The experiences of new graduate nurses working in a paediatric setting : A systematic review protocol of qualitative evidence

Review question/objective
The overall objective of this systematic review is to identify, critically appraise and synthesize the literature regarding the experiences of new graduate nurses working in a pediatric setting. The specific review question is: what are the experiences of new graduate nurses working in a paediatric setting?

Background
It is estimated that there is a global shortage of 2.4 million nurses, midwives and doctors.1 This shortage has led to an increasing demand for additional new graduate nurses,2 and the need for employers to retain nurses in the workforce.2,3 However, a substantial proportion of new graduate nurses leave their employer or change positions within the first 12 months of employment.4–6 Turnover of new graduate nurses is costly to organizations, for example, expenses incurred in the hiring of temporary staff and additional induction programs.6–10 An important element in the reasons for new graduate nurses' turnover is the nature of their experiences during first year post-registration.5,11

New graduate nurses experience a period of role transition from student nurse to staff nurse.12 Transition is an important concept in nursing, and involves people's adaptation to new circumstances and responses to change over time.13 An individual's adjustment to role transition is complex, and involves personal development as well as interactions with socialization/organizational processes and role requirements.14 New graduate nurses can find transitioning from a student to a graduate nurse to be stressful,12,15 and challenging.16

One challenge that new graduate nurses may face is “reality shock”. Reality shock describes the responses of new graduate nurses to the conflict between the expectations of a new graduate nurse and organizational expectations.17 As a consequence, new graduate nurses may feel inadequately prepared to carry out their new role.17 Other challenges that new graduate nurses consider stressful include their increased accountability and responsibility compared to student nurses,12,18 and perceived lack of skills such as time management,16 decision-making, 12,18 and clinical skills.16,19

Support is important for new graduate nurses to assist in the effective transition to their new role. Support can be provided by the organization or individuals. Colleagues may provide support such as feedback,20,21 debriefing22 and praise.23 Organizations may support new graduate nurses by offering structured preceptorship programmes, which can improve job satisfaction,24 reduce stress and anxiety,24,25 and increase confidence.26,27

The pediatric setting, in general, is different to adult settings in terms of patient population and philosophy of care. Children's anatomy and physiology are different to adults and vary with age and developmental stages,28 requiring specific knowledge, techniques and skills by the nurse that are age and developmentally appropriate.29,30 As children are a vulnerable population, delivery of atraumatic care, which is the avoidance of physical and psychological distress in children,31,32 becomes important. The overall philosophy underpinning pediatric nursing is family-centred care, where the child is considered part of the family unit and the family unit is the focus of care.33 As the pediatric setting and care of children are different to those of adults, the role transition experiences of new graduate nurses working in pediatric settings may also be different.

A search of databases including the Joanna Briggs Institute (JBI), Cochrane Library, CINAHL and MEDLINE identified no systematic reviews pertaining to the topic of the experiences of new graduate nurses working in a pediatric setting. A JBI systematic review by Edwards et al.24 includes some articles involving new graduate nurses working in a pediatric setting, however it is a quantitative review. A JBI systematic review protocol by Tseng et al.34 and a non-JBI qualitative systematic review by Higgins et al.15 have been published, but they do not focus specifically on the experiences of new graduate nurses working in a pediatric setting. This qualitative systematic review will synthesize data from relevant studies to describe and explore the experiences of new graduate nurses working in a pediatric setting. The results may provide evidence to assist nurse managers, nurse educators and other nursing staff to develop appropriate support strategies for new graduate nurses.

© 2015 by Lippincott Williams & Wilkins, Inc.