Other Titles
Rising Star Poster/Presentation
Abstract
Aim: To develop a grounded theory explaining how newly graduated nurses build professional confidence during their transition to practice.
Background: Professional confidence is crucial for newly graduated nurses, particularly when handling uncertainty, advocating for patients, and remaining in the workforce; however, confidence is often viewed as an individual trait or outcome, which limits understanding of how it develops in practice.
Methods: Constructivist grounded theory was employed. Twelve recently graduated nurses in acute care settings participated in in-depth semi-structured interviews. Data collection and analysis occurred simultaneously, utilizing constant comparison, line-by-line and focused coding, memo writing, and theoretical integration.
Results: The core category, Borrowing-to-Owning Professional Confidence, explains confidence development as a socially constructed process in which new graduate nurses initially borrow confidence from peers, preceptors, leaders, and organizational structures and gradually own confidence through patterned clinical reasoning, emotional regulation, and professional entrustment. Six interrelated processes explain this progression: Belonging and Feedback-Looping; Scaffolding Autonomy; Patterning into Credible Voice; Adjusting Confidence; Entrusting Identity; and Regulating Emotion and Advocating Early.
Conclusions: Confidence develops through ongoing relational and organizational processes rather than as a fixed personal trait. This theoretical model offers an actionable framework for designing transition-to-practice environments that intentionally foster psychological safety, support autonomy beyond orientation, and enhance early advocacy practices to improve retention and patient safety.
Notes
References:
Abusubhiah, M., Walshe, N., Creedon, R., Noonan, B., & Hegarty, J. (2023). Self efficacy in the context of nursing education and transition to practice as a registered practitioner: A systematic review. Nursing Open, 10(10), 6650–6667. https://doi.org/10.1002/nop2.1931
Charmaz, K. (2025). Constructing grounded theory (3rd ed.). Sage.
Charmaz, K., & Thornberg, R. (2021). The pursuit of quality in grounded theory. Qualitative Research in Psychology, 18(3), 305–327. https://doi.org/10.1080/14780887.2020.1780357
Duchscher, J. E. B. (2009). Transition shock: The initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing, 65(5), 1103–1113. https://doi.org/10.1111/j.1365-2648.2008.04898.x
Eckerson, C. M. (2018). The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence-based literature review. Nurse Education Today, 71, 84–90. https://doi.org/10.1016/j.nedt.2018.09.003
Hallaran, A. J., Edge, D. S., Almost, J., & Tregunno, D. (2023). New nurses’ perceptions on transition to practice: A thematic analysis. Canadian Journal of Nursing Research, 55(1), 126–136. https://doi.org/10.1177/08445621221074872
Kee, K., & De Jong, D. (2022). Factors influencing newly graduated registered nurses’ voice behaviour: An interview study. Journal of Nursing Management, 30(7), 3189–3199. https://doi.org/10.1111/jonm.13742
Kepplinger, A., Braun, A., Fringer, A., & Roes, M. (2024). Opportunities for nurses to address employee voice in health care providers: A scoping review. BMC Nursing, 23(1), 651. https://doi.org/10.1186/s12912-024-02331-y
Lay, K. S. M., & Masingboon, K. (2025). Turnover prevalence and the relationship between transition shock and turnover intention among new nurses: A meta-analysis. International Journal of Nursing Studies Advances, 9, 100390. https://doi.org/10.1016/j.ijnsa.2025.100390
Lee, M. M. D. (2024). Improving new graduate nurse retention with a transition to emergency nursing practice program. Journal of Emergency Nursing, 50(2), 178–186. https://doi.org/10.1016/j.jen.2023.11.003
Miao, C., Liu, C., Zhou, Y., Zou, X., Song, L., Chung, J. W. Y., Tan, W., Li, X., & Li, D. (2024). Nurses’ perspectives on professional self-concept and its influencing factors: A qualitative study. BMC Nursing, 23(1), 237. https://doi.org/10.1186/s12912-024-01834-y
Mohamed, Z., & Al-Hmaimat, N. (2024). The effectiveness of nurse residency programs on new graduate nurses’ retention: Systematic review. Heliyon, 10(5), e26272. https://doi.org/10.1016/j.heliyon.2024.e26272
Ortiz, J. (2016). New graduate nurses’ experiences about lack of professional confidence. Nurse Education in Practice, 19, 19–24. https://doi.org/10.1016/j.nepr.2016.04.001
Perry, P. (2011). Concept analysis: Confidence/self-confidence: concept analysis: self-confidence. Nursing Forum, 46(4), 218–230. https://doi.org/10.1111/j.1744-6198.2011.00230.x
Zhang, Z., Wang, T., Zhao, Y., & Shi, X. (2025). Transition shock experience of newly graduated nurses: A qualitative study. Contemporary Nurse, 61(1), 21–32. https://doi.org/10.1080/10376178.2024.2432636
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
Grounded Theory
Research Approach
Qualitative Research
Keywords:
New Graduate Nurses, Entry Into Practice, Professional Role, Nursing Practice, Clinical Competence, Confidence
Recommended Citation
Fontenot, Justin; Liu, Fuqin; Immanuel, Jincy; Kubin, Laura; and Fogg, Niki, "A Grounded Theory Study of Confidence Building Among Newly Graduated Nurses" (2026). International Nursing Research Congress (INRC). 88.
https://www.sigmarepository.org/inrc/2026/posters_2026/88
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
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. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Invited Presentation
Acquisition
Proxy-submission
Date of Issue
2026-08-30
A Grounded Theory Study of Confidence Building Among Newly Graduated Nurses
Toronto, Ontario, Canada
Aim: To develop a grounded theory explaining how newly graduated nurses build professional confidence during their transition to practice.
Background: Professional confidence is crucial for newly graduated nurses, particularly when handling uncertainty, advocating for patients, and remaining in the workforce; however, confidence is often viewed as an individual trait or outcome, which limits understanding of how it develops in practice.
Methods: Constructivist grounded theory was employed. Twelve recently graduated nurses in acute care settings participated in in-depth semi-structured interviews. Data collection and analysis occurred simultaneously, utilizing constant comparison, line-by-line and focused coding, memo writing, and theoretical integration.
Results: The core category, Borrowing-to-Owning Professional Confidence, explains confidence development as a socially constructed process in which new graduate nurses initially borrow confidence from peers, preceptors, leaders, and organizational structures and gradually own confidence through patterned clinical reasoning, emotional regulation, and professional entrustment. Six interrelated processes explain this progression: Belonging and Feedback-Looping; Scaffolding Autonomy; Patterning into Credible Voice; Adjusting Confidence; Entrusting Identity; and Regulating Emotion and Advocating Early.
Conclusions: Confidence develops through ongoing relational and organizational processes rather than as a fixed personal trait. This theoretical model offers an actionable framework for designing transition-to-practice environments that intentionally foster psychological safety, support autonomy beyond orientation, and enhance early advocacy practices to improve retention and patient safety.
Description
This grounded theory explains how newly graduated nurses build professional confidence during the transition to practice. Confidence is not a fixed trait; it develops through support from others and the work environment, then becomes internalized through experience, clinical reasoning, emotional regulation, and increasing autonomy. The Borrowing-to-Owning Professional Confidence model offers a practical framework to strengthen safety, advocacy, and retention.