Best practice principles for the transition from student to registered nurse

Collegian Vol 10 No 4 2003 25

Background
Transition from student to graduate has been the subject of
much debate and conjecture and, more recently, some research.
In 2001, a national research project funded by the Australian
University Teaching Committee wasundertaken by a consortium
of three Australian universities. The aim of the study was to
describe current experiencesby exploring stakeholder feedback to
derive contextually appropriate best practice principlesin each of
the following areas: curriculum, clinical education, recruitment,
transition to practice, and retention in nursing (Clare et al 2002).
Thispaper will focuson the transition experience.
Evidence suggests the nursing graduates transition to practice
continues to be stressful and problematic in Australia and inter-
nationally (Fisher & Connelly 1989, Clare 1993, Brighid 1998,
Whitford 1998, Charnley 1999). Transition is defined as:
The period of learning and adjustment to the requirements of
nursing in which the graduate acquires the skills, knowledge and
values (additional to those learned during undergraduate study)
required to become an effective member of the nursing workforce
(Department of Human Services1994 p215).
The first three to six months is considered a critical time for
professional adjustment and creating a commitment to a nurs-
ing career (Greenwood 2000). It constitutes a time of challenge
and self-doubt for many graduates (Kramer 1974, Kramer
1985, Fisher & Connelly 1989, Godinez et al 1999). Transi-
tion programs have been developed to assist transition from
student to registered nurse (Shogan et al 1985, Fisher & Con-
nel l y 1989, Bl egan 1993, Jasper 1996, Gattenhof 1998,
Shepherd 1999). They have been critiqued for their length,
expense, repetition, lack of consensus about graduate perfor-
mance, and negligible involvement from the higher education
sector (Moorhouse 1992, Department of Human Servi ces
1994, Clare et al 1996). In fact, there is only low-level evidence
that programs achieve their desired outcomes, and as yet no
reliable cost-benefit evidence (Queensland Nursing Council
2001). In all, the transition experience of graduate nurses
remains problematic (Madjar 1997, Gattenhof 1998, Runci-
man et al 1998, Gerrish 2000).
This study found that the quality of a graduates transition
experience influences their desire to continue practising as a
Best practice principles for the transition
from student to registered nurse
This paper disseminates findings of one aspect of a national
Australian University Teaching Committee project conducted in
2001. The aim of the study was to describe current experiences
and gain stakeholder feedback to derive best practice principles in
five key areas. This paper focuses on one of these areas, namely
the transition from undergraduate student to graduate nurse. The
transition year provides a mediated entry into the nursing
profession where the graduate infuses patterns of adjustment,
learning to cope, and understanding how and when to seek help
and suppor t. Graduates want to be recognised as coping, capable
and competent, thus they are preoccupied with defining and
adapting to their new role. It follows then that the best aspects of
transition are receiving suppor t, being welcomed and accepted into
the nursing team, and having your contribution valued. The quality
of the graduate s transition experience influences their desire to
continue practising as a registered nurse, thus affecting retention
outcomes. This paper discusses the best and worst aspects of
graduate transition, highlighting the best practice principles that
provide a suppor tive work environment and a quality workplace
orientation, two critical aspects that facilitate smooth transition.
Keywords: nursing recruitment, transition, curriculum,
clinical education
Judith Clare RN PhD, Dean and Professor, School of Nursing and Midwifery,
Flinders University, Adelaide. Email: Judith.Clare@flinders.edu.au
Antonia van Loon RN PhD, Senior Research Fellow, School of Nursing and
Midwifery, Flinders University, Adelaide.
Judith Clare, Antonia van Loon, Flinders University, Adelaide
26 Collegian Vol 10 No 4 2003
registered nurse. Graduates and employers identified two criti-
cal aspect s t o i mprove t ransi t i on experi ences. They are
provision of a supportive work environment and an effective
workplace orientation.
Ethical approval
Appropriate proposals were drafted and placed before the ethics
committee at Flinders University in Adelaide. Approval from
this committee was given in December 2000. All data were
confidential and kept in secure storage. All reasonable attempts
to protect anonymity were made, but it was made clear that
some participants professional association with an organisation
could identify them; in that case anonymity could not be guar-
anteed. This was noted in the consent form and the letter of
introduction. Additionally, all participants were reminded of
this at the commencement of focus group interviews to ensure
they gave their informed consent.
Methods
Multiple methods were used in this study in order to obtain
comprehensive data. National networks of key informants were
developed, a discussion paper was developed and widely distrib-
uted, focus groups were conducted in every state and territory,
and a national survey was administered. These are described in
more detail below.
National network of key informants
Project team members put forward the names of key infor-
mants who would be able to provide expertise and critique of a
discussion paper, and supply names of potential focus group
participants in their state/territory. The recruitment/transi-
tion/retention network was made up of clinical educators,
graduate nurse coordinators, clinicians, employers, and repre-
sentatives from nurse regulatory authorities from every state
and territory in Australia. Network communication within each
national network was the direct responsibility of each project
team, who communicated directly with their network partici-
pants for the duration of the project.
Identification of focus group participants
Liaison took place with the national network members to iden-
tify representative cohorts of students, graduates, clinicians, and
professional and industry contacts to ensure a comprehensive
national scope to the study and provide access to the following
key stakeholder groups: third year students (and fourth year
students in Western Australia); graduates of less than two to
three years experience; academic staff; clinicians; employers
(Directors of Nursing); and representatives from nurse regula-
tory authorities and professional nursing organisations.
Six focus groups were planned and conducted in rural and
remote areas (those in Northern Territory and Tasmania being
classified as rural and remote).
Focus groups were chosen for this research as the explicit use
of group interaction produces data and insights that may be less
accessible without the interaction found in groups. The groups
were focused on:
identifying issues of importance to pre-registration nursing
education and graduate transition, locating the top five issues
of concern for each group;
describing innovative strategies to address the issues raised
and the efficacy of these strategies; and
discussing the additional issues raised during each focus
group interview.
Focus group method
The focus groups were implemented using the ProblemIdenti-
fication Method. This makes use of the Nominal Group Process,
which, though highly structured, facilitates group interaction.
A number of authors have used this method and found the
method valid and reliable (Hegarty 1977, ONeil & Jackson
1983, Adams & Bond 1995, French et al 1996). It ensures:
equal and democratic contribution of participants;
avoidance of potential difficulties in group dynamics of dom-
inance and politicking;
that the group remains task focused;
that the written record encourages a degree of commitment
to the contribution;
that the convergence on conclusion is postponed while dis-
cussion takes place; and
that there is group satisfaction with the process.
Audiotapes of discussions were transcribed in note form and
some verbatim quotes were taken down to illustrate pertinent
points and issues from each tape. The tapes were analysed for
outstandi ng new i ssues, establi shi ng emergi ng themes, or
absence of themes, and areas of ambivalence and potential con-
fusion. Each project officer analysed the tapes of the focus
groups they conducted. Tapes and transcri pt notes of key
points and verbatim quotes to clarify significant issues were
made available to all teams. The data from these focus groups
were used to draft questions for a survey and were included as
possible innovative solutions in the discussion papers.
Developing the national surveys
Initially it was planned to have one survey for graduates and
one for employers that contained elements from all three focus
areas, but the drafted survey forms became too expansive. After
discussion on the need for all areas of investigation to be able to
make realistic and innovative recommendations, the project
team created four survey forms.
These were directed towards:
clinical education and curriculum development for graduate
nurses;
clinical education and curriculum development for Directors
of Nursing;
Best practice principles for the transition from student to registered nurse
Collegian Vol 10 No 4 2003 27
nursing student recruitment, graduate transition, and reten-
tion for graduates; and
nursing student recruitment, graduate transition, and reten-
tion for Directors of Nursing.
The four surveys were drafted from the findings of the focus
groups and the literature. These questions were based on the
Top 5 rankings across all focus groups in the five designated
areas. When collating the survey questions the project team
deliberately focused on positive strategies to improve graduate
capability and clinical competence as well as positive strategies
for recruitment and transition and retention of new graduates,
rather than reiterating the negative issues already documented
in the literature on curriculum and clinical education and in
recent labour force and recruitment reports. The survey con-
tai ned consi derabl e scope for qual i tati ve comment from
respondents.
The surveys were mailed out to graduates and employers
(Directors of Nursing) nationally, from samples that represent-
ed metropolitan, provincial, rural, public, and private health
care agencies. The surveys focused on:
satisfaction with graduate outcomes (ie clinical competence
and graduate capability);
elements of best practice in clinical education models and
strategies; and
issues and strategies for recruitment, transition, and retention
of both students and graduates.
From the analysis of the data, a discussion paper was written
and sent to the national networks. Sealable reply paid envelopes
addressed to the project manager were provided for the secure
return of completed surveys and critical feedback from discus-
sion papers. Participants were informed of the arrangements by
verbal instruction and/or in a written instruction accompany-
ing the survey tools.
Data collection
Focusgroups(n=21) were held in every Australian state and ter-
ritory in 2001. Focusgroup findingswere analysed for recurring
themesand collated into two surveysdistributed to Directorsof
Nursing (n=350) of all major public and private health services
in each state and territory. The second survey wassent to a ran-
dom sample of graduate nurses (n=550) around Australi a.
Survey data were entered in Microsoft Excel and analysed using
the SPSSstatistical package. The survey resultsand focusgroup
findingswere drafted into five discussion paperssent to all focus
group participants and a network of professional experts from
clinical, management, academic, and regulatory disciplines
within nursing (n=350). Feedback was again analysed themati-
cally for possible best practice principles.
Results - Directors of Nursing and graduate data
The best aspects of the graduate/transition year
The graduates (n=137) surveyed were asked to identify the best
aspects of their transition experience. It was encouraging to see
72% of graduates reporting positive transition experiences,
indicating health services are responding to the changing needs
of graduates. This was followed by: experiencing a variety of
clinical rotations to different areas (56%); feeling productive
because your skills and knowledge are put into worthwhile
practice (54%); being allowed to ask dumb questions (42%);
the availability of a support person/s to supervise procedures
(41%); and in-service tutorials and study days (38%).
Additional aspectscontributing to positive transition could be
grouped into two categories. Firstly, the nursing team: graduates
appreciated working with experienced, confident, and compe-
tent nursing role models that welcomed them into the team.
They paid a lot of attention to interpersonal dynamicsand atti-
tudes of experienced nurses toward each other, the patient, the
health team, and the graduate. They were grateful for realistic
expectationsof their skillsand knowledge, and the opportunity
to grow in confidence. They respected those who gave them reg-
ular constructive and non-judgmental feedback. Graduates
appreciated having someone that provided them with backup
support so they could refer questions to that person. They
enjoyed being able to work effectively within a team, feeling
their contribution wasvalued, professional, and worthwhile.
The second category wasindividual graduatesand their capa-
bility and confidence. Graduatesenjoyed consolidating skillsand
gaining additional knowledge. The thrill of becoming an inde-
pendent problem solver and decision-maker provided intrinsic
motivation. They appreciated meeting with other graduates for
debriefing, support, and study days to share experiences, saying
they felt less alone after peer debriefing. Graduates valued the
opportunity to demonstrate competence, gradually building their
workload and responsibility. They took pleasure in meeting peo-
pl e and fel t empowered and respected when they made a
difference in a patients life. These aspects provided powerful
intrinsic motivation, and facilitating such experiences should be
key to improving graduate nurse retention.
The worst aspects of the graduate / transition year
The transition period is a time of heightened stress for most
graduates (Kramer 1974, Kramer 1985, Lathlean 1987, Fisher
& Connelly 1989, Horsburgh 1989, Kramer & Schmalenberg
1991, Clare et al 1996, Gerri sh 2000, Wi nter-Colli ns &
McDaniel 2000). Godinez et al (1999) mention over 20 inter-
national research articles verifying that graduates across the
globe experience stress during transition. The key feelings grad-
uates in this study expressed regarding their worst experiences
included confidence issues, stress, and anxiety.
Lack of confidence in my own knowledge and ability
Graduates said the worst aspect of transition was the over-
whelming feeling of having insufficient knowledge to make
sound clinical judgements and perform competently. Madjar
28 Collegian Vol 10 No 4 2003
(1997) found competence wasinfluenced by the level of support
the graduate received, a finding echoed in many other studies
(Shogan et al 1985, Mooney et al 1988, Allanach & Mowinski
Jennings1990, Stevenson et al 1995, Oermann & Moffitt Wolf
1997). Graduates attributed their feelings of incompetence to
three key causes. Firstly, lack of sufficient clinical experience in
the current area of employment. The crisisin confidence and the
subsequent tension created within the graduate was due largely
to their lack of local knowledge and experience. Graduatesfeared
coming acrossissuesthey did not understand, missing important
symptoms, or doing procedures deemed incorrect according to
the procedures accepted in the clinical agency, which may have
resulted in adverse patient outcomes. This was the major con-
tributing factor to their anxiety. Asone graduate said, I do not
want to learn by my mistakesanymore!
Secondly, many graduates said they had insufficient opportu-
nity to put clinical skills into practice in acute care settings
before graduating. Employers agreed, saying graduates should
be better prepared to manage a normal patient load of complex
care patients. Both groups requested more quality clinical expe-
rience. Graduates noted their confidence was diminished by the
negative attitude about their university preparation from within
the profession. This perpetuated their belief that they were
under-prepared and affected their self-confidence and compe-
tence. Interestingly, 77% of employers and 85% of graduates in
this study rated overall graduate performance as good or out-
standing (Clare et al 2002). Graduates were concerned about
the amount of applied pharmacology and medication manage-
ment in the curriculum, requesting more to allay their anxiety
over possibilities of making drug errors.
Thirdly, not comprehending the vast field of unspoken nurs-
ing knowledge that is acquired with experience diminished
confidence, as this graduate commented:
There is so much unsaid stuff to learn about how to get simple
things done. I know it comes with time and experience in the
area, but not knowing makesme feel so dumb, and that dentsmy
confidence.
Understanding socially embedded knowledge is important for
entry and smooth functioning in the nursing team. Unfortu-
nately, increased workloads leave less time to share stories that
improve clinical judgement and strengthen relational skills in
whi ch embedded knowledge i s shared between expert and
novice (Benner et al 1997). The muted and cryptic socialisation
process in nursing requires the graduate to adopt the generic
perspective of nursing or they face losing sponsorship into the
team, resulting in active isolation (Spouse 2000). The failure to
adjust leads to ambivalence about being a nurse, or attrition.
The graduate has three choices, adjust by leaving your theory
behind and assuming beliefs and behaviours held by the team;
leave; or tolerate rejection from the team (Coeling 1990).
It should be noted that a small but notable number of gradu-
ates felt confident and they expressed frustration at not being
al l owed to make cl i ni cal j udgements and deci si ons about
patient care, saying they were being spoon fed and baby sat.
This appeared to cause as much frustration as being unsupport-
ed, indicating the need for preceptors to assess each graduates
confidence and competence, challenging and extending them,
but not beyond their level of knowledge or capacity.
The reality of shif t work
Working full time shift work and feeling consistently tired and
socially isolated was mentioned by 59% of the respondents as a
negative transition experience. Transition was intellectually,
emotionally, and physically exhausting. Graduates felt experi-
enced nurses had li ttle empathy, forgetti ng how ti ri ng the
novice position was. When tiredness, exhaustion, and isolation
were compounded with negative feedback and bullying, the bal-
ance tipped and almost all graduates began to contemplate
leaving nursing (96%).
Lack of professionalism and bullying
Sadly, 48% of respondents described unprofessional behaviour
they had witnessed or experienced within the health team, using
words such as horizontal violence, bullying, bitchiness,
rudeness, terse, aggro, cow, dragon, mean, and nasty.
Graduates were unprepared for and overawed by such unprofes-
sional attitudes and behaviours. Those experiencing it on a
regular basis had all considered leaving (or had left) nursing.
Issues related to local transition programs
The issues around length of rotation were contentious. Some
graduates wanted longer in one rotation, but most wanted to
move to two or three wards/units during the transition year to
increase their experience. They expressed enjoyment at the vari-
ety of clinical experiences they witnessed during their transition
year (76%). However, they disliked the insecurity of leaving a
unit when they just begin to feel useful. The challenge was to
balance variety with security. One employer said her solution
was to allow graduates to decide the length of their rotations. In
this way they were likely to flourish because they had requested
the change. For all graduates, a supportive work environment
promoted positive transition.
Graduates and employers said the key issue to positive transi-
tion was to genuinely welcome the graduate and make them feel
a part of the nursing team. This was best achieved by providing
sufficient supportive nurses, facilitating quality communication,
demonstrating professional practice that role models positive
attitudes, and providing continuing education opportunities.
Some researchers claim that the biggest problem for new gradu-
ates is the prioritisation of their workload and anticipating
patient problems (Horsburgh 1989, Fey & Miltner 2000). This
is best assisted by support, active coaching, and role modelling
from a preceptor (Jeffreys 2001).
Best practice principles for the transition from student to registered nurse
Collegian Vol 10 No 4 2003 29
Tabl e 1: Best practi ce pri nci pl es for a suppor ti ve work envi ronment
Qual i ty Best practi ce pri nci pl es
Suffi ci ent suppor ti ve Preceptorship from mentor or buddy present on every shif t
nurses for the number Preceptor or designated nurse has same roster as graduate of graduates for weeks 1 and 2
Preceptor or designated nurse has same roster as graduate at least 2-3 days each week from week 3 onward
Changing preceptors during placement will provide graduate with a range of experiences
One hospital found a 4 week complete buddy system worked extremely well: the preceptor and graduate nurse had the same
patients and worked together every shif t for the first 4 weeks
Having a designated clinical educator accessible to graduates for supervising and assisting in new procedures: this takes the pressure
off the buddy (who has a patient workload) and allows the graduate to per form properly without the pressure of a pending workload
to agitate their progress
Experienced nurses present on the unit on every shif t who are permanent employees in that unit and know the unit s specific
processes and protocols
Designated nurses help to orient graduates to the physical layout and function of the ward/ unit on arrival
Graduates have supernumerary days to gain confidence in clinical practice on commencement
Qual i ty communi cati on Nurse Manager (NM) / Clinical Nurse Consultant (CNC) offer direction to staff regarding nursing care and professional practice
NM/ CNC fosters facilitative interactions between staff
Regular staff appraisal and/ or per formance goals/ targets are set for nurses of all levels
NM/ CNC assists graduate s introduction to health team
Unit provides structured orientation with competency based job descriptions and a framework of per formance resource and
development planning sessions for all nursing staff regarding graduate suppor t
NM/ CNC has prepared graduates regarding expected role definition, scope and competencies
NM/ CNC regularly liaises with graduates regarding progress and learning
Positive regular feedback from the DoN to new graduates
Graduates not meeting the required standards have their learning needs identified, and programs to address deficit/ s are implemented
Graduate nurses invited to par ticipate in unit decision making
Graduates have the oppor tunity to debrief with each other and with qualified staff
Nurses are represented on all hospital executives and decision-making forums
Active par tnerships with academic boards and professional associations to advance knowledge and allow all sectors to be informed
on current nursing issues
Posi ti ve atti tudes Interaction between nurses on the ward/ unit is positive
demonstrated by nurses Nurses demonstrate respect for one another, other health team members and the patients
Graduates are welcomed and made to feel a par t of the nursing team (several par ticipants noted that being accepted by medicos in
rural areas and private hospitals was very impor tant)
Graduates are valued, receiving affirmation for their contribution to the team
Graduate nurses not meeting required standards of practice should be handled with sensitivity
Units should work together to foster learning and welcome each team person in a social way eg morning tea
Recognition by health team and management of the value of nurses as the one constant in multidisciplinary patient care
Solidarity in nursing regardless of chosen practice field, ie management, research, education, and clinical
Professi onal nursi ng Graduates are given/ accept appropriate levels of autonomy
i s practi sed Graduates are able to take on increasing responsibility once they have demonstrated appropriate, safe, competent practice
The strength of evidence based practice emanates from the power of one , therefore professional standards are expected and suppor ted
Graduates should be active in cross discipline activities
Create oppor tunities to par ticipate in quality projects, planning projects, research at a level that extends but does not threaten
Create an environment that acknowledges the graduate as a beginning registered nurse (not as a probationary nurse, a student, or an
experienced nurse, ie don t expect too little, or too much)
All nurses in the team evaluate the quality aspects of nursing practice regularly and openly so the graduate can learn
Uniform appraisal processes occur for the term of graduate s placement
Conti nui ng educati on NM/ CNC secures learning resources for staff/ students
i s provi ded Nurses on unit/ ward have relevant qualifications in specialty
Nurses in the unit are actively engaged in teaching graduates
A shor t bibliography of relevant readings is available to graduates on ward/ unit
Time is set aside for regular planned learning oppor tunities
Graduates have access to continuing education and in-service on ward/ unit
A solid framework of in-service teaching that improves the quality of nursing
Alternative modes of study are offered, eg. CD-ROM, video, self -guided workbooks
Essential qualities of a supportive work environment:
best practice principles
Graduates and Directors of Nursing believed that there were
some best practice principles that may be employed to achieve a
supportive work environment for new graduates. These best
practice principles are described in Table 1.
Discussion
The best practi ce pri nci ples summari sed above have been
addressed in a fragmented way in the literature many times
before (see, for example, literature reviews in Nursing Education
Review Secretariat 2002, Clare et al 2002). However, the princi-
ples outlined above are supported by research evidence and
interpreted in pragmatic ways in the discussion that follows.
Effective workplace orientation promotes positive transition
Provision of a formal orientation
This study found several key aspects of orientation to the work-
place that promoted smooth transition. Both employers and
graduates agreed being formally orientated to the hospital and
then the unit/ward was pivotal to positive transition. Graduates
said that a written orientation booklet should be provided on
arrival to the clinical area. This should be structured as an easy
reference to commonplace situations, such as how to page an
30 Collegian Vol 10 No 4 2003
intern, how to send a laboratory specimen, discharge proce-
dures etc. The graduate must be given a tour of the physical
layout of the unit on arrival indicating all fire and safety exits
and emergency equipment. They should be told about the hos-
pital/unit philosophy, goals, organisational structure, facilities
and services, communication channels, policies and procedures,
emergency, safety and fire procedures. The graduate must be
given clear role descriptions and expectations that are commen-
surate with their level of experience. They should be informed
of their rights and responsibilities and the procedures that will
be used to assess personal progress and provide formal feed-
back. Fi nal l y t hey must be made aware of t he rout i ne
procedures used within the local area so they can function inde-
pendently as soon as possible.
Providing suppor t
Graduates appreciated having a specifically appointed support
person or mentor available on call, especially during orienta-
tion. This person should be impartial and supportive, orienting
graduates to ward or local procedures and protocols, and avail-
able for the duration of the transition year. On the other hand
the buddy or preceptor may change. Their task is to orient
graduates to local issues and processes. It is imperative that this
person be competent, friendly and enjoy teaching. Graduates
appreciate peer support from recent or current graduates. They
enjoy meeting together for study days to debrief and share their
experiences, tips, ideas, warnings and general encouragement.
They val ue some form of Graduat e Survi val Gui de i n
print/electronic format that is accessible before commencing
their placements so they arrive prepared. Additionally, gradu-
ates value designated study days that allow them to increase
their local knowledge.
Provision of a supernumerar y period
Graduates value a supernumerary period at the commencement
of orientation to a unit. It provides opportunity to shadow
experts, locate equipment, and discover unit specific processes
and protocols.
Providing complaints mechanisms
The graduate must be made aware of avenues and opportuni-
ties to make complaints. Services such as suggestion boxes or an
electronic chat line may help to provide support and identify
inappropriate behaviours before they manifest as bullying.
Graduates request anonymity because they fear reprisal.
Provide appropriate rosters
Graduates said they underestimated the impact of full time
shift work on their personal life. Therefore attempts to provide
rosters that allow for adequate rest and reasonable prospects for
family and social contact are important during orientation. The
National Review of NursingEducation 2002 report highlights
the following standards for transition programs in Recommen-
dation 14 (Nursing Education Review Secretariat 2002 p22):
To ensure consistency and quality in the development and delivery
of transition programs:
a) a national framework should be developed to provide guide-
linesand standardsfor institutions;
b) State and Territory Nursing Boards should accredit transition
programs;
c) employing institutions should be responsible for meeting the
standards.
Development of frameworks, guidelines and standards should
be a joint endeavour between employing agencies, accreditation
bodies, and universities, taking into account new graduates
needs and experiences. Universities should be involved to advise
on the curri cul um and cl i ni cal educati on new graduates
received while they were students so that transition programs
will build on this foundation.
Conclusion
This study has found that graduates and employers regard the
transition year asa critical mediated entry into the nursing profes-
sion. The transition is about infusing patterns of adjustment so
the graduate learns to cope, and knows how and when to seek
help and personal support. Thistask isaffected by the quality of
support and orientation the graduate receives. Graduateswant to
be recognised as coping, capable, and competent, thus they are
preoccupied with defining and adapting to their new role. The
best aspects of transition are receiving support, being welcomed
and accepted into the nursing team, and having your contribu-
tion valued. It doesnt seem much to ask for really!
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