Transitioning from being an undergraduate nursing student to becoming a clinical nursing professionalis often depicted as a stimulating yet stressful and uncertain time (Duchscher & Windey, 2018; Reebalset al., 2022). Approaches such as encouraging and facilitating the development of networks, on-the-jobtraining, and mentoring have been suggested to support the development of professional capabilities among early career workers (Jackson et al., 2022). To facilitate learning and socialization processes when newly graduated nurses (NGNs) enter working life, transition programs are implemented in hospital settings (Kenny et al., 2021; Aldosari et al., 2020). These programs generally include a combination of components, such as ward-specific orientations, supervision with an experienced nurse, mentoring and training sessions (Rush et al., 2019; Eklund et al., 2021). Another activity applied in transition programs to address transitional issues for NGNs is process-oriented group supervision (POGS); reflection seminars with peers led by a supervisor. The aim of this activity is to provide a forum for the participants to identify, discuss, and reflect upon their daily work situations, dilemmas, and ethical issues, to support the NGNs' professional development (Carlson et al., 2020).

Work-Integrated Learning (WIL) in this study interpreted as to explore “different types of connections between work and learning” (Sunnemark et al., 2023). Reflection can be such a connective activity, as it has been described as learners processing their experiences (of work), by exploring their understanding of what they are doing and why they are doing it and impact on themselves and on others’ (Boud, 1999).This definition could be useful in the context of health care, where the professionals work on their own, in teams and with patients where their decisions and actions will have consequences on the care.

Clinical group supervision with NGNs has been reported to be an effective activity in the transition process by providing a supportive peer environment with time to vent and a sense of belonging while sharing and listen to others’ care situations (Mangone et al., 2005; Carlson et al., 2020) and gaining a deeper understanding of their profession as the seminars supported a translation of their situational experiences (Eklund et al., 2021), and supporting NGNs to develop expertise more rapidly within their working area (Brink et al., 2012). Benefits such as sharing of experiences whilst receiving feedback and support are reported, while challenges identified related to group processes (Tulleners et al., 2023), or to get time to participate (Carlson et al., 2020). In addition, studies from the WIL context have emphasized reflection on workplace activities as a practice to better prepare students for work (Sykes & Dean, 2013) and to connect experiences from different contexts and refine skills (Jackson, 2015).

However, studies from this field are predominantly retrospective interview studies focusing on nurses’ experiences. This study aims to contribute to this research field by exploring the learning progression over time in POGS as an activity in a transition program for early career nurses. More specifically, the study aims to identify what issues the NGNs addressed and how these issues are processed in POGS.

Purpose

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

Design/methodology/approach 

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

Findings

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

Originality/value 

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

Purpose – The aim of this study was to identify and describe the collaborative and professional boundary challenges at a hospital ward from a bottom-up perspective.

Design/methodology/approach – The study was conducted as a bottom-up improvement project at a hospital ward in western Sweden. An insider action research (IAR) approach was used during the project. The theoretical framework for this project was based on the Cultural-Historical Activity Theory (CHAT). Data were collected between 2019 and 2021.

Findings – The findings showed that unclear professional boundaries and limited resources challenged and hindered interprofessional collaboration. The project group had to reorganize its daily work to adjust to the different disciplines’ legal responsibilities in relation to the patients’ recovery process. To safely discharge patients, the professionals needed to talk about each other’s professional responsibilities, professional boundaries and ethical codes.

Originality/value – The IAR project revealed that revising the daily team-round routine improved the status of assistant nurses and encouraged physicians to consider input from all professions during the patients’ recovery process. However, the new approach faced resistance from clinic leadership, who believed it could prolong patients’ stays in the ward. The findings underscore the challenges of modifying hierarchical structures and social orders within hospital settings.

BACKGROUND: Transition programs for newly graduated nurses in hospital settings are reported to provide learning opportunities, strengthening confidence, workplace integration and skills, retention and job satisfaction. Still, our knowledge of long-term effects is scarce and few studies have used control groups.

OBJECTIVE: To explore the long-term impact of having attended a transition program on the nurses' experiences of the first years of practice. More specifically, ideology-infused psychological contract, ethical stress, perceived organizational support, job satisfaction, opportunities for learning, and intention to stay in the nursing profession, were explored as outcome variables.

METHODS: A questionnaire survey was carried out among registered nurses from November 2019 to January 2020, with a 54% response rate. The analysis was based on 149 nurses who had attended a transition program, and 72 who had not attended. The nurses had seniority between one and three years. Independent samples t-test were used to investigate differences between the groups.

RESULTS: The two groups showed small and non-significant differences in the outcome variables. However, regarding the frequency of ethical value conflicts induced by insufficient resources, as well as experiences of ethical value conflict distress, the group of nurses who had attended a transition program showed statistically significantly higher mean values, although the effect sizes were small.

CONCLUSION: Newly graduated nurses need more than transition programs and skills training to progress in their nursing role and develop competence, increase job satisfaction, and reduce stress. Achieving these goals requires a long-term supportive learning environment that is integrated into everyday work.

Till skillnad från många länder där verksamhetsförlagd utbildning (VFU) ställdes in, fick sjuksköterskestudenter i Sverige stanna kvar i vårdmiljöer med COVID-19. Hur påverkades sjuksköterskestudenternas lärande under dessa förhållanden? 

COVID-19-pandemin har globalt orsakat stora påfrestningar på sjukvården. Till skillnad från många länder där verksamhetsförlagd utbildning (VFU) ställdes in, fick sjuksköterskestudenter i Sverige stanna kvar i vårdmiljöer med COVID-19. Denna studie undersökte hur den svenska strategin – att hålla samhället öppet – påverkade sjuksköterskestudenternas lärande och vilka strategier som användes för att hantera den unika och kritiska miljön. Studien hade en kvalitativ utforskande och beskrivande ansats. Insamlad data bestod av semistrukturerade intervjuer med tolv sjuksköterskestudenter under sitt sista läsår, just när COVID-19 pandemin bröt ut. Intervjuerna analyserades med tematisk analys enligt Braun & Clarke (2022).

Resultatet visade att pandemin kunde ses som en kritisk situation vilken hade oavsiktliga konsekvenser för lärandet. Det skapade en stressig och utmanande lärmiljö med begränsat stöd under handledning. Pandemin påverkade sjuksköterskestudenternas lärande både vad gäller anpassningsinriktat- och utvecklingsinriktat lärande eftersom de var tvungna att direkt i praktiken ta personligt ansvar för arbete, reflektion och lärande. I den kaotiska situationen blev både studenter och handledare som nykomlingar. Studenterna kämpade för att hänga med i det snabba tempot med nya rutiner och samtidigt ha ansvar för sitt eget lärande. Lärandet sträckte sig utanför både kursplanens och kursens lärandemål. De förvärvade omfattande kunskap om att arbeta under en pandemi, med basala hygienrutiner och arbete på säkert avstånd med skyddsutrustning. Studenterna utvecklade nya tankebanor och kunskap som ett resultat av den ökade efterfrågan på flexibilitet och kreativitet. De uppgav också att de hade mer kontakt, på grund av besöksförbudet, med både vårdsökande/patienter och deras närstående i förhållande till tidigare VFU under utbildningen samt utvecklade tydligare etiskt förhållningssätt om vårdande relaterad till en pandemi.

För att stödja och utveckla lärande under VFU i en kritisk miljö är det väsentligt att diskutera vilka strukturer och processer som är viktiga för att minska studenters stress när de genomför sin kliniska placering. Studien kan även bidra till diskussion bland pedagoger och handledare om lärandeprocesser i liknande kritiska situationer under sin utbildning.

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work.

Background: Previous research has raised questions about new graduate nurses’ (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs’ expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce.

Design: A cross-sectional survey design was used. Method: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses.

Results: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit.

The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses’ readiness for clinical work, the challenges they perceive, and their needs for learning and supp

I presentationen berättar jag lite om hur vi arbetat med VGR:s regionala grupp för Kliniskt basår, och lite kort om våra studieresultat i kontexten att skapa förutsättningar för nyutexaminerade.