Received: 27 February 2019 | Revised: 16 June 2019 | Accepted: 30 June 2019

DOI: 10.1111/jocn.14996

ORIGINAL ARTICLE

On the difficulty of finding one’s place: A qualitative study of

new nurses’ processes of growth in the workplace

Ya‐Ting Ke PhD, RN, Nurse Supervisor1 | Joel F. Stocker PhD, Associate Professor2

1
Nursing Department, Chi‐Mei Medical
Center, Tainan, Taiwan
2
College of Medicine, National Cheng Kung
University, Tainan, Taiwan
Correspondence
Joel F. Stocker, College of Medicine, National
Cheng Kung University, No. 1 Daxui Rd, East
District, Tainan 701, Taiwan.
Email: stocker@mail.ncku.edu.tw
Abstract
Aims and objective: To explore new nurses’ processes of growth in the workplace in
order to understand the challenges they face.
Background: Quantitative and qualitative research to date has not adequately ex‐
plored the complex ways in which initial work experiences may shape new nurses’
very high quit rate and, consequently, impact the long‐term nursing shortage in
Taiwan.
Design/Methods: We conducted in‐depth interviews with new nurses to explore
their professional development, including the challenges they faced, and their feel‐
ings about staying or quitting. Twenty newly registered nurses who had worked in
a hospital setting full‐time for a year or less in two southern Taiwan medical centres
were interviewed. Data were collected from March–November 2016. EQUATOR
guidelines were followed, using the COREQ checklist.
Results: Interview transcripts were analysed and coded; three stages of growth were
discovered: Feeling disillusioned and shocked, Gaining experiential knowledge and
Making a place for oneself. Most nurses (n = 18/20) went through these three stages
within 9 months and continued to work in nursing at follow‐up 2 years later.
Conclusions: Job continuity was contingent upon new nurses’ enduring a painful pro‐
cess of adjustment in the first two stages when new nurses were unsure of them‐
selves and their interactions with preceptors were wrought with social tensions. New
nurse development and retention efforts should make explicit the possibility of these
tensions and how to deal with them.
Relevance to clinical practice: A better understanding of new nurses’ growth pro‐
cesses and adjustment pains can help refocus professional development and reten‐
tion efforts towards how new nurses can succeed in finding a place for themselves.

KEYWORDS
new nurses, professional development, quitting, self‐positioning

1 | I NTRO D U C TI O N
The high turnover rates seen in nursing throughout the world
negatively affect hospital operating costs, the lives of the remain‐
ing staff and the career trajectories of the new nurses who quit,
transfer or move (Buchan, Shaffer, & Catton, 2018). Most health‐
care personnel around the world are nurses, and nursing labour
demands will continue to grow alongside ageing populations as
well as climate change‐related health problems. Therefore, im‐
proving new nurse retention rates is an urgent, global issue facing

J Clin Nurs. 2019;00:1–11. wileyonlinelibrary.com/journal/jocn

© 2019 John Wiley & Sons Ltd | 1
2 |
nurses and nursing administrators as well as medical systems as
a whole. In the face of an ageing nursing workforce (ICN, 2015),
with some countries reporting between a quarter and a third of
their nurses eligible to retire in the next 5–10 years, in addition
to the sheer scale of nursing workforce growth required over the
next 15 years, retention strategies must be considered to be at
least of equal importance to recruitment (Buerhaus, Auerbach,
Staiger, & Muench, 2013). Although figures vary widely (18%–
61%), a large number of new nurses quit their job or move to an‐
other unit or facility within 1 year of practice in many countries
(Bowles & Candela, 2005; ICN AWFF & AANA, 2015; Willemsen‐
McBride, 2010), which poses serious recruitment and retention
challenges.
Nurse leaders at the 19th Asian Workforce Forum of the
International Council of Nurses (ICN), representing 10 Asian coun‐
tries, recently strongly reiterated the need to deal with the ongoing
nursing shortage in Asia by increasing nurse staffing and enhancing
nurse retention (ICN AWFF, 2018). A recent policy brief on nurse
retention for the International Centre on Nurse Migration similarly
highlighted the importance of retaining nurses (Buchan et al., 2018).
Taiwan's nurse retention problems have been severe for several de‐
cades now and continue to worsen. In fact, its retention crisis is the
worst in Asia; in 2015, the mean years of nursing work experience of
nurses in Taiwan was only 6.5 years (ICN AWFF & AANA, 2015), the
lowest among Asian countries, and the annual turnover rate of first‐
year new nurses was the highest (18.4%), followed by Korea (16.9%;
ICN AWFF & AANA, 2014). Chang, Lu, and Lin (2010) concluded
that the turnover rate of new nurses in Taiwan in the first 3 months
was approximately 30%–70%, which was 5–10 times higher than the
overall rate among nurses and high even relative to the first‐year
quitting rate noted above for Taiwan. We know that the turnover
rate is high for new nurses, but what is less clear is what experiences
in the process of becoming a new nurse lead to wanting to stay or
leave. The present study seeks to clarify the special challenges faced
by new nurses.
2 | BAC KG RO U N D
These high turnover rates in the early months of nursing work in
Taiwan are likely tied to the fact that new nurses face the highest
levels of stress in the initial 3 months of practice (Ke & Hsu, 2015;
Feng, Chen, Wu, & Wu, 2011; Wu et al., 2012). We must be aware of
the challenges new nurses face at each stage of professional devel‐
opment (Duchscher, 2008). Prior studies inform us that new nurses
go through developmental stages of adaptation in response to the
various challenges posed by early experiences of nursing work and
that guidance and support are important. Based on their study of
a Taiwanese population of nurses, Ho, Liu, Hu, Huang, and Chen
(2010) identified three stages in new nurses’ professional develop‐
ment: understanding of, acclimation to and acceptance of the new
role. Kramer (1974), in research on new nurses in the USA, similarly
described four phases to becoming a professional staff nurse, as
KE et al.
What does this paper contribute to the wider global
clinical community?
• We shed light on an important aspect of the global nurs‐
ing shortage: new nurses’ struggles to stay in nursing.
• This study suggests that professional development and
retention efforts should focus more on ways by which
to resolve social tensions that may occur between new
nurses and preceptors, and on other potential barriers
to supporting new nurses’ finding a place for oneself.
• We conclude that the potential social tensions between
new nurses and preceptor roles should be explicitly ad‐
dressed in new nurse training programmes.
• New nurse's decision to leave is incredibly complex, and
the first 3–6 months of their first year is a crucial time
for supportive intervention for retention.
follows: gaining professional competence, social integration, moral
outrage and conflict resolution.
Shock is a commonly noted part of nursing experience in
the early stages of a nurse's career. Based on Kramer's theory,
Duchscher (2009) proposed that transition shock manifests itself
in new nurses’ physical, emotional, intellectual, developmental and
sociocultural lives. When entering the workplace, new nurses expe‐
rience turmoil and frustration due to the gap between their idealistic
expectations and the reality of heavy workloads, role ambiguities
and conflicts, and value conflicts. Additionally, new nurses are likely
to experience anxiety, fear and restlessness and a desire to main‐
tain close‐knit relationships with preceptors when facing unfamiliar
environments, working partners, patients and nursing techniques
(Duchscher, 2009), as several studies on Taiwanese nurses have also
shown (Ke & Hsu, 2015; Feng et al., 2011). New nurses generally
experience this reality shock during the early months of transitioning
from nursing student to nursing staff. Wu et al. (2012), in a quasi‐ex‐
perimental study in Taiwan comparing new nurses in a last‐mile pro‐
gramme and new nurses not enrolled in the programme, discovered
that new nurses were still in the role transition process during the
first 6 months of practice and that their job performance had been
compromised by reality shock. Studies in Taiwan and Japan found
that new nurses were shocked and overburdened by the multiple
stresses and challenges posed by role transition, highly demanding
clinical tasks and unit requirements, excessive overtime work that
was often undocumented and unpaid, unpredictable changes in pa‐
tient conditions, poor interactions with senior nurses, reconciling
differences between nursing theory and clinical technique, and un‐
familiar surroundings (Ke & Hsu, 2015; Ishihara, Ishibashi, Takahashi,
& Nakashima, 2014).
Nurses go through the various stages of shock, setbacks, ad‐
aptation and reflection and, if all goes well, gradually learn to fulfil
the duties of their new role, care for patients independently, seek
role models and group identification, adjust to obligatory night
KE et al.
shifts and seek support from co‐workers and head nurses. Finally,
the survivors come to embody the new role by learning to adapt:
controlling their time and work conditions, gaining competence,
perceiving recognition from unit co‐workers, rediscovering enthu‐
siasm for work, considering matters outside of work, and perceiv‐
ing and appreciating the support of nursing peers and leaders (Ho
et al., 2010).
Administrative support is of vital importance to new nurses,
since a lack of such support can lead to an adverse work environ‐
ment and job attrition among nurses—particularly when economic
austerity measures trump the care ethic (Tuckett, Winters‐Chang,
Bogossian, & Wood, 2015). It is not surprising that new nurses are
unwilling to stay in nursing if they feel isolated and helpless and
are not supported in their new workplaces and local cultures (Ke
& Hsu, 2015; Tuckett et al., 2015). Ishihara et al. (2014) found that
job burnout and turnover among newly graduated nurses (NGN) in
Japan were mitigated when help was received from nursing peers
as well as work supervisors. They concluded, “a longitudinal study is
needed to reveal the long‐term effects of organizational factors and
work environments on NGN and how they impact role transition and
adaptation of the NGN to professional practical roles” (Dewanto &
Wardhani, 2018; Ishihara et al., 2014, p. 200).
Ultimately, if the medical establishment fails to deal with the
nursing shortage in Taiwan, as elsewhere, patient safety and quality
of care will be put in jeopardy (ICN AWFF & AANA, 2015). Many
studies have examined transitional support programmes for new
nurses, but deeper knowledge of new nurses’ dynamic growth pro‐
cesses is needed. The prior studies have neither sufficiently demon‐
strated the dynamic growth processes nor thoroughly explored the
correlates of new nurse turnover (Ke & Hsu, 2015; Lee, Tzeng, Lin,
& Yeh, 2009; Martin & Wilson, 2011). Hussein, Everett, Ramjan,
Hu, and Salamonson (2017) note that “understanding new graduate
nurses’ experiences and their unmet needs during their first year of
practice will enable nurse managers, educators and nurses to better
support new graduate nurses and promote confidence and compe‐
tence to practice within their scope” (p. 9). Moreover, greater un‐
derstanding of the issues facing new nurses will contribute to the
development and implementation of effective interventions to re‐
duce high turnover rates. To address the lack of evidence for how to
guide retention efforts in Asia, we conducted in‐depth qualitative
interviews with new nurses at medical centres in Taiwan, focusing
on the transition process. This study can serve as a valuable refer‐
ence for new nurses as well as nursing and hospital administrators in
understanding and managing new nurses’ experience of work. Thus,
this study aims to improve nursing retention rates, organisational ef‐
fectiveness and work environment, and quality of patient care.
3 | M E TH O DS
3.1 | Aims
To understand the challenges faced by new full‐time nurses in the
workplace.
| 3
3.2 | Design
An exploratory research design was used based on content
analysis of qualitative interview‐based nursing work narratives.
EQUATOR guidelines were followed, using the COREQ checklist
(Supplementary File S1).
3.3 | Participants
In this study, an interviewer (first author) conducted face‐to‐face in‐
terviews with 20 new registered nurses who had worked full‐time
for less than or equal to 1 year and were working at one of two
medical centres located in southern Taiwan. These hospitals are two
major employers of newly registered nurses in southern Taiwan, with
40–50 new nurses under their employ at the time of the study. One
is a public hospital and the other is run by a foundation. Before data
collection, this study underwent ethics review and was approved by
the institutional review boards of the participating hospitals. The
purpose, content and procedure of the study were explained to re‐
cruits. All participants voluntarily signed an informed consent form.
Each participant was informed that any record containing identifying
personal or private information would be kept confidential and that
they could withdraw or end their participation for any reason and at
any time, even after giving consent.
3.4 | Data collection
Fourteen participants were recruited from new nurse orientation
training courses based on purposive sampling, the other six partici‐
pants by snowball sampling. Interview times and places were chosen
based on interviewees’ preferences. Participants were given the op‐
tion to have their interviews audio‐recorded or to only have notes
taken. Audio recordings were deleted upon completion of all text
transcript analysis, and text transcripts and notes were digitally pre‐
served offline (in a password‐protected external hard drive locked
in a cabinet) for reference purposes to ensure the consistency of
the study.
The new nurses were asked semi‐structured questions during
the interviews (in Chinese): (a) “Could you share your impressions
and experiences since studying in nursing school and entering the
workplace?” (b) “Could you talk about your feelings and thoughts
when entering the workplace as a new nurse?” (c) “Could you de‐
scribe the most memorable experiences of incidents and coping in
your work?” (d) “Could you please talk about your ideas about inten‐
tion to stay?” A topic guide was used to keep the interviews focused
and to enhance consistency. The interviewer adjusted the direction
and detail of each interview based on the interviewee's responses.
Each interview lasted 30–90 min. Some details missed during the
interview were obtained 2–6 weeks later by other contact methods,
such as email or smartphone APP, through specific, limited questions
which would help maintain participant privacy. In addition, to check
on the work status of each interviewee, a brief follow‐up interview
was carried out by the first author 2 years later.
4 |
TA B L E 1 New nurses’ demographic characteristics
Variables Mean ± SD
Age 22.2 ± 1.81
Average working years
Sex
Male
Female
Educational level
5 years of vocational training and held a 2‐year associate degree
5 years of vocational training and held a 2‐year BSN degree
4‐year BSN degree
Working unit
Medical ward
Surgical ward
Obstetric/gynaecologic and paediatric units
Emergency
Operating room
Intensive care unit
3.5 | Data analysis
The first author and a well‐trained research assistant made tran‐
scripts out of 13 audio‐recorded interviews and seven notes‐only
interviews, which comprised the new nurses’ narratives. These nar‐
ratives were analysed by the first author and a research assistant
following Lieblich, Tuval‐Mashiach, and Zilber’s (1998) “category‐
content” analysis method. The transcript contents were classified
through iterative reading to grasp meanings which were gradually
extracted and merged into a few categories and numerous subcat‐
egories. To meet rigour requirements, we followed the standards of
integrity, fittingness, reliability, neutrality and consistency recom‐
mended by Graneheim and Lundman (2004), Sandelowski (1986)
and Speziale and Carpenter (2003). To improve accuracy, the first
author and research assistant each listened to at least three different
recordings to confirm the consistency of the transcripts with the re‐
cordings. Then, two weeks after the preliminary data analysis, they
performed content analysis on randomly chosen paragraphs from
the transcripts and compared the results with the original results,
which showed 80% consistency and inter‐rater reliability. Stages in
the growth process of the new nurses were discerned and treated as
the smallest unit of meaning, and retention issues were elucidated
and categorised. These preliminary analyses were then combined
into a summary table of categories and subcategories. Finally, both
authors analysed and refined the results through numerous itera‐
tions of analysis, focusing on relevance and consistency between
categories and subcategories and in relation to the prior literature.
4 | R E S U LT S
The participants (n = 20) included 15 women and five men. Eight
participants had 5 years of vocational training and held a 2‐year
KE et al.
n (%) Case number
20 100
0.5 ± 0.26
5 25 7, 14, 17, 18, 20
15 75 1–6, 8–13, 15, 16, 19
8 40 1–3, 5, 7, 8, 9, 12
4 20 4, 6, 10, 11
8 40 13–20
3 7, 11, 12
5 1, 4–6, 8
2 2, 3
7 14–20
1 13
2 9, 10
associate degree in nursing; four participants had 5 years of voca‐
tional training and held a 2‐year BSN degree; and eight participants
had a 4‐year BSN degree. Thirteen participants (Cases 1, 7, 8 and
11–20) had transitioned from working 1–9 months part‐time be‐
fore moving to full‐time work, including three participants (Cases
1, 16 and 17) who had moved from another hospital and 10 par‐
ticipants who had worked at the same hospital but in a different
unit. Participants’ work areas included internal medicine, surgery,
gynaecology and paediatrics, emergency, operating room or ICU
(Table 1). One nurse (Case 16) moved to a different hospital in the
first 3 months, and two others (Cases 8 and 12) had left the field of
nursing entirely by 2‐year follow‐up.
Our analysis of the interview data revealed the emergence of
three distinct stages during the one year or less of each participant's
work as a full‐time nurse: Feeling disillusioned and shocked, Gaining
experiential knowledge and Making a place for oneself. These
stages generally took about 1–3 months each to get through and
overlapped somewhat. (Underlined parts of quotations indicate key
points gleaned from our analysis).
4.1 | Stage 1: Feeling disillusioned and shocked
4.1.1 | Unspeakable, bitter suffering
After entering the workplace, the new nurses faced role ambiguity
and role conflict due to the gap between their expectations and the
reality of social role‐related tensions that may keep new nurses and
preceptors from developing mutually beneficial relations. They were
astonished by the heavy nursing workload and frustrated by feelings
of not contributing enough to their work unit (Ho et al., 2010). In
their new work environments, no longer accompanied by teachers
and schoolmates and having to survive in an unfamiliar place among
unfamiliar people, they felt out of place and inadequate. Unfamiliar
KE et al.
as well with the full array of clinical tasks and techniques used in their
new workplace, they often felt defeated and ineffective. Moreover,
when something unfavourable happened, they tended to choose to
suffer in silence, trying to avoid the appearance of excuse‐making.
Therefore, the new nurses were likely to have deep‐seated memo‐
ries of bitter suffering from their early months of nursing experience.
Typical comments included the following:
The senior nurse told me that I always forgot things,
no matter how many times she had taught me. It made
me feel so frustrated.
(Case 3)
I felt unhappy because I didn't get a sense of accom‐
plishment. Back then the senior nurse who oversaw
my work made me feel that I was wrong about every‐
thing. The most egregious thing was that I gave a pa‐
tient the wrong medication. I felt so guilty and I didn't
mean to do it, but the mentor… said something harsh
to me. So, later on when I made the same mistake
again … I had nothing to say. When the senior nurse
started to blame me, I just kept silent. Otherwise she
would have treated me even worse and kept nagging at
me for quibbling.
(Case 6)
The senior nurse thought it strange that I was inca‐
pable of doing my work even though I once worked part
time. Also, she thought that I didn't perform the tech‐
niques properly. But I dared not to tell her that I was
just following the book's instructions.
(Case 7)
During their first year of work, the newbies only gradually began
to find their place and some recognition from co‐workers, nursing unit
managers and senior nurses in their new work environment. When
faced with difficult and unfavourable situations, they could not explain
themselves or kept silent due to a lack of self‐confidence or worries
about harsh reactions to what they said. One nurse recalled: “I was
afraid because I had never done a certain procedure before … then, I
thought that the senior nurse was a little upset because she was so busy,
and I hadn't paid more attention to what I should do” (Case 2). Said an‐
other, “She could say it nicely. She really didn't have to give me that
kind of attitude, but I think that perhaps she had something else on her
mind and was just taking it out on me” (Case 16). Another nurse had very
strong feelings about her mentor: “I was mentored by a real jerk of a
preceptor. She would ask me lots of questions and roll her eyes when I
was unable to answer her” (Case 12).
Preceptors often were not easy to get along with or did not agree
with them. Poor preceptor and new nurse relationships and other
difficult interpersonal interactions adversely affected new nurses.
| 5
The new nurses who tried to address problems in their interac‐
tions with preceptors could not escape attacks by team members;
the resulting gossip was unbearable and made the new nurses feel
isolated. Not even co‐workers could be trusted to support them; in‐
stead, airing grievances often opened them to more censure (Fox,
Henderson, & Malko‐Nyhan, 2005). When tense relationships with
preceptors reached the freezing point, the new nurses felt they had
no choice but to suppress their anger. One replied, “I don't dislike
this unit; it's just the people involved … the whispers behind the back
can easily hurt your feelings” (Case 8).
The new nurses felt disrespected and frustrated in many situa‐
tions and scenarios, including in relation to patients. One reported,
“I think that we are helpless in the face of many things. For example,
when patients are admitted to the hospital, we have to meet patients’
needs and answer patients’ doubts and questions at all times. But there
are many things that we cannot control … all we can do is respond to
patients’ emotions. Most patients have some misconceptions, prefer‐
ring people in white coats over nurses. What on earth is our profes‐
sion? … We do our best to look for doctors to help with patients, but
we still can't get the respect from our patients … I think that we usu‐
ally can't call the shots, but we are often asked to resolve all the patients’
complaints” (Case 1). Said another, “Even what we have learned in
school can be applied into clinical practice. However, the difference
lies in the feelings of tension and extreme urgency which can only occur
in clinical practice. I always lose control of everything in my work, I think
I don't seem to fit here. I’m not cut out to be a nurse” (Case 8). The new
nurses felt like they were being treated as low‐status workers by
patients and their families, expected to be available to take care of
all their needs.
When entering the shock stage, the only thing that new nurses
could do was to endure with dogged will and try to figure out how
to adapt to the new environment while fighting against the urge to
quit. Two nurses (Cases 8 and 12) left the field of nursing entirely at
this point because of poor preceptor and new nurse relationships.
4.1.2 | Newbie stress
Only after engaging in full‐time clinical practice as working nurses,
after 1–2 months, did the new nurses begin to realise the full extent
of the gap between what they had learned in school and what was
required for their job. Their overwhelming newbie stress was primar‐
ily associated with unknown or unfamiliar clinical procedures. In ad‐
dition, they were afraid to make mistakes, particularly when dealing
with matters of life and death (Feng et al., 2011). Typical reactions
included the following:
I feel highly stressed when performing clinical tasks,
especially when dealing with urgent situations or life‐
threatening emergencies. Only if you have worked
in clinical settings can you ever know how it feels
having adrenaline at full speed. When you perform
some procedures that you have never done before,
you might experience great stress because you really
6 |
know nothing about it … I think that nurses feel the
greatest stress when it comes to life‐threatening
emergencies. You may have heard about it at school,
but now you have experienced it yourself and realized
the reality shock. Then you will regret that you didn't
learn enough.
(Case 19)
Now we have to deal with everything by ourselves
… we never know what kind of patients we are going
to meet. At the time when I was about to work inde‐
pendently, I was actually quite nervous … so far I still
lacked sensitivity to patients’ diseases. Clinical practice
is very different from theory. Sometimes I really don't
know how to apply theory to practice until I have had
the opportunity to deal with related situations. I think
that roles play a particularly important part. Successful
role transition really … takes time, and when it's done,
I can finally call myself a full‐time registered nurse and
independently deal with all the challenges in nursing
… in the past, senior nurses would help me deal with
such situations … I didn't know how to do it, so I was
a little scared.
(Case 13)
One new nurse bluntly observed: ‘You are not an in‐
tern anymore and you won't have senior schoolmates
and teachers to watch your back. Now you have to care
for 8 human lives. You are absolutely not allowed to make
any mistakes or you'll be dead.
(Case 5)
The new nurses who had accidentally harmed a patient reported
reflexively flinching away from similar situations, becoming cautious
and hesitant, and feeling like giving up. One noted, “I am terrified of
making mistakes. So … one incident occurred, and I felt a little … frus‐
trated…. I was shocked by that incident and felt extremely sad. Since
then I have started to think and wonder if I am suitable for working in clin‐
ical settings” (Case 1). Another related, “Once while helping a mother
during her child's pretension movements, I accidentally hit the child
on the washbasin. It had never, ever happened before and I was ner‐
vous and panicking … I was considerably frustrated and sad and felt guilty
about my carelessness. What's more, I said something to express my
self‐loathing, which further made the patient's family members believe
that I was untrustworthy” (Case 2).
Compared to their internship loading when they were students,
now they needed to handle an incredibly challenging workload.
When they failed to keep up with having double the number of pa‐
tients, more responsibilities to team members, and keeping track
of each doctor's work habits and remembering all the workflows,
they would be rebuked. One said, “As a nurse intern, I felt relieved,
KE et al.
thinking that after a few more days, only a few more days, my intern‐
ship will be over. But now it is completely different as a staff nurse.
I’ll still be here as the days go by” (Case 2). Similar reactions included
the following: “He keeps giving me things and telling me what he
wants, but I really can't do so many things at one time. All I can do is
write all the things down, but I really don't have enough time to do
them” (Case 4); “During my internship, I felt it easy to take care of one
patient. When I started working in the hospital ward as a full‐time
RN, there were tons of things to do, and I had to care for patients
based on the individual presenting disease. However, I knew nothing
about it so I felt highly stressed—and I think that the main reason was
complexity of workflow processes” (Case 13); “My preceptor would tell
me, ‘I already taught you, but you still forget. No matter how many times
I teach you, you still forget how to do it.’ It'd make me feel awful… In fact,
I’m sure I didn't learn from the preceptor all that I should've learned.
Still, I’ll never forget the way she spoke to me. Did she have to be so
severe with me? I was crying every day when I was being taught by
my preceptor. I felt that I would be sick soon. I felt like I would quit
this job….. I told the head nurse that I had been thinking about it for
a long time” (Case 16).
New nurses were closely watched and were not easily trusted by
senior staff. Having to sign their names on patients’ charts signified
to the new nurses that they had to take full responsibility for the
consequences of their actions and patient outcomes, which sealed
the feeling of being overwhelmed. Yet, all but two (Cases 8 and 12)
of the new nurses overcame the challenges and shock of this first
stage and entered the second stage.
4.2 | Stage 2: Gaining experiential knowledge
The work lives of the new nurses who remained began to stabi‐
lise. They were adapting to their new role: independently caring
for patients, seeking role models and group identification, gaining
increased control over their time and competence, rediscovering
passion for work, rekindling an interest in matters outside of work,
and valuing and affirming support from co‐workers and head nurses
(Tuckett et al., 2015).
4.2.1 | Exerting willpower and shouldering heavy
responsibilities
The new nurses started to accept the realities of clinical practice
in their experiential knowledge stage. Although they often had re‐
grets that they did not do as well as expected and usually worked
overtime to handle their heavy workloads, they gradually adapted
and learned how to overcome frustration and take on responsibili‐
ties as the frontline staff for patient care. One expressed her ex‐
perience in this way: “Patients keep coming and rushing me, but I
can't do everything on my own. It really frightens me, but someone
will always come to save you. You just have to stay calm and you
will be able to slowly deal with the situation” (Case 13). Another re‐
ported, “The feeling was like I would never get things done and I
might have missed a lot of stuff. Those feelings were usually ones
KE et al.
of frustration. The busy and heavy workload would exhaust you
to the extent that you feel there is no way to go on … I always felt
extremely tired when I got off duty and home” (Case 16). Typical
reactions also included the following: “I remember at that time I
cried almost every day when off duty. I couldn't get all the tasks
done, so I always worked overtime … at that time, I didn't even have
time to go back to the nursing station to do anything, such as obtain or
enter patient data. Worse still, it was a huge mess if you also had to
discharge or admit patients” (Case 1).
In transitioning from knowledge to experience, new nurses
learned how to bring out their full potential and adopt strategies to
shift from knowledge gained from books to competence in perfor‐
mance and managing to get through hard times. One noted, “A lot of
things needed to be done at the same time … I think that's a big mess
… the senior nurse told me that I did well … saying that I paid attention
to the right kind of stuff and I was making progress day by day. So the
sense of frustration slowly disappeared … I would cry when I felt sad,
but meanwhile I had to think about what the problem was and how
to solve it” (Case 13). Another said, “Every time I screw up, I will think
and try to find a way to make it better. On the other hand, I also have
to adjust my attitude, trying not to fall into the trap of regretting the
past. Otherwise I would be stuck in a vicious cycle and wouldn't
be able to figure out how to progress … I will never ever make the
same mistake again and I have to be more cautious…. I think I still
can neither get work done quickly nor have good time management,
but I think that I’m improving” (Case 16). Similar reactions included
the following: “In the beginning of practice, we were inexperienced
and acted unprofessionally, totally unlike senior nurses. Then we
gradually and slowly accumulated our professional experience … Now
I still have poor time management, but I think that I am progress‐
ing gradually” (Case 20). The new nurses gradually gained experi‐
ential knowledge through perseverance and became more deeply
socialised into the nurse role through interpersonal relationships
that helped them find the best coping strategies. Senior nurses—in
particular, preceptors—gave the new nurses more social recognition
now that they had survived the first few months and were making
fewer significant mistakes, which made them worthier of positive
attention. In turn, the new nurses’ comments about preceptors and
other senior nurses became more positive, if not entirely so, as mu‐
tual recognition grew.
4.2.2 | Shift in relationship with preceptor
The new nurses recognised that spending enough time to get to
know everyone was important and could help them get along and
work well together. Still, when it came to preceptors, their feelings
were mixed. One new nurse warned, “It is quite important to under‐
stand their personality traits when [administrators are] selecting precep‐
tors, because I think that preceptors are like a temporary shelter for
novices like us” (Case 18). “A good preceptor makes you feel like you're
in heaven. If you have a bad preceptor, it's impossible for you to sur‐
vive in the workplace” (Case 20). Although the bitter memories of in‐
adequacy, frustration and isolation lingered, relations with mentors
| 7
began to feel less unequal and far less fear‐inducing. “Although my
preceptor was always busy, during her spare time at work, she would
debrief me about the day, letting me feel safe and cared for” (Case 1).
One more nurse quit midway through this stage, after three months
of scrambling and desperation (Case 16). The remaining nurses felt
they had made progress in learning how to embrace their numerous
duties, build mutual trust or respect with their preceptor, and work
well with others, as well.
4.3 | Stage 3: Making a place for oneself
The new nurses, over the first 6 to 9 months of being full‐time nurses,
had become experienced and knowledgeable enough to express
themselves more confidently and act more independently while, at
the same time, grow more embedded within a community of coop‐
erative social ties. They had overcome numerous struggles and frus‐
trations in the first and second stages, and now they were becoming
adept at finding and positioning themselves more effectively amid
all the technical details of the job as well as within the larger social
setting. During this self‐positioning stage, they learned to reflect on
their predicaments and to anticipate future actions and reactions.
Typical comments included the following: “After an [adverse] inci‐
dent, I would recall the course of the incident and the workflows, and I
would consider what and how to do [better] next time. Afterwards,
similar incidents occurred one after another. [But eventually,] With
improved experience and techniques, I wouldn't do that [i.e., make those
mistakes] anymore” (Case 11). “My family frequently supports and
encourages me. The most important thing is that the senior nurses in
our unit are very nice and willing to encourage me … now I have slowly
adapted to the environment and can get off duty on time. When I
have a sense of accomplishment, I am less likely to reject my work, al‐
though I still feel tired every day … In fact, I found that the reason I am
doing better in work is because I have help and affirmation from many
senior nurses … they also give me feedback, and so I’ve gradually been
able to develop good adaptation strategies” (Case 6). No matter what
the new nurses most cared about, when they gained recognition for
their competence or work, they could find their place and no longer
feel lost. Typical reactions included the following: “When the pa‐
tients’ family members run to me and say ‘thank you’, I feel that all
is worth it” (Case 2). “Now, I have adjusted to the work environment
and can finish my work on time. I feel like this unit is my home away
from home. I really enjoy working on the unit” (Case 20).
The new nurses who had made it through the first 6 months
had boldly faced their mistakes and grown through their struggles.
By the last 3–6 months of their first year of full‐time nursing work,
they had worked out a place of their own grounded in a gradual con‐
solidation of job competence, social belonging and self‐awareness.
As preceptors and other senior nurses showed more willingness to
support them and express positive encouragement, the new nurses’
confidence grew. Feeling like they were both doing worthy work and
being rewarded for being worthy, they became aware of their inte‐
gral role in a larger whole, and this made them realise the value of
their existence.
8 |
5 | D I S CU S S I O N
Our content analysis of qualitative interviews with full‐time nurses
at two medical centres in southern Taiwan revealed three stages of
growth during their first year of practice: Feeling disillusioned and
shocked, Gaining experiential knowledge and Making a place for
oneself. These stages generally took 1–3 months each to get through;
they tended to overlap and vary by individual; yet they were experi‐
enced by all the new nurses, regardless of whether they were male
or female, at their first or second workplace, or had part‐time work
experience. Against the odds and under trying circumstances, 17 of
the 20 nurses persevered for the first year in the same workplace,
one moved to another medical facility after 4 months, and, at 2‐year
follow‐up, 18 remained in nursing while two had left the field. We
can speculate that the odds of staying in nursing were increased for
the 13 nurses who had part‐time work experience—in a different
area at the same facility (n = 10) or in a different facility (n = 3)—be‐
cause it provided a more gradual path into nursing; additionally, the
two hospitals’ new nurse training programmes have a good reputa‐
tion. Nevertheless, they and the other participants harboured deep
misgivings about their first year of nursing, stemming largely from
their conflicted relations with senior nursing staff as well as patients
and patients’ family members.
When first entering clinical practice, new nurses generally are
known to rely heavily on the assistance of preceptors. Preceptor
programmes vary by country. In Taiwan, most preceptor training
courses involve more than or equal to 8 hr of training and cover
topics such as the role and responsibilities of preceptors, teach‐
ing strategies, evaluation and coaching skills, problem‐solving, and
emotion awareness and management (Ke, Kuo, & Hsu, 2017; Lee
et al., 2009). A study in Canada by Willemsen‐McBride (2010) and
one in England by Allan et al. (2018) found that most nurses had
a positive attitude towards preceptorship programmes and that
trained preceptors were capable of teaching clinical skills, providing
positive feedback, building self‐confidence, creating learning goals,
giving suggestions, correcting errors and providing career planning
advice. However, Clark and Holmes’ (2007) qualitative study in the
UK reported more mixed, both positive and negative effects of
preceptors, and Ishihara et al. (2014) mentioned poor interactions
with senior nurses as a factor contributing to new nurse stress.
Moreover, Killian (2015) showed that mentoring could be nega‐
tively affected by complex change in the work environment as well
as inadequate staffing. The participants in the current study expe‐
rienced many negative feelings related to their self‐perceived poor
performance in the first and into the second stage as patient load
and clinical responsibilities increased, which included complicated
workflows, manual labour, extra nonprofessional tasks, team influ‐
ence‐building, administrative duties, overtime and environmental
factors such as dealing with computer and equipment software and
hardware. Nurses’ crucial tasks were commonly left undone because
of a shortage of time, which tends to leave new nurses (as well as
more experienced nurses) feeling stressed over not having enough
time to complete jobs (Ke, Wang, & Hsu, 2016; Antinaho, Kivinen,
KE et al.
Turunen, & Partanen, 2016; Bae & Fabry, 2014; Hayward, Bungay,
Wolff, & MacDonald, 2016; Wang, Ku, Chen, Jeang, & Chou, 2016).
Enhancing professional organisational commitment and giving pos‐
itive support may be effective in reducing burnout and increasing
intention to stay in new nurses (Cao, Chen, Tian, Diao, & Hu, 2015).
We found that when the professional commitment of new nurses
was higher, they could deal better with confrontation and avoiding
it, and were less likely to burn out when faced with work stress and
workloads, as Nesje (2017) similarly found.
Preceptors were perceived to be holding back support or pro‐
viding too much negative feedback. Thus, preceptors initially had a
negative or mixed impact on many of the new nurses’ adaptation to
work, contrary to previous research findings on Taiwan (Ke & Hsu,
2015; Lee et al., 2009) as well as the USA (Modic & Harris, 2007) and
Canada (Willemsen‐McBride, 2010). In fact, the new nurses com‐
monly feared senior nurses’ reactions, felt disrespected by senior
nurses as well as patients and their family members, and secretly felt
that senior nurses ought to be better listeners and more support‐
ive. The key factor here, however, appears to be length of time: until
some point into the second stage, many of the preceptors were not
willing to make a fuller commitment to supporting the new nurses,
which coincided with the latter not yet being in a position to rec‐
ognise the extent of the time‐management dilemmas faced by se‐
nior nurses and that preceptors were not simply acting out personal
preferences. The general sense among our interviewees was that
the preceptors and other senior nurses were more willing to support
new nurses who had survived the first 3–6 months and were making
fewer mistakes. This phenomenon could be explained by goal gra‐
dient theory (Malik, 2017), as a resource scarcity situation in which
preceptors are more strongly motivated to be supportive only after
new nurses have reached a perceived threshold based on which
preceptors adjust their own work time, effort, emotional labour and
so on vis‐à‐vis new nurses. Several interviewees reported attempts
by their own or another new nurse's preceptor to break away from
the relationship when faced with an underperforming new nurse or
adverse judgement from their colleagues and superiors that the pre‐
ceptor's own performance was poor, similar to some of Ke and Hsu
(2015) data. That is, senior nurses appeared to be hesitant to com‐
mit their emotional or intellectual labour to managing new nurses
during the period when new nurses were most in need of positive
support and attention (Dewanto & Wardhani, 2018). The generally
high attrition rate in Taiwan might make new nurses seem like a poor
investment for senior staff, already overburdened by the ongoing
attrition. New nurses earned support and gained recognition from
others, including preceptors, by showing that they could persevere
through this early period and forge a place for themselves, making
them “worthy” of being cared for.
Our interviewees emphasised their lack of skills, a gap between
practice and theory, hesitancy in life‐and‐death situations, and shock
and stress during the transition to caring for a full patient load by
themselves. Important to new nurses’ willingness and commitment
to continue working while facing such challenges were their efforts
to engage in making a place for oneself. Workplaces are key sites of
KE et al.
place‐making, in the sense that “places are socially constructed by
the people who live in them and know them; they are politicized,
culturally relative, and historically specific multiple constructions”
(Low, 2009, pp. 21–22; Rodman, 1992). Integral to place‐making are
embodied spaces of lived experience where people take action and
forge “a location for speaking and acting on the world” (Low, 2009,
p. 26). In finding their place, the new nurses were supported by an
eventual shift in preceptor and other senior nurses’ level of support
and encouragement (cf. Hayward et al., 2016; Ho et al., 2010). As
Case 6’s statement—“The most important thing is that the senior
nurses in our unit are very nice and willing to encourage me … now
I have slowly adapted”—suggests, intention to stay was significantly
related to professional commitment and peer support among nurses
(Cao et al., 2015; Han, Trinkoff, & Gurses, 2015; Nesje, 2017). In
other words, after deep self‐doubts and broader questioning—for
example “What on earth is our profession?” (Case 1)—new nurses
who had managed to stay were able to settle into their nurse role
and find a place for themselves, coinciding with their growing expe‐
riential knowledge and confidence. Additionally, they began to earn
the recognition that they had been seeking all along from their co‐
workers, nursing unit managers and senior nurses as well as patients
and patients’ family members.
6 | CO N C LU S I O N
New nurses typically experience transition shock and a desire
to maintain close ties with preceptors (Duchscher, 2009) as they
gain the confidence and competence required for practice readi‐
ness (Ortiz, 2016). Yet our findings point to social tension between
new nurses and preceptors; many of the new nurses in our study
recalled bitter experiences in their initial interactions with senior
nurses, which some of the data in Ke and Hsu (2015 also suggested.
Underlying these difficulties, we suggest, are social tensions built
into the preceptor and new nurse roles which are symptomatic of the
broader care crisis in nursing. The extrinsic reward of social approval
typically noted by sociologists (Folbre & Wright, 2012) is apparent
in our findings, in the form of Chinese cultural values within Taiwan
of socialising people through “fictive” familial ties in the workplace
(Ke & Hsu, 2015) and through an increasing sense of mutual under‐
standing, respect and support in the process of performing intensive
and extensive care work. Nonetheless, preceptors may hold off on
asserting familial ties until they consider new nurses to be deserv‐
ing. In this respect, although employers commonly use familial ties
to encourage loyalty and hard work, the withholding of familial ties
could in this case be interpreted as a strategic reaction by preceptors
to the larger, intractable institutional conditions of their own over‐
work in the context of chronic understaffing and overtime work.
However, this is a view in need of further research.
Our findings raise important questions about how to reduce
the reality shock of new nurses, what kind of learning programmes
and support plans new nurses need before or after graduation, and
why preceptors may initially hesitate to help new nurses in their
| 9
first year. New nurses’ stage of learning needs to be periodically
assessed in the first year, and more support specific to that stage
and its challenges needs to be provided. Furthermore, more atten‐
tion could be paid to new nurses’ experiences, which might differ
by type of nursing degree, work experience or gender. Vocational
college nursing training programmes in Taiwan focus on skills prac‐
tice, whereas BSN training focuses more on general and theoretical
nursing knowledge (Yang, 2009). Even though 12 of the participants
had 5‐year vocational school training (including 3 years of vocational
high school), which provides extensive multisite training, and 13 had
some part‐time work experience, most still struggled to keep up with
the workload once they became full‐time nurses. Although by no
means a long‐term solution, initial part‐time work could provide a
longer period of adaptation. Research on when nurses leave nurs‐
ing is also needed, particularly on nurses who quit after the average
6–7 years of working. In addition, the question remains of why more
than half of nursing graduates in Taiwan do not even enter the field
of nursing: What do such nursing graduates experience in the first
year after graduating and why do they decide not to pursue nursing
as a career?
No matter what preceptorship programme is selected (i.e. fixed
preceptors or multidimensional and changing preceptors), it seems
advisable for hospital or nursing administrators to try a matched‐pair
design to pair the new nurse with a preceptor who has a compat‐
ible learning style, personality traits and behaviours (Willemsen‐
McBride, 2010; Yin, 2010). Indeed, the 19th Asian Workforce
Forum's (AWFF) Communiqué asserts that, in addition to equitable
pay, “positive and supportive working environments, manageable
workloads, and safe staffing levels will also enhance nurse reten‐
tion and facilitate the delivery of high‐quality patient care” (ICN
AWFF, 2018). Ultimately, the tensions between preceptor and new
nurse roles in Taiwan need to be resolved at the institutional level,
which, as the AWFF Communiqué suggests, would require increas‐
ing nurse–patient ratios and stabilising work hours—that is engaging
more resources in support of all nurses.
6.1 | Limitations
The current study was limited by the difficulty of doing follow‐up
interviews with nurses who quit, which, in turn, made comparison
with those who stayed difficult. Future research could be carried out
exploring preceptors’ views, to confirm whether they make support
decisions based on the worthiness of a new nurse in Taiwan. Efforts
should be made to develop ways in which nurses can mutually rec‐
ognise potential institutional conflicts between senior nurses and
novice nurses, and to help each other avoid them.
7 | R E LE VA N C E TO C LI N I C A L PR AC TI C E
A better understanding of new nurses’ growth processes and ad‐
justment pains will serve to refocus professional development and
retention efforts on how new nurses can succeed in finding a place
10 | KE et al.
for themselves. New nurses need more support in their struggles
to consolidate work ability, social belonging and self‐awareness.
Preceptors and other senior nurses should consciously socialise new
nurses into the workplace by helping them realise the significant
challenges and potential conflicts embedded in the professional care
roles of new nurses and their preceptors.
C O N FL I C T O F I N T E R E S T
We have no conflicts of interest to declare.
ORCID
Ya‐Ting Ke https://orcid.org/0000-0003-1359-9537
Joel F. Stocker https://orcid.org/0000-0001-7058-7458
REFERENCES
Allan, H. T., Magnusson, C., Evans, K., Horton, K., Curtis, K., Ball, E., &
Johnson, M. (2018). Putting knowledge to work in clinical practice:
Understanding experiences of preceptorship as outcomes of inter‐
connected domains of learning. Journal of Clinical Nursing, 27, 123–
131. https​://doi.org/10.1111/jocn.13855​
Antinaho, T., Kivinen, T., Turunen, H., & Partanen, P. (2016). Improving
the quality of registered nurses’ working time use data. Journal of
Clinical Nursing, 26, 3031–3043. https​://doi.org/10.1111/jocn.13650​
Bae, S. H., & Fabry, D. (2014). Assessing the relationships between nurse
work hours/overtime and nurse and patient outcomes: Systematic
literature review. Nursing Outlook, 62, 138–156. https​://doi.
org/10.1016/j.outlo​ok.2013.10.009
Bowles, C., & Candela, L. (2005). First job experiences of recent RN grad‐
uates: Improving the work environment. JONA: the Journal of Nursing
Administration, 35, 130–137. https​://doi.org/10.1097/00005​110-
20050​3 000-00006​
Buchan, J., Shaffer, F. A., & Catton, H. (2018). Policy brief: Nursing re‐
tention. Philadelphia, PA: International Centre on Nurse Migration
(ICNM). Available at: https​://www.icn.ch/sites/​defau​lt/files/​in‐
line-files/​2018_ICNM%20Nur​se%20ret​ention.pdf. Access date: 20
January 2019.
Buerhaus, P. I., Auerbach, D. I., Staiger, D. O., & Muench, U. (2013).
Projections of the long‐term growth of the registered nurse work‐
force: A regional analysis. Nursing Economics, 31, 13–17.
Cao, X., Chen, L., Tian, L., Diao, Y., & Hu, X. (2015). Effect of profes‐
sional self‐concept on burnout among community health nurses in
Chengdu, China: The mediator role of organizational commitment.
Journal of Clinical Nursing, 24, 2907–2915. https​://doi.org/10.1111/
jocn.12915​2907
Chang, H. L., Lu, M. S., & Lin, C. F. (2010). Factors related to new nursing
staff turnover rates. The Journal of Health Sciences, 12, 161–172.
Clark, T., & Holmes, S. (2007). Fit for practice? An exploration of the de‐
velopment of newly qualified nurses using focus groups. International
Journal of Nursing Studies, 44, 1210–1220. https​://doi.org/10.1016/j.
ijnur​stu.2006.05.010
Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived
causes and consequences: A preliminary study at private hospi‐
tals in Indonesia. BMC Nursing, 17, 1–15. https​://doi.org/10.1186/
s12912-018-0317-8
Duchscher, J. B. (2008). A process of becoming: The stage of new nurs‐
ing graduate professional role transition. The Journal of Continuing
Education in Nursing, 39, 441–450.
Duchscher, J. E. (2009). Transition shock: The initial stage of
role adaptation for newly graduated registered nurses. The
Journal of Advanced Nursing, 65, 1103–1113. https​://doi.
org/10.1111/j.1365-2648.2008.04898.x
Feng, M. C., Chen, Y. M., Wu, L. K., & Wu, L. C. (2011). Perceived
stress and coping strategies of newly graduated nurses. Journal of
Nursing and Healthcare Research, 7, 98–107. https​://doi.org/10.6225/
JNHR.7.2.98
Folbre, N., & Wright, E. O. (2012). Defining care. In N. Folbre (Ed.), For
love and money: Care provision in the United States (pp. 1–20). New
York, NY: Sage.
Fox, R., Henderson, A., & Malko‐Nyhan, K. (2005). They survive
despite the organizational culture, not because of it: A lon‐
gitudinal study of new staff perceptions of what constitutes
support during the transition to an acute tertiary facility.
International Journal of Nursing Practice, 11, 193–199. https​://doi.
org/10.1111/j.1440-172X.2005.00530.x
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis
in nursing research: Concept, procedures and measures to achieve
trustworthiness. Nursing Education Today, 24, 105–112. https​://doi.
org/10.1016/j.nedt.2003.10.001
Han, K., Trinkoff, A. M., & Gurses, A. P. (2015). Work‐related factors,
job satisfaction and intent to leave the current job among United
States nurses. Journal of Clinical Nursing, 24, 3224–3232. https​://doi.
org/10.1111/jocn.12987​
Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualita‐
tive study of experienced nurses’ voluntary turnover: Learning from
their perspectives. Journal of Clinical Nursing, 25, 1336–1345. https​://
doi.org/10.1111/jocn.13210​
Ho, H. H., Liu, P. F., Hu, H. C., Huang, S. F., & Chen, H. L. (2010). Role tran‐
sition and working adaption in new nursing graduates: A qualitative
study. The Journal of Nursing, 57, 31–41.
Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017).
New graduate nurses’ experiences in a clinical specialty: A follow up
study of newcomer perceptions of transitional support. BMC Nursing,
16, 1–9. https​://doi.org/10.1186/s12912-017-0236-0
ICN. (2015). Nursing and Ageing Workforce. Geneva, Switzerland:
International Council of Nurses. Available at: https​://www.twna.org.
tw/front​end/un07_inter​natio​nal/file/2015/20151​0 07.pdf. Access
date: 30 December 2017.
ICN AWFF. (2018). Communiqué. International Council of Nurses (ICN)
19th Asian Workforce Forum (AWFF), November 15–16, 2018.
Available at: https​://www.icn.ch/syste​m/files/​d ocum​e nts/2018-
12/19th_AWFF_Commu​nique_en.pdf. Access date: 20 January
2019.
ICN AWFF & AANA. (2014). The Report on the 15th International Council
of Nurses (ICN) Asia Workforce Forum (AWFF) & 11th Alliance of Asia
Nurses Association (AANA). Retrieved from https​://www.twna.org.
tw/front​e nd/un07_inter​n atio​n al/webPa​ges_5/files/​2 0151​1 2301.
pdf. Access date: 30 December 2017.
ICN AWFF & AANA. (2015). The Report on the 16th International Council
of Nurses (ICN) Asia Workforce Forum (AWFF) & 12th Alliance of Asia
Nurses Association (AANA). Retrieved from https​://www.twna.org.
tw/front​e nd/un07_inter​natio​nal/webPa​ges_5/files/​20151​231.pdf.
Access date: 30 December 2017.
Ishihara, I., Ishibashi, Y., Takahashi, K., & Nakashima, M. (2014). Effect
of organizational factors and work environments on newly gradu‐
ated nurses’ intention to leave. Japan Journal of Nursing Science, 11,
200–210. https​://doi.org/10.1111/jjns.12021​
Ke, Y. T., & Hsu, M. T. (2015). An exploration of nursing preceptorship
and functions and nurses’ intention to stay from the perspective of
cultural differences. Nurse Education Today, 35, 597–601.
Ke, Y. T., Kuo, C. C., & Hsu, S. C. (2017). The effects of nursing preceptor‐
ship on new nurses competence and retention: A systematic review.
Journal of Advanced Nursing, 73, 2296–2305.
KE et al.
Ke, Y. T., Wang, H. H., & Hsu, S. C. (2016). Improving the issue of nurses'
delay of off-duty from work through organizational transformation.
Leadership Nursing, 17, 58–70.
Killian, S. M. (2015). Examining mentoring relationships for nurses: A
pilot study. JOCEPS: the Journal of Chi Eta Phi Sorority, 59, 17–21.
Kramer, M. (1974). Reality shock: Why nurses leave nursing. St. Louis, MO:
C. V. Mosby.
Lee, T. Y., Tzeng, W. C., Lin, C. H., & Yeh, M. L. (2009). Effects of a precep‐
torship programme on turnover rate, cost, quality and professional
development. Journal of Clinical Nursing, 18, 1217–1225. https​://doi.
org/10.1111/j.1365-2702.2008.02662.x
Lieblich, A., Tuval‐Mashiach, R., & Zilber, T. (1998). Narrative research:
Reading, analysis, and interpretation. Thousand Oaks, CA: Sage.
Low, S. M. (2009). Towards an anthropological theory of space and place.
Semiotica, 175(1/4), 21–37.
Malik, S. A. (2017). Revisiting and re‐representing scaffolding: The
two gradient model. Cogent Education, 4, 1331533. https​://doi.
org/10.1080/23311​86X.2017.1331533
Martin, K., & Wilson, C. B. (2011). Newly registered nurses’ experience
in the first year of practice: A phenomenological study. International
Journal for Human Caring, 15, 21–27. https​://doi.org/10.20467/​
1091-5710.15.2.21
Modic, M. B., & Harris, R. (2007). Masterful precepting: Using the
BECOME method to enhance clinical teaching. Journal for Nurses
in Staff Development, 23, 1–9. https​://doi.org/10.1097/00124​6 45-
20070​1000-00001​
Nesje, K. (2017). Professional commitment: Does it buffer or intensify
job demands? Scandinavian Journal of Psychology, 58, 185–191. https​
://doi.org/10.1111/sjop.12349​
Ortiz, J. (2016). New graduate nurses' experiences about lack of profes‐
sional confidence. Nurse Education in Practice, 19, 19–24. https​://doi.
org/10.1016/j.nepr.2016.04.001
Rodman, M. (1992). Empowering place: Multilocality and multivocality.
American Anthropologist, 94(3), 640–656. https​://doi.org/10.1525/
aa.1992.94.3.02a00060
Sandelowski, M. (1986). The problem of rigor in qualitative research.
Advances in Nursing Science, 8, 27–37. https​://doi.org/10.1097/00012​
272-19860​4 000-00005​
| 11
Speziale, H. S., & Carpenter, D. R. (2003). Qualitative research in nursing,
3rd ed. New York, NY: Lippincott Williams & Wilkins.
Tuckett, A., Winters‐Chang, P., Bogossian, F., & Wood, M. (2015). ‘Why
nurses are leaving the profession … lack of support from managers’:
What nurses from an e‐cohort study said. International Journal of
Nursing Practice, 21, 359–366. https​://doi.org/10.1111/ijn.12245​
Wang, P. H., Ku, Y. C., Chen, C. C., Jeang, S. R., & Chou, H. C. (2016).
Work‐related frustration among senior nurses at a medical centre.
Journal of Clinical Nursing, 25, 2040–2051. https​://doi.org/10.1111/
jocn.13241​
Willemsen‐McBride, T. (2010). Preceptorship planning is essential to pre‐
operative nursing retention: Matching teaching and learning styles.
Canadian Operating Room Nursing Journal, 28(8), 10–11.
Wu, H. M., Liu, P. F., Ho, H. H., Chen, P. L., Chao, H. L., & Chen, H. L.
(2012). Reducing occupational burnout and enhancing job perfor‐
mance in new nurses: The efficacy of “Last Mile” programs. The
Journal of Nursing, 59, 30–42. https​://doi.org/10.6224/JN.59.4.30
Yang, K. P. (2009). The effect of professional aptitude on core com‐
petence of junior college nursing graduating students. Journal of
Cardinal Tien College of Healthcare & Management, 7, 5–18.
Yin, Y. C. (2010). Preceptorship in nursing. VGH Nursing, 27, 219–224.
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section at the end of the article.
How to cite this article: Ke Y‐T, Stocker JF. On the difficulty
of finding one’s place: A qualitative study of new nurses’
processes of growth in the workplace. J Clin Nurs. 2019;00:1–
11. https​://doi.org/10.1111/jocn.14996​