Novice nurses and factors that influence job adaptation after incorporation into the world of work

Abstract

Objective

To analyze the factors that influence the job adaptation of hospital nursing, during the transition period of graduates as a health workforce in their new stage.

Method

An exploratory, cross-sectional study, involving 100 graduate nurses as a workforce of hospital units. The collection was carried out with a questionnaire on the web platform in the period November 2020 - August 2021. The analysis was carried out using descriptive statistics.

Results

There was a predominance of women, single, aged between 23 and 32, licensed and operational, working between 19 months and 2 years. Regarding the factors, three most influential were identified, corresponding to: Autonomy; Psychological; Staff.

Conclusions and implications for practice

The adaptation of nursing staff in the hospital presents difficulties in the transition period; the internal factors of the professional, whether acquired through practices or developed during life, and the training of employers have influence. For improvement, it would be essential that the induction protocols guarantee the adaptation of the novice and that the employee training programs evaluate the effectiveness of the nursing staff in the hospital, until the achievement of the adaptation of nursing to the hospital.

Keywords:
Nursing Education; Professional Practice; Working Conditions

Resumo

Objetivo

Analisar os fatores que influenciam a adaptação ao trabalho da enfermagem hospitalar durante o período de transição dos egressos como força de trabalho em saúde em sua nova etapa.

Método

Estudo exploratório, transversal, que envolveu 100 enfermeiros graduados como força de trabalho de unidades hospitalares. A coleta foi realizada com um questionário na plataforma web no período de novembro de 2020 a agosto de 2021. A análise foi realizada por meio de estatística descritiva.

Resultados

Houve predomínio de mulheres, solteiras, com idade entre 23 e 32 anos, licenciadas e operacionais, trabalhando entre 19 meses e 2 anos. Em relação aos fatores, foram identificados três mais influentes: Autonomia; Psicológico; Funcionários.

Conclusões e implicações para a prática

A adaptação da equipe de enfermagem no hospital apresenta dificuldades no período de transição; os fatores internos do profissional, sejam adquiridos por meio de práticas ou desenvolvidos ao longo da vida, e a formação dos empregadores influenciam. Para melhoria, seria fundamental que os protocolos de indução garantissem a adaptação do novato e que os programas de treinamento de funcionários avaliassem a efetividade da equipe de enfermagem no hospital, até a realização da adaptação da enfermagem ao hospital.

Palavras-chave:
Condições de Trabalho; Educação em Enfermagem; Prática Profissional

Resumen

Objetivo

Analizar los factores que influyen en la adaptación laboral de enfermería en hospital, durante el período de transición de graduados como fuerza laboral en salud en su nueva etapa.

Método

Estudio exploratorio, transversal, participaron 100 enfermeras/os graduados como fuerza de trabajo de unidades hospitalarias. La recolección se realizó con un cuestionario en plataforma web en el período noviembre 2020 – agosto 2021. El análisis se realizó mediante estadística descriptiva.

Resultados

Se encontró predominancia de mujeres, solteras, de edades entre 23 y 32, licenciadas y operativas, trabajando entre 19 meses a 2 años. Respecto a los factores, se identificaron tres más influyentes, correspondientes a: Autonomía; Psicológico; Personal.

Conclusiones e implicaciones para la práctica

La adaptación del personal de enfermería en hospital se presenta con dificultades en el período de transición, los factores internos del profesional ya sean adquiridos mediante las prácticas como desarrollados durante la vida, y la formación de los empleadores influyen. Para la mejora, sería fundamental que los protocolos de inducción garantizarán la adaptación del novato y los programas de formación de empleados evalúen la efectividad del personal de enfermería en el hospital, hasta el logro de la adaptación de enfermería al hospital.

Palabras clave:
Condiciones de Trabajo; Educación en Enfermería; Práctica Profesional

INTRODUCTION

Graduation and the transition to professional work are very important events for graduate nursing professionals, as well as for many other professionals who experience these stages. Today, these professionals enter a chaotic workplace dictated by long shifts, high patient severity, and limited resources. Undoubtedly, the new world they are facing is an environment in which they must deal with the development of their skills, while at the same time they have to live with their peers, doctors, patients, family members, among others.¹

It is a reality that, initially, can be a complex process and that requires learning from institutional policies, getting to know colleagues, adapting to new environments and learning new techniques, therefore, when having to adapt to new roles in professional practice, we are talking about transition.² This transition to professional practice has been studied by several authors, who point out that there is a reality shock to imply that the knowledge learned in training contradicts the reality they face at work.³

Thus, certain investigations mention some stages that trained professionals go through, their first work experiences, their feelings and how they see the world of work that used to seem so distant and that now generates challenge, frustration and the ability to abandon the profession.^1,2,4,5 Many distressing events also occur in this professional environment, such as work overload, responsibility, fear of making mistakes, deficits in clinical skills, emergency work and time management. Which implies, in the face of these difficulties, making the decision to continue or stop working, determined both by the professional and personal expectations of the individual and by the current reality of their work experience.⁶

These associated difficulties in achieving adaptation become more intense during the first three to 12 months of employment. Therefore, newly graduated nurses experience feelings of abandonment of the profession during the first year of work.⁷ It is noteworthy that some authors consider that newly graduated nurses would need two to three years to become competent in their practice, also citing the development of confidence and competence as essential to feel good at work.^8,9

It is then that the term “labor adaptation” becomes increasingly important when trying to measure the work climate, assess the performance or satisfaction of workers, since it is a complex process that goes beyond vocational skills and competencies of the person, as it implies adapting to the organization, the task and the environment, making this process difficult. This is driven by changes and unfavorable working conditions present in many organizations, which affect both performance and job satisfaction.¹⁰

A study carried out with newly graduated Canadian nurses in Canada showed, based on responses to an email survey, that the involvement of situational and personal factors were significantly related to changes in mental health and post-traumatic stress when being a nursing professional, with a strong tendency to want to abandon the profession.¹¹

In other research on work adaptation, the authors obtained results on the perceived level of personal competence, and the leadership role in extracurricular activities was associated with job satisfaction.¹² In other studies, they found that the greater the adaptability, the better the job satisfaction performance at work and less stress they self-perceived,¹³ although no study was found that investigated factors that influence adaptation to work of recent nursing graduates. Thus, the objective of this study was to explore which elements influence this adaptation experienced by novice nurses.

Thus, it becomes a challenge for administrative nursing for new nurses to develop and improve their skills during their job transition process, but also manage to retain new talent. In view of the above, this study aims to analyze the factors that influence the work adaptation of a nursing team in the hospital, during the transition period of the egress as a workforce in health in their new stage.

METHOD

Cross-sectional exploratory study, carried out through online digital means, with graduated nursing professionals from Chile and Mexico, who work in second-level hospital institutions, with two years of employment or less. The sample was by convenience and had 100 graduated nursing professionals, being a non-probabilistic sampling technique, used to create samples according to the ease of access, such as the availability of people to be part of it.

Data collection was carried out from November 2020 to August 2021. Professionals were invited to participate digitally in the following social networks (Facebook, Instagram, LinkedIn, WhatsApp), based on The Career Adapt-Ability Scale (CAAS)¹⁴ designed by Savickas in 2012. It measures professional adaptability in working adults. The CAAS was tested internationally in 13 countries and its application proved to be valid and reliable. It is noteworthy that in questions 1, 3, 4, 5, 7, 10, 12, 13, 14 and 16 a wording modification was made for the participants-understanding. Their understanding was validated through the online application of the scale with five nurses and face-to-face with five other professionals, to determine the understanding of the wording change. Then, the said scale was applied via Web Google Forms, containing two sections: sociodemographic and labor data, such as: gender; age; marital status, nationality; educational level; position and time worked and data corresponding to adaptation to work.

Inclusion criteria were defined based on the nursing professional: general, undergraduate, specialty or postgraduate; graduated nursing professional, with two years or less of employment; and who agreed to participate in the study. Nursing professionals who were not working in hospitals were excluded. Nursing professionals who, for some reason, did not respond to the questionnaire were eliminated. Data were analyzed using the SPSS V. 18 statistical program, with descriptive statistics.

This study was approved by the Academic Committee of the Universidad Autónoma de San Luis Potosí (UASLP), on 06/29/2020, and by the Research Ethics Committee of the Facultad de Enfermería y Nutrición de la Universidad Autónoma de San Luis Potosí (UASLP), under opinion No. CEIFE-2020-330 (08/05/2020), fulfilling the formal requirements according to the General Health Law Regulation on Health Research, Article 21, Section VIII; Declaration of the Helsinki Ethical Principle 23; and the provisions of items 12.1 and 12.3 of NOM-012.

RESULTS

In this section, first, the characteristics of the population participating in the study are presented, followed by the main factors involved in the job adaptation of novice nurses. Table 1 shows that 80% of the total study participants were women, most aged between 23 and 32 years (78%), mean 31, and mode 27 years. Most participants were single (66%). The vast majority are from Chile (62%), graduates with a diploma (67%). As for the work characteristic, the majority had an operational position (82%) and 52% had service time between 19 months and two years (52%).

Table 1
Sociodemographic and work characteristics of the 100 new nursing professionals, corresponding to the period; November 2020 to August 2021.

Characteristics	Fr	%
Sex
Female	80 *	80.0
Male	20	20.0
Marital status
Married	24	24.0
Single	66*	66.0
Stable union	9	9.0
Divorced	1	1.0
Age in years (Mean ± SD)	31
23 to 32	78*	78.0
33 to 42	10	10.0
43 to 52	9	9.0
53 to 62	3	3.0
Nationality
Chilean	62*	62.0
Mexican	38	38.0
Educational level
General	9	9.0
Graduation	67*	67.0
Specialist	8	8.0
Postgraduate	16	16.0
Position
Operational	82*	82.0
Shift manager	12	12.0
Leadership	4	4.0
Continuity nurse	1	1.0
Administrative	1	1.0
Service time
Less than 1 month	6	6.0
2-6 months	13	13.0
7-12 months	24	24.0
13-18 months	5	5.0
19-24 months	52*	52.0

• Source: Direct survey of socio-occupational data. Own elaboration.
• Note*: Bold text shows the highest frequencies.

According to the descriptive statistical analysis, the average obtained by the highest frequencies, answered in the category “always”, stood out for those who corresponded to two factors out of a total of four as influential in the work adaptation of nursing professionals: with Preoccupation (75.25), Control (67.45) /Curiosity (65.2) and Confidence (58.25) factors in the mean score, respectively.

In Table 2, it can be seen in the Preoccupation factor that 78% of beginning nursing professionals are always interested in their professional career, followed by 76% who recognize that their decisions can shape their profession in the future. With a smaller percentage, represented with 46%, those who always recognize the skills they need to master; and within this last item, 12% recognize it sometimes, others with 2% almost never and 1% never. In this factor, it was verified that three participants answered almost never/never, repeating with 1% for both answers.

Table 2
Items belonging to the Concern factor, which influences job adaptation, during the period; November 2020 to August 2021.

Preoccupation	Always		Almost Always		Sometimes		Almost Never		Never
	Fr	%	Fr	%	Fr	%	Fr	%	Fr	%
I think about what my future will be like from here on out	69*	69.0*	16	16.0	13	13.0	1	1.0	1	1.0
I recognize that what I decide to choose today can shape my profession in the future.	76*	76.0*	16	16.0	6	6.0	1	1.0	1	1.0
I am currently interested in my professional career	78*	78.0*	15	15.0	5	5.0	1	1.0	1	1.0
Do I recognize the skills I need to master for my job?	46	46.0	40	40.0	12	12.0	2	2.0	2	2.0

• Source: Direct, survey “Factors that influence adaptation to the workplace”. Own elaboration.
• Note*: Bold text shows higher frequencies.

Regarding Table 3, the Control factor was observed, which shows that all participating nursing professionals are always capable of assuming responsibilities at work, represented by 91%, where the remaining 9% are divided into almost always, sometimes and almost never. Next, 75% of nurses believe in their abilities as a professional - the remaining 25% are mostly found almost always and less often sometimes. Finally, 63% always know how to make decisions at work, compared to the remaining 36%, just as the previous item it repeats almost always and sometimes as results. It is important to highlight that in this factor it was found that only 1% responded in the almost always category, corresponding to the item they are faithful to their convictions, in addition to adding that in this factor no one ever responded.

Table 3
Items belonging to the Control factor, which influence labor adaptation during the period; November 2020 and August 2021.

Control	Always		Almost Always		Sometimes		Almost Never		Never
	Fr	%	Fr	%	Fr	%	Fr	%	Fr	%
True to my convictions	70*	70.0*	25	25.0	5	5.0	1	1.0	0	0.0
Ability to take responsibility for my actions at work.	91*	91.0*	7	7.0	2	2.0	0	0.0	0	0.0
I believe in myself and my abilities as a health professional.	75*	75.0*	23	23.0	2	2.0	0	0.0	0	0.0
I know how to make my own decisions within my work	63*	63.0*	34	34.0	3	3.0	0	0.0	0	0.0

• Source: Direct, survey “Factors that influence adaptation to the workplace”. Own elaboration.
• Note*: Bold text shows higher frequencies.

DISCUSSION

The present study made it possible to identify some of the factors that interfere with the adaptation to work of professionals graduated in nursing during the transition phase. On the other hand, the study participants show that 80% of the studied population represented women. In a study carried out by some authors, it was revealed that a characteristic feature of employment in health is its predominantly female composition,¹⁵ something that historically, as well as in other occupations linked to assistance services, such as the area of education, has had a strong presence of women. Instead, if we ask ourselves who adapts better to work, a study carried out with doctors and nurses from public hospitals in Chile found that women's adaptation was greater than that of men, showing that women tend to adapt better to working conditions presented to them.¹⁶

As for marital status, more than half stated that they were single, and almost a quarter of the total sample is married. Similar to the studies found,¹⁷ it is observed that young people today, at the end of their university studies, are more concerned with meeting their personal and economic needs than being parents or getting married, and this behavior is classified as a “world youth crisis”¹⁸.

On the other hand, the age group of the studied population was between 23 and 32 years old, where the majority is in the young adult phase. This is consistent with the average graduation age in Chile, according to data obtained from the “2018 Higher Education Graduation Report”, SIES 2019,¹⁹ which indicates that the average graduation age in Chile was 27.5 years, while in Mexico, the “National Graduate Survey 2019”²⁰, indicated an average of 27 years for women and 26 years for men, proving the similarity in both countries.

The predominant level of education among professionals was a bachelor’s degree. As for this increase in professionals, it was found in Chile and, according to other authors²¹ in their studies on Graduate Nursing Training in Latin America, it is noted that, in order to obtain a professional title in that country, it is a requirement to have obtained an undergraduate degree, previously licensed. It is also observed that a large percentage of respondents are recently graduated Chilean nursing professionals, confirming the high predominance obtained in this question.

Regarding labor aspects, the highest incidence was found in operational personnel, that is, active, which can be explained by the recent incorporation into the labor market, such as the difficulty of health institutions in increasing positions and applying for other positions, as mentioned in other studies.²² Regarding working time, a greater predominance was identified between 19 months and two years, a period found described in studies that explain it as the “restart” phase, where they begin to feel integrated in the work group, lose fear and strengthen their confidence in the execution of procedures, assuming greater responsibilities.⁸

Likewise, trained nursing professionals need 2 to 3 years to feel competent and feel safe in their professional practice. Therefore, it can be concluded that the vast majority of recent graduates in this study are experiencing a new beginning as professionals and it is likely that they feel adapted to their work, as mentioned by the authors.²²

As for the most influential factors in this study, it was observed that the first factor was Preoccupation, with three of the four items with the highest scores obtained and where a majority group of recent nursing graduates is interested in their professional career (78%).

A study carried out in 2018²³ indicates that 100% of professionals would participate in activities to update their profession, as well as continue to learn and acquire knowledge that would help in their professional career, being useful to advance in the area in which they are working, in addition to mention that 7% are not very clear about their interest in their future as a professional. In the second item, 76% recognize that their decisions help shape their profession in the future.

In that same study²³ it is pointed out that the entire sample feels satisfied in the exercise of their profession, which leads them to make better decisions regarding their professional future. However, the remaining 36% would be dissatisfied with their career, which would affect their decisions about their professional future.

Continuing with the third item, it was found that 69% of professionals are always interested in their future, since they are already working. This author²² mentions that the entire population studied feels fully satisfied in the exercise of their profession, which generates in professionals a satisfaction that results from feeling competent and identified as professionals. Another study²⁴ shows a different point of view, where interest is generated from academic training, as the preceptor is the one who motivates the future nurse, encouraging her to develop skills, competencies and critical thinking, in order to later acquire this interest for her future.

Another important finding was that 15% of the professionals surveyed did not show interest in their future once they are working, this may be due to what is mentioned in another study about the rotation that is done in their work areas to avoid excessive turnover. If this does not happen, they lose interest because they are not stabilized in a certain institution.

It should be added that this factor obtained majority percentages in almost all of its items and an average of 67.25, which would be considered a factor that helps to look ahead and prepare for the future. The activities or where they are currently working are linked to what is desired in the future, which is an important element for job adaptation.

Regarding the Control factor, it was found that it was the only one in which its four items obtained higher scores. However, it was decided to highlight only two, which talk about responsibility and professional capacity, considered according to the project of International Norms of Medical Education²⁵ fundamental role in the professionalization of the career. This shows that almost the entire sample is capable of taking responsibility at work with 91%, therefore, this group would be in the second phase as a professional, called “gaining experience as a nurse”²⁶, where they manifest awareness of responsibility, need for recognition and for having good experiences.

In the same sense, a study with interviewed nursing professionals stated that, when faced with the complex environment, service rotation and incorporation into critical services, pediatrics or surgical center, it implied in them a feeling of great responsibility, because, in the administration of drugs, the professional is subject to an error, as these are actions that require great care and responsibility when working. Regarding the second highest score found, it was observed that 75% of them believe in their abilities as professionals. For the beginning nurses interviewed by Marrero, this professional capacity they possess often causes them concern and fear for not having provided quality care or not having developed good practices.²⁴

Another aspect to be highlighted is the ability of novice nurses, which Carrillo mentions as limited by their lack of experience, the anxiety generated in them and the development of clinical judgment.⁹ However, in this study it was found that, although novice nurses have a limited capacity given the little or no experience and insecurity regarding the care or practice with the patient, their way of thinking about professional skills at work was not affected in this group, which did not prevent them from feeling capable as professionals despite the short working time they have.

An important finding to be mentioned is that an average of 74.75 points was obtained, considered the most suitable in this study to verify adaptation to work. Still, to say that this group of professionals is responsible and decision maker related to the profession, where having control over the career helps to be more decisive in career-related choices.

Among the limitations of the study, it is worth mentioning that, according to the occurrences resulting from the health situation, the fieldwork had to be modified and the decision was made to use digital means to reach the professionals, which made it difficult to obtain participants for the study.

On the other hand, it was also identified in this sense the scarce bibliography in Spanish that was found on themes related to the adaptation to work in recent nursing graduates, as well as research of the same nature. Therefore, it is intended to contribute with these results to the scientific production in that same language.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The evidence presented in this study shows that, for the field of nursing, an analysis of the influencing factors in job adaptation in novice nurses is extremely necessary, as it allows rescuing the importance of the novice nursing professional in their development in the practice and management of care provided, but also reinforces the organization of human resources in administration. Adaptation to work was influenced by some psychological and academic factors acquired during the development of professional training. Likewise, these factors positively influenced the first two years of work, an aspect that makes them feel adapted to the workplace.

It is emphasized that it is important to generate strategies or programs that allow the adaptation of the newly hired nursing team, as it is known that upon admission there is little practical experience due to the time of completion of studies, however, with the aid of an institutional instructional guide a better adaptation can be achieved. Therefore, being able to contribute to the identification of strategies to improve the way managers and educators manage this process can be important to provide these professionals with an induction period that favors their adaptation.

On the other hand, it can be pointed out that this situation can be seen as a competitive advantage, because if it is possible to identify the factors that positively influence these professionals, in addition to the help of guides; tutors; among others, this transition from student to professional would no longer be a challenge. Just as adapting to the workplace would be considered less traumatic, and without the idea of abandoning the profession.

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Edited by

ASSOCIATED EDITOR

Cristina Lavareda Baixinho 0000-0001-7417-1732

SCIENTIFIC EDITOR

Marcelle Miranda da Silva0000-0003-4872-7252

Publication Dates

• Publication in this collection
  27 Mar 2023
• Date of issue
  2023

History

• Received
  07 July 2022
• Accepted
  30 Dec 2022