International Journal of Nursing Practice

2003;

9

: 300–305

Blackwell Science, LtdOxford, UKIJNInternational Journal of Nursing Practice1322-71142003 Blackwell Science Asia Pty LtdOctober 200395300305Original ArticleSupport for new graduates

V Parker

et al.

Correspondence: Desley Hegney, Centre for Rural and Remote AreaHealth, University of Southern Queensland, PO Darling Heights,Toowoomba QLD 4350, Australia. Email: hegney@usq.edu.au

✠

R E S E A R C H P A P E R

✠

Adequacy of support for new graduates during their transition into the workplace:

A Queensland, Australia study

Victoria Parker RN GradDipCritCare BHSc MN MRCNA

Lecturer in Nursing, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia

Ashley Plank DipTeaching BSc MSc(Hons) PhD

Department of Mathematics and Computing, University of Southern Queensland, Toowoomba, Queensland, Australia

Desley Hegney RN BA(Hons) PhD FRCNA

Chair of Rural Nursing, Centre for Rural and Remote Area Health, University of Southern Queensland, Toowoomba, Queensland 4350

Accepted for publication December 2002

Parker V, Plank A, Hegney D.

International Journal of Nursing Practice

2003;

9

: 300–305

Adequacy of support for new graduates during their transition into the workplace: A Queensland, Australia study

In 2001, a study into issues of concern to assistant-in-nursing, registered and enrolled nurse members of the QueenslandNurses Union was undertaken. Approximately equal numbers of nurses from each of the aged care, acute private and acutepublic sectors were surveyed. Overall, 1477 nurses responded, representing a response rate of 53%. This article focuseson one aspect of the study—the perceived adequacy of support offered to new nursing graduates as they exit universityand begin their transition into the workplace. In particular, responses from nurses are compared with professional level orcurrent role designation, age, time spent in the workplace and health sector. Considerable divergence of opinion amongthe respondents, particularly across designation, age and years of experience, was found within the three sectors. Forexample, in the public and private employment sectors, older and more experienced nurses were more likely to perceivethe support for new nurses as adequate compared to younger and less experienced nurses. Additionally, in the acute privatesector, the more senior the nurse the more likely the perception that there was adequate preparation for new graduatesentering the workforce.

Key words:

Australia, new graduates, Queensland, support, transition.

INTRODUCTION

In the current climate of nursing staff shortages, and withrecruitment and retention issues on State and Federal gov-

ernments’ agendas, an issue of critical importance to theprofession and to the management of health care facilitiesis the need to nurture and support new graduates in theirtransition from university to the workplace as registerednurses. There is persistent criticism that tertiary educationdoes not adequately prepare registered nurses for the ‘realworld’ of clinical nursing practice.

1

A criticism of newgraduate registered nurses is the failure to integrate the-

Support for new graduates 301

ory into practice. Other authors argue that universityundergraduate nursing programmes have failed to mini-mize the ‘reality shock’ experienced by many new grad-uates as they enter the nursing workforce.

1,2

Despite thedebate, it is apparent that, regardless of the teaching andclinical model used in universities, newly registerednurses all enter the workforce as new graduates and,therefore, as novice practitioners.

The period that separates a novice practitioner from anadvanced beginner is one which requires support, guid-ance and constant supervision by experienced clinicians toensure new graduates develop competently and safely,both personally and professionally.

2

Lack of professionaland collegial support during this transition phase can seri-ously affect both short and long-term performance and,therefore, determine whether or not the new graduateremains in the nursing workforce.

Many studies have been conducted of new graduatesand their experiences, expectations and perceptions ofthe transition into the workplace in terms of quality ofgraduate programmes, collegial and social support, andclinical expectations.

3–12

However, there have been nopublished studies in Australia that have ascertained if thereare differences between the perceptions of nurses acrossemployment sectors regarding the support of new grad-uates within the workplace.

Aim of the study

The aim of the main study was to collect data to deter-mine the workplace conditions and needs of QueenslandNurses’ Union (QNU) registered nurse (RN), enrollednurse (EN) and assistants-in-nursing (AINs) members inorder to strategically plan union priorities for the nextfew years. This article specifically details the respondents’perceptions of the adequacy of support provided to newgraduates within three sectors of employment (aged care,private acute and public acute) during their transition intothe workplace.

METHOD

This study involved a postal survey of members of theQNU in October 2001. A stratified random sample ofnurses was drawn from the three largest nursing em-ployment sectors in Queensland. These were the publicor State government sector, the private care (non-government) sector, and the aged care (non-governmentand government) sectors. Equal numbers of nurses fromeach of the three sectors were randomly selected from the

QNU membership in the expectation of approximatelyequal response rates and approximately equal levels ofprecision for key measures in each sector based on theresults of a pilot study. The sampling frame was restrictedto financial members of the QNU to reduce the number ofnon-active nurses selected.

The total number sampled was 2800, and the totalnumber of completed surveys returned for analysis was1477. This represented a response rate of 53%. Aftereliminating 41 cases where the work sector could not beprecisely determined and adjusting for conflicts in identi-fication of work sector between the QNU database and thesurvey itself (about 5% of cases), the final sample sizes andresponse rates in the main study by sector were: 441 agedcare (47%), 497 public acute care (56%); and 498 privateacute care (56%).

The question asked in the questionnaire that this articlespecifically focuses on was: ‘In your professional opinion,are new nursing graduates given adequate support at yourworkplace’? Available responses were ‘Yes’, ‘No’, ‘Don’tknow’ and ‘Not applicable’.

Data analysis

Quantitative data were analysed using SPSS for Windows(Release 10.0.5). Only participants who responded ‘yes’or ‘no’ to the question of support were included in theanalysis. This excluded about 12% of ‘don’t knows’ fromeach sector and a further 27%, 12% and 7% of ‘not appli-cables’ from the aged care, acute public and acute privatesectors, respectively. The number of respondents involvedin the analysis was therefore 263 (61%), 378 (77%) and391 (80%) from the aged care, acute public and acute pri-vate sectors, respectively. Analyses involved comparisonsof the proportions of ‘yes’ or ‘no’ responses across cate-gories and were analysed using the Chi-square test of inde-pendence and logistic regression. To protect against Type Ierrors, generally only results that were significant at the1% level were reported. The exception was where aneffect was significant at the 1% level in one of the othersectors, in which case a threshold of 5% was used. Per-centages, if aggregated across the three sectors, wereweighted to reflect QNU membership. These weightingswere 19.6%, 63.2%, and 17.2% for the aged care, acutepublic and acute private sectors, respectively.

Limitations of the study

The conclusions in this paper apply to nurses who areQNU financial members working in the aged care, acute

302 V Parker

et al.

public and acute private sectors in Queensland inOctober, 2001. The presence or otherwise of bias in theconclusions has been investigated by comparing thedistributions of employment designation and of genderbetween the sample and QNU membership for each sec-tor. Trends in the time order of receipt of the completedquestionnaires with respect to responses of interest werealso assessed as indicators of potential bias.

On the basis of these analyses, there is no reason tobelieve bias exists with regard to conclusions for nursesemployed in the acute public and acute private sectors.Because of a discrepancy in the proportions of respon-dents in the aged care sector, where RNs are significantlyover-represented and AINs are significantly under-represented, some bias is possible. The impact of this biashas been estimated for the results reported in this paperand is relatively small, being insufficient to qualitativelyaffect the conclusions.

The reliability in estimating proportions with the sam-ple sizes extant in this study are such that at the 1% levelof significance, differences in population proportions ofless than 16% in the aged care sector and less than 13% inthe acute public and acute private sectors are likely toremain undetected. Hence, the absence of a significanteffect might indicate that any difference in population pro-portions is smaller than these figures, rather than absent.

Ethics

This research study was granted ethics approval fromHuman Research and Ethics Committee at the Universityof Southern Queensland (USQ). To ensure anonymity ofthe participants, the QNU generated for each participantan individual code which was forwarded to the researchteam at USQ. The team coded each questionnaire andreturned them to the QNU for distribution to respon-dents. At no stage of the study did the QNU have access tothe raw data, nor did the research team have access toQNU membership details.

RESULTS

It should be noted that the proportions reported in theremainder of this paper are conditional. They representpercentages of those nurses who feel able to offer an opin-ion on the adequacy of support given to new graduatesrather than percentages based on all nurses in a particularsector. As previously indicated, the percentages of nursesin this category are 61%, 77% and 80% of the aged care,

acute public and acute private sector respondents,respectively.

There is a significant difference (

P

=

0.002) across thesectors regarding the perceptions of the adequacy of sup-port given to new graduates at their workplace. In partic-ular, 65% (

n

=

171) of nurses from the aged care sectorperceived new graduate support to be adequate comparedto 51% in the public (

n

=

196) and 52% in the private(

n

=

206) sectors.As the aged care sector participants were employed in

either government (public) or non-government (private)funded facilities, the data were further analysed to ascer-tain if there were any differences in the responses of thesetwo groups (Fig. 1). A higher proportion of respondentsemployed in the private aged care sector (67%) than thoseemployed in the public aged care sector (59%) believedthat new graduates were adequately supported, althoughthe difference was not significant (

P

=

0.03).As the data were collected and analysed in three dis-

crete sectors, further results will be presented in eachindividual sector.

Aged care sector

Age of participants

There were no statistically significant differences in theperception of adequacy of support for new graduatesacross age groups.

Job designation

The data were analysed to ascertain if the perceptions ofadequate support for new graduates differed betweenENs, AINs and RNs. For RNs, further analysis was under-

Figure 1.

Perception of adequacy of support for new graduates. A

comparison between aged care, acute public and acute private sectors.

, yes;

�

, no.

0

10

20

30

40

50

60

70

Acute public Acute private Aged public Aged private

Sector

Num

ber

of n

urse

s (%

)

Support for new graduates 303

taken to examine if there were any differences across thelevel of appointment of RNs (that is, Levels 1–5). No sig-nificant differences existed.

Years of service

Although there were no statistically significant differencesin the perceived adequacy of support according years ofservice in nursing, there are trends. Specifically, nurseswho had been employed between five and nine years andfrom 25–34 years were more likely to indicate that theybelieved there was insufficient support for new graduates(Fig. 2).

Acute public sector

Job designation

In this sector, Level 1 RNs appeared more likely thanother nurses to believe that there was insufficient supportfor new graduates. For example, 51% of Level 1 nursesanswered ‘no’ to this question compared to 44% of ENs,48% of Level 2 RNs and 42% of Level 3, 4 and 5 RNs.However, the differences were not significantly different(

P

=

0.06).

Age of nurse

There was significant evidence (

P

=

0.03) of a differenceacross age groups in the perceptions of the adequacy ofsupport of new graduates (Fig. 3). Nurses aged 20–29years (62%) were more likely to perceive inadequate sup-port than nurses aged > 60 years (23%).

Time spent in nursing

There is strong evidence (

P

< 0.001) of differences in theperceptions of adequacy of support of new graduates

across nurses with different levels of experience. In par-ticular, nurses with > 35 years of experience were morelikely to perceive that support was adequate compared tonurses who had been employed for < five years (Fig. 4).

The data suggest that the greater the years of service,the greater the perception of adequate support offered tonew graduates, and the younger the nurse and the lesstime spent in nursing, the greater perception of inade-quacy of support offered to new graduates. These differ-ences persist, albeit with lessened significance (

P

=

0.01),after taking into account the job designation of the nurse.Therefore, the experience of the nurse appears to be ofmore importance than the job designation in producingthis effect in the acute public sector.

Acute private sector

Time spent in nursing

Although less significant than in the acute public sector,there was also evidence of an association between time

Figure 2.

Adequacy of support for new graduates in the aged care,

acute public and acute private sectors according to time spent in nurs-

ing. , yes;

�

, no.

0

10

20

30

40

50

60

70

80

<5 5–9 10–14 15–24 25–34 >35

Years of service

Num

ber

of n

urse

s (%

)

Figure 3.

Perceptions of adequacy of support for new graduates by

the age of nurses in the public acute sector. , yes;

�

, no.

0

10

20

30

40

50

60

70

80

90

20–29 30–39 40–49 50–59 >60

Age of nurse (years)

Num

ber

of n

urse

s (%

)

Figure 4.

Perceptions of the adequacy of support for new graduates

against time spent in nursing in the public acute sector. , yes;

�

, no.

0

10

20

30

40

50

60

70

80

90

<5 5–9 10–14 15–24 25–34 >35

Time spent in nursing (years)

Num

ber

of n

urse

s (%

)

304 V Parker

et al.

spent in nursing and the perception of adequacy of sup-port for new graduates (

P

=

0.04) in the acute private sec-tor. In particular, 67% of nurses with 25–35 years ofexperience believed adequate support was provided com-pared to 46% of nurses with 10–15 years of experienceand 48% of nurses with 15–25 years of experience.

Job designation

A significant difference exists across the job designationsof nurses and their perception of the adequacy of supportfor new graduates (

P

=

0.007). Similar to the findings inthe acute private sector, RNs Levels 3–5 (77%) weremore likely to answer ‘yes’ to this question than othernurses (Fig. 5). This effect persists after allowing for anyeffect due to the amount of time spent in nursing, sug-gesting that designation rather than experience is moreimportant in the acute private sector.

DISCUSSION

The results of this study suggest that there are differencesin nurses’ perceptions of the adequacy of support for newgraduates depending upon the sector in which they areemployed, the age of the nurse, the job designation of thenurse and the time that the nurse has spent in nursing.

Employment sector and support of new graduates

The results of this study suggest that nurses employed inthe aged care sector, particularly those in the private agedcare sector, believe that there is adequate support pro-vided for new graduates. In contrast, nurses from theacute public and acute private sectors were less likely toperceive that the current level of support was adequate.Approximately 50% answered ‘yes’ and 50% answered

‘no’. This finding has not been reported elsewhere in theliterature.

Job designation and perceptions of support for new graduates

There is a similar trend across all sectors with regard tojob designation and perception of the adequacy of supportfor new graduates. This trend is most evident in the acuteprivate sector were 77% of RNs Levels 3–5 believed thatsupport was adequate compared to 57% in the public and70% in the aged care sectors. The perception of Level 1RNs differed, particularly in the acute private sector, fromthose of the more senior nurses.

This finding is supported by previous studies whichsuggest that senior nurses are less likely to provide sup-port to new graduates in clinical areas.

3,5,8,9,12

Therefore, itis possible that the differences in perceptions highlightedin this study occur because of nurses’ declining capacity tooffer professional and clinical support to new gradu-ates.

3,5,8,9,12,13

These differences in perceptions were alsoapparent in other findings of this study, where more seniornurses were less likely than other nurses to perceive thatnursing morale was poor and deteriorating.

14

Age of nurses and perceptions of the adequacy of support

The data suggest similar trends across sectors in that oldernurses perceive more adequate support for new graduatesthan younger nurses. In the acute public sector, it appearsthat experience rather than job designation is the majorfactor behind this effect, whereas in the acute private sec-tor it appears that seniority of position rather than age orexperience is more important. This finding has not beenreported elsewhere.

CONCLUSION

This study has highlighted that perceptions of the ade-quacy of support of new graduates differ, not only acrossemployment sectors within nursing, but also amongnurses within sectors. These findings provide new infor-mation which suggests that ‘one size fits all’ new graduatesupport programmes might not meet the differing needswhich are apparent across nursing employment sectors.

There are many related questions that the study did notask. Further studies, for example, might address the rea-sons for the differences in perceptions and the relationshipof these differences to the type of graduate programmealready in place.

Figure 5.

Perceptions of adequacy of support for new graduates

according to job designation in the private acute sector. , yes;

�

, no.

0

10

20

30

40

50

60

70

80

90

Enrolled nurse RN Level 1 RN Level 2 RN Level 3, 4, 5

Job designation

Num

ber

of n

urse

s (%

)

Support for new graduates 305

The data suggest that for those nurses who are newgraduates (Level 1 nurses) and for those who are mostlikely to provide supervision to new graduates (Level 1and 2 nurses), improvement in support is required. With-out this improved support, not only might patient/clientsafety be compromised, but also the poorly supportednew graduates might be lost from the nursing workforce.

ACKNOWLEDGEMENTS

We wish to thank all participants who took the time tocomplete the questionnaire. This was a QueenslandNurses’ Union funded project.

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