title: Challenging graduate nurses' transition: Care of the deteriorating patient.
abstract: OBJECTIVE
  To explore graduate nurses' experiences of caring for deteriorating patients during the first year of practice.
  
  
  BACKGROUND
  Hospital-based transition programmes have been established to ease graduate nurse transition. Despite this, novice nurses persistently cite caring for deteriorating patients as a clinical challenge. Few studies have explored the unique needs of novice nurses during such encounters, even less research has been undertaken from their perspective.
  
  
  METHODS
  Qualitative interpretive phenomenological analysis.
  
  
  METHODS
  One-on-one, semi-structured, in-depth, audio-recorded interviews were conducted between July-November 2014. A purposive sample of eight novice nurses working in acute care, ICU and the ED was recruited through the use of flyers.
  
  
  RESULTS
  Three major patterns with related themes illuminate the experience of caring for deteriorating patients as it is lived by graduate nurses. Dwelling with uncertainty occurred during initial encounters with deteriorating patients with its deeply felt impact upon these novices causing them to question their capability of becoming a nurse. 'Success' or 'failure' of their performance during these encounters extended to their view of themselves as nurses and impacted transition. Building me up was influenced by participants' expressed need for and importance of trusted relationships with preceptors, nurse colleagues and/or educators as they learned to care for deteriorating patients. A new lifeline: Salient being emerged as change in participants' identity and increased self-understanding as professional nurses.
  
  
  CONCLUSIONS
  Caring for deteriorating patients impacted graduate nurses because they viewed such encounters to be 'high stakes' not only for their patient but also for themselves. Crucial to their development were trusted relationships with preceptors, nurse colleagues and/or educators.
  
  
  CONCLUSIONS
  The findings identify needs of graduate nurses' during a high-stakes patient encounter and shed light upon one aspect of transition. Clinical leaders may use the findings from this study to improve preceptor development and transition programme curricula.
authors: Department of Undergraduate Studies, School of Nursing, Stony Brook University, Stony Brook, NY, USA. carol.della-ratta@stonybrook.edu.
authors: Carol
authors: C
authors: Della Ratta
mesh_terms: D000328:Adult; D002321:Career Choice; D005260:Female; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D013727:Terminal Care; D055815:Young Adult
keywords: graduate nurse; interpretative phenomenological analysis; patient deterioration; qualitative research; role transition