153The Journal of Continuing Education in Nursing · Vol 50, No

153The Journal of Continuing Education in Nursing · Vol 50,
No 4, 2019
Newly Licensed Nurse Resiliency and
Interventions to Promote Resiliency in the First
Year of Hire: An Integrative Review
Lisa Concilio, MSN-ED, RN, CCRN; Joan Such Lockhart, PhD,
RN, CNE, ANEF, FAAN;
Marilyn H. Oermann, PhD, RN, ANEF, FAAN; Rebecca Kronk,
PhD, MSN, CRNP, CNE, FAAN;
and James B. Schreiber, PhD
The nursing shortage has been a long-standing problem in the
United States and spans eight decades (National League for
Nurses, 2017).
Newly licensed nurses (NLNs) are graduate RNs who
have passed the National Council Licensure Exam-RN
(NCLEX-RN®) and are employed for the !rst time in
the role as a professional nurse. NLN turnover has been
reported in recent years to a"ect patient safety and com-
pounds the global nursing shortage (Boamah & Las-
chinger, 2015; Bradbury-Jones, 2015; Kovner, Brewer,
Fatehi, & Katigbak, 2014; Spence Laschinger, Zhu, &
Read, 2016; #omas & Kellgren, 2017; World Health
Organization, 2017). #e American population is liv-
ing longer with chronic diseases and expanding disabili -
ties; more well-prepared RNs are needed as health care
is ever-advancing and technology is at the forefront to
help solve health care problems and improve quality of
life (Academy of Medical-Surgical Nurses, 2018; Ghe-
breyesus, 2018; National Academy of Medicine, 2017;

Reinhard, 2014).
PROBLEM IDENTIFICATION AND SIGNIFICANCE
#e American Association of Colleges of Nursing
(2017) reported that 1.2 million RN positions will be
vacant between 2014 and 2022 and that approximately
700,000 nurses will retire or leave the workforce by 2024.
Cline, La Frentz, Fellman, Summers, and Brassil (2017)
abstract
Background: Lack of resiliency contributes to grow-
ing dissatisfaction among newly licensed nurses (NLNs)
and often leads to clinical errors and job resignations.
Method: An integrative review synthesized current re-
search investigating NLNs’ resiliency within their first
year of hire and interventions that may affect their re-
siliency. Results: Key database searches (2008 to 2018)
yielded 16 studies. Insufficient resiliency among NLNs
has been correlated with intentions to leave current
jobs and decreased job satisfaction. Residency pro-
grams, well-prepared preceptors, and peer support
promoted NLN resilience and enhanced patient safety.
Lack of coworker support has led to NLNs’ intentions
to leave their current jobs or the profession entirely.
Conclusion: NLN turnover has been interpreted to be
an outcome of poor NLN resilience. The first year of
practice is stressful and affects NLNs’ mental health
and cognitive reasoning, thereby risking patient safe-
ty. Resiliency should be measured using a resiliency
scale rather than turnover rates. [J Contin Educ Nurs.
2019;50(4):153-161.]
Ms. Concilio is PhD Student, Dr. Lockhart is Professor and
MSN Nurs-

ing Education Track Coordinator, Dr. Kronk is Associate
Professor, and
Dr. Schreiber is Professor of Epidemiology/Statistics, Duquesne
University
School of Nursing, Pittsburgh, Pennsylvania; and Dr. Oermann
is !elma
M. Ingles Professor of Nursing, Duke University School of
Nursing, Dur-
ham, North Carolina. Ms. Concilio is also Lecturer and Clinical
Instructor,
School of Nursing, San Diego State University, San Diego,
California.
!e authors thank Dr. Jane Brannan, EdD, Professor of Nursing,
Ken-
nesaw State University, Kennesaw, Georgia, for her content
expertise and
support. !e authors also thank David Nol", MLS, AHIP Head,
Research
Engagement, Health Sciences/STEM Initiatives, Assessment
Coordinator
Gumberg Library, Duquesne University, Pittsburgh,
Pennsylvania, for on-
going support.
!e authors have disclosed no potential con#icts of interest,
"nancial
or otherwise.
Address correspondence to Lisa Concilio, MSN-ED, RN, CCRN,
Lec-
turer and Clinical Instructor, School of Nursing, San Diego
State Uni-
versity, 10006 Maya Linda Rd. #5207, San Diego, CA 92126; e-
mail:
[email protected]

Received: August 13, 2018; Accepted: October 22, 2018
doi:10.3928/00220124-20190319-05
154 Copyright © SLACK Incorporated
reported that training one NLN may cost a health care
system $60,000 to $96,000; therefore, increasing NLN
resiliency is imperative to maintain patient safety and
is a !nancial priority. NLNs experience immense stress,
leading to a state of shock while transitioning to practice
(Duchscher, 2009) and resulting in burnout and turn-
over (Laschinger et al., 2016; Pfa", Baxter, Jack, & Ploeg,
2014). Dyrbye et al. (2017) de!ned burnout as a syndrome
characterized by emotional exhaustion that leads to poor
performance and an attitude that is contrary to caring.
Nurse burnout has led to sta$ng shortages and increased
turnover rates, which has resulted in the use of physical re-
straints, patient falls, and the formation of pressure ulcers
(Aiken et al., 2014; Robert Wood Johnson Foundation
[RWJF], 2012).
Resiliency has been identi!ed as a key factor in manag-
ing the stress of nursing work–life, bu"ering burnout, and
positively in%uencing NLNs’ intentions to stay their cur-
rent jobs (Chesak et al., 2015; Cope, Jones, & Hendricks,
2016; Delgado, Upton, Ranse, Furness, & Foster, 2017;
Reyes, Andrusyszyn, Iwasiw, Forchuk, & Babenko-Mould,
2015). Mudd (2016) stated that the concept of resiliency
is elusive and a closer examination of resiliency is needed
in order to decrease burnout and decrease turnover. With-
out resiliency or ways to cope with the emotional stressors
and workplace adversities (Delgado et al., 2017), nurses
(including NLNs) may develop inconsistent thoughts, be-
liefs, and values that will render them unsafe for practice

and increase intentions to leave their jobs (Hart, Brannan,
& De Chesnay, 2014; Stephens, 2012; Tahghighi, Rees,
Brown, Breen, & Hegney, 2017). #is article describes an
integrative review of the literature that examined NLNs’
resiliency within their !rst year of hire and interventions
that a"ect their resiliency.
EXPLORING THE CONCEPT OF
RESILIENCE IN NURSING
#e youngest generation of nurses are the most likely
group of nurses to lack the protective factors of resilien-
cy and leave the profession within the !rst year of hire
(Flinkman, Isopahkala-Bouret, & Salanterä, 2013; RWJF,
2014). Resilience assists a nurse’s psyche to cope with the
negative consequences of workplace stress (Fletcher &
Sarkar, 2013). Stressors encountered by nurses in health
care organizations include an increasing aging population,
growing numbers of patients with chronic illnesses, and
an aging nursing workforce (American Association of Col-
leges of Nursing, 2017). To overcome these organizational
and systemic stressors, nurses have been remediated to
provide excellent customer service and uphold standards
of care; yet, these approaches have not addressed the afore-
mentioned stressors or bolstered nurses’ resilience (Insti -
tute of Medicine, 2014; Spence Laschinger et al., 2016;
Wonder, York, Jackson, & Sluys, 2017).
A resilient nurse receives information and acts on it
to safeguard patients and advocate for their needs (Sieg,
2015). Resiliency is the ability to command psychomotor
skills (the ability to perform tasks and communicate cor-
rectly and in a timely manner) and cognitive-behavioral
skills (cognitive re-framing, mindfulness, compassion,
and emotional intelligence) in order to perform success-

fully while stressed (Academy of Medical-Surgical Nurses,
2018; McAllister & Lowe, 2011). In this article, we pro-
vide current knowledge on the concept of NLN resilience
during the !rst year of hire because the lack of resiliency
causes nurses to act in a manner that is contrary to caring.
As dissatisfaction builds, it leads to an increase in errors
and contributes to NLNs leaving their current jobs (Ga-
briel, Diefendor", & Erickson, 2011; Hart et al., 2014).
#erefore, a need exists to understand NLN resilience
during the !rst year of hire.
PURPOSE AND SPECIFIC AIMS
#e purpose of this integrative review is to summarize
and synthesize NLN resiliency and interventions used to
promote NLN resiliency within the !rst year of hire in
an e"ort to guide future research in this area. Although
resilience has been widely studied in nurses (Delgado et
al., 2017; Hart et al., 2014; Stephens, Smith, & Cherry,
2017) and nursing students (Stephens, 2012, 2013), few
studies have examined NLN resilience. #is integrative
review explores the past literature to describe factors as -
sociated with a lack of resiliency or its protective factors
and to investigate approaches that increase NLN resil-
iency. #e following speci!c aims guided this integrative
review:
t� What is the state of NLNs’ resiliency within their !rst
year of practice?
t� What are the contributing factors that promote or hin-
der NLNs' resilience?
t� What are the outcomes associated with NLNs' resil-
ience or lack of resiliency?
t� What are the current interventions or strategies used to

build protective factors of resilience that lead to NLNs’
intention to stay at their current jobs?
t� What tools have been used to measure NLNs' resiliency
and have been correlated with intentions to leave jobs?
METHOD
An integrative approach by Whittemore and Kna%
(2005) guided this review of the literature. #is model
included !ve stages (problem identi!cation, literature
search, data evaluation, data analysis, and presentation) to
enhance accuracy and ensure a thorough search.
No 4, 2019
Literature Search
A systematic process was used to review the pri-
mary studies of qualitative and quantitative research
designs (Whittemore & Kna%, 2005). #e process of
conducting an integrative review is to provide an unbi -
ased review of the literature. To retrieve relevant litera-
ture, searches were conducted with the assistance of a
health science librarian using the Cumulative Index to
Nursing and Allied Health Literature (CINAHL®) and
PubMed® databases and restricted to English-language
articles published from January 2008 to May 2018.
#e following subject headings were used to retrieve
articles that included descriptions about NLNs: newly
licensed nurses, resiliency, and intention to leave. #e
Boolean operators AND and OR were used to com-

bine these terms with newly licensed nurse* and nurs*
(Table A; available in the online version of this arti -
cle). Inclusion criteria included (a) the topic addressed
resilience or protective factors leading to resilience in
NLNs; (b) study participants were NLNs within their
!rst year of practice; (c) any research design was used;
(d) the studies were conducted in the United States;
and (e) publication was between January 2008 and May
2018. #e review excluded nonresearch publications,
gray literature, and publications that did not address
the inclusion criteria.
A total of 789 articles were identi!ed from CINAHL
and PubMed using the initial search terms; 56 duplicates
were removed, resulting in 733 publications. As shown
in the PRISMA %ow diagram (Figure 1), 570 articles
were removed based on their abstracts, which did not
meet the inclusion criteria. Next, 163 articles were re-
trieved for full-text evaluation; 147 of these were exclud-
ed as they did not meet the inclusion criteria, leaving 16
articles that comprised the !nal sample for this review
(Anderson, Linden, Allen, & Gibbs, 2009; Bontrager,
Hart, & Mareno, 2016; Clark & Springer, 2012; Cline et
al., 2017; Clipper & Cherry, 2015; Fiedler, Read, Lane,
Hicks, & Jegier, 2014; Fink, Krugman, Casey, & Goode,
2008; Gill, Deagan, & McNett, 2010; Hodges, Keeley, &
Troyan, 2008; Hodges, Troyan, & Keeley, 2010; Kramer
et al., 2013; Li, Early, Mahrer, Klaristenfeld, & Gold,
2014; Martin & Wilson, 2011; McCalla-Graham & De
Gagne, 2015; Olson, 2009; Pellico, Brewer, & Kovner,
2009). #ere was no follow-up with authors to retrieve
additional information.
Sample studies included qualitative (n = 8), quantita-
tive (n = 5), and mixed-methods (n = 3) designs. Quali-
tative studies used case study (n = 2), phenomenological

(n = 3), and grounded theory analyses (n = 3). Quantita-
tive studies were nonexperimental (n = 5) and included
causal-comparative (n = 1) and descriptive analyses (n =
4). Mixed-methods studies used sequential, exploratory
designs (n = 3).
Data Evaluation
#e data evaluation stage used a methodological ap-
proach to appraise the quality of each publication (Whit-
temore & Kna%, 2005). Each quantitative study was
evaluated and categorized based on its quality of evidence
and recommendation level for practice using the GRADE
(Grading of Recommendations, Assessment, Develop-
ment, and Evaluations) Guideline Criteria for Appraising
Quality of Evidence (Schünemann, Ahmed, & Morgan,
2011); for qualitative studies, the GRADE-CERQual
Con!dence in the Evidence from Review of Qualitative
Research (Lewin et al., 2018) was used. Qualitative stud-
ies were evaluated using GRADE-CERQual and catego-
rized using a systematic approach to increase transparency
in the appraisal process. Four components were used to
evaluate qualitative studies: methodological limitations,
coherence, adequacy of data, and relevance. Publication
bias is also important and was considered in the appraisal
of qualitative evidence and placed as a !fth criterion. Elev-
Figure 1. Graphical representation of the flow of citations
reviewed.
Adapted from “Preferred reporting items for systematic reviews
and
meta-analyses: The PRISMA Statement,” by D. Moher, A.
Liberati, J.
Tetzlaff, and D.G. Altman, 2009, Physical Therapy, 89, pp. 873-
880.

Copyright 2009 by Moher et al. Adapted with permission.
en studies were rated as moderate to low quality (quali -
tative, n = 8; mixed-methods, n = 3) and the remaining
!ve quantitative studies were rated moderate to very low
quality.
A matrix was created to track key data extracted from
each study using the following subheadings: author, pub-
lication year, design, sample population, setting, purpose/
aims, variables, instruments, and the quality appraisal
(Table B; available in the online version of this article).
Evidence was recorded as high, moderate, low, or very low
(Table B). Observational designs were noted using ++,
and experimental studies were noted using ++++ (Lewin
et al., 2018; Ryan & Hill, 2016).
Data Analysis
During data analysis, primary studies were organized,
categorized, summarized, and integrated into a conclu-
sion about the research problem of each study based on
(a) NLNs’ resiliency within the !rst year of practice, (b)
contributing factors of NLNs that promote or hinder re-
silience, (c) the outcomes associated with NLNs' resilience
or the lack thereof, (d) methods found to build resilience
in NLNs, and (e) an examination of the tools that have
been used to measure NLNs' resiliency and correlated with
intentions to leave their jobs. Results were synthesized us-
ing a consistent, correlative method to identify patterns
and relationships, create themes, draw conclusions, and
provide a comprehensive summary (Whittemore & Kna%,

2005).
RESULTS
Presentation of data is the !nal stage of an integrative
review, which exhibits detailed evidence from each sample
study (Whittemore & Kna%, 2005). #e presentation also
includes a synthesis of sample studies based on the review’s
purpose and aims.
Description of Sample
All 16 sample studies were published in the United
States and distributed from 2008 to 2017; most studies
(n = 3) were published in 2009, and none were published
in 2013. Studies were published in nine di"erent journals,
and more than one study was included in the Journal of
Nursing Administration (n = 4), !e Journal of Continuing
Education in Nursing (n = 3), and Nursing Outlook (n = 3).
A wide range of sample sizes existed by study designs:
qualitative studies (7 to 612 participants); quantitative
(51 to 558 participants); and mixed-methods (7 to 434
participants). Both male and female NLNs were included
as study participants in half of the studies, with female
NLNs comprising the majority of study participants,
ranging from 83.4% to 94.2%. #e percentage of male
NLNs included as study participants ranged from 5.8% to
16.6%. Conversely, the remaining half of the studies did
not disclose participants’ gender. Reported age ranges of
participants varied among studies, with most NLNs rang-
ing from 21 to 25 years; two studies repeated mean ages of
33 and 33.4 years; and one study reported a median age of
38.6 years. Other studies reported diverse age ranges: 18
years or over (n = 1); 21 to 50 years (n = 1); 20 to 25 years

(n = 1); and younger than 30 years (n = 1).
Only four studies reported the participants’ race/eth-
nicity. Caucasian was the highest group represented (n =
4, 54.7%) followed by Black (n = 4, 13.6%), Latino (n =
3, 6.1%), and Asian (n = 2, 16.7%). Study settings were
mainly inpatient care settings in medical centers and hos-
pitals across the United States.
NLN Resiliency
Literature published over the past decade revealed that
NLNs' resiliency must be fostered for NLNs to remain
at their current jobs. Insu$cient resiliency among NLNs
has been correlated with intentions to leave current jobs,
turnover, and decreased job satisfaction. According to the
sample studies (n = 14), most NLNs want to leave their
jobs due to dissatisfaction with nursing work and/or their
work environments (Anderson et al., 2009; Bontrager
et al., 2016; Clark & Springer, 2012; Cline et al., 2017;
Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al.,
2008; Gill et al., 2010; Hodges et al., 2008; Hodges et al.,
2010; Kramer et al., 2013; Li et al., 2014; Martin & Wil -
son, 2011; McCalla-Graham & De Gagne, 2015; Olson,
2009; Pellico et al., 2009).
Factors That Promote or Hinder NLN Resiliency
Residency programs and coworker support were re-
ported to enhance NLNs’ intentions to remain in their
current jobs and the nursing profession. Residency pro-
grams speci!cally designed to address the needs of NLNs
positively a"ected NLN resiliency (Anderson et al., 2009;
Cline et al., 2017; Fiedler et al., 2014). #e protective fac-
tors of resilience that emerged among the sample studies
were social support (Clipper & Cherry, 2015; Fiedler et

al., 2014; Hodges et al., 2008; Li et al., 2014; Martin &
Wilson, 2011), group cohesion (Anderson et al., 2009;
Bontrager et al., 2016; Gill et al., 2010; Li et al., 2014),
well-prepared preceptors (Bontrager et al., 2016; Clip-
per & Cherry, 2015), relationship-based care practices
(Clark & Springer, 2012; Clipper & Cherry, 2015; Fink
et al., 2008; Kramer et al., 2013; McCalla-Graham & De
Gagne, 2015; Olson, 2009; Pellico et al., 2009), organi -
zational support (Fiedler et al., 2014; Fink et al., 2008;
Olson, 2009), and plentiful clinical support (Fink et al.,
2008).
No 4, 2019
NLN resiliency decreased when NLNs experienced
verbal abuse from physicians and incivility among other
sta" nurses (Kramer et al., 2013; Martin & Wilson, 2011;
Olson, 2009; Pellico et al., 2009). #eir inability to meet
expectations of preceptors, unengaged preceptors, and de-
creased support when making errors also hindered NLNs’
con!dence and job satisfaction which, in turn, negatively
a"ected their resiliency (Gill et al., 2010; Li et al., 2014).
Outcomes Associated With NLN Resiliency
Positive Outcomes. NLN resiliency, which has been in-
ferred as NLNs who want to stay in their jobs (McAllister
& Lowe, 2011), improves empathy toward patients, job
engagement, augmented teamwork, enhanced ability to
perform tasks, boosted con!dence, adaptability, and im-
proved clinical reasoning. All these outcomes of resiliency
assist in closing the preparation–practice gap and enhance
patient safety (Fink et al., 2008; Martin & Wilson, 2011;

Olson, 2009).
Negative Outcomes. #e most common outcome as-
sociated with poor NLN resiliency cited in the nurs-
ing literature is high turnover (Anderson et al., 2009;
Bontrager et al., 2016; Clark & Springer, 2012; Cline et
al., 2017; Clipper & Cherry, 2015; Fiedler et al., 2014;
Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008;
Hodges et al., 2010; Kramer et al., 2013; Li et al., 2014;
Martin & Wilson, 2011; McCalla-Graham & De Gagne,
2015; Olson, 2009; Pellico et al., 2009). Second, a lack
of support from preceptors, sta", physicians, and other
NLNs increases NLNs’ intentions to leave their jobs or
the profession entirely (Anderson et al., 2009; Li et al.,
2014; Martin & Wilson, 2011; Olson, 2009). Finally,
poor resiliency decreases an NLN’s capability to work in
a team setting (Bontrager et al., 2016; Clark & Springer,
2012; Fink et al., 2008; Gill et al., 2010; Hodges et al.,
2008; Hodges et al., 2010; Kramer et al., 2013; Mar-
tin & Wilson, 2011; Pellico et al., 2009). Teamwork is
the cornerstone of patient care delivery as clinicians col-
laborate and use enhanced communication to bene!t
patients to attain mutual goals (World Health Organiza-
tion, n.d.). As NLN resiliency decreases, so does patient
safety.
Methods to Build Resiliency
and Decrease Turnover
Nurse residency programs have been reported to build
NLN resiliency and decrease turnover or the intention to
leave a job (Anderson et al., 2009; Bontrager et al., 2016;
Clark & Springer, 2012; Cline et al., 2017; Fiedler et al.,
2014; Fink et al., 2008; Gill et al., 2010; Kramer et al.,
2013; Li et al., 2014). Residency programs coordinate
group learning and utilize a buddy system approach to

on-the-job learning; residency programs were reported
to increase socialization, which Dyer and McGuinnes s
(1996) reported is a protective factor of resiliency. Eleven
of the sample studies concluded that collegial relation-
ships, social support, and professional acculturation were
formidable and essential to cope with stress of a chaotic,
foreign, and challenging work environment (Anderson
et al., 2009; Bontrager et al., 2016; Fiedler et al., 2014;
Fink et al., 2008; Gill et al., 2010; Hodges et al., 2008;
Hodges et al., 2010; Li et al., 2014; Martin & Wilson,
2011; McCalla-Graham & De Gagne, 2015; Olson,
2009). Hodges et al. (2010) and Fiedler et al. (2014) de-
scribed NLNs building comradery with others to negate
feelings of inadequacy as method to protect themselves
from the daily assault of stress and self-doubt. Addition-
ally, Martin and Wilson (2011) described NLNs forming
caring groups to enhance collegial relationships; these
supportive groups helped to decrease feelings of doubt
and stress experienced during their transition from aca-
demia to practice.
Measuring Resiliency and the Outcomes
#is integrative review presents studies that correlated
resiliency using satisfaction surveys, evaluations of precep-
tor e"ectiveness, and intention to leave surveys to best un-
derstand the reasons why NLNs leave their jobs. Table C
(available in the online version of this article) outlines the
tools used in sample studies (n = 8) to evaluate strategies
to build NLN resiliency (Anderson et al., 2009; Bontrager
et al., 2016; Clark & Springer, 2012; Cline et al., 2017;
Clipper & Cherry, 2015; Fiedler et al., 2014; Fink et al.,
2008; McCalla-Graham & De Gagne, 2015). Studies
did not evaluate patient outcomes while measuring NLN
satisfaction or intention to leave. Yet, Gill et al. (2010)

explored NLNs’ work perspectives to gauge nursing qual-
ity by using the 10-item abbreviated version of the Na-
tional Database of Nursing Quality Indicators (NDNQI)
(reliability coe$cient = .91; Taunton et al., 2004). #e
NDNQI was correlated with intentions to leave one’s job,
yet the majority of the participants (n = 7) in this study
intended to leave their current job despite indicating they
were satis!ed. #e same !nding was reported by Clark
and Springer (2012), in which NLNs expressed intentions
to leave their jobs despite being satis!ed with the car e they
delivered (n = 37).
DISCUSSION
An iterative process of examining each sample study to
identify patterns, themes, noting intervening factors, and
relationships between variability (Whittemore & Kna%,
2005) was done to clarify, summarize, and synthesize what
is known about the phenomenon of resiliency in NLNs,
within the !rst year of hire, in an e"ort to guide future
research in this area.
First, the concept of NLN resiliency is not well un-
derstood as NLN turnover has been interpreted to be
an outcome of poor NLN resiliency. Second, the expec-
tation of NLNs is to take on new responsibilities and
overcome numerous challenges to integrate themselves
into a practice environment that stresses teamwork;
this belief is so overwhelming that it negatively a"ects
NLNs’ mental health. #ird, these feelings drain NLNs,
which, in turn, can cause cognitive and emotional la-

bility and a"ect clinical reasoning, a clear and present
danger to patient welfare. Finally, resiliency should be
measured using a resiliency scale, as the decision or in-
tention to leave one’s job is not a surrogate to determine
NLN resilience.
A growing body of research indicates NLNs’ attri-
tion is increasing at an alarming rate, despite residency
programs assisting in their transition to help them as-
sume professional responsibilities for which they may
be unprepared (Clark & Springer, 2012; Cline et al.,
2017; RWJF, 2014). Nurse incivility among sta", in-
cluding NLNs, occurs due to the high-stakes climate
and coworkers’ ine"ective communication skills (Las-
chinger, Wong, Regan, Young-Ritchie, & Bushell,
2013). A paradox ensues as NLNs believe they would
be cared for by caring professionals in a caring environ-
ment (Hart et al., 2014; Hodges et al., 2008; Marine,
Ruotsalainen, Serra, & Verbeek, 2006; Martin & Wil-
son, 2011; Pariyo, Kiwanuka, Rutebemberwa, Okui, &
Ssengooba, 2008).
Implications for Practice, Policy, and Research
#e implications for this integrative review provide
information to hospital educators and administrators re-
garding the trends and needs of NLNs and adds a new
perspective on workforce readiness in an e"ort to pro-
mote patient safety. Nursing research has used a positiv-
ist approach to assess NLN resiliency, a philosophy that
has not advanced nursing science in this area. Millennials
(ages 22 to 37) (Dimock, 2019) comprise the majority of
newcomers to the nursing workforce and have the high-
est attrition rate among any generation that has entered
the nursing profession (RWJF, 2014). #erefore, nurse
researchers must apply a social constructivist approach,

as there is much to learn about the Millennial generation
in the workplace (Veesart, 2018). A social constructivism
approach encourages a participant’s own interpretation of
the situation to better understand the meaning of their
experience (Dahnke & Dreher, 2010). #is sociological
lens may help researchers, managers, and educators evalu-
ate NLN resilience as a truth created by their own per-
ceptions rather than through job satisfaction surveys or
intention to leave scales. #e American Academy of Nurs-
ing Policy agrees there is a need to build NLNs’ resilience
(Goode, Glassman, Ponte, Krugman, & Peterman, 2018)
to mitigate the negative e"ects of stress and encourage in-
tention to stay at their !rst job is paramount. Research
regarding low-cost, social support strategies to encourage
NLNs’ motivation and engagement in nursing is needed
to garner patient safety.
Limitations
Several limitations existed among the sample studies
that may result in the !ndings not being applicable to
each NLN’s experience during their !rst year of hire or
to their abilities to build resiliency. For example, detailed
information was not provided regarding sample char-
acteristics such as age in nine studies (Anderson et al.,
2009; Clark & Springer, 2012; Fink et al., 2008; Hodges
et al., 2008; Kramer et al., 2013; Li et al., 2014; Martin
& Wilson, 2011; McCalla-Graham & De Gagne, 2015;
Olson, 2009). Additionally, there was minimal represen-
tation of men in all sample studies, as well as a poor
representation of ethnic/racial diversity. Various prac-
tice settings among the studies limited generalizability
of the !ndings as the settings included medical centers,
hospitals, and specialty units (i.e., oncology). Each set-
ting used di"erent ways to orient NLNs and participants

faced varying types of experiences, which may not repre-
sent all NLNs’ experiences when transitioning into their
!rst jobs.
#e designs of the 16 sample studies were primar-
ily surveys or qualitative interviews. One study did not
report the reliability and validity of the instrument used
(Anderson et al., 2009). Researchers did not directly mea-
sure participants’ resilience in any of the sample studies
yet inferred that participants’ resilience was low if they
intended to leave their jobs. #is ambiguity may have
led to a lack of di"erentiation among the search terms, as
turnover and intention to leave have been correlated with
resilience. However, strategies that encourage group cohe-
siveness, managerial involvement, and adequately prepare
preceptors for what Duchscher (2007, p. 23) referred to as
the “transition shock” period may increase resiliency and
decrease intentions to leave (Anderson et al., 2009; Bon-
trager et al., 2016; Clark & Springer, 2012; Cline et al.,
2017; Clipper & Cherry, 2015; Fiedler et al., 2014; Fink
et al., 2008; Gill et al., 2010; Hodges et al., 2008; Hodges
et al., 2010; Kramer et al., 2013; Li et al., 2014; Martin
& Wilson, 2011; McCalla-Graham & De Gagne, 2015;
Olson, 2009; Pellico et al., 2009; RWJF, 2014). Despite
these e"orts, NLN attrition rates continue to rise each
year.
No 4, 2019
CONCLUSION
#is integrative review provides pertinent informa-
tion to researchers, managers, educators, and health care

administrators about the concept of NLN resiliency. De-
creased resiliency threatens patient safety. NLNs expressed
di$culties feeling con!dent, which, in turn, a"ects profes-
sional development—a factor that is crucial to preparing
a competent workforce. A supportive sta" of nurses and
physicians who are empathetic to the challenges NLNs
face during the !rst year of hire is a proven facilitator of
NLN resiliency; these supportive attributes increase NLN
job engagement, con!dence, and enhances team building
skills. Additionally, resilience may be an indicator of prac-
tice readiness, a vital key to motivate and retain NLNs.
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Table A
Search Terms by Databases Used in the Literature Search
Database Search Term Headings Used: Newly Licensed Nurse,
Leaving within
First Year, and Resiliency
No. of
Titles and
Abstracts
CINAHL
search
terms
( (“Newly licensed nurse*” OR (MH "New Graduate Nurses")
OR ((MH

"Nurses+") OR nurse*) AND (MH (“Internship and Residency)
OR MH
(“Transitional Programs) OR MH (“Employee Orientation) OR
MH
(“Preceptorship))) )
AND
( (MH "Personnel Retention") OR (MH "Personnel Turnover")
OR
Retention OR Turnover OR Attrition OR Quit OR Stay OR
“Negative
Nurse Outcomes” OR “Intention to Leave” OR “Intention to
Quit” OR
(MH "Intention") OR (MH “Personnel Attitudes”) OR (MH
“Motivational factors for turnover intention”) OR (MH
“Professional
Identity”) OR (MH “Locus of control”) OR (MH “Negative
Patient
Outcomes”) OR (MH “Willingness to leave”) OR Manpower OR
“Motivational factors” OR “Psychosocial Factors” OR “negati ve
patient
outcomes”)
AND
( (MH ("Adaptation, Occupational") OR (MH "Avoidance
(Psychology)" OR (MH "Coping") OR (MH "Cultural Safety")
OR (MH
"Disengagement") OR (MH "Disruptive Behavior") OR (MH
"Hardiness") OR (MH "Job Satisfaction") OR (MH "Optimism")
OR
(MH "Reality Shock") OR (MH "Self-Efficacy") OR (MH
"Social
Adjustment") OR (MH "Stress Disorders, Post-Traumatic+") OR
(MH
"Stress, Occupational") OR (MH "Support, Psychosocial") OR
(MH
"Symptom Distress") OR (MH "Symptom Distress") OR (MH
"Vulnerability") OR “Nurse Shock” OR “Occupational

Adaptation” OR
“occupational shock” OR “personal identity disturbance” OR
“Post-
Traumatic Stress Disorder” OR “Professional ident*” OR
“psychological
capital” OR “Reality Shock” OR Coping OR Optimis* OR
Protective
factors OR PTSD OR Resiliency) OR (MH “Motivation”) OR
(MH
“Psychological Factors”) OR (MH “Occupational Coping”) OR
(MH
“Shared decision-making”) OR (MH “Workplace
empowerment”) OR
(MH “growth mindset”) OR (MH “Prevention and Control”) OR
(MH
“Occupational Commitment”) OR (MH “Professional
commitment”) OR
(MH “Controlled Motivation”))
397
PubMed
search
terms
(((( "Emotional Adjustment"[Mesh]) AND "Sense of
Coherence"[Mesh]
OR "Resilience, Psychological"[Mesh] OR "Adaptation,
Psychological"[Mesh] OR "Problem Behavior"[Mesh] OR
“disruptive
behavior”[tiab] OR “disruptive behavior”[ot] OR "Job
Satisfaction"[Mesh] OR "Absenteeism"[Mesh] OR
392

Note. CINAHL = Cumulative Index to Nursing and Allied
Health Literature.
"Presenteeism"[Mesh] OR "Optimism"[Mesh] OR "Self
Efficacy"[Mesh] OR "Social Adjustment"[Mesh] OR "Stress
Disorders,
Post-Traumatic"[Mesh] OR "Social Support"[Mesh] OR “Nurse
Shock”
[tiab] OR “Occupational Adaptation” [tiab] OR “occupational
shock”
[tiab] OR “personal identity disturbance” [tiab] OR “Post-
Traumatic
Stress Disorder” [tiab] OR “Professional identity” [tiab] OR
“Professional identities”[tiab] OR “psychological capital” [tiab]
OR
“Reality Shock” [tiab] OR Coping[tiab] OR Optimis*[tiab] OR
“Protective factor” [tiab] OR “Protective factors” [tiab] OR
PTSD[tiab]
OR Resiliency[tiab] OR “Nurse Shock” [ot] OR “Occupational
Adaptation” [ot] OR “occupational shock” [ot] OR “personal
identity
disturbance” [ot] OR “Post-Traumatic Stress Disorder” [ot] OR
“Professional identity” [ot] OR “Professional identities”[ot] OR
“psychological capital” [ot] OR “Reality Shock” [ot] OR
Coping[ot] OR
Optimis*[ot] OR “Protective factor” [ot] OR “Protective
factors” [ot]
OR PTSD[ot] OR Resiliency[ot] OR "Motivation"[Mesh] OR
"psychology" [Subheading] OR "Decision Making"[Mesh] OR
“Prevention and Control”[Subheading]))) AND ((Quit[ot] OR
Quit[tiab]
OR retention[ot] OR Retention[tiab] OR Stay[ot] OR Stay[tiab]
OR
Turnover[ot] OR Turnover[tiab] OR "Personnel

Turnover"[Mesh] OR
"Personnel Loyalty"[Mesh] OR Retention[tiab] OR
Retention[ot] OR
Turnover[tiab] OR Turnover[ot] OR Attrition[tiab] OR
Attrition[ot] OR
Quit[tiab] OR Quit[ot] OR Stay[tiab] OR Stay[ot] OR “Negative
Nurse
Outcomes”[tiab] OR “Negative Nurse Outcomes”[ot] OR
“Intention to
Leave”[tiab] OR “Intention to Leave”[ot] OR “Intention to
Quit”[tiab]
OR “Intention to Quit”[ot] OR Manpower[tiab] OR
“Motivational
factors” [tiab] OR “Psychosocial Factors” [tiab] OR “negative
patient
outcomes” [tiab] OR Manpower[ot] OR “Motivational factors”
[ot] OR
“Psychosocial Factors” [ot] OR “negative patient outcomes”
[ot]))) AND
((“Newly licensed nurse”[tiab] OR “Newly licensed nurse”[ot]
OR
“Newly licensed nurses”[tiab] OR “Newly licensed nurses”[ot]
OR
"New Graduate Nurse"[ot] OR "New Graduate Nurse"[ot] OR
"New
Graduate Nurses"[ot] OR "New Graduate Nurses"[ot] OR
“Novice
nurse” [tiab] OR "Novice Nurse"[ot] OR “Novice nurses” [tiab]
OR
"Novice Nurses"[ot] OR “Newly licensed nurse*”[tiab] OR
"New
Graduate Nurses"[ot] OR “Novice nurse” [tiab] OR "Novice
Nurses"[ot]
OR ("Nurses"[Mesh] OR nurse*[tiab] OR nurse*[ot]) AND
("Internship,
Nonmedical"[Mesh] OR "Inservice Training"[Mesh] OR

"Preceptorship"[Mesh]))
Total no.
of
citations
including
duplicates
789
T
able B
Sum
m
ary of F
indings from
R
esearch Studies (N
=
16)
_____________________________________________________
_____________________________________________________
A
uthor/year
D

esign/M
ethod
Sam
ple population/ Purpose, A
im
s, Findings A
ppraisal R
ating/
Setting
V
ariables, and Q
uality of E
vidence
Instrum
ents using G
R
A
D
E
or
G
R
A

D
E
-C
E
R
Q
ual
_____________________________________________________
________________________________
A
nderson et
al. (2009)
m
ixed m
ethods/
sequential
exploratory
90 new
graduate
nurses, gender and
ethnicity not
reported/interactive
nurse residency
Purpose: to com

pare
perceived job
satisfaction and
em
ployee
engagem
ent of new
graduate nurses
com
pleting an
interactive nurse
residency.
A
im
s: to m
easure job
satisfaction and
engagem
ents
perceptions of new
nurses after
com
pleting
interactive residency

m
odules and to test
the environm
ent
nursing satisfaction
survey.
V
ariables: change for
nurse residency –
Q
ualitative results
revealed 2 them
es
(protective factors
of resiliency
em
erged): w
hat
satisfied nurses
(patients, patient
outcom
es, and
team
w
ork) and w

hat
did not satisfy
nurses
(staffing/scheduling,
lack of team
w
ork,
M
D
disrespect).
Q
uantitative results:
“A
fter the nurse
residency sessions
and 1 year later, the
quantitative findings
on the H
alfer-G
raf
survey revealed that
the nurse residents
+
+
⨁
◯

◯
◯
R
isk of bias: T
here
w
ere lim
itations in
detailed design as the
outcom
e w
as not
confidently
determ
ined as the
tool’s psychom
etrics
w
ere not discussed.
T
here w
as no
discussion about the
H

alfer-G
raf Job/W
ork
E
nvironm
ent N
ursing
Satisfaction Survey
other than stating it
w
as reliable and valid
as previously stated in
previous studies.
M
ost inform
ation w
as
stated from
studies at
im
plem
entation of a
2- day interactive
nurse residency.

Instrum
ents: H
alfer-
G
raf Job/W
ork
E
nvironm
ent N
ursing
Satisfaction Survey
(psychom
etrics not
reported)
significantly
perceived that they
w
ere able to
perform
their job,
identify resources,
understand
perform
ance
expectations,
accom

plish w
ork
tasks, and m
anage
the dem
ands of the
job effectively” (p.
168).
A
n interactive
learning
environm
ent assists
new
graduate nurses
in job satisfaction
and em
ployee
engagem
ent. M
ost
valuable strategy
w
as em
ail

com
m
unication as a
form
of support (a
protective factor of
resiliency).
low
or unclear risk of
bias. T
his denotes
serious risk of bias,
dow
n grade one level
(R
yan, 2016).
Inconsistency: the
sam
ple w
as from
one
cohort of new
graduate nurses and
one period in tim

e.
T
his denotes som
e
inconsistency and a
dow
ngrade of one
point is recom
m
ended
(R
yan, 2016).
Indirectness: the
author answ
ered the
question of w
hether
this particular cohort
w
ere satisfied and
engaged by using
interactive residency
m
odules.
Im

precision:
C
onfounding
variables w
ere not
discussed as to other
reasons to the 4%
increase of new
graduate nurse
retention w
hen
com
pared to past
years. T
here w
as not
enough inform
ation to
detect a precise
estim
ate of the effect

(interactive residency
m
odules on new
graduate satisfaction
and job engagem
ent).
Publication bias: N
ot
detected, Journal of
N
ursing
A
dm
inistration has
various studies of size
and design.
B
ontrager et
al. (2016)
quantitative/
descriptive,
prospective, cross-
sectional
84 new

ly licensed
registered nurses
enrolled in a residency
program
. 5.8%
of
participants w
ere m
ale.
66.7%
participants
w
ere C
aucasian, 17.9%
w
ere black, 3.6%
L
atino, and 7.1%
A
sian.
Purpose: to

understand how
preceptor role
effectiveness and
group cohesion affect
N
L
N
s’ satisfaction
and intent to stay.
A
im
s: W
hat w
ere the
relationships am
ong
preceptor role
effectiveness, group
cohesion, and job
satisfaction am
ong
N
L
N
s? W

hat w
ere
the relationships
am
ong preceptor role
cohesion, job
satisfaction, and
H
igh levels of
intention to stay at
job w
as perceived
by nurses due to the
role of preceptors,
job satisfaction, and
group cohesion
(protective factor of
resiliency).
Preceptors that are
effective ensure a
quality orientation
and can help
socialize a new
nurse and encourage
job satisfaction.
G
roup cohesion w

as
found to be vital to
increase feelings of
+
+
⨁
⨁
◯
◯
R
isk of bias: T
ool
psychom
etrics w
ere
reported and
C
ronbach D
scores
show
ed reliability and
validity. T
he

tools/scales w
ere
justly chosen to
predict the outcom
e
level.
Inconsistency: the
sam
ple w
as not
discussed regarding
units w
orked on or
shift w
orked. T
he
ability to exam
ine
intent to stay am
ong
N
L
N
s?

V
ariables: D
V
:
preceptor role
cohesion, and job
satisfaction
Instrum
ents:
Preceptor R
ole
E
ffectiveness Scale,
N
urse Job
Satisfaction Scale,
Intent to Stay
Scale.
value, reduce
burnout, stress and
anxiety. G
roup
cohesion is
im
portant to reduce

transition shock and
intention to stay.
changes during the
orientation period w
as
not discussed.
D
oubtful that there
are large variations in
the degree to w
hich
the outcom
e is
affected, no
dow
ngrade if on the
basis that it does not
seem
to be an issue.
Indirectness: T
here
w
as evidence of
indirectness as the
outcom
e w

as assessed
at only one period in
tim
e w
hich lim
ited
the ability to exam
ine
changes. T
he
evidence that w
as
found w
as m
ore
restrictive than the
review
question and
m
ay not directly
answ
er the review
question, “W

hat w
ere
the relationships
am
ong preceptor role
cohesion, and job
satisfaction am
ong
N
L
N
s? W
hat w
ere the
relationships am
ong
preceptor role
cohesion, job
satisfaction, and
intent to stay am
ong
N

L
N
s?” D
ow
ngraded
one point as som
e
indirectness exists.
Im
precision: good
correlation w
ith
prim
ary studies, no
im
precision detected.
Publication bias: N
ot
detected, T
he Journal
of C
ontinuing
E
ducation in N
ursing

has various studies of
size and design.
C
lark &
Springer
(2012)
qualitative/
case study m
odel
37 new
graduate nurses
in a nurse residency
program
across m
any
specialty areas/
northw
estern U
S
15.6%
of participants

w
ere m
ale. T
he
ethnicity of participants
w
as not reported.
Purpose: to exam
ine
the lived experience
as new
nurses to
assess the level of job
satisfaction during
the first year of
practice.
A
im
s: 1. H
ow
do new
graduate nurses
describe their typical
w
orkday?

2. W
hat are the m
ost
satisfying aspects of
T
hem
es that
em
erged: learning
to w
ork in chaos,
feeling valued,
stress of the
unknow
n, life-long
learning, and
preserving the
profession.
Preceptors and staff
are vital to
enhancing job
satisfaction and
+
+
⨁
⨁

⨁
◯
M
ethodical
lim
itations: Prim
ary
studies revealed
conflicting evidence
regarding the lived
experiences of new
nurses. W
e are
confident that the
findings in this study
reflect this sm
all
the new
graduate
nurses’ nursing?
3. W
hat are the m

ost
concerning aspects of
the new
graduate
nurses’ practice?
4. W
hat educational
topics do new
graduate nurses
w
ant to know
m
ore
about?
5. W
here do the new
graduate nurses see
them
selves
practicing nursing in
the future?
V
ariables: D
V

: job
satisfaction
Instrum
ents: open-
ended questions
com
m
itm
ent to
nursing. Support
resiliency) w
as
m
entioned to
im
prove job
satisfaction. T
he
stress of life-long
learning w
as
divided into sub-
them
es that

included dealing
w
ith incivility,
adapting to change,
and stress
m
anagem
ent.
Participants
described being
valued by
colleagues as a
m
ajor contributor to
job satisfaction.
O
rganizations can
help new
nurses feel
valued by using
relationship-based
care and increasing
collegial
relationships as
w
ays for enhancing
satisfaction and
feelings of
com

petence. Som
e
sam
ple’s lived
experience as it did
represent w
hat w
as
found in prim
ary
studies discussed.
R
elevance: N
ew
nurses are
experiencing a new
environm
ent and w
ay
to function yet one of
the research questions
asked about
educational topics

they m
ay w
ant to
know
m
ore about.
T
he prem
ise of being
“new
” and the chaos
this brings, it seem
s
contrary and not
relevant to pursue this
aim
. N
ot applicable to
the context specified
in describing the lived
experience of a new
nurse; dow
ngraded
one point.

C
oherence: T
here is
good fit betw
een the
data from
the prim
ary
studies and the review
findings.
A
dequacy of data:
T
here is good
participants stated
preceptors w
ere
unsupportive and
disinterested and
this decreased job
satisfaction. T
his
also increased stress

and decreased new
nurses’ ability to
w
ork in team
s.
am
ounts of data
supporting the review
finding and this aligns
w
ith prim
ary studies
about the lived
experiences of new
nurses.
Publication bias:
N
ursing O
utlook has
published diverse
studies designs w
ith

various sam
ple sizes.
C
line et al.
(2017)
Q
uantitative/
descriptive,
retrospective
analysis of 10
years of residency
data
First stated over 1,000
participants’ data w
ere
analyzed then table
show
ed 558 new
nurses
w
ithin 12 m
onths of
hire/residency program
in a cancer center

w
ithin the U
S 8.9%
w
ere m
ale participants.
Percentage of
C
aucasian participants
w
as 36%
, B
lack
21.6%
, L
atino 12.2%
,
A
sian 26.3%
.
Purpose: to present a
10-year retrospective
review

of outcom
es
from
an internally
developed nurse
residency program
A
im
s: an analysis of
an internally
developed residency
program
on the
developm
ent of new
nurses.
V
ariables:
“custom
ized” nurse
residency program
at
one cancer care

center and w
as
“enhanced” over
tim
e, sim
ulation w
as
Scores in support
declined over the
course of the
residency program
w
hich decreased
professional
satisfaction. T
he
C
asey-Fink scores
revealed
participants’ stress
levels w
ere low
during this
residency program

,
this is not consistent
w
ith prim
ary studies
or new
ly licensed
nurses’ experiences
in the literature. T
he
authors suggested
that findings
+
+
⨁
◯
◯
◯
R
isk of bias: there
w
ere lack of details in
the design and
execution as the

residency program
over tim
e had m
any
changes.
Inconsistency: there
w
as little
understanding of the
outcom
es from
this
longitudinal study and
how
the data
supported the
outcom
e that
residency program
s
assist in new
nurse

also added through
the years.
Instrum
ents: C
asey-
Fink G
raduate N
urse
E
xperience Survey,
institutional retention
m
etrics
developed in this
“custom
” residency
program
em
phasized that a
program
just about
entry to practice can
com
fort new

nurses
and prom
ote
confidence
resiliency) w
hich
w
ill lead to positive
retention.
job satisfaction and
therefore retention.
Indirectness:
applicability of this
custom
ized residency
program
(undetailed)
did not help reader to
understand the
phenom
enon of new
nurse retention or the
ability to enhance
dealing w

ith stress or
adversity (resilience).
Im
precision: there is a
large am
ount of
inadequacy due to the
levels of stress
reported and the
confounding variables
such as the
possibilities of
financial stress due to
the level of support
the hospital m
ay have
offered participants as
opposed to the actual
stress of the job.
Publication bias: yes,
this study w
as m
ost
likely published due
to the positive
findings that a
residency program

can possibly influence
new
nurse retention.
C
lipper &
C
herry
(2015)
quantitative/
descriptive,
com
parative
59 participants/
gender and ethnicity
w
ere not specified
Purpose: to describe
the im
plem
entation
and evaluation of a

preceptor
developm
ent program
and its effect on the
new
graduate nurse’s
transition to practice
and m
easure first-
year turnover.
A
im
s: to assess new
nurses’ perceptions
of their transition and
preceptors betw
een 2
groups of preceptors
(one group trained in
a structured and w
ell-
developed program
:
details w

ell
explained, and the
other group w
as
untrained).
V
ariables: ID
: new
nurses w
ithin the first
year of hire. D
V
:
perceptions of
betw
een 2 groups of
preceptors. T
rained
T
he study evaluated
the effectiveness of
a preceptor program

by m
easuring
perceptions of
and 1
st year
retention of 2
groups of form
er
nurse graduates and
the other group w
as
those that did not
participate in
structured training.
N
ew
graduates have
m
ore positive
perceptions
regarding safe care
giving and have a
slightly better
retention rate than
those w
ho did not
have a structured

new
graduate
program
.
Preceptors need to
address them
es of
socialization
(protective factors
+
+
⨁
⨁
◯
◯
R
isk of bias: Possible
lim
itations in the
design – obviously
w
ell-trained
preceptors w
ould

better understand the
needs of new
nurses
and help m
itigate the
stress of transition,
but the study did not
reveal reasons for
consistent turnover or
new
nurse
dissatisfaction during
the first year of hire.
It w
as clear from
previous literature
that a w
ell prepared
and trained preceptor
w
ill decrease
transition shock, but
still not a big change
in new
nurse
retention.
Inconsistency: the

findings w
ere
consistent w
ith the
preceptors and
untrained preceptors.
Instrum
ents: 16-item
investigator
developed surveyed
based on the
attributes of
transition shock
theory w
as used to
obtain data regarding
new
nurse
perceptions of the
transition process and
the effectiveness of
their preceptors.
in resiliency) in
order to build
confidence and

foster good
relationships to
build form
s of
support.
N
ew
nurses that had
trained preceptors
expedited to a
higher level of
practice faster than
the untrained
preceptor cohort.
It w
as anticipated
that those that w
ere
in the cohort of
untrained preceptor
w
ould stay at the
organization due to
lack of confidence
and that w
as not the
case.
C

onfidence w
as
found to directly
im
pact patient
outcom
es positively
and increase w
hen
new
nurses had a
good relationship
phenom
enon of new
nurses during the first
year of hire.
Indirectness:
inform
ation in this
study w
as not very
applicable to
understanding new
nurse turnover or how

transition shock
m
itigation strategies
can decrease turnover.
Im
precision:
inadequate am
ount of
data regarding new
nurse confidence, the
support a new
nurse
receives, and the
intention to leave first
job.
Publication bias: N
ot
found. T
he Journal of
C
ontinuing E
ducation
in N
ursing publishes

m
any types of studies
that reveal positive
and negative findings
such as this study.
w
ith his or her
preceptor. T
his also
w
as correlated w
ith
the new
nurse
having a safer
practice than those
w
ith an ineffective
preceptor.
Fiedler et al.
(2014)
quantitative/
descriptive

51 new
nurses in a
residency program
(m
ost w
ere second
degree students) on
diverse units/ m
edical
center in the M
idw
est,
a U
H
C
/A
A
C
N
program
. G
ender and
ethnicity of participants

w
ere not specified.
Purpose: to determ
ine
w
hat influence a
nurse residency
program
has on long-
term
outcom
es
including turnover,
career satisfaction,
and leadership
developm
ent. A
im
s:
1. describe the long-
term
(beyond the 1st
year of em
ploym
ent)

turnover rates of N
R
P
graduates, 2. exam
ine
the long-term
career
satisfaction of
N
R
P graduates
beyond the 1st year
of em
ploym
ent,
and 3. explore long-
term
leadership
developm
ent
of N
R
P graduates
beyond the 1st year

of em
ploym
ent.
T
he long-term
outcom
es of a nurse
residency program
have benefits to the
organization and
individual turnover
rates low
er than the
national average of
14.7%
(1.5-3 years
after the residency
program
.
T
he literature
review
in this study
points out that

w
ithin 6 m
onths,
residents noticed
decrease job
satisfaction, yet at
the end of the year,
significant increase
in satisfaction
resulted. Support
resiliency) from
the
+
+
⨁
◯
◯
◯
R
isk of bias:
D
etected. U
sing one
instrum

ent, w
hich
m
easures satisfaction
to evaluate turnover
lim
ited the execution
of the study and other
data or qualitative
factors w
ere m
issed
for reasons or
intentions to leave.
Inconsistency:
D
etected. Sam
ple size
w
as sm
all, it w
as
diverse yet getting in
touch w
ith
participants that have

left but filled out the
survey w
as difficult
and possibly lead to
inconsistencies w
ith
results.
V
ariables: IV
: A
A
C
N
residency program
.
D
V
’s: career
satisfaction,
leadership
developm
ent,
hospital com

m
ittee
involvem
ent,
certification status,
pursing an advanced
degree.
Instrum
ents:
M
cC
loskey/M
ueller
Satisfaction Scale
(M
M
SS) has 8
subscales: extrinsic
rew
ards, scheduling
satisfaction,
fam
ily/w
ork balance,
cow

orkers,
opportunities
for social contacts,
professional
responsibilities,
praise/
recognition, and
control/responsibility.
organization,
m
anagers, and
recognition leads to
satisfaction and w
ell
as good collegial
relationships.
Peer support w
as
ranked as a m
ajor
com
ponent of
nurses’ job
satisfaction.
Indirectness: N
one
detected as the

applicability is
reasonable as
residency program
s
are supportive and
foster new
nurses’
careers, therefore
increased retention is
very probable.
Im
precision:
D
etected.
D
issatisfaction results
in turnover yet the
tool w
as m
easuring
satisfaction and that
w
as assum
ed the
reason for turnover,
m

ore investigation
regarding w
hat led to
dissatisfaction w
ould
have been m
ore
helpful in
understanding if a
residency program
,
over years, affects
retention rates alone.
Publication bias: N
ot
detected. T
he Journal
of N
ursing
A
dm
inistration
publishes pilot studies
w
ith negative results

and also larger sam
ple
sizes.
Fink et al.
(2008)
m
ixed m
ethod/
sequential
exploratory
434 graduate nurse
residents in the
U
niversity
H
ealthSystem
C
onsortium
/A
A
C

N
nurse residency
program
at 12
academ
ic hospital sites.
G
ender and ethnicity of
participants w
as not
specified.
Purpose: T
o evaluate
if qualitative
responses to C
asey-
Fink G
raduate N
urse
E
xperience Survey
could be analyzed
quantitatively to
easily analyze new

during a post B
SN
nurses residency
program
.
A
im
s: 1. to analyze
the qualitative voices
of the
resident respondents
to determ
ine if
com
m
ents could
further enrich the
quantitative data and
2. to determ
ine if
analysis of the
them

es m
ined from
the qualitative data
could be used to
convert the open-
ended questions on
the C
asey-Fink
G
raduate N
urse
E
xperience Survey
“T
he results of this
qualitative analysis
perm
itted further
revisions of the
C
asey-Fink
G
raduate N
urse
E

xperience Survey.
T
hem
es identified
from
data analysis
of the 3 top skills
difficult to m
aster at
each period, and the
5 open-ended
questions asked on
the original survey,
w
ere of sufficient
strength to convert
these item
s to
m
ultiple-choice
form
at. T
he one
open-ended item
that the authors

retained w
as
the final survey
question that asked
residents to
com
m
ent on their
experiences”
(p.347). N
ew
nurse
stressors w
ere
+
+
⨁
⨁
◯
◯
M
ethodical
lim
itations: D

etected.
T
he design and
execution of the study
w
as to use a
quantitative tool to
gather qualitative data
and revision of the
tool w
as suggested.
R
elevance: T
he body
of evidence from
prim
ary studies
supported review
findings that is
applicable to the
context specified in
the review
questions.
C

oherence: T
here is a
clear fit betw
een the
data from
prim
ary
findings, yet the
sam
ple is
hom
ogeneous,
dow
ngraded 1 point.
A
dequacy of data:
T
here is a good
into quantitative
questions for ease of
test adm

inistration
and analytic
procedures.
V
ariables: D
V
s: role
changes, lack of
confidence,
w
orkload, fears,
orientation issues. IV
:
residency program
w
ithin the first year
of hire.
Instrum
ents: C
asey-
Fink G
raduate N
urse
E

xperience Survey.
Q
ualitative data
outcom
es w
ere
gathered via open
ended questions from
the author.
issues w
ith skills
over a period of
tim
e, they w
ere not
getting easier. T
his
w
as attributed to
constant preceptor
assistance and lack
of being able to
perform
skills

independently
during com
plex
patient cases.
W
ork/life balance
w
as a m
ajor stressor
and im
pacted the
ability to function at
the job.
B
eing able to
com
m
unicate w
ith
M
D
s (a protective
factor of resiliency)
and organize their
w

orkload w
ere
barriers to
transitioning into
their new
role w
hich
reflected K
ram
er et
al. (2013) and
H
alfer and G
raf’s
(2006) results.
am
ount of qualitative
data to represent the
hom
ogeneity sam
ple.
Publication bias: N
ot
detected. T

he Journal
of N
ursing
A
dm
inistration
publishes pilot studies
w
ith negative results
and also larger sam
ple
sizes.
Q
uality increased by
1 point due to all
plausible residual
confounding factors
dem
onstrated an
effect.
C
om
m
unication

from
m
anagem
ent
and the desire to be
a part of the unit’s
culture w
ere pointed
out to be a m
uch-
needed support.
T
he top 3 m
ost
satisfying aspects of
graduate nurse
residents’ w
ork
environm
ent
included as follow
s:
support,
cam
araderie,
and caring for

patients.
“T
here is not
enough socialization
in the residency
program
. B
ecom
ing
a new
nurse in a
new
environm
ent is
difficult’’ (p.347).
G
ill et al.
(2010)
cohort study using
m
ixed m
ethods/
sequential
exploratory

7 participants/ inpatient
care areas at L
evel 1
traum
a center. 7.7%
participants w
ere m
ale.
T
he ethnicity of
Purpose: to
investigate the
expectations,
perceptions, and
satisfaction of
graduate nurses after
N
ew
graduates are
fairly satisfied. T
w
o
them
es em

erged:
establishing
relationships and
learning the job.
+
+
⨁
⨁
⨁
◯
M
ethodical
lim
itations: N
ot
detected as the
participants w
as not
specified.
6 and 12 m
onths of
em

ploym
ent.
A
im
s: to describe
new
graduates during
the first year of
practice.
V
ariables: D
V
:
perceptions regarding
the first year of
practice such as
social support, stress,
professional values
Instrum
ents: 10-item
abbreviated version
of the N
ational
D
atabase of N
ursing

Q
uality Indicators
(N
D
N
Q
I) revised
survey for R
N
s w
hich
is a series of
statem
ents relating to
the nurses’
perceptions of their
w
ork. It has been
show
n to be both
reliable. “A
t the
com
pletion of the
final interview

,
graduate nurses w
ere
asked to com
plete a
brief three-item
survey on intent to
leave. Individuals
Strong tie to
prim
ary studies that
states group
cohesion (a
resiliency) and
satisfaction can
increase the ability
to stay at one’s job
and in nursing.
A
t the end of the
12-m
onth study,
m
any graduates
considered leaving

their until and the
organization, but
few
participants
thought of leaving
the profession
entirely.
prim
ary studies are
reflected in the review
findings.
R
elevance: T
he study
w
as relevant. T
he
body of evidence
from
prim
ary studies
supported the review
finding and is
applicable to the

context of new
nurse
graduates and the
aim
s of the study.
C
oherence: T
he study
w
as coherent, and the
findings w
ere a fit
betw
een the prim
ary
finding.
A
dequacy of data:
T
here w
as adequate
data supporting the
review

finding but the
sam
ple w
as very
sm
all.
Publication bias:
T
here is no detection
of publication bias as
results revealed
perceptions and w
ere
not deem
ed as
positive or negative.
w
ere asked to
indicate how
often
they contem
plated
leaving their unit, the

organization, or the
profession of nursing
on a 5-point L
ikert
scale” (p. E
13).
H
odges et
al. (2008)
qualitative:
phenom
enological
m
odel/
exploratory
11 new
nurses/
southeastern U
S and
had experience
betw
een 12 and 18
m

onths. 9%
of
participants w
ere m
ale.
T
he ethnicity of
participants w
as not
specified.
Purpose: T
o explore
the nature of
professional
resilience in new
B
SN
nurses in the
acute care setting and
to extrapolate
pedagogical
strategies that can be
developed to support
resilience and career
longevity.
A

im
s: to explore the
existence and social
structure of
professional
resilience am
ong
practicing nurses to
evolve a m
iddle
range theory to
explain the
relationships of
constructs w
ithin the
concept.
N
ew
nurses spend a
significant am
ount
of tim
e learning
their place in the
social structure and
need positive
experiences to feel

they are a part of the
w
ork environm
ent.
R
esilience is needed
to ensure new
nurse
self-protection, risk
taking, and m
oving
forw
ard w
ith
reflective
know
ledge of self.
T
hem
es that
em
erged w
ere
learning the m

ilieu
(developing
confidence and
skills), discerning fit
(accepted by the
culture), and
+
+
⨁
⨁
◯
◯
M
ethodical
lim
itations: N
ot
detected as prim
ary
studies revealed
sim
ilar findings.
R
elevance: the study
is relevant due to its

context to the aim
w
hich explored
professional resilience
and as a protective
factor, social support.
C
oherence: it is clear
that social support is
needed to be
professionally
resilient, yet it w
as
not coherent
regarding how
to
garner social support
to ensure the
V
ariables: D
V
:
experiences of social
support of new

nurses.
Instrum
ents: open-
ended questions
m
oving through
(recovering from
stress and
identifying those
they can trust in
order to develop
protective factors
against w
ork-life
issues).
Participants noted
significant am
ount
of adapting that
m
ust take place to
be accepted socially
and also the
disparity betw
een
academ

ics and
practice. T
his
distressed new
nurses as they
actualized the
discrepancies.
N
ew
nurses’
em
otional energy is
consum
ed by
cognitive w
ork;
resilience is
necessary for such
w
ork in order to
grow
from
adversity.

developm
ent of
resiliency,
dow
ngraded a point.
A
dequacy of data:
T
here is an adequate
am
ount of data but is
from
a sm
all sam
ple
yet does reflect
current findings
regarding the
phenom
enon of new
nurse resilience.
Publication bias:
T
here is no detection

of publication bias as
results revealed
perceptions and w
ere
not deem
ed as
positive or negative.
C
onstruction of a
new
nurse’s social
identity w
as found
to be im
portant to
create their
professional
identity.
H
odges et
al. (2010)
qualitative:
grounded theory/
descriptive

19 new
and
experienced B
SN
nurses w
orking in
direct patient care (9
participants w
ere 11 to
18 m
onths in
practice)/southeast U
S-
m
ultiple levels of m
ed
centers and hospitals.
N
o gender or ethnicity
of participants w
ere
specified.
Purpose: to explain

how
B
SN
acute care
nurses understand,
adapt to, and
negotiate challenge
and change in acute
care settings in the
context of social and
structural features
and career
persistence.
A
im
s: to understand
career persistence in
B
SN
acute care
nurses and create a
m
iddle range theory
to place into practice
to encourage career
resilience.
V
ariables: nurses

spanning 11 m
onths –
over 5 years.
Instrum
ents: open-
ended questions
T
he central them
e
w
as building
professional
resilience, w
as
noted to be the
central social
process.
V
erifying fit:
participants stated
incongruent
personal principles
and values
regarding nursing
practice and
incom
patibility w
ith

the environm
ent
(the environm
ent
does not m
atch their
strengths).
Stage setting: how
to protect one’s self
and form
relationships in
+
+
⨁
◯
◯
◯
M
ethodical
lim
itations: D

etected
as the studied w
as
com
posed of new
nurses (w
ithin 11-18
m
onths of practice to
those w
ith 5 or m
ore
years). T
hat is a large
breath of experience
to find out about
nurse’s resilience as
the stress of a new
job
tests one’s resilience
and those that have
overcom
e adversity
are know

n as
resilient. D
ow
ngraded
one point.
R
elevance: G
ood
relevance as the
concept of an ever-
changing health care
order to feel secure
and supported
(protective factors
of resiliency).
O
ptim
izing the
environm
ent:
seeking activities
that help one attain
professional goals.
T
he key to

understanding
professionalism
of
nurses is to
understand one’s
social group.
arena is obvious,
career resilience is a
characteristic one
needs to stay in the
career.
C
oherence: T
he data
aligns to the prim
ary
studies.
A
dequacy of data:
T
he data is com
ing
from
a sm
all
population of
different ages and

tim
e fram
es w
ithin
their careers (18
m
onths to over 5
years), dow
ngraded
one point.
Publication bias:
M
ost likely this study
w
as published
because of its
“sensibility”
regarding
recom
m
endations to
help nurses stay
engaged w
ith their
w
ork life and w

ork
environm
ent,
dow
ngraded one
point.
K
ram
er et
al. (2012)
qualitative:
grounded theory/
exploratory
82 participant
interview
s w
ere done.
A
t the tim
e of
interview
ing, 71%

(n =
236) of the 330 N
L
N
s
w
ere betw
een 9 and 12
m
onths post hire/local
M
agnet hospitals.
G
ender and ethnicity of
participants w
ere not
specified.
Purpose: to elicit
from
new
nurses and
experienced nurses
on clinical units w
ith

very healthy w
ork
environm
ents, the
com
ponents and
strategies of nurse
residency program
s
and effective in new
nurse integration into
professional practice.
A
im
s: W
hat N
R
P
com
ponents and
strategies do N
L
N
s

and clinical nurses
practicing on clinical
units w
ith V
ery
H
ealthy W
ork
E
nvironm
ents
(V
H
W
E
) identify as
effective in N
L
N
transitioning and
integrating into
professional practice?
V
ariables: D
V

s:
delegation,
prioritization, conflict
resolution w
ere used
to construct the
interview
schedule
and as the basis for
selection of
First them
e w
as
about delegation.
Second them
e w
as
about prioritization.
T
hird them
e w
as
about getting w
ork
done. Fourth them

e
clinical autonom
y
and how
to m
ake
the right decisions.
T
ext m
essages to
M
D
s to relay info
and data w
as citing
as an effective
com
m
unication
technique in
hospitals. Fifth
them
e: constructive
conflict resolution.
Sixth: feedback to
restore self-

confidence (a
resiliency).
R
esults of this study
support the
recom
m
endation
that developm
ent of
tw
o-stage,
T
ransition plus
Integration, N
R
Ps
are no longer an
+
+
⨁
⨁
⨁
◯

M
ethodical
lim
itations: D
etected.
Interview
s w
ere
conducted w
ith 2 or 4
new
nurses and
experienced nurses
(contam
ination
possible as responses
m
ay not have been as
genuine if nurses
w
ere alone) in each of
the units and w
ere
interview

ed by
various hospital unit
educators. D
ecreased
one point.
R
elevance: V
ery
relevant as learning
about w
hat creates a
healthy w
ork
environm
ent can help
prepare a strong
w
orkforce and good
transition experience
is very desirable for
organizations.
C
oherence: Som
e
hospitals had clinical
coaches and others
did not, this m

ay have
participant
observations.
Instrum
ents: open-
ended questions
option but a
necessity. T
hese
N
R
Ps need to have
clearly
differentiated goals,
com
ponents,
expected role
perform
ance, and
rites of passage.
affected participants’
responses and
experiences lim

iting
generalizability yet
since all program
s
w
ere enrolled at
hospitals w
ith
residency program
s
greater than 3 years,
and since not every
hospital has coaches,
the sam
ple size w
as
large enough to
represent the
population of those in
residency program
s.
A
dequacy of data:
T
here is adequate data
to support the finding
that residency

program
s are
preferred w
hen
transitioning to first
year of practice.
Publication bias:
findings w
ere not
positive or negative,
therefore none
detected.
L
i et al.
(2014)
quantitative,
correlational/
descriptive,
A
convenience sam
ple
of 251 nurse residents
(0-3 m
onths of w
orking
Purpose: T

he purpose
of the study
exam
ined protective
“O
rganizational
com
m
itm
ent
+
+
⨁
⨁
◯
◯
predictive
on a pediatric unit in
L
os A

ngeles, C
A
).
7.9%
of participants
w
ere m
ale. Percentage
of C
aucasian
participants 30.3%
,
B
lack 0.8%
, L
atino
2.4%
, and other
ethnicities w
ere not
reported.
factors that m
ay

decrease burnout and
increase job
satisfaction in a nurse
residency program
over 3 m
onths. G
roup
cohesion optim
izes
practice w
hereas
organizational
com
m
itm
ent helps to
create an intention to
stay at current job (p.
96).
A
im
: to determ
ine
w
hether factors such

as group cohesion
and organizational
com
m
itm
ent w
ould
be protective and
m
oderate the
association betw
een
stress exposure and
posttraum
atic stress
sym
ptom
s and other
negative nurse
outcom
es w
hich
w
ould create positive
ones.

V
ariables: D
V
s:
stress, com
passion,
satisfaction, group
cohesion, and
w
as not found to
protect nurse
residents from
negative nurse
outcom
es, it did
play an im
portant
role in prom
oting
job satisfaction” (p.
95). “R
esults
confirm
ed previous

findings that stress
exposure and PT
SD
sym
ptom
s have
serious im
plications
for a range of
affective outcom
es
for new
resident
nurses” (p. 95).
Inform
ation w
as
provided about the
relationships that
group cohesion and
negative nurse
outcom
es have and
that establishing a
relationship in a
group can serve as a

protective factor in
helping bounce
back from
negative
nurse outcom
es like
burnout and
com
passion fatigue.
R
isk of bias: sam
ple
bias due to
convenience sam
pling
and collection of
inform
ation w
as not
reliable and only at
one hospital, one type
of floor.
Inconsistency:
findings w
ere
consistent w

ith other
findings w
ithin the
context of group
social support
decreases the adverse
effects of stress.
Indirectness: Findings
w
ere applicable to the
context of the study.
Im
precision: relevant
only to one hospital
on one floor,
dow
ngraded one
point.
Publication bias: not
likely as findings
w
ere neither positive
or negative.
organization
com
m
itm

ent.
Instrum
ents: L
ife
E
vents C
hecklist
good reliability,
PT
SD
C
hecklist
C
ivilian V
ersion,
C
om
passion
Satisfaction and
Fatigue T
est, N
urse
Job Satisfaction
Scale, G

roup
C
ohesion Scale, and
O
rganizational
C
om
m
itm
ent Scale
**Social support
could also im
pact
how
nurses respond
to stress (p. 97).
M
artin &
W
ilson
(2011)
qualitative/
interpretive

phenom
enology,
descriptive
7 new
nurses w
ithin the
first year of practice
w
ho participated in an
intensive transition
program
designed as a
com
ponent of an
orientation program
to
ease new
graduates into
nursing practice on
various
m
edical/surgical units/
purposive convenience
sam
ple. 14%
of

participants w
ere m
ale.
Percentage of
C
aucasian participants
w
as 85.7%
, B
lack
Purpose: to exam
ine
the lived experience
of new
ly licensed
R
N
s in their first year
of practice in a
hospital setting.
A
im
s: to extract the
m

eaning and
understand from
the
hum
an experience,
new
nurses, during
their first year of hire.
V
ariables: D
V
:
experiences of new
nurses during their
first year of hire.
T
hem
es: real nurse
w
ork, guidance,
transitional
processes,
institutional context,
and interpersonal
dynam

ics. “T
he
cum
ulative effects
of socialization,
skill acquisition,
and stress on new
nurses indicate that
research is needed
to answ
er questions
regarding
recruitm
ent,
retention, and job
+
+
⨁
⨁
⨁
◯
M
ethodical

lim
itations: som
ew
hat
detected as
convenience sam
ple
w
as used to recruit
sam
ple yet fram
ew
ork
for the study m
atched
the purpose and aim
s
for this study.
R
elevance: the
findings are very
applicable to the
context of new
nurse
experiences.

14%
, there w
ere no
other ethnicities
reported.
(purposive: the
researcher deliberately
selects subjects m
ost
know
ledgeable about
the issue under study.)
Instrum
ents:
interview
questions
satisfaction” (p. 21).
C
aring of the
profession vs non-
caring w
ithin the
profession is posed
as an argum
ent for a

new
orientation
objective – possibly
the form
ation of a
“caring group”
(better know
n as
support group).
“Professional
acculturation is a
com
plex process
that requires tim
e to
navigate. T
he
success of the
process is often
dependent upon the
degree of perceived
support the new
ly
licensed R
N
receives” (p.22).

R
elationships are
required to adapt to
the stress of starting
nursing. C
ollegial
relationships w
ith
all nursing staff and
M
D
s, and ancillary
staff m
atters to new
nurses.
C
oherence: good
coherence w
ith
previous studies of
professional
acculturation and
struggle to create a
professional identity
w

hile transitioning to
practice w
hich is
deem
s extrem
ely
stressful.
A
dequacy of data:
findings aligned w
ith
K
ram
er’s sem
inal
w
ork (1974), R
eality
Shock, and
reconfirm
ed via
D
uchscher’s w
ork on

Transition Shock
Theory.
Publication bias: none
detected as the study
did not report positive
or negative findings.
M
cC
alla-
G
raham
&
D
e G
agne
(2015)
qualitative:
phenom
enological/
exploratory
10 participants, using a
purposive, snow

ball
sam
pling/southw
est
Florida, m
ost w
ere
experiencing their
second career. G
ender
and ethnicity w
ere not
specified.
Purpose: to explore
the lived experiences
of new
graduate
nurses em
ployed in
an acute care setting.
A
im
s: to best
understand new

graduate nurses’
experiences in the
acute setting
V
ariables: D
V
: acute
care setting in the
first year of hire.
Instrum
ents: 11 open-
ended questions
Participants stated
that nursing school
did not prepare
them
for current
roles or
responsibilities and
that the goal of
nursing school w
as
only to assist the
new
grad in passing
the N
C
L

E
X
. “T
he
findings suggest
that the graduate
nurses thought that
if they developed
good coping skills,
the acute care
clinical setting
m
ight be less
stressful for them
”
(p. 125).
Participants also
stated they w
ere
very overw
helm
ed
by the w
orkload and
that positive
reinforcem

ent
helped m
itigate this
stress.
+
+
⨁
⨁
⨁
◯
M
ethodical
lim
itations: none
detected as the
findings reflected
sim
ilar findings as
prim
ary studies, there
w
ere very little issues,
other the sam
pling

m
ethod, in the w
ay
the study w
as
designed/
conducted.
R
elevance: the
findings w
ere relevant
and the extent of the
body of evidence
from
the prim
ary
studies supported and
is applicable to the
context of the new
nurse shortage
phenom
enon
occurring w
ithin the
first year of practice.

C
oherence: T
he
researchers discussed
a clear fit betw
een the
data from
prim
ary
findings.
A
dequacy of data:
there w
as rich data
and the am
ount to
support the findings
w
ere adequate.
Publication bias: none
detected as the results
are neither positive or

negative influencing
the preference to
publish.
O
lson
(2009)
qualitative/
exploratory,
interpretive,
phenom
enological,
longitudinal
12 participants/
purposive sam
ple of 2
groups of new
graduates: 6 B
SN
and 6
A
D
N
nurses – full tim
e

staff nurses at the tim
e
of data collection.
16.6%
of participants
w
ere m
ale. E
thnicity of
participants not
specified.
Purpose: to
understand the
experience of new
ly
licensed nurses from
their perspective.
A
im
s: to understand
m
illennial, novice
throughout the first
year of practice

V
ariables: D
V
: new
nurse experiences
Instrum
ents: open
ended interview
s at 3,
6, and 12 m
onths
T
hem
es that
em
erged: being in
unfam
iliar
surroundings w
hich
seem
ed confusing
and overw

helm
ing
because they had
spent lim
ited tim
e in
acute care as
students. A
fter a
year, participants
expressed fear about
being oriented to a
different place. T
he
second them
e, “out
of the blue,” w
hich
are the “never to be
forgotten”
experiences – so
+
+
⨁
⨁

⨁
◯
M
ethodical
lim
itations: lim
itation
regarding sm
all
sam
ple yet findings
w
ere analyzed w
ell,
and researcher
dem
onstrated a good
ability to reflect on
participants’
experiences to create
com
m
on them
es that
are applicable to the

phenom
enon of new
graduate experiences.
R
elevance: Prim
ary
studies support the
chaotic and the
difficulty of trying
to keep up – this
w
as relayed to
researchers as
feelings of
helplessness, guilt,
and extrem
e sadness
as novices coped
w
ith death or a
m
edical error for the
first tim

e. T
he third
them
e: finding m
y
voice, this w
as a
description of
novices’
relationships w
ith
preceptors, M
D
s,
and other staff
m
em
bers. Feeling
w
elcom
ed and
confronting
incivility w
ith other
nurses w

ere crucial
to feeling successful
in the transition.
T
he fourth them
e
w
as “am
I ok?”
O
btaining feedback,
trust w
ith know
ing
som
eone w
ould tell
them
they w
ere
doing som
ething
findings and it is
applicable to
m

illennial, novice
nurses’ and their
intentions to do
everything really w
ell
regardless of how
foreign som
ething is
and the need for
im
m
ediate attention
and feedback to
continually grow
and
learn.
C
oherence: there is a
good fit betw
een the
prim
ary studies and
the findings in this
study.
A

dequacy of data: the
quantity and degree of
richness in prim
ary
studies support the
review
findings.
Publication bias:
D
oubtful due to
neither positive or
negative results w
ere
shared, only reported
experiences of a
sam
ple of new
nurses.
w
rong w
as very
im
portant to
participants as they
expressed great
anxiety regarding

m
aking m
istakes.
T
he acute setting is
very unfam
iliar, and
socialization can
assist w
ith the
stressful adjustm
ent
w
hich m
akes it
difficult to grow
and
continue to learn.
M
illennials w
ant
nurturing, attention,
and continuous
feedback w

hich
places an extensive
value on social
support (a
resiliency).
Pellico et al.
(2009)
qualitative: case
study m
odel/
descriptive
612 participants in 12-
18 m
onths of practice
/stratified sam
pling in
m
etropolitan m
idsize
areas in the U
S
w
orking inpatient.

E
thnicity and gender of
participants not
specified.
Purpose: “T
he
purpose of this article
w
as to explore the
perceptions of 612
N
L
N
s’ nascent
experiences as
reflected in their
com
m
ents provided
in a national survey
“5 them
es w
ere
discovered.
“C

olliding
expectations”
describes conflicts
betw
een nurses’
personal view
of
nursing and their
+
+
⨁
⨁
⨁
◯
M
ethodical
lim
itations: this w
as
secondary findings
from
a parent study
and there w
ere no

lim
itations in the
that sought to gain a
better understanding
of the w
ork life of
N
L
N
s” (p. 194).
A
im
s: to understand
N
L
N
’s w
ork-life
experiences.
V
ariables: m
ultiple
areas across the U

S
Instrum
ents: 16-page
survey w
ith 207
item
s.
lived experience.
“T
he need for
speed” describes the
pressure related to a
variety of tem
poral
issues. “Y
ou w
ant
too m
uch”
expresses the
pressure and stress
N
L
N
s feel

personally and
professionally.
“H
ow
dare you”
describes
unacceptable
com
m
unication
patterns betw
een
providers. “C
hange
is on the horizon”
suggests optim
ism
for the future as
N
L
N
s speak of
transform
ing the

system
s w
here care
is provided (a
resiliency). T
his
content analysis
reveals that the
w
orking
environm
ent w
here
N
L
N
s begin their
design of the findings
of the prim
ary
studies.
R
elevance: the
findings are
applicable to the

context specified to
explore perceptions of
new
nurses’ w
ork life.
C
oherence: T
here is a
good fit betw
een the
data from
the prim
ary
studies and the
findings yet prim
ary
studies did not reveal
any m
ention of
w
anting to change
new
nurses’
experiences as stated
in the review

of
findings in this study.
A
dequacy of data: the
data underlying a
review
finding are
rich and com
e from
different num
bers of
participants per study.
Publication bias:
doubtful as the results
w
ere neither positive
or negative but
reported the
career is in need of
reform
” (p. 194).
experiences of
participants.
N

153The Journal of Continuing Education in Nursing · Vol 50, No

153The Journal of Continuing Education in Nursing · Vol 50, No

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153The Journal of Continuing Education in Nursing · Vol 50, No