Dissertations & Theses (Open Access)

Date of Award

Fall 12-13-2019

Degree Name

Doctor of Philosophy in Nursing (PhD)


Joan Engebretson, DrPH

Second Advisor

Cathy Rozmus, PhD

Third Advisor

Jason Etchegaray, PhD


Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems.

Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and the actual reality of working as a nurse; and 2) to describe the perceived influences in the transition of newly licensed nurses into practice within an acute care setting.

Methods: Using a medically focused, ethnographic approach semi-structured interviews were conducted with purposive sampling of 15 NLNs who had just completed a NRP. Transcribed interviews were coded using Atlas ti. V8. Data content was analyzed and once redundancy was reached relevant themes were identified through content analysis from exemplars.

Findings: Perceptions of the NLN experience of being a nurse was that it was overwhelming and hard. Interpretive descriptive analysis of their perception of transition showed that nursing school provided them with a foundation but clinical experiences were not realistic to their real life practice. Four concepts to the reality of being a nurse emerged from the data; “Unexpected patient care experiences”; “More responsibility than expected”; “Difficulty with patient coordination and time management”; “Living the nursing lifestyle”. Success depended on NLNs receiving additional education and sufficient support.

Conclusion: NLNs enter practice not prepared for the role of the real nurse. Strong academic preparation, an NRP, and time and support from experienced nurses is necessary for NLNs to become confident in navigating the physical, mental and emotional requirements of caring for acutely ill patients.


Newly Licensed Nurses, Transition into Practice, Job Satisfaction, Support, Stress

Included in

Nursing Commons



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