Content area
Aim
To update the rapid evidence assessment by Wray et al. (2021), identify specific approaches used to enhance newly qualified nurses’ (NQNs) transition and retention, and evaluate the strength of evidence.
Background
Nursing shortages threaten care quality, making the recruitment and retention of newly qualified nurses (NQNs) essential. Recruitment and retention of NQNs is crucial, as their successful transition, helps address staff shortages. Wray et al. (2021) highlighted this connection, and the present study builds on their work by providing updated insights.
Design
Rapid Evidence Assessment, a structured and time-efficient method for reviewing literature using systematic and transparent procedures.
Methods
A Rapid Evidence Assessment was conducted until February 2024 using CINAHL, Academic search premier, Open Grey, ERIC, Web of Science and PubMed searching for articles using keywords related to nursing transition and retention. For this review, NQHs were nurses with a maximum of 12 months of work experience. Different quality appraisal tools were used according to the type of study.
Results
Our findings supported those of Wray et al. (2021) and provided additional evidence that a supportive work environment, one-to-one mentoring, supportive programmes, a well-structured final clinical practicum, and positive team experiences are key to enhancing the transition and retention of NQNs. Overall, quality appraisal of studies included in our review was medium-high.
Conclusions
Given the global relevance of the topic, more higher quality studies will be needed to investigate the transition experience of NQNs’ and explore the long-term effects of the programmes implemented to enhance both transition and retention.
1 Introduction
Nursing workforce shortages are one of the most serious problems that healthcare systems are facing to ensure safe and quality care to their populations ( Peters, 2023), yet nursing shortages persist ( Buchan and Catton, 2023) and it is predicted that by 2030 there will be a shortage of 4.5 million nurses ( Boniol et al., 2022).
The recent response to Covid-19 has exacerbated the shortage of nurses, increased healthcare workers’ moral and physical distress, burnout and workload, leading nurses to leave their job to seek roles outside the healthcare sector with better working conditions. Moreover, the healthcare needs of the population are increasing ( Lin et al., 2021).
In Italy, for example as declared by the Italian National Federation of Nursing Professions (FNOPI), applications to access undergraduate nursing courses have decreased in the last two years by 10 % ( Federazione Nazionale Ordini Professioni Infermieristiche (FNOPI), 2023). If this situation persists, it will aggravate the already critical shortage nurses due to the progressive reduction of newly qualified nurses, who will not compensate for the increasing numbers of nurses leaving the profession or retiring ( Federazione Nazionale Ordini Professioni Infermieristiche (FNOPI), 2023).
In this scenario, it is critical to address the factors affecting recruitment and retention. The development of new strategies to improve the transition of newly qualified nurses (NQNs) could be one approach to address this issue.
Moreover, recent data from the Programme for International Student Assessment (PISA) indicate that, between 2018 and 2022, interest in nursing careers among 15-year-old students has declined in at least half of the countries of the Organisation for Economic Co-operation and Development ( OECD, 2024). Considering the profession’s decreasing appeal to younger generations, compounded by an ongoing workforce shortage and a high number of impending retirements, there is a pressing need to help healthcare organisations develop and implement more effective recruitment and retention strategies.
2 Background
Newly qualified nurses (NQNs) are nurses who have a work experience of less than one year after registration ( Xu et al., 2021). Therefore, NQNs are a vulnerable population with a high probability of leaving their job or the profession altogether ( Brook et al., 2019). The factors that may influence the transition of NQNs have been explored and may include both individual and organisational factors ( Wray et al., 2021). In addition, expectations, such as professional socialization, professional development opportunities, and the acquisition of competencies and skills relevant to clinical practice, could play a fundamental role ( Aldosari et al., 2021; Innes, Calleja.,2018; van Rooyen et al., 2018; Li et al., 2020).
For example, NQNs believe and expect to be supported throughout their transition period, but when these expectations are unmet, NQNs experience several negative emotions like anxiety, emotional distress, and lack of self-confidence ( Kaldal et al., 2023). Several studies have also shown that work environment and workplace culture have an important impact during transition, and a positive clinical learning environment may help promote the transition of NQNs ( van Rooyen et al., 2018). Meanwhile a negative workplace environment or working in understaffed settings have a serious negative effect on transition, contributing to emotional distress, heightened anxiety, and an increased intention to leave the profession ( Li et al., 2020).
Moreover, some studies have highlighted the importance of addressing ways to facilitate transition already in the final year of undergraduate nursing programmes and suggest curriculum revisions ( van Rooyen et al., 2018; Hampton et al., 2020). Wray et al. (2021) indicated that most of these studies only deal with transition without considering the impact on nurses’ retention. Another issue that arises when discussing transition and retention is the lack of a standard definition that could guide the discussion on these issues. Therefore, in their review, Wray et al. (2021) investigated the approaches that are used to enhance transition and retention, and the strength of the evidence for these specific approaches.
Given the importance of the issue and the relevance of nursing turnover in the last two years, we decided to update the review conducted by Wray et al. (2021) which included data up to 2018 using the same research questions.
Therefore, the aim of this study is to update the rapid evidence assessment conducted by Wray et al., (2021) on the approaches used to enhance NQNs’ transition and retention, and to evaluate the strength of the evidence for specific approaches to newly qualified nurses’ transition and retention.
3 Methods
3.1 Design
This study used a rapid evidence assessment (REA) design to ensure to ensure methodological continuity in relation to the previous REA conducted by Wray et al. (2021). The REA design was originally chosen to produce information in a timely manner ( Tricco et al., 2015), maintaining the rigour of the systematic review approach but in a shorter time with fewer questions. Nevertheless, there is currently no universally standardized methodology for conducting rapid reviews. For this review, as for the previous one, the term NQN is used throughout, and refers to nurses with 12 months or less of working experience. This is consistent with earlier research exploring the stages of transition.
3.2 Research questions
• What approaches are used to enhance the transition of newly qualified nurses?
• What approaches are used to enhance the retention of newly qualified nurses?
• What is the strength of evidence for specific approaches to nurse transition and retention?
3.3 Search methods
The following electronic databases were searched in February 2024: CINAHL, Academic search premier, Open Grey, ERIC* (Education), Web of Science–Social Science Citation Index and PubMed).
We used the following search strategy: ((Newly qualified nurse) OR (Newly registered nurse) OR (New nurse) OR (Student Nurse) OR (Nursing Student)) AND ((Transition) OR (Retention) OR (Attrition) OR (Turnover) OR (Stability)). We searched for articles published from February 2018 to February 2024.The inclusion and exclusion criteria are reported in
3.4 Search outcomes
A total of 5649 records were identified across the databases (
The titles of the 3773 records were examined for relevance; 712 were excluded because they did not meet the inclusion criteria ( Table 1). Another 2769 records were removed after examining the abstracts. Full texts of the remaining 292 papers were examined and assessed for eligibility. Each member of the team was randomly allocated to the full texts for this phase.
Another 265 full texts were excluded, and one full text excluded because its quality was considered too low, leaving 26 full texts for data extraction: quasi experimental (9), survey/other quantitative methodologies (6), qualitative studies (8), and mixed methods studies (3). The PRISMA (
Page et al., 2021) flow diagram is reported in
3.5 Quality appraisal
Each member of the team undertook the quality assessment of the full texts using an appropriate appraisal tool. The CASP (
Critical Appraisal Skills Programme, 2018) appraisal tool was used to assess qualitative studies. The MMAT (Mixed Methods Appraisal Tool) was used to assess mixed methods studies (
Hong et al., 2018), and a customised tool based on
Kelley et al. (2003) was used to evaluate the quality of surveys. The STROBE checklist (Strengthening the reporting of observational studies in epidemiology) (
von Elm et al., 2008) was used to assess the quasi-experimental study. The Consolidated Standards of Reporting Trials (CONSORT) (
Moher et al., 2001) guidelines were used to evaluate non-randomised studies (
Reeves and Gaus, 2004). To ensure consistency, the quality of each paper was assessed at this stage by another member of the team. Any disagreement was resolved via discussion or involvement of another team member. A descriptor of quality (high; medium; low) was assigned to each paper, based on whether the paper was highly, moderately, or poorly adherent to the requirements highlighted by the quality assessment instrument. The results of the quality appraisal are reported in
3.6 Data extraction and Synthesis
The key details of the included papers are summarised in Table 3. The review included studies employing a range of various research designs, with different focuses and outcome measures, therefore a narrative synthesis of the data was appropriate.
4 Results
The results are presented under the first two research questions.
4.1 What approaches are used to enhance the transition of newly qualified nurses?
Transition has been proved to be a challenging period for NQNs. The main challenges encountered by newly qualified nurses (NQNs) during the transition period often stem from unrealistic expectations placed upon them and a lack of support from colleagues and organisations, which could result in unfriendly or even hostile work environments (Moon et al., 2024; Feltrin et al., 2019; Ho et al., 2021; Kim and Shin, 2020; Wildermuth et al., 2020). In this scenario, staff shortages and the resulting excessive workloads have a negative impact on NQNs’ transition experience, especially by limiting learning opportunities and hindering the acquisition of new skills ( Austin, Halpin.,2021; Baldwin et al., 2021; Doughty et al., 2018; Ho et al., 2021; Wildermuth et al., 2020). These issues generate negative feelings in NQNs, such as lack of confidence, feeling overwhelmed, nervousness, fear, and a great amount of stress (Moon et al., 2024; Austin, Halpin.,2021; Kim and Shin, 2020; Wildermuth et al., 2020). Such emotional strain not only impacts NQNs on a personal level but may also compromise team dynamics and adversely affect patient outcomes ( Feltrin et al., 2019). One study focused on NQNs’ expectations of transition at the start of a supportive programme ( Berglund et al., 2022): this qualitative study found that transition was constituted by: the courage to grow; responsibility and fear; belonging and vulnerability; and support and challenge ( Berglund et al., 2022).
4.1.1 Supportive programmes
The most investigated and used approaches to address these challenges related to transition have proven to be supportive programmes for NQNs at the beginning of their working experiences. We found and examined programmes from Australia ( Feltrin et al., 2019; Charette et al., 2023), China ( Chen et al., 2021; Hu et al., 2023; Xu et al., 2022), Finland ( Lindfors et al., 2022), New Zealand ( Doughty et al., 2018), Sweden ( Berglund et al., 2022), UK ( Austin, Halpin.,2021; Ho et al., 2021), South Korea ( Kim et al., 2024; Moon et al., 2024; Song et al., 2024) and USA ( Cantrell et al., 2024; Baldwin et al., 2021; Wildermuth et al., 2020; Miller et al., 2023), Korea ( Choi and Yu, 2022) and Egypt ( Hassan et al., 2024). These programmes may include the assignment of a preceptor/mentor to NQNs ( Cantrell et al., 2024; Kim et al., 2024; Moon et al., 2024; Austin, Halpin.,2021; Baldwin et al., 2021; Chen et al., 2021; Doughty et al., 2018; Ho et al., 2021; Lindfors et al., 2022; Song et al., 2024; Wildermuth et al., 2020; Charette et al., 2023), education interventions directly linked to clinical issues ( Berglund et al., 2022; Cantrell et al., 2024; Baldwin et al., 2021; Chen et al., 2021; Doughty et al., 2018; Wildermuth et al., 2020; Charette et al., 2023), debriefings on the transition experience with mentors and participants ( Moon et al., 2024), tailored training, department tours, and peer workshops ( Kim et al., 2024), psychological counselling ( Xu et al., 2022), and simulations ( Wildermuth et al., 2020; Hassan et al., 2024).
In general, the length of these programmes ranged from one to 14 months ( Cantrell et al., 2024; Kim et al., 2024; Moon et al., 2024; Xu et al., 2022; Austin, Halpin.,2021; Baldwin et al., 2021; Chen et al., 2021; Doughty et al., 2018; Lindfors et al., 2022; Miller et al., 2023; Hu et al., 2023; Charette et al., 2023; Hassan et al., 2024; Song et al., 2024) however, some of the studies included in this review did not specify the exact length of the programmes ( Feltrin et al., 2019; Ho et al., 2021; Wildermuth et al., 2020). We found that these programmes measured different variables using specific tools or qualitative approaches: in particular these programmes effectively supported NQNs both in clinical practice and emotional coping during transition ( Kim et al., 2024; Moon et al., 2024; Xu et al., 2022; Austin, Halpin.,2021; Chen et al., 2021; Wildermuth et al., 2020) improving the self-efficacy of less experienced nurses ( Moon et al., 2024; Choi and Yu, 2022) and social support from clinical nurse educators ( Moon et al., 2024).
Regardless of the programme type, outcomes did not differ significantly, as long as NQNs were paired with preceptors ( Cantrell et al., 2024). The study by Hu et al. (2023) shows that NQNs improved their professional identity immediately after the transition programme, although this did not remain stable over time.
Preceptors and mentors have been recognized as crucial figures in supporting NQNs, and several studies have outlined the specific characteristics they should possess. They should be approachable experts with whom NQNs can speak confidentially and ask questions without feeling judged, which implies strong communication skills and empathy ( Austin, Halpin.,2021; Chen et al., 2021; Ho et al., 2021). The relationship between preceptors/mentors and NQNs should be built on trust, equality, mutual respect, mutual approval, and ongoing interaction ( Lindfors et al., 2022). In addition to being experienced nurses, preceptors and mentors must also be genuinely willing to take on this guiding role in clinical practice ( Chen et al., 2021). Their support should include encouraging NQNs’ learning ( Lindfors et al., 2022), as well as promoting the development of new competencies through opportunities outside the workplace, such as attending courses, conferences, and seminars ( Chen et al., 2021; Baldwin et al., 2021; Ho et al., 2021). In one study, the support programme, without the presence of a preceptor or mentor, helped NQNs integrate more effectively into the team, fostered a supportive environment, and improved communication ( Hassan et al., 2024). Where such programmes were not in place, in some studies it was suggested that hospital organisations should offer skills and knowledge training, such as structured monthly teaching sessions ( Miller et al., 2023), as well as training in soft skills, including stress management, time management, and effective communication within the hospital environment ( Kim and Shin, 2020).
4.1.2 Final clinical practicum
Another approach that was reported to be effective involved nursing students in their final clinical practicum before graduation, with the aim of preparing them to face the challenges of transition to practice once they graduated ( Kaihlanen et al., 2021). The features that positively influenced the transition phase involved the extent to which the final clinical practicum was systematic, feeling part of a professional team during the practicum, and being prepared for the demands of a nurse’s work during the practicum ( Kaihlanen et al., 2021).
4.1.3 A positive and supportive work environment
Another widely recognized factor facilitating the transition of NQNs was the presence of a positive and supportive work environment. Key elements of such an environment include effective communication between NQNs and their colleagues ( Chen et al., 2021; Brown et al., 2018; Feltrin et al., 2019; Kim and Shin, 2020), mutual trust and familiarity among team members ( Wildermuth et al., 2020; Charette et al., 2023), and supportive leadership from ward managers ( Kaihlanen et al., 2021). Additionally, NQNs reported that being supernumerary at the beginning of their clinical experience was beneficial to their adjustment and confidence ( Ho et al., 2021; Charette et al., 2023).
4.2 Instruments to evaluate transition
With respect to the instruments used in the included quantitative studies to evaluate the transition, most were designed to assess various aspects associated with the transition experience, including the organisational commitment of NQNs ( Choi and Yu, 2022). For example, Kim and Shin (2020) and Cantrell et al. (2024) used a tool that evaluates NQNs’ experiences of transition (the Casey-Fink Graduate Nurse Experience Survey) and consists of five sections: demographic information; skills/procedure performance; comfort/confidence; job satisfaction dimensions; work environment and difficulties in role transition. Kaihlanen et al. (2021) used a single question on transition and evaluated different factors, such as turnover intention, occupational commitment, and learning environment. Xu et al. (2022) and Chen et al. (2021) used a scale developed by Xue et al. (2015) that measures the transition shock of NGNs, but it was not available in English. They also used a tool by Blegen et al. (2015), which aims to evaluate the experiences of NQNs regarding their preceptorship programmes, including questions about preceptor evaluation, preceptor self-evaluation, and the transition programme. Finally, the study by Kim and Choi (2022) used different scales to investigate resilience, preceptors' teaching behaviours, organisational socialisation, and intention to stay of the NQN.
4.3 What approaches are used to enhance the retention of newly qualified nurses?
4.3.1 One-to-one mentoring
Only four studies directly assessed NQNs' retention through retention rates ( Tseng and Hwang, 2021) and turnover rates ( Zhang et al., 2019; Miller et al., 2023; Song et al., 2024). An effective strategy to support NQNs' retention during their first year of employment involved providing direct one-to-one mentoring ( Zhang et al., 2019) or implementing tailored transitional programmes based on theoretical models, designed to guide nurses beyond the task-oriented phase and foster critical thinking (Miller et al., 2023).
Although not specifically measuring turnover and retention rates, Kim and Choi (2022) highlighted that positive teaching behaviours from preceptors significantly enhanced the resilience of newly graduated nurses, with resilience playing a mediating role in strengthening organisational socialization. Additionally, Kim and Yang (2023) found that a relationship with preceptors was positively correlated with job retention and negatively correlated with burnout among new nurses. In the quasi-experimental study by Tseng and Hwang (2021), there were no significant differences in retention rates between the control group and the intervention group that received a targeted programme. Similar findings emerged from another study, where NQNs participating in a transition programme showed no significant differences across the three time points at the end of the programme ( Hu et al., 2023).
Several factors contributed to NQNs leaving their jobs within the first three months, including difficulties adapting to the work environment, high workloads, workplace atmosphere and lack of belonging, relationships with colleagues, and job-related stress ( Tseng and Hwang, 2021).
One study examined NQNs' intentions to stay following participation in a nursing practice preparation improvement programme tailored for NQNs ( Kim et al., 2024)and reported higher intentions to stay among those who took part compared to those who did not.
Lastly, while not directly focused on retention, Moon et al. (2024) found that relationships built through a supportive programme — where NQNs were paired with mentors and engaged in scheduled discussions about their transition experiences — helped them to better manage challenging situations, ultimately reducing the likelihood of resignation.
4.3.2 A well-structured final clinical practicum
Another strategy that emerged from the study by Kaihlanen et al. (2021) was the implementation of a final clinical practicum prior to entering the profession, which not only facilitates the transition process but also helps to strengthen NQNs' commitment to the profession, thereby supporting retention. The same study found that a supportive pedagogical atmosphere, a strong supervisory relationship, and effective ward leadership were all associated with a smoother transition and higher levels of occupational commitment, particularly normative and affective commitment, which are closely linked to long-term retention ( Kaihlanen et al., 2021).
4.3.3 c) Experience with the work team
Finally, two other qualitative studies addressed retention indirectly ( Brown et al., 2018; Ho et al., 2021). From the themes that emerged, one of the determining factors that favoured the retention of new employees was the experience with their work team ( Brown et al., 2018), while the lack of support or even the impact of one's work activity on one's life led more than one-third of the NQNs participating in the study to leave their job or even switch to another profession ( Ho et al., 2021).
5 Discussion
This rapid evidence assessment was conducted to investigate the latest evidence about the approaches adopted to enhance the transition and retention of newly qualified nurses and the strength of the evidence for specific approaches to update Wray et al.’s review.
5.1 Approaches to enhance the transition of newly qualified nurses
5.1.1 Assigning preceptors or mentors
The transition phase is a significant challenge for NQNs. A recent study investigated this phenomenon ( Zhou et al., 2024) by examining the degree of transition shock, a state of insecurity, confusion, and anxiety influenced by physical, psychological, social, and professional factors ( Duchscher, 2009). Zhou et al. (2024) suggested various factors that could influence this phenomenon even beyond 12 months. These factors included the context of origin of new nurses—whether from rural or urban areas—and the commuting distance between home and the workplace. As noted by Zhou et al. (2024) in the context of Chinese nursing, and similarly was observed in Italy, where nurses from rural areas may be more willing to relocate in search of employment opportunities in urban hospitals, which are perceived to offer better working conditions. Nursing leaders should take these elements into account when designing transition support strategies.
Given these challenges, it becomes essential to implement targeted support strategies to ease NQNs' transition into clinical practice. One of the most adopted approaches, as identified in this review, was the development of structured support programmes, which often include assigning preceptors or mentors, offering education on how to manage clinical issues, and incorporating simulations.
Several studies underscore the crucial role of mentors and preceptors, who must not only possess technical expertise but also strong interpersonal and teaching skills. Abdelaliem et al. (2025) further highlighted the need for comprehensive strategies to ease the transition from academia to clinical practice, advocating for structured preceptorship programmes. These programmes are essential for nurturing clinical competencies and boosting the confidence necessary for effective professional practice in healthcare settings.
Preceptors can be either internal or external to the NQNs’ workplace. However, assigning expert preceptors who are independent from the workplace can be particularly beneficial, as NQNs may feel more comfortable expressing doubts and concerns to someone who is not simultaneously a senior staff member of their hospital ( Austin and Halpin, 2021). Moreover, the role of external preceptors can be filled by senior nurses or legacy mentors — experienced nurses nearing retirement or already retired — willing to share their knowledge and support NQNs ( Wray et al., 2023).
For preceptorship to be effective, organisational support through proper training and education is essential ( Brook et al., 2019). Given their pivotal role, preceptors should be regularly evaluated by both nursing managers and NQNs to ensure the quality and effectiveness of their mentorship ( Blegen et al., 2015).
5.1.2 Work environment and workload
A recurrent theme across the included studies of our review was the effect of the work environment and workload on the success of transition programmes. Work environment and workload are two elements that negatively affect transition programmes even when these are good. Indeed, structured transition programmes have an impact on workplace influencing NQNs’ perceptions of their work environment significantly ( Ma et al., 2021a) but at the same time they do not decrease exposure to workplace bullying and violence ( Alshawush et al., 2022). Moreover, negative work environments undermine learning experiences and opportunities for NQNs, which inevitably result in a negative effect on patient outcomes ( Chen et al., 2021, Feltrin et al., 2019, Brown et al., 2018). In fact, Labrague and De Los Santos (2020) found a link between the transition shock and patient outcomes, especially between NQNs’ relationships and adverse events or omissions. Therefore, poor work relationships and support are predictive of adverse events and omissions of nursing care. Reflections on the influence of the work environment on the transition programme inevitably leads us to the role played by nurse mangers who could determine and facilitate a positive learning environment and culture in the organisation (Alshawush et al., 2021; Brook et al., 2019).
5.1.3 Evaluation of the transition programmes and experience
The final issue that emerged from the review was how to evaluate the transition programmes and the transition experience of NQNs. Qualitative methods are the first and the most frequent approach used to evaluate the experience of NQNs. However, measuring the effects of a transition programme in a standardized way could be the first step to compare different approaches and identify which of the NQNs’ personal characteristics influence the transition programme. Moreover, evaluating the status of the transition programme using a questionnaire administered to NQNs at standardised times could be functional way of intercepting any problems that could affect the success of the programme ( Ma et al., 2021b).
As stated by Wray et al. (2021) and confirmed by the present review, preceptorship is the most widely used strategy by organisations to ease transition. What clearly emerges here is that preceptors play a key role and therefore must be supported by the organisation, but at the same time their performance must be carefully evaluated. Moreover, studies included in the review underlined the importance of the work environment, so all the approaches used to create a good work environment had a positive impact on the transition programmes and on the learning opportunities for NQNs.
5.2 Approaches used to enhance retention of newly qualified nurses
Five papers discussed the approaches used to enhance retention, three were quantitative studies ( Tseng and Hwang, 2021; Zhang et al., 2019, Kaihlanen et al., 2021) and two were qualitative studies ( Brown et al., 2018; Ho et al., 2021). Transition programmes and mentorships, implemented in a good work environment, were the most frequently discussed approaches in the included studies.
Retention and turnover rates were the two outcomes used to measure the effects of a transition programme. Unfortunately, both Tseng and Hwang’s quasi-experimental study (2021) and another study ( Brook et al., 2019) showed no significant differences in the retention rates between nurses who participated in a transition programme and those who did not. Kaihlanen et al. (2021) studied the effects of a well-structured final clinical practicum on transition and therefore also on retention. Literature is unequivocal in stating that NQNs who are clinically competent and prepared, are better placed to cope with the difficulties associated with transition and are therefore more likely to remain in the profession. Alongside, qualitative studies ( Brown et al., 2018; Ho et al., 2021) underlined the impact of the work environment and relationships on intention to stay, retention, and turnover rates. Intention to stay could be a positive proxy measure of retention like the other elements that emerged from Wray et al.’s (2021) review, such as adaptation, organisational commitment, and satisfaction. Certainly, work environment and positive working relationships were protective factors that improved the retention rate ( Pressley and Garside, 2023).
5.3 Strength of evidence for specific approaches to nurse transition and retention
Various tools were used to evaluate the quality of the studies. The quality of the two experimental studies ( Zhang et al., 2019; Tseng and Hwang, 2021) was fair. The first one was evaluated using the CONSORT Statement adapted to non-randomised trials ( Reeves and Gaus, 2004), the first study met most of items, but it did not identify clearly the study design, the second one was evaluated using the STROBE Statement because the study had a quasi-experimental design. The quality of the study by Tseng and Hwang, (2021) was fair, because the authors did not describe how they addressed potential sources of bias and how they addressed missing data. Moreover, the results were not generalisable, but they confirmed their results using other published studies.
The qualitative studies were evaluated using the CASP tool, three met all the items and were of high quality ( Feltrin et al., 2019; Ho et al., 2021; Wildermuth et al., 2020), three were of medium quality ( Doughty et al., 2018; Brown et al.; 2018; Baldwin et al., 2021) and one was of low quality ( Austin and Halpin, 2021). The study by Austin and Halpin (2021) did not meet most of the items, in particular the methodology was not clear, and results were not appropriately discussed. The quality of the two descriptive studies was high according to the Survey assessment Tool ( Kelley et al., 2003). The mix-method study was of low quality using MMAT, because this study did not state the research question, nor did it specifically describe the research approach. Moreover, the sampling strategies could lead to bias.
In general, the quality of the studies included in the present review was medium-high, so the results of the review could be considered relevant as an upgrade of the results obtained by Wray et al. However, given the international relevance of the topic, the methodology of future qualitative studies will need to be of high quality to appropriately investigate the transition experience of NQNs.
6 Conclusions
The purpose of the present rapid evidence assessment (REA) was to update the previous REA to investigate strategies that support transition and increase retention in NQNs ( Wray et al., 2021). The development of support programmes for NQNs with specific preceptors or mentors, the development of standardized tools to evaluate these programmes, and the promotion of a supportive work environment and a congruent workload are some of the suggested strategies that emerged. However, our review included few high-quality experimental studies; therefore, considering the new evidence-based medicine pyramid ( Murad et al., 2016), the strength of evidence must be considered weak. It is necessary in the future to give voice to NQNs and evaluate the transition experience from their perspective, thus producing new high-quality qualitative studies. These findings reinforce the need for ongoing evaluation of transition programmes using standardized, validated tools, and for incorporating NQNs’ perspectives to gain a deeper understanding of their experience. Additionally, as already highlighted and suggested by the previous review ( Wray et al., 2021), future research should examine the long-term impact of mentorship and workplace conditions on retention outcomes. While this REA offers a useful update, a full systematic review, particularly of experimental studies, may provide a more comprehensive and robust evidence base to guide policy and practice in nursing workforce development.
Limitations
This rapid review has some limitations. First, the definition of ‘newly qualified nurses’ may have led to the exclusion of some studies that investigate the transition and retention in newly qualified nurses, because we considered only nurses with no more that 12 months of work experience, based on Wray et al.’s (2021) review. Moreover, since the present review was an update, we considered only papers published from 2018 to 2024. We decided to exclude all other reviews published before 2018 because, the purpose of this REA was to identify only the latest papers published on the subject. Although the methodology followed a systematic approach, the nature of a rapid evidence assessment (REA) entails certain constraints. For experimental studies, a full systematic review would be more appropriate to ensure comprehensive coverage and in-depth appraisal.
Ethical considerations
This study was a review of the literature, and therefore did not require ethical approval.
CRediT authorship contribution statement
Bagnasco Annamaria: Project administration, Supervision, Writing – review & editing, Conceptualization. Zanini Milko: Supervision, Writing – review & editing, Conceptualization. Sasso Loredana: Supervision, Writing – review & editing, Conceptualization. Aleo Giuseppe: Writing – review & editing, Supervision, Conceptualization. Catania Gianluca: Writing – review & editing, Conceptualization, Supervision. Watson Roger: Validation, Formal analysis, Writing – review & editing, Methodology, Data curation, Supervision, Investigation, Conceptualization. Moro Andrea: Writing – original draft, Validation, Formal analysis, Visualization, Investigation, Conceptualization, Methodology, Data curation. Wray Jane: Writing – review & editing, Conceptualization, Supervision. Gammone Mariarosaria: Visualization, Formal analysis, Methodology, Conceptualization, Writing – original draft, Validation, Investigation, Data curation. Calzolari Michela: Writing – original draft, Methodology, Data curation, Validation, Investigation, Conceptualization, Visualization, Formal analysis.
Declaration of Generative AI and AI-assisted technologies in the writing process
During the preparation of this work the author(s) used ChatGPT to improve the readability and language. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Given their role as Editor-in-Chief and Editor, Prof. Roger Watson and Dr. Jane Wray had no involvement in the peer-review of this article and have no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to another journal editor. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper
Acknowledgements
None.
Table 1
| Inclusion | Exclusion |
| Primary | Theoretical or conceptual papers, commentaries, secondary research |
| Published between February 2018 and February 2024 | |
| English language | |
| NQNs | Nurses in practice longer than 12 months |
| Not about NQN transition | |
| Not about NQN retention |
Table 2
| Database name | Number of references |
| Academic Search Premier | 38 |
| CINAHL | 1035 |
| ERIC | 7 |
| PubMed | 2190 |
| Web of Science | 2379 |
| Subtotal | 5649 |
| Duplicates | 3164 |
| Total | 3061 |
Table 3
| Study first name (date) | DesignQualitative, Descriptive, Mixed Method, Quasi-sperimental | Results/Main findings | Study quality |
| Austin, Halpin (2021) | Qualitative | Thematic analysis found three principal themes and five subthemes. Theme 1: Personal professional mentor (PPM): independent, accessible, experienced confidant - subtheme: the simple but effective first meeting and beyond. Theme 2: PPM: a new addition to the portfolio of staff supports roles - subtheme: an aid to transition isolation. Theme 3: Recommendation for PPMs and the scheme - subtheme: showcase and promote the PPM scheme; PPM should contact the newly graduated nurses first; scheduled, protected meeting times. | CASP LOW |
| Baldwin et al. (2021) | Qualitative | Twelve themes emerged from the analysis grouped into four categories: 1) factors intrinsic to the new graduate nurses and high-acuity speciality areas (HASA) staff; 2) factors extrinsic to the new graduate nurses; 3) comparisons with non-specialty new graduate nurses; 4) recommendations to future HASA new graduate nurses. | CASP MEDIUM |
| Berglund et al. (2022) | Qualitative study | The phenomenon is constituted by four constituents: "The courage to grow", "Responsibility and fear", "Belonging and vulnerability", and "Support and challenge". The study found that transitioning into the nursing profession through the program required courage for growth, seen as a conscious decision to foster lifelong learning. | CASPMEDIUM/HIGH |
| Brown et al. (2018) | Qualitative | Several themes emerged from the analysis of the in-depth interviews conducted. The major themes were the impact of nursing school, hospital orientation of a new nurse, environment that promote teamwork, taking time for self-care, confidence and expectations versus reality in doctor interactions | CASP MEDIUM |
| Cantrell et al. (2024) | Quasi-sperimental | The comparative study concerns two orientation methods for graduate nurses on their first work experience, the first one is a patient-layered orinetation (26 nurses), the socond one il task-layered orientation. There are not statical significance between the two groups | STROBELOW |
| Charette et al. (2023) | Mixed Method | Data were collected at T0 (n = 88), T1 (n = 29), T2 (n = 15), T3 (n = 11), and T4 (n = 9). Competence significantly increased at T1, at T2, despite no significant increase in competence. Participants felt more confident and in control due to the support they received. There was no significant increase at T3. Finally, at T4, competence significantly improved. Moreover,at T4 job satisfaction was hight except for the categories "patient care" and "nursing education". | MMATHIGH |
| Chen et al. (2021) | Descriptive | 81.40 % of NGN worked one-on-one with the preceptor on patient assignments and most had the same schedule with their preceptor. 72.60 % of participant reported that the preceptor had a reduced patient load while precepting the NGRNs. The mean score for the transition shock perceived by the participants was 3.05 on a 5-point scale. Participants scored the nursing competency of critical thinking and research aptitude as the lowest (mean=2.68). Transition shock (r = −0.21, p < .001) and perceptions of preceptor support (r = 0.56, p < .001) were statistically significantly correlated with nursing competency. Preceptor context and the emotional challenges of transition shock were the main predictors of nursing competency (F = 36.86, p = .00). | Survey Assessment Tool HIGH |
| Choi and Yu (2022) | Descriptive | The results showed that mentoring function significantly affected novice nurses’ self-efficacy and organizational commitment. Further, the preceptorship training period had a significant effect on organizational commitment. | Survey Assessment ToolMEDIUM/HIGH |
| Doughty et al. (2018) | Qualitative | Four themes emerged from the analysis common both to New Graduated Nurses and Directors of Nursing. Themes were: support - transition program and preceptor aid new graduates (NGNs) transition into the role of Registered Nurse; nursing environment - negative impact of work environment on the wellbeing of NGNs, clinical practice development and programme workload. | CASP MEDIUM |
| Feltrin et al. (2019) | Qualitative | Three main categories and several subthemes were used to describe the strategies used by graduated nurses to adapt themselves at pre-existing social frameworks. 1) Self-embodiment and self-consciousness; 2) Navigating the social constructs; 3) Raising consciousness. | CASP HIGH |
| Hassan et al. (2024) | Quasi-sperimental | The intervention involved 132 NQNs. Teamwork Perceptions score and Patient Safety Culture score increased from T0 to T1 and to T2. So the impact of the program is significant. | STROBEMEDIUM |
| Ho et al. (2021) | Qualitative | Thematic analysis highlighted three themes: transition shock; workplace factors with two subthemes (experience of support and feeling unsupported and alienated), work-life balance. | CASP HIGH |
| Hu et al. (2023) | Quasi-sperimental | Fifty-three ICU NQNs completed the preceptorship intervention and the post evaluation. Authors measures outcomes at baseline (T1), post intervention (T2) and after six month (T3). The total score about the professional identity were significantly different at three point with increase from T1 to T2 and decrease from T1 to T3 and from T2 and T3. The main score of NQNs' intention to remain employed have no significally differcence at three points. The study showed the immediatly positive effects on the professional identity after the intervetion. | STROBE LOW |
| Kaihlanen et al. (2021) | Descriptive | Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment and easy transition | Survey Assessment Tool HIGH |
| Kim and Shin (2020) | Mixed Method | The quantitative phase found that self-efficacy, job satisfaction, nursing stress and structural empowerment have a significant influence on new graduates’ transition. The qualitative phase explored transition facilitators and barriers and confirmed what found in the quantitative phase. The barriers were fears, workload, excessive role expectations, emotional difficult from bullying instead the facilitators were self-efficacy, interaction with colleagues, positive and supportive work environment, and phase transition program. | MMAT LOW |
| Kim et al. (2024) | Quasi-sperimental | The study proposes a 4-weeks training program of nursing practice readiness improvement program tailored for NQNs. The results showed that nursing practice was effective in reducing transition shock, improving nursing practice readiness, job satisfaction, and retention intentions. | STROBEMEDIUM |
| Kim and Choi (2022) | Descriptive | The study envolved 167 participants. Perceptors' teaching behavior have an effect on NQNs' resilience and intention to stay and not on organization socialization. Resilience and organisation socialization mediate preceptors' teaching behavior, significantly impacting the intention to stay within the organization. | Survey Assessment Tool MEDIUM/HIGH |
| Kim and Yang (2023) | Descriptive | The impact of burnout on the job retention intention was mediated by the exchange relationship with the preceptor. Infact burnout was negatively associated with job retention intention and exchange relationship with preceptor. | Survey Assessment Tool HIGH |
| Lindfors et al. (2022) | Quasi-sperimental | Seventytwo NQNs recieved the intervention - preceptors face to face orientation or standard preceptorship. The results didn't show statistically significant differencies. The impact of the intervention was inconclusive. | STROBE MEDIUM |
| Miller et al. (2023) | Quasi-sperimental | 77 NQNs were enrolled in the intervention programme and 29 in the control group and took surveys at baseline, after 6 weeks, 3 months and 6 months. Nurse retention and Job satisfaction scores increased for resident nurses and decreased for the control group. The retention rates of nurses at 1 and 2 years during showed a clear improvement. | STROBE LOW |
| Moon et al. (2024) | Mixed Method | The intervention, led by clinical nurse educators, demonstrated significant difference between intervention and comparison group for self-efficacy outocme and perceived social support. Also for field adaptation there are not notable changes in pre-test and post-test scores within the intervention group. No statistically significant differences between groups regarding active and passive coping strategies. Two main themes emerged from the qualitative part: gaining positive energy through empowerment and solidarity and cinical nurse educators sharing strategies for improved role adaptation and capacity building. | MMATMEDIUM |
| Song et al. (2024) | Quasi-sperimental | 167 NQNs were involved. The experimental group demonstrated significantly higher clinical competence scores compared to the control group, as well as higher job satisfaction and organizational socialization. Additionally, the experimental group had lower turnover intention and turnover rate. | STROBELOW |
| Tseng and Hwang (2021) | Quasi-experimental | Four outcomes were studied: nursing competencies, work self-efficacy, nurse occupational stress, and retention rate. Nurses exposed to the intervention program shown better overall competencies (β = 0.52, p = 0.024), work self-efficacy after 12 months of work (β = 4.23, p = 0.043), and lower occupational stress after 6 months of work (β = − 24.03, p = 0.024) than the control group. The retention rate didn't show statistically significant difference among experimental and control group. | STROBE MEDIUM |
| Wildermuth et al. (2020) | Qualitative | From the study of the phenomena three major themes emerged: 1) feeling overwhelmed; 2) feeling supported; 3) feeling confidents; and four secondary themes; 1) communication with physicians; 2) relationship with experienced nurses; 3) Jumping in; 4) learning. | CASP HIGH |
| Xu B., et al. (2022) | Quasi-sperimental | The study involved seventyone NQNs assisigned to the psycological counselling intervention or to the control group. Transition shock was evalueted pre and post the training: after intervention the score of transitions shock drecreased and the score of the control group was higher than in the intervention group. | STROBELOW |
| Zhang et al. (2019) | Non-randomised trial | The turnover rate for the first year in the experimental group was 3.77 % compared to the 14.07 % of the control group (p < 0.001). A one-on-one program has a positive impact for the retention of new graduates’ nurses in the first year of work. | CONSORT non-randomised studies MEDIUM |
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