From Classroom to Chaos: The Early‐in‐Career Mental Health Nursing Experience. A Qualitative Descriptive Study

ABSTRACT

Persistent challenges remain in attracting and retaining early‐in‐career mental health nurses in Australia. Key contributing factors include gaps in undergraduate nursing preparation, with many students reporting insufficient mental health placement experience to inform career choice. Health services have responded to recognised gaps between undergraduate preparation and the realities of clinical practice by developing structured early‐in‐career programs, such as graduate nurse and transition‐to‐practice initiatives. These programs combine supported clinical exposure, targeted education and mentorship to consolidate core skills. However, early‐in‐career mental health nursing practice often occurs within unpredictable and complex environments that can be hostile and emotionally demanding, compounding stress for recently graduated nurses. This study aimed to explore early‐in‐career mental health nurses' experiences of (1) workplace readiness, (2) wellbeing and (3) preparedness for practice. Using a qualitative descriptive design, we recruited 12 early‐in‐career mental health nurses from a tertiary hospital in metropolitan Melbourne, Australia. Semi‐structured interviews were thematically analysed according to Braun and Clarkes methodology. From analysis, four themes were identified: (1) Feeling ready, becoming ready; (2) Finding the right fit; (3) Practising under pressure; and (4) Organisational influences on readiness. This study provides important insights into early‐in‐career nursing experiences, highlighting the role of placement quality, exposure to workplace violence and organisational support in shaping preparedness and workforce retention. Variability in placement experiences contributed to misaligned expectations and heightened transition challenges. Findings also underscore occupational violence perpetrated by consumers and their family members highlighting the need for targeted preparation during undergraduate education and early career transition, as well as organisational responses to support safe workplaces.

1. Introduction

Persistent challenges remain in attracting and retaining early‐in‐career mental health nurses (ECMHN) in Australia (Australian Government Department of Health and Aged Care ²⁰²²). Key contributing factors include significant gaps in undergraduate nursing preparation (Alexander et al. 2025; Lakeman et al. ²⁰²⁴) and ongoing stigmatising attitudes towards mental illness and mental health care (Happell et al. 2018). Transition into mental health nursing practice often occurs within unpredictable and complex environments that can be hostile and emotionally demanding (Cranage and Foster 2022; Tonso et al. ²⁰¹⁶). Such challenges are compounded for recently graduated nurses who may be particularly vulnerable to transition stress (Wakefield 2018) and are expected to rapidly develop specialist knowledge and skills whilst establishing professional identity and adapting to full clinical responsibilities (Ford et al. 2024). Despite evidence that transition programs support early career nurses and improve workforce retention (Hooper et al. 2016), the experiences of early career mental health nurses when transitioning into mental health nursing remain underexplored. These challenges underscore the importance of understanding ECMHN preparedness and transition experiences to inform targeted strategies that enhance wellbeing, practice readiness and workforce retention.

1.1. Background

In response to significant workforce deficiencies in Australia, multiple pathways now exist for nurses to transition into mental health nursing. This approach to recruitment is vital to maintaining a consistent supply of suitably trained nurses and supporting the long‐term capacity of the mental health nurse workforce. In Australia, newly registered nurses can enter mental health nursing practice directly following registration as a Registered Nurse. Bachelor‐prepared newly graduated nurses transition through either a 12‐month Graduate Nurse Program entirely focused on mental health or a blended program that equally combines experience in general and mental health nursing (Jackson and Cleary 2025). Nurses experienced in general nursing can also specialise in mental health through Transition to Specialty Practice (TSP) programs that develop their skills specific to mental health nursing (Boardman et al. 2026).

Different transition to practice programs have emerged in response to a widening gap between mental health service demands and workforce capability. This gap followed the national shift in the 1980s and 1990s towards comprehensive generalist nursing education, which has substantially reduced mental health nursing content within undergraduate curricula in Australia (Lakeman et al. 2024). Undergraduate mental health placements are now limited in duration and variable in quality and relevance (Alexander et al. 2025). This reality of nursing education is in direct opposition to evidence that highlights the link between meaningful mental health undergraduate exposure and positive student perceptions, reduced stigma towards people living with mental illness and a greater intention to pursue mental health nursing as a career (Lim et al. 2020). Consequently, the move away from teaching mental health nursing as a discrete specialty in the Australian nursing curriculum has contributed to successive cohorts of graduates entering the workforce without sufficient skills to practice safely in mental health care settings.

Healthcare providers have increasingly assumed responsibility for workplace‐based training as a means of workforce assurance in response to growing demand for mental health services and ongoing workforce shortages (Mellor et al. 2022). This shift has occurred within a context of increasing demand for mental health care and workforce shortages, promoting a greater emphasis on strategies to attract, prepare and retain a skilled mental health workforce (Australian Government Department of Health and Aged Care ²⁰²²). While transition to practice programs were essentially established to fill the skill gap in preparedness to work in mental health care, they have been shown to support ECMHN by reducing stress, improving wellbeing and reducing turnover intention (Boardman et al. 2026). Beyond these outcomes, transition to practice programs for early career nurses provide structured opportunities for supervised skill development, supported clinical‐decision making and professional socialisation within complex practice settings (Rogers et al. 2023).

Poor preparedness among mental health nurses limits their capacity to develop the resilience, therapeutic communication and risk management skills required to feel confident and competent in their role (Hazelton et al. 2024). Consequently, ECMHN face heightened vulnerability to workplace stress, reduced wellbeing and early attrition, with possible risks to patient and clinician safety (Foster et al. 2024). The increased reliance on workplace‐based training during the transition into professional and specialist practice can intensify pressure on ECMHNs to achieve clinical competency within compressed timeframes (Lakeman et al. 2024). The struggle to gain competence faced by underprepared nurses, in the absence of sufficiently supportive transition structures, leaves ECMHNs particularly vulnerable to workplace stress, emotional exhaustion and reduced wellbeing during the early transition period (Lay and Masingboon 2025). These pressures can undermine confidence, disrupt professional identity formation and increase the risk of early attrition from the mental health nursing workforce (Foster et al. 2024).

Systemic health care and educational pressures have a pronounced impact on transition into mental health nursing; however, little is known about how ECMHNs experience preparedness, wellbeing and adaptation to the demands of contemporary mental health practice. Capturing these experiences is critical to understanding how workforce assurance strategies are realised in practice and where gaps in support may persist. Insight into ECMHN perspectives can inform the design of education, transition and workplace supports that better align with the realities of mental health nursing practice. Therefore, the aim of this study was to explore ECMHNs' experiences of workplace readiness, wellbeing and preparedness for practice.

2. Methods & Design

This study employed a qualitative descriptive design. This study is reported using the EQUATOR network recommendations for consolidated criteria for reporting qualitative research (COREQ) guidelines (Tong et al. 2007).

2.1. Participants & Setting

ECMHN currently undertaking a transition to practice program or graduate year in mental health and employed in a large tertiary hospital in Melbourne, Victoria were invited to participate. All participants were Registered Nurses, and in the first 18 months of their career in mental health nursing. N = 12 graduates signed consent and agreed to an interview. All participants were enrolled in an ECMHN program of varying length (see Table 1 for these programs). Characteristics of participants are noted in Table 2.

TABLE 1.

Early‐in‐career mental health nursing program descriptions.

Name	Description
Graduate Year—mental health	12 months mental health graduate program 2 × 6‐month rotations.
Graduate Year—blended mental health/general Transition to Specialty Practice—mental health	12‐month graduate program split across mental health and general nursing rotations 1 × 6‐month rotation in mental health nursing 1 × 6‐month rotation in general nursing For experienced general RN's 6‐months experience in mental health inpatient unit

TABLE 2.

Participant demographics N = 12.

Age (years)	n (%)
21–25	4 (33%)
26+	8 (66%)

Gender	n (%)
Female	6 (50%)
Male	6 (50%)

Novice learner program	n (%)
RN—Blended Mental Health/General Graduate	8 (66%)
RN—Mental Health Graduate	3 (25%)
RN—Transition to Mental Health	1 (8%)

Experience as RN (months)	n (%)
0–6 months	8 (66%)
7–12 months	1 (8%)
> 12 months	3 (25%)

2.2. Data Collection

Nurses provided written and verbal consent to participate in a semi‐structured interview comprising of questions developed by the research team. Purposive sampling was the technique employed to recruit participants. Data were collected between April and June 2025 until data sufficiency was reached in accordance with Guest et al. (2006). The research team brought together senior clinicians and leaders in mental health nursing, as well as senior academics with established expertise in mental health nursing research. This interdisciplinary composition ensured that the interview guide was informed by both contemporary clinical practice realities and methodological rigour (see Table 3).

TABLE 3.

Semi‐structured interview guide.

Domains	Questions
Wellbeing	How do you understand your own wellbeing and how would you describe your wellbeing during your graduate or transition‐to‐practice year?
	What factors supported your wellbeing during this time and what factors negatively affected it?
Preparation	How prepared did you feel to work in mental health nursing and how did your university, clinical placements and the health service influence your sense of readiness?
Organisation support	How have organisational supports, workplace culture and your specific program (TSPP/blended/pure MH) shaped your experience as an early career mental health nurse?

Interviews were recorded using Zoom by two senior research academics (LA, GB), transcribed verbatim and recoded to remove any identifying information. Interview transcripts were sent to participants for verification, and no transcripts were returned with changes.

2.3. Data Analysis

We used the six‐phase approach to thematic analysis described by Braun and Clarke (2006, 2021): (1) familiarisation with the data through repeated reading, (2) generation of initial codes to identify meaningful features, (3) searching for themes by grouping related codes, (4) reviewing themes to ensure they accurately reflect the dataset, (5) defining and naming themes to capture their essence and (6) producing the final analysis, where themes were integrated into a coherent narrative supported by data extracts. The research team met several times to code data consistently, then came together to develop preliminary themes in accordance with Vonna et al. (2022). While there were no conflicts during this process, the team had agreed to manage differences in line with Hemmler et al. (2020). Once the team agreed on the themes, the first author guided the subsequent stages, refining theme definitions and ensuring consistency across the dataset.

2.4. Ethical Considerations

Ethics approval was granted by the relevant hospital Human Research Ethics Committee (LR24‐066‐112 907) and reciprocal ethics was granted by the University ethics committee (2025/HE000295). No activation of the distress protocol was necessary, and no participants requested to withdraw consent.

3. Results

Twelve ECMHNs participated in interviews comprising 6 males (50%) and 6 females (50%) (see Table 2 for participant demographics). The average interview length was 44 min and 32 s, with a range between 63 min 26 s and 29 min 24 s. After analysis, four themes emerged: (1) Feeling ready, becoming ready; (2) Finding the right fit; (3) Practising under pressure; (4) Organisational influences on readiness. Participants are referred to ECMHN in the findings.

3.1. Theme 1: Feeling Ready, Becoming Ready

This theme is defined as the perceived readiness of mental health nursing graduates to enter professional practice, shaped by their university education, clinical placement experiences, development of core mental health competencies, and their ability to navigate the transition from student to Registered Nurse. It reflects both the formal learning they received and their subjective confidence in meeting the realities of mental health nursing work.

For many ECMHNs, a dominant narrative was one of insufficient preparation during their university education for the demands and complexities of mental health care: ‘…we did two mental health subjects, but I left it thinking ‘I don't know what the subject was. “I don't believe we learnt that much in it”’ (ECMHN4). This ECMHN reflected that their nursing degree was largely centred on general nursing, with limited emphasis on mental health: ‘I think they really prepared us for general, but in mental health, not so much’ (ECMHN11). Another described wanting greater education on specific areas: ‘It would have been nice to focus on certain areas more…like how to deescalate certain situations…how to protect yourself’ (ECMHN7).

ECMHNs frequently referred to their clinical placement experiences, noting that while these placements often shaped their decision to enter mental health nursing, they also underscored significant gaps in their preparedness for the role: ‘it would have been nice to have at least a week or a few days in an inpatient unit’ (ECMHN10) and ‘I had never been in an inpatient unit before and when I started my grad program I was allocated an acute inpatient ward. It was challenging to be honest’ (ECMHN3). This sentiment of needing to have a placement in an acute inpatient unit was echoed by several other participants. Another ECMHN articulated the limitations of their theoretical preparation, noting that it did not adequately translate into meaningful clinical context: ‘We can't rely based solely on what we learn from a module or book…we cannot actually base it off anything’ (ECMHN5).

The transition from student to registered nurse emerged as another area that ECMHNs consistently described as challenging, with one highlighting the abrupt realisation of being fully responsible: ‘…you are responsible even though you are a beginner…when things are so acute…someone is trying to kick in the door…you don't feel like you can be in that beginner place. There is no scope’ (ECMHN8). This responsibility was particularly concerning for some ECMHNs around medication administration: ‘…there is no one there to watch me and I have to do this all on my own correctly…that was a bit of a shock’ (ECMHN2). Another ECMHN described how their student placement in a private mental health facility didn't prepare them for an acute inpatient ward:

I never thought it would be this hard to be honest…I thought I would sit with them (consumers) and do colouring, but it ended up being someone would just flip a table in front of me…I feel like ‘ok well this is every day. Daily chaos’ (ECMHN9).

Additionally, students who undertook placements in community settings had mixed experiences in how readily this prepared them for a realistic entry in mental health: ‘On my placement I pretty much went to community with the CATT team, it didn't expose me to an acute setting, it's pretty chill and pretty laid back…’ (ECMHN2). This ECMHN also described feeling unprepared for an inpatient graduate year after only doing a community placement:

I guess my community placement didn't give a picture of how the inpatient unit is going to be…I learned how to do an MSE, but I did not face any like aggressive behaviours or patients who are really unwell. I guess if more students can be in an inpatient unit, maybe they'll…prepare them more for when they are a grad nurse, because as a grad nurse, you have to go into a ward… I feel like if I did have an inpatient experience as a student, I might not have gone back to mental health. (ECMHN10).

These accounts highlight the variability in how community‐based placements shaped ECMHNs' perceived preparedness for inpatient mental health practice, with some reporting limited exposure to the acuity and challenges of ward‐based care. Participants also suggested that placement experiences influenced career intentions, with positive experiences encouraging entry into mental health nursing and negative experiences potentially discouraging pursuit of the speciality.

3.2. Theme 2: Finding the Right Fit

This theme explored how individuals navigated the physical and emotional demands of practice while considering their preferences for different models of nursing care. Participants reflected on the factors that attracted them to mental health nursing, the generalist skills they brought with them and the extent to which mental health nursing aligned with their professional interests and career aspirations. This theme also considered the time and cognitive space required to meaningfully apply mental health‐specific skills alongside the broader health‐related tasks that formed part of their roles.

ECMHNs described the nuanced differences between general nursing and mental health nursing, emphasising in particular the contrast between the predominantly physical demands of the former and the emotional demands of the latter: ‘Working in mental health, I think you don't realise it, but it builds up. Mental exhaustion is there, although you might not be physically exhausted as you are in gen‐med but it builds up…’ (ECMHN10) and another noted ‘it's not like physically tired, but a little bit more mentally exhausted sometimes’ (ECMHN3).

ECMHNs described a range of factors that influenced their decision to work in mental health, including witnessing the physically demanding nature of general nursing through close family members and seeking to avoid such burdens, as well as transitioning from previous roles as enrolled nurses in general settings. Most ECMHN chose a blended graduate program because they wanted greater experience in mental health nursing and their clinical placement experience was insufficient to give them confidence to make the full commitment to a 12‐month mental health graduate year:

I only had three weeks for my placement, so that's the reason (I did blended), I want to explore more in mental health…I think it's very hard to decide whether you want to go general nursing or you want to do mental health (ECMHN12).

Others described a positive clinical placement experience as their reason for choosing a blended program: ‘I had a really positive experience and really enjoyed it, but I thought it would be good to do blended to keep those general nursing skills up’ (ECMHN7) and ‘…I'm still kind of on the fence on which direction I'm trying to go’ (ECMHN5). Participants' accounts suggested that career decisions were influenced not only by demands of practice but also by perceptions of professional fit. Participants valued aspects of mental health nursing that enabled meaningful consumer engagement and therapeutic relationship‐building, with one participant describing mental health nursing as ‘a different type of nursing, and I really liked it’ (ECMHN2). Conversely, concerns regarding emotional demands, occupational violence and workplace instability were identified as factors that could discourage continued practice in some settings. These considerations appeared to influence both attraction to and retention within the specialty.

For other participants, the appeal of mental health nursing lay in its sustained therapeutic relationships and continuity of care: ‘I like getting to know consumers, and to have that extended period of care…you get to know them more’ (ECMHN11). This participant described being drawn to mental health because of a desire to spend more time with consumers and contemplating their own personal lived experience, but this did not live up to their expectations: ‘I want to go back to mental health, but not acute. It's not the right space for me at this point of time given that I don't have the tools to deal with the effects on my own mental health’ (ECMHN8).

3.3. Theme 3: Practising Under Pressure

This theme reflects the confronting aspects of early career mental health nursing, including exposure to consumer violence, suicide and other distressing clinical events that can undermine feelings of safety and wellbeing. These challenging experiences prompted reflective and deliberate consideration of how best to maintain and safeguard personal wellbeing within volatile practice environments. Nevertheless, early career mental health nurses also described a growing sense of support, safety and professional development as they transitioned into these settings. This included the constructive guidance offered by multidisciplinary team members, strategies for managing risk and encouragement to develop reflective capacities that fostered resilience and ongoing professional growth.

ECMHN described the impacts that the relational work of mental health had on their own wellbeing: ‘…I'd go home after a PM shift and I'd be up until 2am, just thinking ‘I shouldn't have said that’, or ‘I could have said that instead…oh I have to go back tomorrow’…just having those long thoughts where I couldn't leave work at work, as they say’ (ECMHN8). Many of the experiences of ECMHNs were shaped by their early exposure to acute settings and the development of their emerging skillsets within a volatile workplace environment that frequently lacked the structures necessary to support a gradual and supportive transition: ‘When you first see patients who get aggressive, you get really, sort of like ‘oh my God, what do I do now?’ I have to do something because I'm the nurse, but you're also kind of scared’ (ECMHN10) and ‘I couldn't leave work at work…I would always come back (to it) and be up like 2am thinking, ruminating, brooding…constant panic, I couldn't eat, I couldn't sleep, would have no energy’ (ECMHN8).

This ECMHN described the impacts of vicarious trauma: ‘…we're hearing quite horrific stories, and you get told the history of someone and you think that only happens in the movies, but this is real life…this is a man in front of you’ (ECMHN4). Another ECMHN described the emotional toll of working with consumers who were suicidal: ‘I've walked in on situations and patients are trying to hurt themselves and take their own lives…that can be quite confronting…by the end of the shift I feel really uneasy’ (ECMHN7).

These experiences of wellbeing were counterbalanced by reflective and deliberate considerations regarding how best to maintain and promote their own wellbeing: ‘It's not letting yourself be consumed by your work life’ (ECMHN11) and ‘I really enjoy my days off, I sit in the sun’ (ECMH9). This participant described setting good boundaries to manage stress and preserve their wellbeing: ‘It only happens (being frustrated) during work, after work, I manage to forget about all those unpleasant things about work. I'm feeling good. I'm not concerned about my wellbeing’ (ECMHN1). Several participants identified the importance of balancing work‐life commitments as highlighted by this ECMHN:

When it comes to work, I put myself 100% at work, like focus, just trying to complete the task perfectly. And then when you finish your work, just forget everything about work. Focus on your personal life. So just separate between work and personal lives. So that's how I balance it (ECMHN12).

For many ECMHN these challenging experiences were mitigated with support from the wider mental health team: ‘…they're really supportive…they teach me a lot…they make sure I'm ok’ (ECMHN3) and ‘I definitely take advantage of my colleagues if they have the time…they're willing to help’ (ECMHN11). Many described being actively discouraged by the education team from taking on overtime and ensuring that they finished on time and did not ‘hang around’ after their shift was completed: ‘everyone is encouraged to leave without staying over’ (ECMHN5). The team supportive camaraderie was also noted: ‘…the nurses' station is a really good space for people to go back and express your frustration…they're really good at cheering you up…it's a crucial component’ (ECMHN1). Several ECMHNs also described the benefits of supernumerary time in supporting their developing skills and noted that additional supernumerary hours would have been advantageous to their learning: ‘We only have three (supernumerary shifts) …I feel like you're thrown in the deep end, and it was like sink or swim’ (ECMHN11).

3.4. Theme 4: Organisational Influences on Readiness

This theme described the systems, education and workplace culture that shaped early career nurses' preparedness and wellbeing in mental health settings, and included the structure of formalised learner programs, workforce culture and the organisational constraints that influenced support and learning.

ECMHNs reported that the education sessions delivered by the health service, introduced to compensate for gaps in university preparation for mental health practice, were beneficial to their learning and transition. Several ECMHN noted the benefit of these sessions: ‘…those in‐services are pretty insightful; make a difference’ (ECMHN2) and ‘yeah they're really helpful’ (ECMHN3). Additionally tailored study days which targeted specific mental health nursing skills (e.g., mental state examination) were particularly beneficial to ECMHNs: ‘…that was very helpful for someone starting out as a new employee’ (ECMHN6).

Early career mental health nurses also described the ‘revolving door’ of acute mental health services—where consumers were discharged before they felt ready or stabilised, only to be readmitted shortly thereafter—as a significant emotional and professional burden:

…it worsened my (own) mental health, because I'll be so sad sometimes, I'd come home and I was like ‘that's the hardest thing I've ever done…discharging that patient’…I can tell they are not well enough to go back home (ECMHN8).

Witnessing repeated cycles of crisis, discharge and return often generated feelings of frustration, helplessness and moral distress among ECMHNs, who questioned the effectiveness and sustainability of the system in which they were working: ‘…we don't have accommodation! We don't have funding!’ (ECMHN8). For many, this pattern wore down their sense of achievement and undermined confidence in their developing clinical skills, as progress made with consumers felt temporary or easily undone. Over time, the cumulative impact of these repeated disruptions contributed to emotional fatigue, compassion strain and a diminished sense of professional efficacy: ‘…they are nearing discharge and they say, ‘I can't wait to get out, do drugs again’. Perfect! It's disheartening. I'm not sure what I can do for you anymore other than this’ (ECMHN5).

4. Discussion

The aims of this study were to explore early‐in‐career mental health nurses' experiences of workplace readiness, wellbeing and preparedness for practice. ECMHN experiences of transitioning in their role and the level of preparedness they felt is not well understood in the literature and this paper provides some key novel elements to add to the discourse. A prominent finding from this study was that many participants chose blended graduate programs incorporating rotations in both general and mental health nursing, often to gain additional exposure to mental health nursing while maintaining ‘general’ nursing skills. These programs may be particularly advantageous for early‐career graduates who are unsure about committing exclusively to a mental health nursing pathway, allowing for informed career decision‐making while facilitating exposure to the complexities of mental health practice. Importantly, exposure to general nursing practice within blended programs is particularly valuable given the substantial comorbidity of physical and mental health conditions among mental health service users (Launders et al. 2022). This broader clinical preparation supports the development of holistic care capabilities while allowing early‐career graduates to build confidence in managing complex physical health needs alongside mental health care. Additionally, the four themes identified in this study highlight the importance of adequate tertiary preparation and the importance of wellbeing strategies to support longevity in their careers.

ECMHN in our study described inadequate preparation in their undergraduate training, particularly in relation to the variability of clinical placement experiences resulting in some describing deciding on a career in acute mental health after having only undertaken a private or community mental health placement. This resulted in transition shock for several ECMHN who had underestimated the acuity of the role they were stepping into, and concerns over their ability to manage challenging situations such as occupational violence and aggression and their skills in deescalation. Hazelton et al. (2024) suggest that variability in the quality and structure of clinical placements significantly influences early‐career mental health nurses' perceptions of preparedness for professional practice. The influence of clinical placement experiences on nursing students' attitudes towards mental health nursing practice is substantial and is documented in the literature. However, marked variability in placement quality can contribute to misaligned expectations regarding the scope and realities of the mental health nursing role. Alexander et al. (2025) note that community mental health placements may not consistently provide an optimal learning experience for students, largely due to significant variation in structure, support and learning opportunities. This misalignment is further compounded by the fact that ECMHN are generally unable to complete their graduate year in community settings because of the complexity of care involved. Consequently, disparities between students' expectations and the realities of professional mental health nursing practice may persist beyond graduation. As many participants were attracted to mental health nursing because of opportunities for therapeutic engagement and continuity of care, commencing practice in acute inpatient settings may influence both satisfaction with the specialty and future career preferences.

These experiences have the potential to create additional challenges and stress during ECMHN transition into practice, placing further strain on an already pressured workforce. Evidence suggests that exposure to workplace violence during clinical placement is a common experience for nursing students. In a systematic review, Dafny et al. (2023) report that nursing students frequently experience workplace violence while on placement and highlight the need for appropriate supports and organisational structures within clinical environments. However, most studies included in their review focused on horizontal violence perpetrated by staff, rather than violence directed at students by patients or families. This distinction is significant, as patient‐ and family‐directed violence was identified by ECMHN in our study as a pivotal factor influencing their feelings of preparedness for practice. Supporting this concern, Hunter et al. (2022) found that 70% of student nurses experienced verbal or physical violence during clinical placements, with people experiencing mental illness identified as the most common individuals involved. Taken together, this body of literature underscores the necessity of comprehensive occupational violence prevention and de‐escalation training for students undertaking mental health placements, given that clinical placement represents a key context in which such incidents most frequently occur.

Several ECMHNs in our study also reported a preference for mental health nursing over general nursing attributing this preference to perceptions that general nursing was more physically demanding. While physical workload may differ across nursing contexts, this view risks underestimating the substantial psychological and emotional demands inherent in mental health nursing practice. Although these challenges have been well documented in the literature (Delgado et al. 2021; Foster et al. ²⁰¹⁹), participants were also attracted to opportunities for therapeutic engagement, continuity of care and meaningful relationships with consumers, suggesting that these rewarding aspects of practice may support ongoing commitments to the speciality despite its challenges. The sustained exposure to heightened emotional labour, complex interpersonal interactions and frequent encounters with distress, risk and uncertainty may impose a burden that is equal to, or in some cases greater than, the physical demands associated with other areas of nursing practice. Within the Australian context, mental health‐related claims and injuries resulting from interactions with physically aggressive individuals remain prevalent, accounting for a considerable proportion of occupational injury claims (Safe Work Australia ²⁰²⁵). As such, it is imperative that ECMHN develop a comprehensive understanding of the occupational stressors inherent in mental health nursing, alongside evidence‐based strategies to effectively manage these demands. Without adequate preparation in this area, early‐career nurses may be at heightened risk of psychological distress, burnout and reduced workforce retention.

ECMHN in our study described significant distress associated with the perceived ‘revolving door’ of acute mental health care, particularly when consumers were discharged before they were considered ready. While identified by ECMHNs, similar concerns have been reported by more experienced mental health nurses, suggesting this is not solely a transition‐to‐practice issue. Bushell et al. (2021) found that nurses often experienced frustration when consumers repeatedly represented to services, contributing to a sense that recovery gains were difficult to sustain. The consistency of these findings across career stages suggests that the emotional burden associated with the perceived ‘revolving door’ of mental health care reflects broader service and system challenges rather than issues unique to early‐career practice.

Another key finding of this study was that ECMHN developed personal coping strategies early in their transition to mental health nursing, particularly when supported by cohesive teams and opportunities to acquire effective mental health‐specific skills that enhanced their sense of control and psychological safety. For participants in this study, the development of these coping strategies was facilitated by service‐level supports, including structured in‐service education and formal training opportunities. These organisational supports were complemented by individual wellbeing strategies, such as limiting overtime and maintaining predictable work hours, which together contributed to participants' capacity to manage the demands of early‐career mental health nursing practice. The importance of support for ECMHN during early career transition is documented in the literature (Foster et al. 2025; Joseph et al. ²⁰²²). In particular, organisational culture, team dynamics and the quality of the workplace environment have been consistently identified as pivotal factors influencing ECMHN decisions to remain within a service (Foster et al. 2025; Joseph et al. ²⁰²²). The quality of transition‐to‐specialty practice programs has also been found to strengthen mental health nursing role clarity (Alexander et al. 2024), a significant benefit given the challenges ECNHN face when understanding their new role.

Participants described experiences that underscored the importance of organisational supports in promoting wellbeing, confidence and work satisfaction during their transition to clinical practice. Clinical supervision may provide an additional mechanism of support during this period. Organisational support during the initial years of mental health nursing practice has been identified as an important influence on transition and retention (Joseph et al. 2022), while clinical supervision has been associated with positive workforce outcomes, including professional support, competence development and workplace culture (McDonough et al. ²⁰²⁴). As such, clinical supervision may represent an important strategy to support ECMHNs as they navigate the emotional and professional demands of speciality practice.

5. Strengths & Limitations

This study provides in‐depth insights into early career mental health nurses' experiences of transition from student to Registered Nurse, using a qualitative descriptive design that remained closely grounded in participants' accounts. The use of reflexive thematic analysis strengthened the rigour of the study through a systematic and transparent analytic process, while acknowledging the interpretive role of the research team in the development of themes. Additionally, the inclusion of participants with varied placement backgrounds enhanced the richness and diversity of the data. However, the findings should be considered in light of several limitations. The study was conducted within a single health service, which may limit the transferability of findings to other settings with different models of care or educational partnerships. A further limitation is that the research team comprised senior clinicians and nursing leaders and did not include a lived experience researcher. Inclusion of a lived experience perspective may have enriched the interpretation of findings and provided additional insights into factors influencing early‐career mental health nursing practice and workforce retention. The research team did not include an early‐career mental health nurse, which may have also limited the perspectives informing interpretation of findings. As with all qualitative research, the findings are context‐specific and rely on self‐reported experiences, which may be subject to recall bias. Furthermore, participants self‐selected into the study, raising the possibility that those with particularly strong or divergent experiences were more likely to participate.

6. Conclusion

This study provides important insights into the early career experiences of ECMHN, highlighting the central role of clinical placement quality, exposure to workplace violence, and organisational support in shaping preparedness for practice and workforce retention. Variability in placement experiences contributed to misaligned expectations and heightened transition challenges. Findings also underscore that patient‐ and family‐directed occupational violence is a salient concern for ECMHN, reinforcing the need for targeted preparation during undergraduate education and early career transition. Additionally, this study identifies blended graduate programs as a potentially valuable, yet under‐explored, workforce strategy, offering flexibility and informed career decision‐making for graduates uncertain about committing exclusively to mental health nursing, while maintaining competence in general nursing skills essential to holistic care. Collectively, these findings emphasise that early transition experiences are shaped not only by individual capability but by structural, educational and cultural supports that warrant greater attention in mental health nursing education and workforce planning.

7. Relevance to Clinical Practice

The findings of this study have clear implications for clinical nursing practice, particularly in supporting ECMHN during the critical transition to professional mental health nursing roles. Clinical services play a pivotal role in fostering preparedness and retention through the provision of supportive team cultures, structured supervision and access to skill‐building opportunities that enhance psychological safety and professional confidence. The prevalence of occupational violence during placements and early practice highlights the necessity of embedding comprehensive occupational violence prevention and deescalation training within mental health clinical education and graduate transition programs. Furthermore, service‐led strategies that promote wellbeing—such as manageable workloads, predictable hours and avoidance of excessive overtime—are essential in mitigating early career stress and burnout. Participants' preference for blended graduate programs also highlights the importance of flexible workforce pathways that support professional development while enabling exploration of career options in both general and mental health nursing. Such pathways may be particularly relevant given the complex physical and mental health comorbidities experienced by mental health service users. Further research is needed to understand the impact of blended graduate programs on transition experiences, career decision‐making and workforce retention. Strengthening these clinical supports is therefore integral to sustaining a resilient and competent mental health nursing workforce.

Author Contributions

Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.