Difficulties adjusting to nursing practice affect patient care

The transition from nursing student to professional nurse involves much more than applying classroom knowledge in a hospital setting. Taking on new responsibilities, making decisions about patient care, becoming part of a healthcare team, and balancing professional and personal life can all present challenges for newly qualified nurses. But how do these difficulties affect patient care?

A study by Assist. Prof. Pınar Doğan and Assoc. Prof. Merve Tarhan from Istanbul Medipol University School of Health Sciences,Department of Nursing, examined these challenges during nurses' first year of professional practice and their relationship with patient care.

Published in the Journal of Clinical Nursing, the study, titled “The Relationship Between Transition Shock and Missed Nursing Care Among New Graduate Nurses: A Cross-Sectional Study”, investigated the relationship between transition shock and missed nursing care.

Transition shock refers to the difficulties arising from the gap between expectations formed during nursing education and the realities of professional practice. Missed nursing care, meanwhile, refers to necessary patient care that is delayed, omitted entirely, or left incomplete.

Based on nurses' self-reported assessments, the findings showed that those experiencing greater difficulties adjusting to professional practice also reported higher levels of missed nursing care.

277 NURSES FROM FOUR HOSPITALS PARTICIPATED
The study involved 277 nurses in their first year of professional practice working at four private hospitals affiliated with a university in Istanbul. Conducted between December 2023 and February 2024, the research included full-time nurses who held at least a bachelor's degree and had between three months and one year of professional experience.

The participants had an average age of 24, with most working in inpatient units and on day shifts. The researchers assessed transition-related difficulties across four dimensions: interpersonal relationships, professional decisions and practices, social life, and roles and responsibilities. Regarding patient care, the study focused on two distinct aspects: the extent to which nurses reported missed nursing care and the conditions they identified as contributing to these omissions. This approach allowed the researchers to examine not only gaps in care delivery but also nurses' perceptions of staffing, material resources, and communication-related problems.

IS ADJUSTING TO THE PROFESSION ENOUGH TO ENSURE COMPLETE PATIENT CARE?
The study found that nurses generally experienced low levels of transition shock, while their reported levels of missed nursing care were moderate. These findings suggest that although participants did not generally experience severe difficulties adjusting to professional practice, necessary patient care was not always delivered in full. However, difficulties adjusting to nursing practice alone do not explain missed nursing care.

The research indicates that this relationship must also be considered alongside other factors in the working environment, including available resources and communication.

DIFFICULTIES IN SOCIAL LIFE STAND OUT
Among the dimensions of transition shock examined, social life was the area in which nurses experienced the greatest difficulties. This dimension extends beyond challenges in finding time to meet friends or participate in social activities. It also includes physical and psychological difficulties affecting everyday life, such as persistent work-related anxiety and reduced appetite.

One of the study's notable findings was that, when all four dimensions of transition shock were examined together, social life was the only dimension that remained statistically significantly associated with missed nursing care. In other words, nurses who experienced a greater burden from work on their social and daily lives also reported higher levels of missed patient care.

The researchers noted that adjusting to shift work and maintaining a balance between professional and personal life can be particularly challenging at the beginning of a nursing career. They therefore emphasized that support for newly graduated nurses should address not only hospital duties and clinical skills but also the effects of professional responsibilities on everyday life.

COMMUNICATION EMERGES AS A KEY FACTOR IN MISSED CARE
The researchers examined three categories of conditions that nurses identified as reasons for missed nursing care: communication, material resources, and human resources. Communication was the most frequently emphasized category, followed by material resources and staffing-related factors. Importantly, these findings were based on nurses' perceptions of how these conditions contributed to missed care, rather than direct measurements of hospital resources or observations of communication processes.

According to the results, nurses who experienced greater transition difficulties also identified problems across all three categories as more significant reasons for missed nursing care. This association was particularly notable in their assessments of communication and material resources. The researchers identified adequate staffing and material resources, together with effective communication within healthcare teams, as priority areas for improvement in efforts to reduce missed nursing care.

TEAM INTEGRATION AND DECISION-MAKING ARE ALSO PART OF PROFESSIONAL ADJUSTMENT
The study showed that not all difficulties experienced during the transition into nursing practice were associated with missed care in the same way. While difficulties in social life stood out in relation to the extent of missed nursing care, challenges involving interpersonal relationships and professional decision-making were associated with the reasons nurses reported for care omissions.

Nurses experiencing greater difficulties in interpersonal relationships were more likely to identify staffing, material resources, and communication problems as contributing factors to missed care. Difficulties with professional decisions and practices, meanwhile, were particularly associated with staffing- and communication-related reasons for missed care. These findings suggest that evaluating new graduates' professional adjustment solely in terms of their ability to learn and perform nursing procedures may be insufficient. Building relationships within healthcare teams and making professional decisions are also essential components of the transition into nursing practice.

EDUCATION AND MENTORSHIP SUPPORT FOR NEWLY GRADUATED NURSES
The researchers recommend strengthening orientation programs for newly graduated nurses through continuing education and guidance from experienced colleagues. Such support could help new graduates prepare for professional responsibilities and further develop their patient care skills.

The researchers also emphasize that mentorship should extend beyond clinical procedures to include understanding the working environment, reducing uncertainty about professional duties, and supporting communication within healthcare teams. The study did not directly evaluate the effectiveness of an education or mentorship program. Instead, the researchers proposed these approaches based on their findings as potential ways to support newly graduated nurses and help prevent missed nursing care.