7
M.D.
Ankers
et
al.
/
Collegian
xxx
(2017)
xxx–xxx
7
SA
Health.
(2016).
SA
Health
2017
Transition
to
Professional
Practice
Program
(TPPP)
for
registered
nurses.
South
Australian
Department
of
Health.
Retrieved
from.
http://www.sahealthcareers.com.au/campaign.php?id=37
Van
Manen,
M.
(1990).
Researching
lived
experience:
Human
science
for
an
action
sensitive
pedgogy.
University
of
Western
Ontario,
Canada:
The
Althouse
Press.
Zinsmeister,
L.
B.,
&
Schafer,
D.
(2009).
The
exploration
of
the
lived
experience
of
the
graduate
nurse
making
the
transition
to
registered
nurse
during
the
first
year
of
practice?
Journal
for
Nurses
in
Professional
Development,
25(1),
28–34.