High workloads and job stressors have led to unprecedented nursing shortages internationally [1], as reported by Canada [2, 3], China [4], India [5], and Australia [6]. This shortage is especially significant given the increasingly aging global population, which may require progressively more complex and chronic care [7]. Nursing bridging education programs, which enable nurses to transition from one level of educational preparation to another, have been proposed to address the current human health resource crisis in nursing [8].
The employment and retention of nurses within long-term care (LTC) and home and community care (HCC) sectors has historically been challenging; however, these staff shortages have now reached an unparalleled high level [9, 10]. In Ontario, Canada, LTC homes offer around-the-clock housing, healthcare, and personal support services to adults, many of whom are elderly, with comprehensive and chronic care needs [11]. Alternatively, HCC comprise health and social support services for individuals to remain living safely in their own homes or community [12]. Recent reports from both the LTC and HCC sectors in Canada revealed an exponential increase in absenteeism and job vacancies for point-of-care staff since 2021 [13, 14]. Understandably, the ramifications of a strained nursing workforce have led to adverse effects on the physical and mental wellbeing of point-of-care staff, leading to widespread burnout and exacerbating the existing human health resource crisis in the wake of the COVID-19 pandemic [15, 16]. Moreover, stigmatization related to aged care and perceived workplace conditions has contributed to perceptions of LTC and HCC as undesirable sectors for work when compared with other sectors, which may discourage new nurses from entering the workforce in these areas in the future [17, 18]. Understanding the lived experience of transitioning to work in LTC and HCC, from the perspective of the nurses themselves, may bring to light pivotal areas of emphasis for retention efforts.
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Enhancing workforce retention and recruitment of nurses have been widely recommended as strategies to overcome the growing gap between the need for and availability of nursing care providers [6]. In Ontario, there are different categories of nurses, including Registered Practical Nurses (RPNs) - trained at the college level through a diploma program and providing direct patient care to increasingly complex care patients [19] - and Registered Nurses (RNs) - requiring a bachelor’s degree at the university level, providing advanced knowledge and training in clinical practice, critical decision-making, and leadership [20]. Research related to the retention of nurses and health support workers in various settings has emphasized the significant impacts of workplace culture, attitudes, engagement, quality of work life, and job satisfaction on nurse retention [21‐24]. In contrast, role ambiguity, lack of staff and resources, wage disparities, emotional ‘tolls’, and unclear scopes of practice among RPNs and RNs have compounded negatively on the retention of nurses in LTC and HCC as sites saturated with work-related stressors [25‐27]. At this pivotal moment in time when nurses are desperately needed, particularly in LTC and HCC, it is essential to consider innovative ways to recruit and retain more nurses into these healthcare sectors.
Nursing bridging education programs for nurses with previous education and work experience, which support transitions from one level of educational preparation to another (e.g., PSW to RPN, PSW to RN, or RPN to RN) [8] with tuition reimbursement and opportunities for career development could positively influence job satisfaction and intentions to stay in the nursing field [7, 8, 28, 29]. Expanding access to nursing bridging education programs, by providing financial support to students, including internationally educated nurses, and facilitating opportunities for clinical placements in LTC and HCC could further enhance attraction and retention among nurses [30, 31]. Previous research has reported on factors influencing PSWs and RPNs to pursue nursing bridging education programs, including expanded opportunities for career mobility, as well as challenges in pursuing additional education such as family responsibilities, financial cost concerns, time commitments, and work-related stressors [8, 31‐33].
While the available literature widely supports the expanded opportunities associated with nursing bridging education programs, it has also been suggested that the transition to practice experience of new nurse graduates from any nursing program is often associated with feelings of under-preparedness, high stress, and high attrition rates [34, 35]. Two studies highlighted the experiences of RNs and RPNs transitioning to practice in LTC, finding swift transitions from beginner roles to leadership positions that were challenging for new graduates given their lack of experience in the sector [36, 37]. However, to our knowledge, no research has focused on transitioning nurses who have previously worked as healthcare professionals and recently graduated from a nursing bridging education program; graduating from a nursing bridging education program may affect their role transition, given their previous work involvement. Moreover, the experience of transitioning to practice within LTC and HCC settings may pose unique challenges. The proposed research will discover previously taken-for-granted meanings with respect to nurses’ experiences in transitioning from a nursing bridging education program to practice within LTC and HCC settings. The aim of this research was to explore the lived experiences of new graduate nurses transitioning from nursing bridging education programs to working in the LTC and HCC sectors.
Methods
Design
A hermeneutic phenomenological design was employed to explore nurses’ experience of transitioning from a nursing bridging education program to practice within the LTC and HCC sectors. Underscoring individual perceptions and emphasizing the everyday experiences of new graduate nurses transitioning to working in LTC and HCC upon completion of a nursing bridging education program, this methodology allowed for the exploration of human experiences in context, appreciating significances which were unique to specific individuals and yet inextricably connected to context, timepoints, culture, and social situations [38‐40]. This methodology centralizes the significance of everyday experiences and the meanings they hold [41, 42], which is especially appropriate for research within professional disciplines such as nursing where human experiences and relationships are of utmost importance [43]. Hermeneutic phenomenological research offers an opportunity to develop a deeper and more complete understanding of the meaning the experience holds for those who experience it, situating it within the sociocultural context [38, 44]. In so doing, this exploration of the depth and complexity of human experience aims to induce pathic, felt understanding and generate “action sensitive knowledge” (p. 21) for more tactful action [45].
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The theoretical perspective underpinning this research accepts that people – including participants and researchers – are irremovable from our presuppositions [39]. Thus, ‘truth’ in findings and experience may arise from individuals’ inimitable interactions with the world within their sociocultural and historical contexts and individuals’ lived experiences – and understanding of the meaning of those experiences – are constructed within a context formed by sociocultural, historical, and linguistic factors [39]. The results of this research represent an interpretation of the experience in question for a specific group of nurses; thus, the meaning of the experience may only be significant for the participants in this study. The research does not claim explanatory or generalizable results in a larger sense [46]. Rather, this research offers findings, which may resonate with key individuals in the nursing, LTC and HCC realms, and encourage deeper, more careful perceptions, understandings and actions with respect to decision-making on nursing practice; support for continuing education/academic preparation; and nursing workforce management in LTC and HCC.
This research was ultimately designed to understand how the experience of transitioning to practice from a nursing bridging education program into LTC or HCC affected participants, including relationships with themselves, the world, and others [47]. By entering the phenomenological realm, the research team aimed to question what the experience of transitioning to practice in LTC and HCC settings was ‘truly’ like, how it was ‘felt’ by the nurses, and what aspects of that experience were essential to its nature [38, 39]. The consequence of phenomenological research in healthcare is its veneration for acting through thoughtful reflection or “tactful thoughtfulness” (p. 156) [39]. In this case, the outcomes of this research may underscore previously taken-for-granted meanings with respect to entry-to-practice experiences for nurses [38]. By enhancing the visibility of this experience, the findings may encourage individuals – including nurses, administrators and decision-makers – to appreciate and act with care and perspicacity when considering nursing within the LTC and HCC sectors, particularly when promoting recruitment and retention of nurses in these realms.
Setting
As part of the Ontario Government’s commitment to recruiting nurses to the LTC and HCC sectors, the Bridging Educational Grant in Nursing (BEGIN) program was launched as a comprehensive initiative – including tuition reimbursement, career coaching, workshops, and post-graduate online modules – for PSWs and RPNs to complete academic nursing programs to bridge to RPNs and RNs [48]. With a return-of-service model, BEGIN recipients must commit to working full-time hours for one year for each academic year of tuition they receive [49], which may increase the employment and retention of nurses in the LTC and HCC sectors [50]. This study specifically engaged new graduate nurses who had received support from the BEGIN program while completing their nursing bridging education programs.
Participants and procedure
Purposive sampling was used to recruit new graduate RPNs and RNs from a tuition reimbursement program supporting students enrolled in nursing bridging education from PSW to RPN and/or RPN to RN in the province of Ontario. All participants in this study were RNs and RPNs who had recently graduated – within the first three years of transitioning to practice following completion of their nursing bridging education program [51, 52] – who received support from the BEGIN program, were employed in either LTC or HCC, and were registered members of the College of Nurses of Ontario (CNO). This working definition facilitated the inclusion of both nurse designations working within LTC and HCC, which allowed for a timeframe for nurses to develop setting-specific nursing knowledge; and aligned with widely accepted definitions of “recent nurse graduates” or “new graduate nurses” within the transition to practice theory literature [37].
Inclusion and exclusion criteria
Participants who met the inclusion criteria, who were willing and able to speak in English, were invited to contribute. As this methodology employed in-depth interviews to gather stories and descriptions of experiences for data, participants who were unable to communicate in English or unwilling to be audio-recorded would have been excluded; however, this did not occur in any instance. No other exclusion criteria were applied.
Data collection
In this study, the researchers engaged with newly graduated nurses’ experiences to develop deeper understanding about the meaning of transitioning to practice in the current climate of LTC and HCC. These findings may resonate with others as a piece of a human experience [39].
After informed consent was obtained and before the interviews took place, self-reported demographic information about the participants’ age, gender, nursing role, years of employment, years of education, and nursing workplace sectors in Ontario was collected using an online survey platform called Qualtrics XM (Provo, UT). Individual semi-structured interviews and follow-up interviews were conducted with nurses (RPNs and RNs) who recently graduated (within the past three years) from a nursing bridging education program with tuition support from the BEGIN program and had transitioned into practice within LTC or HCC in Ontario, Canada. Open-ended questions [53] were utilized in an effort to gather rich descriptions of lived experiences, stories of transition to practice experiences, and information about social context, including working environment, nursing bridging education program and BEGIN participation. Interview questions included, for example: Tell me about your new role as [RPN/RN]. Tell me about a time that stands out in your mind that shows what it is like to be a new graduate nurse in LTC/HCC. Follow-up interview questions included, for example: When you recall your experience of transitioning from your academic nursing training to practicing clinically as an [RPN/RN] in [LTC/HCC], what comes to mind? Can you say more about what it was like for you when you realized you were no longer a [PSW/RPN]? The interviews were conducted and audio-recorded over Zoom and lasted between 45 and 90 min.
Data collection and analysis were iterative processes; thus, the interview guide (Supplementary Files 2–5) and prompts were slightly modified as the interviews progressed and themes emerged to explore developing concepts in further depth and detail, as well as to critically discuss themes with participants ensuring that developing understandings resonated with their experiences [39]. After preliminary data analysis, all participants were approached again and invited to participate in a second, individual follow-up interview over Zoom to further discuss and unpack emerging ideas. The follow-up interview guides may be found in Supplementary Files 3 and 4. As a phenomenological method, interviews and follow-up interviews allowed the research team to delve deeper into the meaning of experiences, returning to participants for clarification, conversation, and refinement around emerging themes [39].
Data analysis
Inductive, iterative data analysis highlighted meaningful insights from the perspective of nurses. Following transcription, repeated interaction with the data – through reading and re-reading the transcripts, as well as reflexive writing and re-writing of the findings – served as a method for reduction, as the research team repeatedly questioned pre-understandings and developed more meaningful understandings of the experience [54, 55]. The research team engaged in a hermeneutic circle of interpretation – moving back and forth between individual parts of the data and the whole interview transcript, along with researchers’ interpretations of each part [56]. Generated themes were considered written interpretations, with the act of writing serving as a transformative reflective tool for understanding the lived experience [55‐57]. The process of ‘eidetic’ reduction, aimed at discovering the essential aspects of experience, occurred as the research team engaged their own presuppositions and values in interpretation of the meaning of this experience [39]. By engaging in reflexivity through conversation and writing, the research team interrogated their own interpretations and the influence of presuppositions, power dynamics, and taken-for-granted knowledge on the findings [58]. The authors recognize, as van Manen [39] emphasized, that the unique essence of an experience is complex and any attempt to distill its meaning through writing represents an interpretation that may not fully capture its involvedness. Nevertheless, the findings offered herein are the result of the researchers’ best efforts to organize participants’ narratives phenomenologically, as richly and deeply as possible in communicating through text [39].
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Quality considerations for the study
Considerations of quality and rigour in this research were attended to throughout the research process, as demonstrated through the strength of the study design and suitability of the methodology to answer the research questions [59]. Coherence – aligning the study objectives, methods, and presentation of findings with the theoretical underpinnings of interpretive phenomenological methodology – was attended to through regular discussions with the research team [60]. Through hermeneutic phenomenology, the research team aimed to examine taken-for-granted everyday experiences of new graduate nurse participants to discover previously unseen significances and generate “depthful understanding and meaningful insight” (p. 776) [55] into their experiences of self, other, and the world as they transitioned from their nursing bridging education programs into practice in LTC and HCC [38, 41]. To ensure sincerity in the study, the research team focused on issues of transparency and reflexivity, as outlined by Tracy [61]. Honesty and transparency were demonstrated through detailed documentation of the procedural and interpretive choices made throughout the research process; these decisions were discussed with the research team. The research design, including the interview guides (Supplementary Files 2–5), was created with input from a Nursing Knowledge Advisory Group (NKAG), comprising researchers, trainees, nursing students, nursing educators, working nurses in LTC and HCC, members of the Registered Practical Nurses Association of Ontario (WeRPN), and employers in LTC and HCC settings. This panel of experts offered valuable insight into the conception of the research and data collection tools.
Ethics approval and dissemination
Ethical approval for this research was received from a research-intensive university in Ontario, Canada (REB# 2023-123271-81749). All participants provided written and verbal informed consent prior to participation.
Results
Twelve new graduate nurses, including ten women and two men, from Ontario, Canada participated in this study. All 12 individuals completed an individual interview, and eight participants returned for a second follow-up interview. The four individuals who did not return for a follow-up interview were invited twice to participate and did not respond. The sample of participants for this study included individuals who had bridged from PSW to RPN (n = 3), RPN to RN (n = 8), and from PSW to RN (n = 1). Six participants were currently employed in LTC, and the other six were employed in HCC. Participants’ ages ranged from 24 to 55 years. The reported duration of prior working experience in either LTC or HCC ranged from 18 months to 11 years. At the time of recruitment for the study, participants’ experience in their current (new) roles ranged from 1 week to 21 months.
The meaning of nurses’ experience in transitioning to new practice roles and work in LTC and HCC
For the new graduate nurse participants herein, the significance of the experience of transitioning to new practice roles into LTC or HCC following a nursing bridging education program was embedded in a fundamentally felt sense of fulfillment. The sense of fulfillment in this transition was considered in light of four major themes: (1) Benevolence; (2) Growth, Eagerness, and Anticipation to Learn; (3) Building from Within; and (4) Work-Life Balance. Each of these four themes was comprised of sub-themes, which are discussed in further detail below. For the purposes of brevity, additional participant quotations in support of each of the themes, sub-themes, and the overall essence of these experiences are provided in Table 1 (Appendix A).
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Benevolence
When considering participants’ stories, a definitive characteristic shared across participants emerged; namely, the predisposition toward benevolence. For each individual in this study, their stories clearly demonstrated that helping was in their nature. Participants emphasized the significance of striving for quality care through relationship building, the development and maintenance of a quiet pride in nursing identity, and the challenge that helplessness hits harder in their contexts. It became evident that achieving their new nursing designations and (re)entering the workforce in LTC or HCC allowed them to fulfil their passion for caring for others, and the sense of benevolence attendant to and emanating from such work. For instance, Participant 11 (RPN, LTC) remarked, “I’ve always been one to like helping people and working in LTC. It makes you feel good to just to talk to the residents, to make them smile or laugh. […] I think I’ve always had that helping kind of trait.”
Likewise, Participant 7 (RPN, HCC) stated:
I know it’s a part of who I am because I’m all about humanity. I’m all about compassion. I’m all about empathy. I never forgot the reason why I started. I know it’s me wanting to care. It’s me wanting to nurture. […] This is me. This is all I know.
Participants shared memories of significant moments in their lives wherein their compass was directed toward nursing and healthcare. Some spoke of family members’ illnesses and a desire to help them, while others recalled positive connections made through volunteer experiences early on. For others, their drive toward nursing was thought to be inexplicably innate. One newly transitioned RN, Participant 8 (RN, HCC) shared:
There is no reason why I wanted to be a nurse, per se. There’s always been an inherent need, a want to help people and be around people and do things. I know it sounds silly. I think in a past life I was a nurse. […] I just think it’s just me. It’s just who I am. […] Almost like a calling.
The meaning of the major theme of Benevolence was comprised of three sub-themes: relationship building, nursing identity, and helplessness hits harder.
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Relationship building
While it might be argued that nursing generally calls to those who have a passion for caring, participants in this study articulated that their motivation for such work was anchored to a feeling or belief that they could make a particular impact in LTC or HCC, which was distinct from care provided in more acute settings. For instance, Participant 4 (RN, LTC) noted,
I just like the relationship building that you do in long-term care opposed to acute care settings. […] I feel like I can really help people in LTC, whether it’s medically or socially or personally, whereas in acute care, I just don’t find that.
Many of these nurses exuded a passion for the specific patient populations they came to serve, including Participant 5 (RN, LTC) who shared, “I love the population. I freaking love them. When I go to the homes, I will spend time just walking around the unit with whatever lady wants to go for a walk or a dance.”
The unique nature of LTC and HCC settings, wherein residents or clients may require long-term or palliative care as opposed to acute or curative care, was spoken about on many occasions. Participant 10 (RN, LTC) noted:
It’s probably the most fulfilling thing you’re ever going to do, but it’s also the most stressful and sad thing you’re ever going to do […] You are the last stop for these residents. So it’s your duty to make this last experience the greatest they’ll ever have. It’s your job in long-term care.
Similarly, Participant 1 (RN, HCC) shared: “In home care you have that connection with people where in the hospital you don’t get time to make those connections.”
It seemed as though the settings of LTC and HCC – through prolonged interactions and meaningful relationships with clients and residents – enabled these nurses to palpably experience a measure of fulfillment in their new transition and work experience, apparently engendered by their inherent proclivity towards benevolence.
Quiet pride in nursing identity
Several participants reflected on the significance of their achievements in completing their nursing bridging education programs and embracing their new roles and responsibilities. The momentousness of achieving a new nursing designation (as RPN or RN) was shared by all participants, not in a boastful way but rather through a quiet, understated sort of pride. Interestingly, one participant shared that she planned to maintain an active RPN license while also registering as an RN. It seemed that both titles represented a significant achievement for the participant and contributed to their sense of self as a ‘nurse’. Participant 4 (RN, LTC) stated, “I still renewed my RPN license this year. So I still have, you know, the identity as an RPN in addition to RN.” Another individual (Participant 5, RN, LTC) shared that becoming an RN was a natural evolution through his career process given his interest in learning. He shared,
Becoming an RN has helped me strengthen those skills and it really articulates things that were sort of naturally inside me. […] That was a nice growth for me that sort of really consolidated like how I felt as a person and as a professional and being an RN. […] My training very much did affect who and what I am, like it helped me be a better person.
While all participants recounted taking an arduous path to become a new nurse, and the significant accomplishment that that held for them, many spoke of a continued transition toward more fully identifying with their new role and title. For instance, Participant 10 (RN, LTC) shared, “I still have moments that I kind of catch myself where I actually sign RPN after my name instead of RN. […] It’s surreal. It’s weird. It just doesn’t feel real. That’s the only way I can describe it.”
In articulating their new titles – verbally or in writing – participants seemed able to experience again a swell of quiet pride and sense of fulfillment towards achieving their lifelong goals. Participant 3 (RN, HCC) spoke about the long journey towards her new role stating, “It feels good, you know, for me, it’s been a long way to that title, so it feels accomplished.” Similarly, Participant 1 (RN, HCC) shared,
I don’t feel like I have to say, ‘oh, I’m just a nurse’, for some reason, I don’t have to justify. I am an RN, and I get to say that I’m a registered nurse. […] It’s cool to be able to reflect and know that you’ve grown and know that your professional self has grown.
Moreover, Participant 11 (RPN, LTC) exclaimed, “It’s been a bit of a change to say, I’m a nurse. […] It’s kind of, wow, I really am this. I really did work hard for this. Yeah, that’s awesome.”
Reflecting on their achievements, and identifying with their new titles, seemed to be a continuing process through which participants were reminded of the magnitude of their accomplishments.
“Helplessness hits harder”: Feeling inadequate in new roles
Participants in the study were beginning new roles in a sector (LTC or HCC) within which they had previous work experience. As such, there was often a feeling of expectation that they should know more and do better despite being new graduate nurses. Participant 2 (RN, HCC) stated,
I feel it more as an RN. You do feel helpless a lot in medical field to begin with. […] I kind of feel like maybe I missed something, maybe I should have known better now that I’m an RN. […] Maybe helplessness hits harder. I kind of hope maybe it will go away. Are you doing your best? […] I was supposed to perform better now. I’m supposed to know more, how come I missed it, how come I didn’t think of it, somebody else did.
Many nurses communicated that this sense of struggle between having prior knowledge and feeling inexperienced was underpinned by the sense that “experience means more than anything in nursing” (Participant 3, RN, HCC). Despite having previous work experience in LTC or HCC, many participants emphasized their new roles required a different skillset than what they had previously acquired, and that there was a gap between the knowledge they had gained in their academic studies and the clinical practice they were now expected to adeptly demonstrate.
The value of experience was felt by participants through their interactions with other more seasoned nurses in their organizations as well. Some participants highlighted that this feeling might be especially heightened within LTC and HCC, as many nurses in those settings appear to be later in their career trajectories. Participant 4 (RN, LTC) noted:
Your colleagues, I feel like, may not look to you like the same way as they do amongst their experienced colleagues. […] A lot of the nurses in long-term care are much older, it’s their second career or last career or last like place of work before they retire. So being a new grad in long-term care is not seen often.
Participants also noted feeling intimidated by other more experienced nurses given that they felt uninformed or helpless in beginning their new role. An RN in HCC, Participant 1 said, “We’re told nurses eat their young, so sometimes you don’t feel comfortable asking questions or you don’t feel comfortable going to the only nurse that’s available.” Similar sentiments also reverberated from nurses in LTC: “Nursing as a culture needs to be overridden and overworked. […] The idea of horizontal violence and nurses eating their young is so ingrained into us as a culture that it’s almost something that happens subconsciously when new nurses join your team.” (Participant 10, RN, LTC). Despite these challenges, it appeared that this group of participants’ keen desire to acquire more experience served as motivation to continue in their learning journey as they transitioned into new roles and harnessed the sense of future fulfillment they anticipated from them.
Growth, eagerness, and anticipation to learn
The importance of continued lifelong learning and eagerness to grow was a theme evident in each interview. Participants underscored that the nursing discipline was synonymous with continual learning. One RPN in LTC (Participant 11) stated, “I always feel like there’s always something to learn. And if there isn’t, it’s probably time to find a new job.”
Despite having newly graduated within the past few months or years, many nurses in this study independently described their goals of future learning. Some individuals sought to acquire further specializations in wound care, palliation, or mental health, whereas others spoke of entering master’s degrees or realizing research ambitions. Participant 10 (RN, LTC) shared, “Nursing is a career where you are constantly learning. […] I thought I was done, but if anything, this program has made me realize how much farther I can keep going.” Similarly, Participant 9 (RPN, LTC) said, “I want to learn more, I want to go more into this nursing career […] I don’t just want to be in one level of my career, so I want to do more training, more learning.” Participants spoke of a gratification that comes from the lifelong process of learning. This was articulated by Participant 7, an RPN in HCC, who stated: “So far the journey has been rewarding. […] I have learned, I have unlearned and I’m still learning.”
The significance of the major theme of Growth, Eagerness, and Anticipation to Learn was believed to include three sub-themes: leadership and opportunities; diligence and drive; and the quest for greater/self-actualization.
Leadership and opportunities
The importance of attaining new opportunities for career advancement and positions of leadership with participants’ new professional designations was a theme in many interviews. A recently graduated RN working in HCC (Participant 8) noted, “Once I gather more education and more experience, I do want to go into management.” For Participant 4 (RN, LTC), bridging provided an opportunity to advance in her career and opened future opportunities that she would otherwise have missed. “I decided to bridge because I wanted to be more in a leadership role. […] There’s a lot of potential to climb up the ladder.” Similarly, Participant 10 (RN, LTC) shared ambitions of higher-level management positions in his organization, which only consider RNs for the role.
The biggest thing for me is it now allows me to transition back into a higher leadership position in long-term care. For long-term care, you have to be an RN to move into the position of a director of care. […] Being an RPN, I was kind of stagnated, I couldn’t move any higher in the nursing leadership role. So that’s what this has allowed me to do.
For others, opportunities for advancement came in the form of a specific nursing role, which was removed from the bedside but still offered opportunities for caring and case management. Participant 1 (RN, HCC) noted, “It really hit home when I was finishing the program and working because I wanted to do something different. I wanted to maybe get away from bedside nursing or just a different opportunity. […] This was the change I was looking forward to.”
For many nurses in this study, achieving their new nursing designations afforded them a feeling of ‘freedom’ through endless possibilities. Participant 12 (RN, HCC) noted, “It feels good. I feel more freedom because now I can look for places [to work].” Similarly, Participant 9 (RPN, LTC) “It’s good, it feels good that I’m starting something new, a new career, which I’ve always wanted in my life, so I’m beginning to fulfill that for myself, so it’s a good thing.” New career opportunities ultimately contributed to a sense of satisfaction and contentment at the core of this transitional experience.
Diligence and drive
Another striking subtheme among the interviews was a predisposition toward diligence and drive. Participants’ industrious outlooks were especially notable when the nurses discussed the demands of completing their nursing bridging education programs while seeking to simultaneously work and balance family and life obligations. In this sample group, all the nurse participants continued to work in some capacity throughout their education despite the rigour and demands of their programs. Participant 3 (RN, HCC) recounted, “It was two, sometimes three courses every semester, literally for five years straight. I didn’t take any semesters off. And I was working full-time for most of it.” Similarly, Participant 8 (RN, HCC) emphasized, “I worked the whole time. I worked full-time the whole time that I’ve been doing this.”
The intrinsic determination and drive seemed part of what set this group of nurse participants apart, perhaps even insofar as helping to prompt their initial decision to return to school and embark on their bridging education. Participant 7 (RPN, LTC) reflected about herself, “I am a very diligent person. […] If it’s worth doing, it’s worth doing well. So if we are going to do, let’s just get going.” Participant 2 (RN, HCC) discussed that the requirements of completing two programs to attain her RN designation may have also contributed to her increased resilience. She stated, “Probably a bit more resilient. Just because when you go through the nursing school twice you kind of get to be a bit stronger maybe emotionally.” It appeared as though the internalized diligence and drive propelled these individuals forward through the intense demands of their nursing programs and motivated them to pursue new career avenues. The act of pushing themselves and striving for more contributed to the overarching sense of fulfillment lived through the process of transitioning to their new roles.
The quest for greater / self-actualization
Contributing to the major theme of growth, eagerness, and anticipation to learn was a continual push or quest for more. This was summarized by Participant 7 (RPN, LTC) who shared:
It’s still the quest for more. It’s still the quest to know that I could just, probably call it self-actualization. You just keep going until you have the mastery of what nursing is about. […] Self-actualization would mean the goals and objectives, things that I’ve set out for myself to achieve. So truth is that if I can do the RPN, I don’t think there’s really anything stopping me from being an RN. […] I don’t see anything stopping me to achieve that. I probably feel I’ll be fulfilled. […] As long as it still makes meaning to me, that will be fulfillment.
When reflecting on his accomplishments and how he would know he was ‘done’ in this quest for more, Participant 10 (RN, LTC) affirmed,
I think it’s only something that I’ll feel and what it will feel like. I don’t think I’ll discover that for a bit. […] I don’t think you’re ever truly done. Right. I don’t think it’s ever truly finished.
In line with the transitional nature of the experience in question, the nurses’ stories exhibited both a persistent pursuit for deeper and broader understanding, along with new roles and opportunities, while also providing pause for a moment to appreciate how far they had come. Participant 5 (RN, LTC) shared,
It was it was nice in a sense. […] It’s affirming. It’s taken me a lot to get there. But it’s very affirming, right? It’s like, I worked hard for this. I deserve nice things, right? So, yeah, it’s been a nice growth, a nice self-realization of coming to terms with all the work that I’ve done. And it was a nice moment of catharsis.
Despite many indications that the nurses planned to continue their learnings in the future, many participants connected the self-actualization achieved through their new roles with a sense of fulfillment.
Building from within
The third theme, Building from Within, emerged from participants’ ties to their sectors of employment. Specifically, as a construct, this theme encapsulated that these individuals had pursued career advancement through bridging programs with the intention of returning to build and enhance their previous workplace sector. The nurse participants in the study all shared that they planned to return to the sectors from which they had previously worked, with some individuals even returning to the same employer.
For many individuals with career ambitions of leadership within their organization or sector, transitioning to practice back into the setting offered new opportunities in a familiar and supportive environment. For instance, Participant 10 (RN, LTC) recalled:
I still work for the same organization and I’m back in a role that I used to do. […] The only difference is there’s a little suffix after my title that says RN, but I’m still an assistant director of care, which I held five years ago as an RPN. So that’s where it’s kind of the same, but different for me.
Several participants spoke about the unique nature of LTC and HCC as appealing to a specific type of nurse, and that the respective setting might not be best suited for everyone. For example, an RN in LTC, Participant 5 shared, “To bring it back to long term care, it’s hard and it’s difficult. […] Do it if you love it. But otherwise, I would go somewhere else is I think the bottom line.”
While LTC and HCC, for many nurse participants, had systemic and contextual constraints that were often frustrating, these sectors held many redeeming qualities which enticed these specific nurses to want to stay and build a culture of excellence within them. Participant 11 (RPN, LTC) noted, “It’s not for everybody, but it really, if you like caring for people, it’s a great way to express. I’ve always liked older people and helping them out. […] I find that it’s very fulfilling to be able to help them, to be able to say I went to work and I made this lady’s day just by being there.”
Participants also underscored the significance of exposure to LTC and HCC, and speaking of these sectors with positive connotations, through schooling and clinical placements. Participant 1 (RN, HCC) shared:
Maybe just more, like not education, but more encouragement for like the home sector and the long-term care sectors because I really feel like our education just does focus on going to hospital and being a hospital nurse.
The meaning of the major theme of Building from Within was interpreted as comprised of four sub-themes: predictability and familiarity in change; contextual nuances of LTC/HCC; support for new graduates in transition; and equity, diversity, and inclusion.
Predictability and familiarity in change
Many participants described positive feelings associated with transitioning to practice in a somewhat familiar environment. Several nurses shared that their passion for the sector, whether LTC or HCC, was deeply rooted and longstanding. In most cases, participants chose to return to the same sector that they had previously worked in after completing their nursing bridging education program. Participant 5 (RN, LTC) shared, “It’s always been LTC.” Similarly, Participant 6 (RN, LTC) echoed:
You stick to what you know, right? So I’m used to long-term care, I know how that works, I know the order of things in long-term care. […] That’s always been my, that’s what I lean towards.
The familiarity and understanding of their workplace sectors may have facilitated the transition into their new roles for some of the new graduate nurses. Participant 4 (RN, LTC) noted, “I think I had a good grasp of the role. I already knew what I was getting into because of my previous experiences, like working with older adults in long-term care. So, there wasn’t a lot of surprises for me.”
Several participants noted the influence of supportive colleagues within their workplace, which seemed to ease the evolution into their new roles. Nevertheless, while the setting might be somewhat known, the new responsibilities associated with the role often remained uncharted territory. For most participants, there was a palpable tension in the transition between fear (of the new and unknown) and familiarity (of the sector). Participant 4 (RN, LTC) exclaimed, “It’s scary and a nice feeling at the same time, I could say. Sometimes I doubt myself, like I might not know the right answer, and that there’s not really anyone else to turn to.” Similarly, Participant 1 (RN, HCC) commented, “It’s an interesting dynamic as a new grad, especially coming from an RPN to RN; the expectation that people hold on you and the pressure that you feel sometimes.” A newly registered RPN working in LTC (Participant 11) noted that encountering tasks she used to do was a tangible reminder that things had changed, stating “several times, especially when I’m there at work. I see what I used to do, so I remember when I was doing that, it’s a different rule for what I’m doing now, so it’s like a new transition for me.”
Each participant demonstrated a connectedness with his or her sector of employment. While new nursing roles came with novel and varied challenges, the contextual familiarity, in some senses, offered predictability through an otherwise unpredictable transitional period.
Contextual nuances of LTC and HCC
Several participants noted distinctions of the LTC or HCC sectors, particularly relating to systemic constraints, which reverberated through their experiences in transitioning to work in their new roles. One nurse felt that addressing challenges in LTC was as multifaceted as the residents they served:
There is no blanket fix. There needs to be a system that is mouldable, that is flexible, that is adjustable to each individual home. […] It should never be an aspect of dollar over quality of life, right? That should never be a question that comes into question when you’re thinking about resident needs. [Participant 10, RN, LTC]
The impact of funding on quality care provision was raised by numerous individuals in the study. Many of the nurse participants shared how the lack of resources impacted nurses’ wages, which in turn adversely affected staffing. One RN in HCC (Participant 12) stated that, despite her passion for community care, the compensation in HCC might not be sufficiently adequate to stay, stating “the community is the best. […] I don’t want to leave the community because I love it, but the community don’t pay enough. I will stay with the community as part time, but I still will go and find another job to fill in the income gap.” For others, the low wages assigned to direct-care nurses served as a motivating drive to pursue different roles in nursing, including care coordination and quality assurance. Participant 3 (RN, HCC) stated, “In the community, nurses don’t get paid enough. It’s not worth it for me.”
Participants noted that client quality of care ultimately suffered as a result of resource limitations. Some specifically highlighted distinctions between non-profit and for-profit organizations as well. In an articulate and pointed comment, Participant 5 (RN, LTC) shared:
Seniors need the utmost care, and we’re not giving it to them. Being in the for-profit side of long-term care is abysmal. I mean, it’s how to clear the lowest bar and not get dinged by the government, right? It’s like how to squeeze the dollars and how to convince people to be here for the least amount of money. It’s very tough and very disheartening.
Several participants alluded to changes in the healthcare system that have directly impacted the client demographic and (higher) acuity of their ailments. For instance, Participant 4 (RN, LTC) noted:
It’s challenging. We’re having a lot of more complex care residents who have more demanding needs coming from hospital. […] I think the demographic is changing in long-term care. And so we kind of have to adjust our knowledge and our time to attend to those needs.
For many nurses in this study, it seemed the experience of transitioning into their new roles – through advancement of their knowledge and designations – felt like an opportunity to fulfill their desires to make a real difference in the sectors and for the people that they cared so passionately about.
Support for new graduates in transition
The notion of support for new graduate nurses transitioning to new professional nursing roles was raised by each participant. Participants emphasized how difficult the first several months of their new roles were while trying to accumulate mass amounts of clinical knowledge in a steep learning curve. Positive sources of support were particularly salient and demonstrated through stories of supportive mentors, colleagues, and management. As an RPN in LTC, Participant 6 noted, “Everybody is helpful. I’ve made so many friends there. […] Even if they were busy, they will come and walk me through. They are really supportive in there.” Participant 3 (RN, HCC) exclaimed, “I would have quit this job if I wouldn’t have been in this [return-of-service] contract, like the only thing that kept me here was my peers because they are amazing.”
Having a dedicated mentor to facilitate learning of new tasks was especially valued. Participant 9 (RPN, LTC) shared the value she felt from having a committed mentor over a more prolonged period during orientation. She recalled, “I have a mentor, I have my arrow and always guiding me with whatever I’m doing. […] I’m just beginning to start the process on my own right now, but with my mentor, which is my arrow, still pointing me through whatever I feel I’m not comfortable doing.” Similarly, Participant 2 (RN, HCC) noted, “If you don’t know how to do some procedure, they organize a buddy visit. So you go with another nurse to see and they teach you so many visits to do something. That was good. Especially for the new grad because you don’t know much after school.” […] Nursing is a lifelong learning process.”
It seemed all participants in the sample herein would advocate for more extended and comprehensive orientation and onboarding processes for these new role transitions. Participant 6 (RPN, LTC) suggested:
It would help if you had a 12-week program where they’re just giving you training on what you need to do. You have that support system, you’re still practicing as a nurse, but you have that support system in place.
Unfortunately, accessing prolonged orientation periods with dedicated mentors was not always possible. In most cases, participants related these shortcomings again with limited resources and staffing shortages. Participant 10 (RN, LTC) noted,
To be honest, my transition over to being an RN was so hectic. I don’t think there was anything. I wouldn’t even say I’ve officially started onboarding, I’ll be fully honest. […] I was working my new role and my old role just because there was no one to backfill me.
One participant drew a distinction between her experience with onboarding in her country of origin, which was vastly different from her most recent experience in Ontario.
In my country, we have three months of training and up to six months of training. Here in Canada, you have a maximum of two weeks. […] In my opinion, this is not enough training for nursing, especially in your grad nursing; you need more training, you need more time.[Participant 12, RN, HCC].
Through these stories, participants suggested that support from significant others at work would enhance their abilities to confidently and effectively fulfill their new roles.
Equity, diversity, and inclusion
When asked to describe stories of experiences that demonstrate what it is like to be a nurse in LTC or HCC, some participants in this study shared striking examples of stigmatization and hostility experienced by virtue of their race, ethnicity, outward appearance, or language. One participant who had many years of nursing experience in a different country described feeling disadvantaged in job interviews because of a language barrier.
When you apply for a new job, and you have an interview, and you feel they don’t like you, and because of the English barrier, you want to maybe tell more than you can. […] This is when I feel helpless. [Participant 12, RN, HCC]
Another nurse shared a detailed example of an interaction she had, prior to entering her nursing bridging education program, with a client with dementia who had never experienced a caring interaction with a Black caregiver. She shared,
You know nothing prepared me. […] In that moment, it was like a fight or flight. I wasn’t sure what to do because now, and something inside me said, ‘oh, maybe this man never had a black PSW. And he has dementia.’[Participant 7, RPN, HCC].
She went on to suggest that healthcare providers in LTC and HCC could benefit from greater training on microaggressions in the workplace as part of their educational programs, and be provided with evidence-informed recommendations on how best to respond to them.
We teach our PSWs, we’re not only just teaching them activities of daily living, bathing, washing. Let us teach them to be prepared that people might act differently or act in a way that, like human behavior. It could be anything, but the readiness is what matters. […] Know that some of them might not be receptive of you. Now, when they’re not receptive of you, what would you do differently? [Participant 7, RPN, HCC]
These participants seemed to associate the encumbrances relating to (in)equity, diversity, and inclusion as challenges to their desire to fulfill their ultimate goals of providing quality care and serving others.
Work-life balance
The final theme, Work-Life Balance, represented participants’ considerations of their new roles as they ‘fit’ within their lives on the whole. Each participant raised the idea of striving for balance between their personal and professional lives. For example, Participant 1 (RN, HCC) noted,
I feel like my work-life balance is going to improve a lot. […] I don’t have on call, I don’t do evenings […] so that is going to be like immensely different, so I feel like it’s going to benefit like my mental health, which was becoming a problem with just work and not being able to relax.
For many, their new roles afforded them opportunities to achieve a better balance than they had held previously. Participant 3 (RN, HCC) shared, “That’s something that when I finished school was, like, my motivation towards having a better work life balance. […] It was definitely part of the reason I even started my RN. It was one of the reasons that it just made it worthwhile for me to do the bridging program.”
Several participants connected improved work-life balance to working within LTC or HCC, as compared to acute hospital care, especially with the shiftwork attendant to the acute setting. Participant 6 (RN, LTC) shared, “With long-term care, the shifts are just eight hours. And it’s just five minutes from my house. I can even come home for lunch. […] Long-term care is more for me like my work-life balance is perfect. I love it.”
For one individual who claimed to have no work-life balance, this appeared to be by choice and served, for him, as a reflection of the leadership traits he held in high regard.
I am very famous for having no work-life balance. I always want to be available. It’s just the type of leader that I am. […] I think it’s just something that is just– that’s who I am. [Participant 10, RN, LTC]
The significance of the major theme of Work-Life Balance was understood as inclusive of three sub-themes: responsibilities of everyday life; perspective changes with burnout; and flexibility and stability.
Responsibilities of everyday life
Several participants in this study shared that they had family responsibilities, including children or other dependants, which contributed to their yearning for better balance between their personal and professional lives. For Participant 7, an RPN, the duties of HCC suited her schedule with seeing her children, “A better work-life balance. […] I don’t know if it can be better than this. So far so good, like so far it works, right? […] I prefer to work when my kids are at school and then when they’re all back at four I am also back home.” Similarly, Participant 6 (RN, LTC) recounted, “I try to make balance and be there for them, if they have anything to do at school, I try to be there. It’s hard when you have three teenagers, because everybody wants to do something else, but I try to be there for every individual.”
Some of the participants in this study reflected on how family life, and having a parental role, seemingly changed their attitude toward work-life balance as well. Participant 5 (RN, LTC), a parent of two children, commented:
Work-life balance, and it’s that triangle where you get paid, you have good work-life balance, or you’re chasing your ambitions and your aspirations, right? And you can only have two. […] Now, for me, it’s work-life balance and money. […] For my family and for my values, those are the two of the triangle that I need to sort of highlight and do. So work-life balance is actually really good.
One of the younger nurse participants shared about her dream to have children and the opportunities for family planning that her new role and organization provided:
I am at the stage of life where like I am looking forward to having kids. […] I feel like it can be like a long-term job that I would be happy that I’d be able to support a family and then stuff like that. [Participant 1, RN, HCC]
The intonations of participants’ stories highlighted that the responsibilities of personal and family life, rather than seeming obligatory or binding, were momentously important. Through educational advancement and bridging and career selection, these individuals seemed able to find roles that enabled them to fulfill both their personal and professional ambitions.
Perspective changes with burnout
An important contextual consideration for participants was that they all had worked in healthcare – and many were in school as well – through the height of the COVID-19 pandemic. A combination of situational stress and overwork contributed, in many cases, to extreme fatigue and ultimately burnout. Many participants shared how those experiences transformed their perspectives and attitudes toward work. Participant 1, an RN in HCC, shared, “I was feeling burnt out with just constantly feeling like I was working the job […] It was weird to have your mental perspective change from being burnt out.” Similarly, Participant 5 detailed the emotional toll of working through harsh pandemic conditions:
I flamed out and I had to take a leave. So, yeah, it was very tough. […] I crashed and burned. So my perspective shifts, right? […] There’s been a lot of value shifting and I don’t want those things anymore, right? […] I do not need the acclaim, I do not need the titles, my goal now is to feel in line with my values as a person, as a professional, and to have the time and money to be with my children. […] It’s a journey, and it’s just sort of being healthy and recognizing when you’re not and what to do going forward.
Several participants also alluded to a sense of overwhelm and fatigue that built throughout their nursing bridging education programs, which continued as they launched into their new roles as well. Participant 11 (RPN, LTC) noted, “There was not much life. There was mostly school and work and nothing in between.” Similarly, Participant 3 (RN, HCC) said:
There was zero balance. During the school year it was like no days off, like at all, like zero days off. […] It was tough. I wouldn’t recommend it, there’s like zero life going on whatsoever.
Completing their nursing bridging education programs and transitioning into new roles offered the promise of freedom for many nurses. Participant 12 (RPN, LTC) shared, “You can be free of studying and you can make money and live your life. Because during the study you have no life.” This newfound freedom seemed to provide participants with a sense of fulfillment in being able to recharge their personal and professional reserves after experiencing tremendous burnout.
Flexibility and stability
Many participants praised the flexibility afforded to them by their workplace setting or employers, which enabled them to better manage work and school responsibilities. In the HCC sphere, Participant 1 (RN) shared,
One day I didn’t start my work day until 12 because I had an exam at like 9:30 […] With home care you have that flexibility so that was really good whereas if you were a nurse at the hospital you would have to have taken the whole day off.
This sentiment was echoed by others whose workplaces allowed for flexibility and split shifts, so long as the job responsibilities and patient care were met. Further, virtual or remote schooling facilitated such flexibility as well.
If I wasn’t in a community, I wouldn’t be able to go to school at the same time and leave, right? Because the hours are flexible, you can always work with your supervisor. […] That’s the advantage I see over community, over the hospitals, actually. It works for me. I’m not even thinking any other way this life can be. [Participant 7, RPN, HCC]
Similarly, Participant 3 (RN, HCC) shared:
Nursing school is kind of a tough one usually, like as a rule. […] I was also combining it with a full-time job as RPN. So that kind of complicated things a bit […] but just the fact that I work in the community kind of makes it way more flexible than for example, doing a shift at the long-term or a hospital. […] We had that online schooling, that’s actually helped too. I liked it.
Flexible work schedules also facilitated quality time outside of work. For Participant 8 (RN, HCC) working in the community was “Just enabling. […] It’s just nice to have the flexibility to be with my family. Family is everything to me. It gives us the flexibility to spend time with them and be with them.”
Overall, the participants in this study seemed to perceive the transition to practice into their new roles as a multifaceted and transformative experience through which they were able to fulfill their ambitions, enact their commitment to benevolence, engender internal growth and development in the sector, and maintain balance with their passions outside of work. The sense of fulfillment proposed in this study extended to both fulfillment of personal and professional goals and realizing a deep intrinsic drive to provide compassion and care to their clients, their families, and themselves.
Discussion
This study explored the meaning of the experience of transitioning to working in the LTC and HCC sectors for new graduate nurses of nursing bridging education programs. This research aimed to extend beyond taken-for-granted understandings to present a co-constructed interpretation of how shifting into new nursing roles within the LTC and HCC sectors is experienced by nurses graduating from these programs. For the new graduate nurse participants in this study, the findings suggest that the meaning of their experience was lived through a deeply ‘felt’ sense of fulfillment. The fulfillment in this transition was further comprised of: Benevolence; Growth, Eagerness, and Anticipation to Learn; Building from Within; and Work-Life Balance.
For the cohort of nurses in this study, the opportunities for fulfilling their passion to care for others through deep relationship building, and the sense of benevolence resulting from such work, seemed to be a major driver toward pursuing new nursing designations and electing to (re)enter LTC or HCC settings after graduation. It may be argued that all nurses are driven by a calling to care for others [62]; however, it has been proposed that positive and professional reciprocity in nursing – the exchange of providing care and receiving benefit from sensing the care receiver’s experience of being cared for – may be an especially unique characteristic of the activity and motivation of caring within aged care settings such as LTC and HCC [63, 64]. It has also been suggested that previous attempts to address staffing shortages in residential aged care settings have focused on the quantity of staff as opposed to attending to the quality of candidates who would be best suited to the specific skills and competencies required for work in these settings [65]. The most recent annual report from the Office of the Auditor General of Ontario [11] emphasized that, while caring for the physical health of residents is essential in LTC, ensuring the care provided encompasses the mental, social, spiritual, cultural, and connectedness needs of individuals is equally important. Adams and Sharp [63] proposed that a component of professional reciprocity involved specific cognitive skills, including relationship building and facilitating reciprocation through communication, which can be taught and learned. The findings from the present study suggest that a potential avenue for enhancing recruitment and retention of skilled nurses best suited to work in LTC and HCC may involve providing more specific education and training on reciprocal communication, particularly with older adults and other individuals who would be care recipients within these sectors.
In addition to the sense of fulfillment perceived by participants through their engagement with clients in LTC and HCC, the nurses herein attached meaning and significance in their work in LTC and HCC to their advanced education and leadership through their role transitions; this was demonstrated through repeated emphasis on continued lifelong learning, seen as tantamount in the nursing profession. One Delphi study conceptualized the notion of lifelong learning for nurses as including appreciation of new perspectives and interrogation of existing knowledge and practices, both personally and professionally [66]. Further, Mlabo et al. in their metasynthesis [67] found elements that contribute to lifelong learning – including supportive organizational culture and workplace environment, positive attitudes and personal motivation of nurses – and recognized the impact of continued education on professional practice and improved patient care. Defining characteristics of lifelong learners have previously been identified as: reflectiveness, engagement and enjoyment in learning [66]. It is worth acknowledging that this persistent push toward further achievement may also stem from a current culture within which overworking is glamorized, leading to emotional depletion and the so-called ‘burnout epidemic’ [68]. The findings from the present research suggest that positioning nursing bridging education programs as offering opportunities for career advancement and as an avenue for enhanced recruitment and retention of nurses would emphasize the sense of fulfilment and enhanced work-life balance for nurses, rather than achievement for the purpose of garnering accolades alone.
Participants in this study returned to LTC or HCC workplaces where they had previous work experience, emphasizing that their pursuit of career advancement was fuelled, in part, by a desire to build and enhance these sectors. For many nurses with goals set on leadership in their organization or sector, transitioning back into the setting might have offered them new opportunities in a familiar environment with support from colleagues, mentors, and administration. The significance of mentor-mentee connection for supporting nurses through education and in transition to work has been previously emphasized in a recent scoping review of nursing bridging education programs [8]. A 2024 ‘Nursing Retention Toolkit’ designed to improve the working lives of nurses in Canada also highlighted guiding principles of professional development and mentorship (i.e., strong management and communication) as essential strategies in targeted efforts to enhance nurse retention [7].
Empowering nurses to experience fulfillment in their vocation and develop into leaders has been emphasized as a goal of retention efforts in the nursing field [7]. Findings from the present study support the importance of receiving personal and professional fulfillment in professional role transitions. Furthermore, the findings suggest that tactfully connecting educational opportunities to enhance skills in nursing bridging education programs with prospects of returning to pursue career goals in the LTC and HCC sectors through extensive mentorship programs may add personal significance to nurses’ decisions to pursue transition programs. Highlighting the prospect of building from within – both personally and professionally – with support from the organization and sector may enhance existing retention strategies.
Finally, new graduate nurse participants in this research spoke at length about considerations of their new roles as they ‘fit’ within their lives overall, underscoring the impact of striving for balance between their personal and professional lives. Several previous studies have identified the connection between work-life balance (or lack thereof) with nurses’ job satisfaction [69], quality of life [70], and intentions for retention [71]. It has even been suggested that achieving a sense of work-life balance may lead to decreased intentions to leave, encouraging enhanced retention among nurses [72]. The findings from the present study further contribute to understanding the complexity and nuance of work-life balance. For this cohort of nurses, recognizing responsibilities of everyday life – including familial and home responsibilities – and appreciating perspective changes, which may have been influenced by burnout, seemed to be of utmost importance through the role transition process. Appreciating the larger lifeworld circumstances of individual nurses may facilitate more thoughtful and evidence-informed creation of retention strategies. Addressing work-life balance through organizational health and wellness support programs as well as flexibly balanced schedules may be one strategy toward enhanced retention [7]. Nevertheless, creating supportive workspaces for nurses in LTC and HCC must also help address current staffing issues. Greater political support will likely be needed to address challenges relating to systemic constraints, limited resources, pay disparities, and inclusion [7, 73].
Limitations
The research described herein was undertaken within a specific sociocultural and temporal context across the province of Ontario and, thus, must be interpreted within that context. The findings of phenomenology are co-constructions developed through contribution and interpretation of both researchers and participants. Therefore, the findings must not be wholly generalized or simply rendered to all new graduate nurses in other contexts.
While the researchers made multiple attempts to connect with all participants for follow-up interviews, only eight of the original 12 participants partook in a second interview. The research team aimed to include follow-up interviews to allow participants to revisit and reflect upon their experiences and delve further into the possible significances of the emerging experiential themes. After completing eight follow-up interviews, no further theme refinement appeared to emerge, suggesting the findings were satisfactorily rich and complex; thus, sufficient ‘information power’ was considered to be achieved and data analysis was finalized [74]. While it would have been preferable to retain all participants for follow-up discussions to ensure resonance and reflexivity, the authors contend that the inclusion of all interviews (including the four participants who did not take part in the follow-up interviews) by virtue of offering multiple perspectives and exploring different facets of participants’ experiences in-depth, added substantial richness to the layers of understanding about the phenomenon under analysis. Part of the challenge in orchestrating follow-up interviews with participants may have reflected the time passed between interviews, as recruitment of participants was exigent.
Additionally, all interviews and follow-up interviews were conducted virtually via Zoom. This format was selected to facilitate meeting times with new graduate nurses with busy schedules and suspected limited availability. This format also enabled inclusion of participants from across the province of Ontario so as not to limit the findings to one isolated geographic location. Nevertheless, the research team recognizes that telephone calls or video calls are not considered to be the preferred method for interview conduct as they may limit connection that is naturally developed through face-to-face interaction [75, 76]. Future research might consider face-to-face interviews or direct observations with nurses to add insight into contextual and experiential nuances of transition to practice in LTC and HCC.
Future implications
Recognizing the significance of perceiving a ‘felt’ sense of fulfillment through role transition requires that decision-makers and nurses themselves reflect on how shifting into new nursing roles in the LTC and HCC sectors may be experienced. Moreover, if cultivating a sense of fulfillment is understood as an imperative aspect of role transition through nursing bridging education programs and transition to practice in LTC and HCC, consideration must be given to the implications of cultivating and promoting benevolence; growth, eagerness, and anticipation to learn; building from within; and work-life balance through educational and workplace opportunities.
Conclusion
Findings from this research offer rich insights contributing to better understandings of everyday practices for a cohort of nurses, which may challenge widely accepted ‘truths’ about transitioning to practice in LTC and HCC. By illuminating the nuances of this experience, the findings may encourage individuals to appreciate and act with care and discernment with respect to nursing in LTC and HCC, especially to promote greater recruitment and retention of nurses in these sectors. Knowledge gained from this research may impact key players’ (e.g., nurses, nurse educators, LTC and HCC employers, policy makers) decisions with respect to nursing bridging education program implementation, enabling nursing bridging education programs to shape the presentation of transition to practice more judiciously in LTC and HCC following completion of bridging programs, thereby supporting nurses’ entry to practice and commitment to remain working in these sectors.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
This research protocol received ethical approval from the University of Western Ontario research ethics board (REB# 2023-123271-81749). Informed consent was obtained from all participants in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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