Abstract
The transition from nursing student to registered nurse is fraught with challenges, including stress, knowledge gaps, miscommunication, and insufficient constructive feedback, which can cause uncertainty for new graduate nurses (NGNs). Although Just Culture principles are taught in nursing education, they are often difficult to apply in practice. The gap between theoretical knowledge and practical application can result in hesitation when reporting errors, communicating effectively with the healthcare team, or participating in quality improvement initiatives. This disconnect underscores the need for more robust support systems and education that bridge the transition from student to practicing nurse. This study aims to triangulate quantitative and qualitative data in a mixed-methods approach to examine perceptions of Just Culture during the NGN transition to practice and assess changes in these perceptions from student to NGN. Data on NGNs' transition to practice were collected using the Just Culture Assessment Tool and the Just Culture Assessment Tool for Nursing Education. Virtual interviews were conducted, and responses were analyzed using Colaizzi’s methodology. Five key themes emerged from the analysis: communication, error reporting, quality improvement, fear, and fairness and balance. While both students and NGNs report an understanding of Just Culture, challenges persist due to institutional and societal norms. Despite the foundational knowledge acquired during their education, NGNs often find themselves navigating environments where the practical application of Just Culture is hindered by established practices and attitudes. This disconnect between understanding and application highlights the need for ongoing support, mentorship, and systemic change to align organizational cultures with the principles of Just Culture, ensuring that NGNs feel empowered to report errors, contribute to quality improvement, and prioritize patient safety without fear of blame or retribution.
Notes
References: 1.Toothaker R, Rommelfaenger MA, Flexner RS, Hromadik L. The challenges of transition to practice expressed through the lived experiences of new to practice nurses. Patient Saf Journal. 2022; 4(4):11-17.doi: https://doi.org/10.33940/culture/2022.12.1
2. Smith CJ, DesRoches SL, Street NW, Hyatt J. New graduate registered nurses: Risk mitigation strategies to ensure safety and successful transition to practice. J Healthcare Risk Manag. 2022; 42(1):24-30.doi:10.1002/jhrm.21514
3. Barnsteiner J, Disch J, Johnson M, Spector N. Applying principles of a fair and just culture to a student scenario. J Nurs Education. 2023; 62(3):139-145.doi: https://doi.org/10.3928/01484834-20230109-03
4. Lee MD, Improving new graduate nurse retention with a transition to emergence nursing practice program. J of Emergency Nurs. 2024;50(2):178-186. doi.org/10.1016/j.jen.2023.11.003.
5. Riess D, Mersiovsky A, Gruhn C. Nurse educators perceptions and self-efficacy in response to COVID-19: a scoping review. Nurs Educator. 2023;48(2):E47-52. doi.10.1097/NNE.0000000000001342
6. Matlack P, Passero L. Nursing skills boot camp: enhancing the transition for new-to-practice RNs. Nursing Made Incredibly Easy! 2024;22(2)27-35.doi: 10.1097/nme.0000000000000037
7. American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. Accessed May 15, 2024.
https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
8. Barnsteiner J, Disch J. Creating a fair and just culture in schools of nursing. Am J Nurs. 2017; 117(11):42-48.doi:10.1097/01.naj.0000526747.84173.97
9. Reason J. Human error: models and management. BMJ, 2000;18;320(7237):768-70.doi:10.1136/bmj.320.7237.768
10. Van Marum S, Verhoeven D, De Rooy D. The barriers and enhancers to trust in a just culture in hospital settings: a systematic review. J Patient Saf 2022;18(7)e1067-e1075. doi:10.1097/PTS.0000000000001012
11. Walker D, Hromadik L, Baker M, McQuiston L. Nursing students transition to practice- a303 longitudinal study. Nur Educator. 2024;49(1):1-7.doi:10.1097/nne.0000000000001486304
12. Creswell J. Research Design: Qualitative, Quantitative and Mixed Methods Approaches. 4th ed. Sage Publication; 2014.
13. Shih F. Triangulation in nursing research: issues of conceptual clarity and purpose. J Am Nurs. 2001;28(3):631-641.doi:10.1046/j.1365-2648.1998.00716.x
14. Petschonek S, Burlison J, Cross C, Martin K, Laver J, Landis R, Hoffman JM. Development of the Just Culture Assessment Tool: measuring the perceptions of health-care professionals in hospitals. J Pt Safety.2013; 9(4):190-197.doi: 10.1097/pts.0b013e31828fff34
15. Walker D, Altmiller G, Barkell N, Hromadik L, Toothaker R. Development and validation of the just culture assessment tool for nursing education. Nurs Educator. 2019; 44(5):261-264. doi:10.1097/NNE.0000000000000705
16. Walker D, Hromadik L, Altmiller G, Barkell N, Toothaker R, Powell K. Exploratory factor analysis of the just culture assessment tool for nursing education. J Research in Nurs. 2021;26(1-2):49-59.doi:10.1177/1744987120951589
17. Neubauer B, Witkop C, Varpio L. How phenomenology can help us learn from the experiences of others. Persp Med Education. 2019; 8(2):90-97.doi:10.1007/s40037-019-0509-2
18. Praveena K, Sasikumar S. Application of Colaizzi’s method of data analysis in phenomenological research. Medico-legal Update. 2021;21(2):914-918.doi:10.37506/mlu.v21i2.2800
19. Heale R, Forbes D. Understanding triangulation in research. Evid Based Nurs. 2013;16(4):98. doi:10.1136/eb-2013-101494
20. Hampton D, Welsh D. Work values of generation Z nurses. J Nurs Adm.2019;49(10):480-486.doi:10.1097/NNA.0000000000000791
21. Serafin L. Danilewicz D, Chyla P, Czarkowska-Paczek B. What is the most needed competence for newly graduated generation Z nurses? Focus groups study. Nurse Educ Today.2020;94:104583.
doi:10.1016/j.nedt.2020.104583
22. Chicca J, Shellenbargwer T. A new generation of nurses is here: strategies for working with generation Z. Am Nurse Today. 2019;14(2):48-50. https://www.myamericannurse.com/new-generation-nurses/
23. Institute for Health Care Improvement. Quality improvement essentials toolkit. IHI.org. 2017. Accessed May 17, 2024. https://www.ihi.org/resources/tools/quality-improvement-essentials-toolkit
24. Rowan B, Anjara S, De Brún A, et al. The impact of huddles on a multidisciplinary healthcare teams' work engagement, teamwork and job s atisfaction: a systematic review. J Eval Clin Pract. 2022; 28: 382-393. doi:10.1111/jep.13648
25. Eguia S, Mohammed M, Potts M. The power of a team huddle during the COVID-19 pandemic. J Perianesth Nurs. 2022;37(4):e11-e12.doi:10.1016/j.jopan.2022.05.030
26. 7 Ways to Create a Positive Work Environment for Nurses. American Nurses Association. Published February 9, 2024. Accessed May 15, 2024. https://www.nursingworld.org/content-hub/resources/workplace/positive-work-environment/#:~:text=valued%2C%20and%20heard.-,Encourage%20Open%20Communication,sharing%20information%2C%20and%20encourage%20feedback.
27. Murray J, Clifford J, Scott D, Kelly S, Hanover C. Leader rounding for high reliability and improved patient safety. Fed Pract. 2024;41(1):16-21.doi: 10.12788/fp.0444.
28. American Association of Critical Care Nurses. Healthy Work Environments. Accessed May 15, 2024. https://www.aacn.org/nursing-excellence/healthy-work-environments
29. Benefits of Mentorship in Nursing: Why It’s Essential. American Nurses Association. Published May 19, 2023. Accessed May 15, 2024. https://www.nursingworld.org/content-hub/resources/nursing-resources/benefits-of-mentorship-in-nursing/
Sigma Membership
Mu Omega
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Transition to Practice, Onboarding, Workforce, Mentoring, Coaching
Recommended Citation
Baker, Manisa; Toothaker, Rebecca; Hromadik, Lora; Flexner, Randi; McQuiston, Linda; and Walker, Danielle, "Mixed Methods Triangulation: Applying Just Culture Principles in Nurses' Transition to Practice" (2025). Creating Healthy Work Environments (CHWE). 80.
https://www.sigmarepository.org/chwe/2025/presentations_2025/80
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Mixed Methods Triangulation: Applying Just Culture Principles in Nurses' Transition to Practice
Phoenix, Arizona, USA
The transition from nursing student to registered nurse is fraught with challenges, including stress, knowledge gaps, miscommunication, and insufficient constructive feedback, which can cause uncertainty for new graduate nurses (NGNs). Although Just Culture principles are taught in nursing education, they are often difficult to apply in practice. The gap between theoretical knowledge and practical application can result in hesitation when reporting errors, communicating effectively with the healthcare team, or participating in quality improvement initiatives. This disconnect underscores the need for more robust support systems and education that bridge the transition from student to practicing nurse. This study aims to triangulate quantitative and qualitative data in a mixed-methods approach to examine perceptions of Just Culture during the NGN transition to practice and assess changes in these perceptions from student to NGN. Data on NGNs' transition to practice were collected using the Just Culture Assessment Tool and the Just Culture Assessment Tool for Nursing Education. Virtual interviews were conducted, and responses were analyzed using Colaizzi’s methodology. Five key themes emerged from the analysis: communication, error reporting, quality improvement, fear, and fairness and balance. While both students and NGNs report an understanding of Just Culture, challenges persist due to institutional and societal norms. Despite the foundational knowledge acquired during their education, NGNs often find themselves navigating environments where the practical application of Just Culture is hindered by established practices and attitudes. This disconnect between understanding and application highlights the need for ongoing support, mentorship, and systemic change to align organizational cultures with the principles of Just Culture, ensuring that NGNs feel empowered to report errors, contribute to quality improvement, and prioritize patient safety without fear of blame or retribution.
Description
This presentation will identify the gaps between theoretical knowledge and practical application of Just Culture principles from nursing student to new graduate nurse (NGN). In addition to identifying the gaps, the team pinpoints interventions organizations can implement to promote Just Culture, therefore leading to NGNs feeling empowered to report errors, contribute to quality improvement, prioritize patient safety without fear of retribution, and provide excellent patient care.