Literature shows that the pandemic negatively impacted nursing education.1-7 Not only did it limit the clinical experiences and the practice of skills and procedures for nursing students,1-7 but it also restricted the workplace training of new graduate nurses (NGNs) entering the workforce.1,3,5 Other effects include reports of negatively influenced job and career opportunities1 and lack of clinical confidence5,6 by NGNs entering the workforce. Transition to practice for NGNs, pre-pandemic, was known to be difficult.8 Perceived readiness-the attitudes and characteristics that aid in successful workplace adaptation-is an important aspect of NGNs9 as they account for the highest numbers of nurses entering and exiting the profession.10,11

The existing nursing shortage, a rise in enrollment in nursing programs, and a lack of sites for clinical learning experiences have led to shifts in alternative clinical experiences during school, such as night shifts, which can ease the transition for NGNs entering the workforce.4 Those who entered amid the pandemic may benefit from extended time with a preceptor and targeted opportunities for clinical reasoning, management of multiple patients, effective communication, and safe skill performance.3 One literature review found consensus for the need for supportive environments for NGNs transitioning from school to practice.5

The Honors Program in my bachelor's of science in nursing (BSN) program required me to complete a research project with the guidance of a faculty mentor. While exploring potential research project topics, I reflected on the challenges I experienced as a nursing student amid the COVID-19 pandemic, particularly my difficulties and frustrations with limited time for hands-on lab and clinical exposure. These challenges were similar to those noted in the background literature I reviewed. As such, it made me curious how NGNs navigated their careers as they transitioned into their RN roles during the pandemic, notably those entering the workforce and nurse residency programs. I was particularly interested in couplet care (also known as mother/baby care), which is focused on the bonding and well-being of the mother and baby during the first stages of the postpartum period that begins immediately upon the birth of the newborn.14 Through my project, I sought to understand the preparedness of NGNs as they transitioned into couplet care during the pandemic.

This article presents my reflections on the project's design, implementation, and analysis processes and suggests possibilities for future research.

Project overview

I designed an internet-based survey for NGNs. The survey had 11 questions: 8 Likert-style and 3 free-response.

I recruited participants through convenience sampling by advertising on my school of nursing's social media accounts that included access to the study information survey via an electronic link I specifically targeted couplet care RNs who graduated between 2020 and 2021.

Due to academic time constraints, the survey was only active from June 1 to June 30th of 2022. Text responses to open-ended questions were evaluated using summative content analysis as described by Hsieh and Shannon.15 I used a spreadsheet to tally common concepts or keywords and organize thematic content and then discussed identified keywords and explored interpretations of the underlying text content with my mentor. These keywords related to clinical rotations, simulation or lab experiences, and course content. Participants could not validate the content due to the anonymity of the survey responses.

Learning from the results

Twenty-five nurses completed the survey. All responses were reviewed and interpreted for insights into the nurses' perspectives on entering the workforce during a pandemic.

The themes of clinical rotations, simulation or lab experiences, and course content were identified in responses to questions about the overall readiness provided by a nursing program.

Lessons learned from project execution and methodology

This was my first attempt at developing a survey. The lack of definition or guidance to classify the residency program type within the recruitment instructions and the survey questions limited the results' analysis and generalizability. Participants may have interpreted a residency program in multiple ways, such as a capstone experience, a clinical placement in school, or an orientation program. Furthermore, the definition of a specialty nursing career lacked an explanation for respondents.

Several demographic questions lacked the clarity for participants to provide specific responses and would benefit from revision. For example, different educational tracks to the BSN (traditional, second degree, and RN-BSN) attract students with varying academic and work experiences that were not considered in my survey development. Race or ethnicity was not collected, limiting the results by a lack of known identifiers and diversity. A question about hospital size lacked specificity to determine trauma level or urban versus rural designations. Various text and numerical responses for estimating the number of clinical hours for obstetric and pediatric courses need clarification.

Future questions should focus on the specialty care of interest (such as couplet care) versus disease processes. Mixed responses in the last two questions revealed a potential lack of question clarity for respondents. A missed opportunity was not reviewing previously validated studies or tools to create my survey.

The survey results did not support generalizability beyond the respondent group. A future survey would benefit from revisions and a longer collection time to provide sufficient responses to meet saturation. While half of the responses were from NGNs not involved in couplet care, they still wanted to share their thoughts on their experiences. More information could be gathered from NGNs regarding residency programs and the impact of the pandemic in all practice areas.

Suggestions for further investigation

More research must explore the impact of simulation on nursing education and skill development during the pandemic. Literature on the effectiveness of virtual clinical experiences, such as web-based applications with a combination of media for interactive learning experiences, is limited.7 However, a systematic review of virtual or web-based simulation applications supports these as effective teaching and learning tools comparable to in-person simulated experiences.12 One study found that the pandemic negatively impacted students' confidence in skills due to outside stressors and remote learning challenges.13 Conversely, a study of readiness for practice in nursing students who had their clinical experiences replaced with virtual experiences during the pandemic found that virtual clinical experiences positively impacted the NGNs' transition to practice.7

Finally, my project would have benefited from the Nursing Practice Readiness Scale (NPRS) to understand an NGN's educational level and needs for additional support in transitioning from school to a work environment.9 The NPRS includes clinical judgment and nursing performance, professional attitudes, patient-centeredness, self-regulation, and collaborative interpersonal relationships, which are important considerations for NGNs' successful transition and employment longevity.9

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