The New Graduate RN Speaks, Again: A Mixed-Methods Study

BACKGROUND: While the academic-practice gap in nursing is widely acknowledged, substantive research exploring it from the perspective of new graduate RNs' transition into practice is lacking. As this gap is thought to be a contributing factor to the exodus of new graduate RNs from the hospital setting and the ongoing nursing shortage, it's crucial that these nurses be given the opportunity to identify specific gaps they are experiencing as they enter practice. PURPOSE: This study sought to explore the specific gaps experienced by new graduate RNs working in medical-surgical hospital-based settings. METHODS: A pragmatic worldview and Meleis's Transitions Theory served, respectively, as the philosophical basis and theoretical framework for this mixed-methods study. Convenience sampling was used to recruit new graduate RNs working in medical-surgical hospital-based settings. Using both the Casey-Fink Graduate Nurse Experience Survey (CFGNES) and additional open-ended questions, participants were asked to identify gaps in their academic preparation for and entry into professional practice. The CFGNES involves the constructs of support, professional satisfaction, communication/leadership, patient safety, and stress. Descriptive statistical and regression analyses were used to explore correlations between these constructs and relevant participant variables. Krippendorff's content analysis method was used to analyze qualitative responses. Mixed-methods integration was used to further illuminate findings. RESULTS: Data from the final sample of 128 new graduate RNs revealed preparedness gaps in the areas of information, knowledge, and tools that adversely affected their transition to professional practice. A significant negative correlation was found between months in practice and the construct of support. A significant, albeit weak, positive correlation was found between months in practice and the construct of communication/leadership. No relationships were found between the five CFGNES constructs and employment at a Magnet hospital versus other hospitals, or for participation versus no participation in residency programs. CONCLUSIONS: The study findings demonstrate that the reality shock experienced by new graduate RNs remains a problem that urgently needs our attention. New graduate RNs working in medical-surgical hospital-based settings experience gaps in the areas of information, knowledge, and tools that adversely affect their transition into practice. Nursing academics and practice-based leaders must work together to better understand the new nurse's experiences, mobilize support, and respond effectively.