Relationship among core competency, self-efficacy and transition shock in Chinese newly graduated nurses: a cross-sectional study

The level of transition shock for newly graduated nurses

The score of transition shock was M=77.641, SD=24.140, which accounted for 57.51% of the total score. The standardised score was M=2.876, SD=0.894, indicating a moderate level, which is similar to the results of studies conducted by Su et al.19 33 34 In terms of each dimension of the scale, the scores of the physical and psychological dimension were the highest, followed by the knowledge and skill dimension, as well as the social–cultural and developmental dimension. This indicated that newly graduated nurses were mostly affected in the physical and psychological dimensions during the transition period, which is inconsistent with the results of Cao et al,35 where the knowledge and skill dimension scored the highest. This may be because this study only included newly graduated nurses who have been employed within 3 years, while Cao et al’s study only included those within their first year of employment. Newly graduated nurses who had worked for 2–3 years had improved their professional knowledge and skills, which may have reduced the impact of transition shock. This study demonstrated that newly graduated nurses encountered a multitude of stressors and were required to promptly acclimate to the clinical environment on commencing their professional practice.

In terms of learning, newly graduated nurses are required to participate in the hospital’s standardised training. At the same time, they need to quickly grasp the environment, core systems, workflow and responsibilities of each shift in the department. Newly graduated nurses with more than 1 year of work experience are expected to independently take care of patients. Therefore, newly graduated nurses need to absorb new knowledge, and they face great physical and mental pressure in both learning and working. Faced with departments with many critically ill patients, newly graduated nurses often have to work overtime due to inadequate competency. These factors make them prone to physical discomfort such as fatigue and sleep disorders, leading to higher scores in the physical aspect of transition shock.36 In addition, lack of life experience, work experience and communication skills make newly graduated nurses less confident when dealing with complex interpersonal relationships such as patient–nurse interactions and doctor–nurse interactions. There is a gap between the theoretical knowledge and practical skills in newly graduated nurses,37 which can lead to feelings of tension and uncertainty when facing complex clinical problems. As newly graduated nurses are in the rotation period, they may feel a low sense of belonging to the department, which contributes to higher scores in terms of their psychological well-being.19

The results of the multiple factor analysis showed that newly graduated nurse transition shock was related to their years of employment and weekly overtime frequencies. The highest transition shock score (M=82.415, SD=25.520) was observed in newly graduated nurses with less than 1 year of work experience, and the longer the work experience, the smaller the transition shock, which is consistent with the findings of previous studies by Kaldal et al.38 39 Powers et al40 found that the first year of employment is a critical period for newly graduated nurses to transition from being students to clinical nurses. During this period, newly graduated nurses leave the structured school environment and enter professional clinical practice, which can cause transition shock, leading to an impact on patient safety events and turnover rates. Previous research indicates that 25% of newly graduated nurses leave their positions during their first year of employment.40 As their work experience increases, newly graduated nurses’ clinical expertise, interpersonal relationship management and communication skills continue to improve, and they gradually adapt to the complex clinical work environment, resulting in a reduction in transition shock. The results of this study also showed that the more weekly overtime frequencies a newly graduated nurse has, the greater the transition shock they experience. Nurses with more overtime have a higher workload, increasing physical fatigue. This may be due to inadequate core competency (within 1 year, new nurses scored 114.5 (110, 153) points on core competency), leading to difficulty in completing their job responsibilities on time.7 This can increase the nurse’s psychological pressure, lower self-confidence and exacerbate their level of transition shock.

The current state of transition shock in newly graduated nurses suggests that nursing managers should pay more attention to transition shock, especially for newly graduated nurses within their first year of employment. The establishment of a complete and standardised training system for newly graduated nurses and the implementation of diversified teaching and training programmes can help them to improve their professional competency. Immersive communication workshops41 and group psychological counselling42 can teach newly graduated nurses to understand and respect patients, learn self-regulation skills and relieve stress, thereby improving their communication skills and psychological resilience,43 and promoting the adoption of positive coping strategies.44 Nursing managers should also monitor and evaluate the professional competency and psychological status of newly graduated nurses, intervene in a timely manner when issues arise40 and help newly graduated nurses to successfully transition into their new roles.

The negative correlation between core competency, self-efficacy and transition shock in newly graduated nurses

This study found a negative correlation between newly graduated nurses’ self-efficacy and transition shock (r=−0.455, p<0.001), which is consistent with the results of Kim et al.19 45 Self-efficacy is an important psychological resource for newly graduated nurses. Nurses with high levels of self-efficacy are more resilient when facing complex clinical nursing work, and are better equipped to solve clinical nursing problems effectively. These experiences help to facilitate their adaptation to clinical nursing work, ultimately alleviating the impact of transition shock.20 45

Furthermore, there is a negative correlation between newly graduated nurses’ core competency and transition shock (r=−0.345, p<0.001), indicating that the higher level of core competency, the lower level of their transition shock. This finding is consistent with previous research by Ma et al.10 16 One of the main reasons for transition shock in newly graduated nurses is their inadequate professional knowledge and skills. Charette et al37 pointed out that newly graduated nurses generally have insufficient knowledge and skills, making it difficult for them to think critically and solve problems in the clinical environment, which result in transitional shock.46 Dev et al47 suggested that joint education from nursing schools and clinical mentors can bridge the gap between theoretical and practical learning and improve critical thinking skills, thereby effectively mitigating the impact of transition shock.18

More importantly, this study demonstrated a positive correlation between newly graduated nurses’ core competency and self-efficacy (r=0.506, p<0.001), which is consistent with the findings of previous research by Na et al.16 17This may be because nurses with higher core competency have greater job competency, enabling them to utilise their knowledge and skills effectively when faced with difficult clinical problems. This will lead to increased social support and enhance their confidence and self-efficacy.

The mediating effect of self-efficacy between core competency and transition shock in newly graduated nurses

The results of this study indicated that the core competency of newly graduated nurses can directly affect their level of transition shock (β=−0.151, p=0.026), and self-efficacy partially mediates the relationship between core competency and transition shock (β=−0.203, p<0.001). This suggests that nursing managers should focus on improving the self-efficacy of newly graduated nurses while enhancing their core competency. In this study, the core competency of newly graduated nurses was at a moderate level, with the lowest score in critical thinking/research ability, which is consistent with the findings of Chen et al.8 The self-efficacy score was also at a moderate level, consistent with the results of Li et al48 and lower than the findings of Yue.19 Nursing managers can improve the judgement skills and competency of newly graduated nurses by perfecting standardised training systems, including case-based scenario simulation workshops and problem-oriented teaching, in addition to traditional theoretical knowledge and skills training and assessment.49 They can also strengthen the training of preceptors and enhance their qualifications by establishing a nursing mentorship programme.40 50 51 This programme can help newly graduated nurses and their preceptors establish a communication mechanism, create an atmosphere of mutual respect and understanding, alleviate newly graduated nurses’ psychological pressure, improve their mental health level, and reduce the level of transition shock.

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