Maria Skyvell Nilsson

Introduction: Research consistently highlights the importance of mentorship and a supportive work environment for newly graduated registered nurses entering clinical settings. Previous research on mentorship has primarily focused on new nurses' perspectives. Further research is needed to explore mentors' perspectives in greater depth. Aim: To explore mentors' perspectives on supporting newly graduated registered nurses in their professional development in a hospital setting. Design: The study had a qualitative explorative design using focus group discussions as a data collection method. Method: A total of 18 registered nurses serving as mentors in a hospital care unit participated in five focus group discussions. The data were analysed using reflexive thematic analysis. Findings: The findings revealed mentors' views that a permissive approach, creating a trusting relationship, and strengthening self‐confidence build a positive foundation for novice nurses. They wished to facilitate novice nurses' learning towards professional independence by encouraging reflection and probing, and by fostering a desire for ongoing clinical competence development and patient safety through their presence in daily practice. Conclusion: These findings underscore the crucial role of mentors as advanced nurses in fostering supportive learning environments for newly graduated registered nurses by establishing meaningful mentoring relationships that offer psychological support. Extending existing mentor literature, the results highlight their intention to deliver pedagogically grounded, hands‐on clinical mentorship integrated into daily practice to ensure patient care. Thereby fostering workplace learning and professional development in daily clinical practice. Implications for the Profession: Health care decision‐makers and managers could use knowledge gained from this study to implement more targeted mentorship programmes to support newly graduated registered nurses and promote workplace learning. The findings emphasise the importance of organisational support, including protected time for mentors, to sustain meaningful mentorship and promote nurses' well‐being and healthy work environments. Impact: (Addressing): What problem did the study address? Mentorship plays a critical role in supporting newly graduated registered nurses entering clinical settings. However, despite the recognised importance of mentorship, there is limited research exploring mentors' perspectives when supporting new nurses. What were the main findings? Mentors can build a positive foundation for newly graduated registered nurses by using a permissive approach to create a trusting relationship. Mentors' intention was to promote a pedagogically grounded learning environment and uphold knowledge support through being present in daily work in order to create security for new nurses and ensure patient care. Where and on whom will the research have an impact? The findings of this study may support mentors and nurse managers responsible for facilitating the transition of newly graduated registered nurses into hospital settings by informing mentorship approaches that promote professional development through workplace learning and foster psychological safety during the transition period. Additionally, effective mentorship may strengthen newly graduated registered nurses' ability to deliver high‐quality care, which is of particular interest to nurse managers seeking to ensure safe and effective patient care. Reporting Method: This study conforms to the reporting of the Consolidated Criteria for Reporting Qualitative Research guidelines and checklist. No Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.

This study introduces and validates a tool for evaluating the core values of transition programs, providing a standardized method for assessing program quality. Findings suggest that higher perceiv...

Aim: To explore newly‐graduated registered nurses' professional needs and how these needs are supported by mentors in clinical practice, at two Swedish hospital care units. Background: Previous studies show that newly‐graduated registered nurses face challenges on initially starting to provide hospital care, thus needing organisational support. Experienced nurses and mentors are commonly described in the literature as facilitating this support and need to be investigated further; however, where this appears in a hospital setting. Design/Method: A qualitative study using focused ethnography was conducted between May 2024 and March 2025. Data was generated from 9 different fieldwork sessions (68 h) for mentoring that included newly‐graduated registered nurses and mentors from two different care units at hospitals within one regional healthcare authority in Sweden. Data was collected by means of participant observations, shadowing, ethnographic interviews, and the use of ethnographic analysis. Findings: One main theme was identified: I'm in freefall and in need of practical, social and emotional support when navigating my new role, as well as two subthemes: (1) I am a new nurse and in need of help in comprehending and performing nursing, and (2) I am undergoing a learning process in need of a trust‐based relationship. Each theme includes three subthemes. Conclusion: Newly‐graduated registered nurses need consistent practical, social, and emotional support in their day‐to‐day work through trust‐based relationships with mentors. This is a relationship crucial for their learning process, and which helps them bridge the gap between understanding and practicing nursing. Implications for the Profession: Structured mentorship can improve the learning environment of newly‐graduated registered nurses and constitute a sustainable working environment for them. Decision‐makers and managers can use this knowledge to implement mentoring programmes that are of interest when it comes to retaining both new and experienced nurses and providing qualitative and safe care. Reporting Method: This study conforms to the reporting of the COREQ guidelines and checklist. Patient or Public Contributions: No patient or public contributions.

The transition process for newly graduated registered nurses (NGN) entering hospital work is critical in managing challenges like insecurity and stress, while also supporting role navigation, learning, job satisfaction and retention. This study aimed to explore NGNs’ perceptions and experiences during their first four months transitioning to hospital work. A cross‐sectional survey with Likert‐scale questions and two open‐ended free text questions was conducted with NGNs enrolled in a regional transition program at five Swedish hospitals, gathering data from 216 nurses between September 2021 and September 2022. Descriptive statistics and qualitative content analysis were used to assess the data. The findings revealed that 61% of NGNs felt well prepared by their undergraduate nursing education, and 85% enjoyed their profession as nurses. Most reported they were integrated into their teams, satisfied with their support, and understood their responsibilities. However, only 28% reported feeling fully recovered for work, and 44% expressed fear of making mistakes. Qualitative responses highlighted feelings of unpreparedness for the workload, pace and ward‐specific routines, although opportunities for learning, building relationships and validating their skills were viewed positively. The transition experience was influenced by individual, social, and organisational factors. Ongoing improvement in transition processes requires shared responsibility between nurses, educational institutions and hospitals.

Purpose: The aim of this study was to identify and describe the collaborative and professional boundary challenges at a hospital ward from a bottom-up perspective.Design/methodology/approach: The study was conducted as a bottom-up improvement project at a hospital ward in western Sweden. An insider action research (IAR) approach was used during the project. The theoretical framework for this project was based on the Cultural-Historical Activity Theory (CHAT). Data were collected between 2019 and 2021.Findings: The findings showed that unclear professional boundaries and limited resources challenged and hindered interprofessional collaboration. The project group had to reorganize its daily work to adjust to the different disciplines’ legal responsibilities in relation to the patients’ recovery process. To safely discharge patients, the professionals needed to talk about each other’s professional responsibilities, professional boundaries and ethical codes.Originality/value: The IAR project revealed that revising the daily team-round routine improved the status of assistant nurses and encouraged physicians to consider input from all professions during the patients’ recovery process. However, the new approach faced resistance from clinic leadership, who believed it could prolong patients’ stays in the ward. The findings underscore the challenges of modifying hierarchical structures and social orders within hospital settings.

Aim: The aim of the present study was to describe nurse managers' perceptions of the provision of mentoring for newly graduated registered nurses (NGRNs) and its contribution to the work environment in a hospital setting.Background: Nurse managers are responsible for the work environment and for supporting the staff's professional development, which includes giving NGRNs organizational support during their introduction to the workplace. Mentorship is one common way to provide support, but there is a lack of knowledge about how nurse managers view this support.Design/Method: This was a qualitative descriptive study, using a semi‐structured interview guide. Fifteen individual interviews with nurse managers were performed in hospital settings. The interview transcripts were analysed using qualitative content analysis. The COREQ guidelines and checklist were used.Results: The results describe the nurse managers' perceptions of the provision of mentoring in three themes: Ensuring and sustaining mentoring for new nurses' needs is a struggle in the harsh reality of healthcare, Identifying mentors who are willing and possess the necessary competence for the assignment and Promoting a secure and attractive workplace by mentoring new nurses.Conclusions: Our study confirms that nurse managers are important in the provision of mentoring for NGRNs' learning and professional development. Mentoring has a positive spillover effect on the entire unit as a sustainable approach to securing and improving the work environment. Our study also identifies challenges for nurse managers to structure mentoring provision.Implications for the profession and/or patient care: This study highlights the importance of investment in mentoring for the NGRNs' professional development and for patient care. Support is needed from the top level of the organization, but how mentoring should be structured and facilitated needs to be investigated further.

Purpose: While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.Design/methodology/approach: An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.Findings: The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.Originality/value: This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

OBJECTIVE: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses’ health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses’ work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety. METHODS: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 – T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling. RESULTS: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses’ health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness. CONCLUSIONS: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts.Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews.Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross‐lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory.Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur.Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve.Implications for the Profession: By ensuring a shared care ideology, good inter‐professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful.Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress.Patient or Public Contribution: No patient or public contribution.

There is a global nurse shortage, and researchers have made great efforts in trying to unveil the reasons for turnover and how to increase retention. However, such research has had a tendency to study variables related to intention to leave (ITL) or turnover as isolated phenomena. Objective. To simultaneously explore what factors motivate experienced nurses in the workplace and the underlying reasons for strong ITL and high staff turnover within the profession. Design. An inductive qualitative content analysis was used based on data from open-ended survey questions. The data originated from the longitudinal analyses of nursing education/employment/entry (LANE) in work-life study. The qualitative data analyzed in this study were distributed in October 2017January 2018, to all nurses in three cohorts corresponding to 11-, 13- and 15-year postgraduation. Of the 2,474 nurses answering the survey, 1,146 (46) responded to one or more of the open-ended questions. Results. The result showed that what motivates experienced nurses, their intention to leave (ITL), and reasons for turnover could be described in the form of five broad categories, namely, organizational characteristics, work characteristics, relationships at work, work recognition, and health issues. There was rarely a one single reason described, rather several reasons needed to be experienced over time for nurses to stay motivated or leave the profession. Conclusions. There is no single reason that makes nurses leave the profession, nor is there one single reason that makes them motivated to stay. Retention and turnover are complex processes and need to be addressed as this, not as a single isolated phenomenon.