The transition from nursing student to professional clinician is a critical period for new graduate nurses (NGNs). As highlighted by the research, this phase is often described as arduous, stressful, draining, and demanding. Understanding the specific challenges NGNs face is essential for fostering a supportive environment that promotes their growth, confidence, and ultimately, patient safety. Drawing on recent studies, several key factors impede this transition, significantly impacting their ability to provide optimal care.

Lack of Confidence and Feeling Unprepared A primary barrier for many NGNs is a profound lack of confidence and the feeling of being unprepared for the realities of clinical practice. Studies indicate that the majority of newly graduated nurses do not feel prepared to work at the bedside.

There is often a perceived gap between theoretical knowledge gained in university education and the practical demands of a real work environment. This feeling of being unprepared extends beyond general clinical work to specific areas such as mastering practical skills, communicating effectively with physicians and patients, delegating tasks, setting priorities, organizing patient care needs, and even making suggestions to the plan of care.

Concerns about this lack of confidence are numerous in the literature, and it can feel debilitating. For some NGNs, particularly those who completed their degrees in online environments during the COVID-19 pandemic, this mode of education also contributed to a lack of confidence. Participants in studies have expressed feeling incompetent and incapable, questioning their clinical abilities.

🩺 Fear of Making Mistakes Closely linked to a lack of confidence is the prevalent fear of making mistakes. New nurses commonly experience stress and anxiety, which research indicates is directly related to an increase in nursing errors. The fear of harming patients significantly reduces their self-confidence.

Apprehension of failure in independent caretaking is a significant subcategory of their experience. NGNs may not fully understand the immense amount of responsibilities that come with the job, including the potential for even a small error to cost a life. This apprehension and perceived incompetence can lead to anxiety and stress, feelings of insecurity, and performance anxiety. Participants have described concerns about their self-doubts regarding their ability to put what they learned into practice and their fear of not reacting quickly or properly in certain situations.

Lack of Support and Educational Opportunities Another critical challenge identified in the research is the lack of adequate support and educational opportunities. New nurses often perceive a lack of support from some managers, which can decrease self-confidence and increase anxiety. There can be minimal educator initiation or completion expectations for required competencies in graduate programs, leaving NGNs questioning the program's offerings. Some new nurses reported that orientations or continuing education opportunities in their workplaces were lacking or not provided at all.

During the pandemic, the absence of educators sometimes led to situations of accelerated learning or self-education. Lack of preceptor support was also reported, occasionally resulting in an immediate transition to being an independent nurse without adequate guidance.

Participants have also shared that the workload on experienced nurses made it difficult for them to be supportive, sometimes leading to frustration when new nurses asked questions, which in turn made the new nurses hesitant to ask. Reduced, delayed, or lost education due to the pandemic, such as the replacement of face-to-face teaching with online sessions and the re-deployment of educators, further compounded these issues.

The Consequence: Errors and Patient Harm The confluence of these factors – a lack of preparedness and confidence, coupled with insufficient support and educational opportunities – directly contributes to the risk of errors in clinical practice. The sources indicate that stress and anxiety are directly related to an increase in nursing errors.

Lack of clinical experience and complexity can cause functional anxiety and insufficient mastery of the work can lead to "clogging" or difficulty functioning effectively. Doubt and hesitation in decision-making, stemming from a lack of experience and knowledge, are also highlighted. Participants have stated that committing errors due to weak knowledge reduces their professional self-confidence. Nurses face conflicting challenges in choosing decisions, especially in critical situations, due to the fear of errors and the possibility of making wrong decisions.

The consequences of these errors are significant. Novice nurses are frequently left out of professional standards and commit errors, negligence, and ultimately malpractice in clinical environments. The fear of harming patients reduces their self-confidence. Crucially, the lack of self-confidence in novice nurses reduces the quality of care. Studies have shown that the lack of preparation and fear of harming patients negatively affects their ability to provide quality care.

During the pandemic, clinical educators observed that NGNs struggled with basic nursing skills, a lack of proficiency attributed to missing clinical hours with real patients and providers in clinical settings. This lack of hands-on experience was a significant barrier and prolonged the time needed to safely orient and transition these NGNs into independent practice.

What Healthcare Leaders Can Do: Invest in Practice-Ready Training These research findings are more than academic they’re operational risk indicators. If new nurses are entering your workforce unprepared, unsupported, and afraid to speak up, the consequences don’t stay in the classroom. They show up on your units in your outcomes, your turnover rates, and your safety reports.

This is exactly why I founded Lifebeat Solutions: to help hospitals bridge the readiness gap with training that actually prepares nurses for the realities of clinical care. Our online courses are built around the skills that reduce harm and build retention: clinical judgment, communication, prioritization, and safe escalation.

Hospitals that implement our training report not just increased nurse confidence but fewer near misses, stronger team coordination, and faster onboarding timelines. Because when nurses know what to do and feel safe doing it every metric improves.

If your new grads are struggling, you don’t have a talent problem. You have a training opportunity. And we can help.

💡 I’d love to hear from you: What’s one thing your hospital has done or needs to do to better support new nurses in their first year?

Visit our website https://drjuliesiemers.com/lifebeat-solutions/ and book a consultation with us. For inquiries, you can also reach out via email at [email protected].

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