Judy Boychuk Duchscher

Digital health technologies are being used in healthcare more than ever, which has implications for the daily work of nurses. As the newest members of the nursing profession, new graduate nurses (NGNs) experience great change during the transition to practice experience. The experience of NGNs transitioning to practice while digital health technologies are being increasingly integrated is not well elucidated in the nursing literature. This proposed scoping review will address this gap and aims to explore and describe the literature involving NGNs and digital health technologies. This review will use the Joanna Briggs Institute (JBI) guidelines to search CINAHL, MEDLINE, Embase, and ERIC databases for keywords and subject headings related to the concepts of “digital health technology” and “new graduate nurses”, published between 2020 and 2026. Included articles will involve new graduate nurses with 0–12 months of experience, use digital health technology in the clinical context of nursing, and be peer-reviewed primary research. Articles will be screened and extracted using Covidence and described in line with JBI guidance and presented narratively. The findings of this scoping review will be key in positioning the transition to practice experience for NGNs in an age of digital revolution. Results will be instrumental in enhancing nursing curriculum, ensuring transition policies and procedures are supportive of developing digital health competence and assuring the delivery of better care to patients when using digital health technologies. The contribution of this review will be unique and novel in exploring NGNs and digital health, providing context for the modern experience of transition to practice.

Background: The transition from student to registered nurse is a vulnerable period characterised by emotional strain, role ambiguity, and transition shock. Although Graduate Nurse Transition Programs (GNTPs) aim to strengthen early practice readiness, few evaluations use longitudinal, theory-informed approaches or validated tools. Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Design and Methods: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. A customised 75-item questionnaire—adapted from the Professional Role Transition Risk Assessment Instrument and the Professional and Graduate Capability Framework—was administered at three transition points (March 2020–March 2021). Four domains were assessed: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis (PCA), chi-square tests, and multinomial logistic regression identified developmental patterns and predictors of transition stage. Results: PCA supported a four-factor structure consistent with the theoretical domains, explaining 62% of variance. Significant stage-based improvements were found in clinical decision-making (RS6, p = 0.005), managing pressure (RS11, p = 0.003), leadership perception (RO5, p = 0.001), and emotional regulation (RL20, p < 0.001). Regression analysis identified role confusion (RS7, χ² = 18.112, p = 0.001), leadership potential (RL1, χ² = 25.590, p < 0.001), workplace support (RL16, χ² = 12.760, p = 0.013), and critical thinking confidence (KN13, χ² = 10.858, p = 0.028) as strong predictors of transition stage. By Stage 3, most NGNs demonstrated increased autonomy, confidence, and professional integration. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship. Conclusions: Findings provide robust evidence for theoretically grounded GNTPs. Tailored interventions—such as early mentorship, mid-stage stress support, and late-stage leadership development—can enhance role clarity, confidence, and workforce sustainability.

Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Background: The shift from student to registered nurse is a critical period marked by emotional strain, role ambiguity, and transition shock. Structured support programs have emerged to ease this transition, yet few are evaluated through longitudinal, theory-informed approaches using validated tools. Design: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. Methods: A customised 75-item questionnaire, adapted from the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework, was distributed across three transition points (March 2020 to March 2021). The survey assessed four domains: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis, Chi-square tests, and multinomial logistic regression were used to analyse patterns, trends, and predictors of successful transition. Results: A clear developmental trajectory emerged. Early-stage participants experienced stress, low self-efficacy, and role confusion. By Stage 3, most demonstrated increased clinical confidence, autonomy, and integration into professional healthcare teams. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship and supportive practice environments. Statistically significant improvements were observed in critical thinking, leadership perception, emotional resilience, and team communication. Conclusions: This study provides robust empirical support for theoretically grounded and policy-aligned Graduate Nurse Transition Programs. Targeted interventions tailored to each transition phase—such as early mentorship, mid-stage stress support, and end-stage leadership development—can enhance confidence, improve role clarity, and promote long-term workforce capability and sustainability.

Background: An academic-practice partnership was implemented in Northwestern Ontario with the goals of enhancing cross- sector collaboration, co-creating research knowledge related to transition to practice, engaging and recruiting nurses, and mobilizing knowledge to improve the transition experience. There is a growing nursing shortage requiring novel solutions to support retention, particularly for rural and remote populations. Academic-practice partnerships can be leveraged to improve working conditions and consequently job satisfaction (Padilla & Kreider, 2020; Rogers et al., 2020). Method: Using qualitative methodology, semi-structured virtual interviews were conducted with nine Registered Nurse participants ranging in experience from three to seven months employed at the same hospital in Northwestern Ontario.The interview guide was developed collaboratively by an advisory board comprised of the researcher, hospital staff and input from two student ambassadors from the graduating class. Thematic analysis was completed and broad categories were established with data then expanded into five overarching themes. Results: Five themes representing impactful sentiments shared by the new graduate nurses were identified: “I couldn’t be the nurse I know I could be”; “I’m with you right now”; “You have to catch up”; “Do you want to learn it with me?”; and “I feel thrown in and unprepared”. Conclusion: New graduate nurses experience a dissonance between expectations and reality influenced by their interactions with preceptors and colleagues. Academic-practice partnerships can create supportive learning environments, allowing new nurses to transition to independent practitioners while establishing stronger professional identity, which is a positive indicator for retention.

New graduate nurse (NGN) turnover is emerging as one of the foremost issues in healthcare systems, primarily due to the implications for patient care and the need to secure the human resource future of the nursing profession. The initial months of transitioning into the professional role are crucial for cultivating and developing clinical practice patterns, professional values and a connection to the profession. However, the initial transition period for new nurses is associated with numerous challenges that can interrupt a healthy introduction into practice, justifying the critical prioritization of these issues. In light of these challenges to NGN entry to practice, this paper aims to conceptualize the contemporary professional role transition experiences of new graduate nurses and highlight the potential leverage that transition theories offer in managing this experience. Eleven transition theories relevant to this discourse were identified to enhance the understanding and comprehension of the new graduate nurses to inform future initiatives, directives, interventions and policies.

Purpose: Newly graduated registered nurses (NGRNs) often face significant challenges when transitioning into professional practice, including the need to bridge the gap between academic preparation and clinical expectations, manage high workloads, and further develop their practice. Organizational support is crucial for their growth, and nurse residency programs have shown promise in addressing these challenges. This project aimed to conduct a comprehensive needs assessment of hospitals across Canada to examine current practices supporting NGRN transitions and to assess employer interest in adopting a national standardized new graduate nurse residency program. Additionally, the assessment sought to identify barriers that may hinder the successful implementation of such a program. Method: This study used a mixed-methods needs assessment design to investigate the transition to practice and the use of nurse residency programs. We developed a survey, consisting of 11 questions adapted from previous research, to collect insights on current transition practices, challenges, barriers, and motivations for participating in a national residency program. The survey was initially distributed through HealthCareCAN, with additional outreach efforts aimed at nursing leaders responsible for NGRNs’ education and practice to ensure broader participation. Results: The survey received responses from 33 participants, representing hospitals in Atlantic and Northern Canada. The findings highlighted significant gaps in the current orientation and support systems for NGRNs. Respondents expressed a clear need for improvements in existing transition-to-practice programs and demonstrated a strong willingness to adopt changes, particularly through a national standardized nurse residency program. Most participants recognized the potential benefits of such a program, noting that it could address current challenges. Conclusion: The study identified significant gaps in current orientation support for NGRNs, highlighting the need for an enhanced approach to easing their transition into practice. Most participants showed strong interest in the development of a national standardized new graduate nurse residency program, recognizing its potential to improve their professional integration. Key challenges included a shortage of experienced nurses to serve as preceptors and mentors, inconsistent onboarding practices across health care settings, and limited resources for comprehensive education. To effectively address these issues, it is recommended to develop inclusive and supportive programs that meet the needs of both NGRNs and nurse leaders. Additionally, conducting further comprehensive and diverse needs assessments using mixed-methods research approaches would provide valuable insights for improving these initiatives.

Objective: Explore the impact of transition program policy directives grounded in foundational elements of transition theory. Background: Within fast-track health service environments nurse leaders remain committed to improving transition programs that support wellbeing and retain new graduate nurses. Duchscher’s Stages of Transition Theory and Transition Shock model was the framework chosen by the health service nurse leaders to implement in the clinical environment, however, implementing elements can be problematic without sufficient support and clear policy directives. Study Design and methods: Descriptive study using multiple methods in one major national health service that incorporates a number of private (eight) and public (four) hospitals across Australia. Online surveys were distributed to new graduate nurses at one, five and eleven months into the initial transition year. The survey tool was a synthesised adaptation of the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework. At the end of the transition year telephone interviews were conducted with the Nurse Managers who were responsible for implementing transition programs policies and processes. Resulting data were summarised using descriptive statistics for quantitative data and a thematic analysis for qualitative data. Results: 158 new graduate nurses returned the online survey and eight Nurse Managers participated in the telephone interviews. As a whole the new graduate registered nurses described feeling accepted during their transition and expressed feeling comfortable when approaching senior staff. They managed challenges of shift work and took time for self-care. The clear majority (88%) of participants reported no plans to leave the profession. Nurse Managers were able, in most clinical areas, to apply transition program policy and directives and enable the implementation of Duchscher’s Stages of Transition as the framework for the transition support initiatives. Retention of new graduates on their wards at the end of the program was determined to be a positive outcome for Nurse Managers. Discussion: A carefully structured Graduate Nurse Transition Program founded on sound theoretically grounded ideology alongside integrated policy directives guided the Nurse Managers implementation of Duchscher’s Stages of Transition Theory and Transition Shock model into practice. Additionally, a dedicated Graduate Nurse Coordinator role with a manageable ratio of graduate nurses was an important component included in the transition program at each participating hospital as it facilitated support of both graduates and Nurse Managers. These positions should be costed into any Graduate Nurse Transition Program. An interesting finding was the consistency in smaller units that were unable to provide or mobilise preceptors for the required allocated mirrored shifts and it was felt this workload management issue impacted the success of graduate transition nurse programs on those units. Conclusions: Implementing policy directives grounded in foundational elements of Duchscher’s Stages of Transition theory and Transition Shock model delivered consistent experiences for new graduate nurses across one major health service that incorporates a number of hospitals across Australia. Data suggested some practical challenges to program implementation for Nurse Managers, including unit/ward size, staffing, and varying levels of understanding of preceptor roles. Implications for research, policy, practice: Introducing formal policy directives that are grounded in strong theoretical frameworks of professional role transition, agreed to and funded by health service nurse leaders are important in guiding a consistent approach across health services in the implementation of evidence-based Graduate Nurse Transition Programs. What is already known about the topic? Duchscher’s foundational research on the Stages of Transition theory and Transition Shock model is applied to inform Graduate Nurse Transition Programs on an international level. There is a current workforce shortage within Australia and internationally. The importance of retention of newly graduated nurses has become a focus for health care services implementing supportive transition programs to prevent new graduates from leaving the profession in the first year. What this paper adds The inclusion of specific policy directives based on Duchscher’s Stages of Transition theory and Transition Shock model provides clear direction to Nurse Managers related to the required implementation steps and time frames to be met during the transition year. Additional Graduate Nurse Coordinator positions, with a manageable ratio of New Graduate Registered Nurses (NGRNs), are important supports for both graduates and Nursing Managers to meet policy directives. Additional positions should be costed within transition programs. Provides additional evidence that well supported newly graduated nurses are likely to remain within the health service.

The transition from student to practitioner for newly graduated nurses is impacted by their physical, social, professional, and practice environments. COVID-19, global insecurity, institutional restructuring, and “acute on chronic” staffing shortages have increased the immediate burden experienced by emerging nurses. As detailed through the historical development of Duchscher's Stages of Transition Theory and Transition Shock Model, theorization of the transition process offers graduates, their educators, and workplace managers key areas of support opportunities for these new practitioners. In part 1 of a 2-part article series, this article explores how novel new graduate supports have been developed and delivered in partnership with nonprofit groups, government bodies, and employers across much of Canada. For nurse stakeholders, theorists, and beyond, support for the transition period of new nurses remains anecdotally, evidentially, and fiscally advisable, with an increasing urgency due to rising human capital pressures.

For newly graduated nurses (NGNs), the characteristically challenging and dynamic period of transition from student to professional practitioner is being further strained by global crises and the uncertainty and insecurity they motivate, health care systems and institutional restructuring, and extreme workload burdens. A novel approach to aiding the transition of NGNs is detailed in this article, culminating in the offering of an inclusive framework of potential strategies aimed at supporting NGNs and those who lead, manage, and educate them. This approach outlines strategies of support deliverable by both centralized and local means and acknowledging contemporary needs such as workload burdens and generationally-sensitive employee needs. Nursing The Future is a platform that uniquely situates an evidence-based, grassroots-driven response to the needs of NGNs, while encouraging collaborative partnering of health care institutions with governmental, professional, and regional advanced education bodies. This is the second article in a 2-part series that builds on the historical and developmental intents of Nursing The Future as an organization and outlines how evidence-informed, creative, and affordable grassroots-driven supports may be offered to NGNs for the purpose of sustaining and advancing our future nurse professionals.

There is a growing concern in education and healthcare that we are not adequately preparing or transitioning newly graduated nurses (NGNs) into the workplace. N