Role Transition of Recent Nurse Graduates Into Practice in Long‐Term Care and Home and Community Care Sectors: A Scoping Review

ABSTRACT

Aim

To explore transition experiences of newly graduated nurses transitioning into long‐term care and home and community care.

Design

Scoping Review.

Methods

Joanna Briggs Institute framework and Arksey & O'Malley's principles for scoping reviews were used. Covidence facilitated evidence selection. Two independent reviewers screened and extracted data, with a third resolving disputes. NVivo 14.0 supported data analysis, and thematic analysis highlighted transition experiences.

Data Sources

Data retrieved from Medline, EMBASE, CINAHL, PsycINFO, Scopus, Google Scholar and Google for published and grey literature; searched February 2026.

Results

From 27 articles, analysis revealed four themes: (1) A Different World: Contextual Challenges in Long‐Term Care and Home and Community Care Sectors, (2) Navigating as a New Graduate Nurse: Knowledge, Skills, and Behaviours, (3) Support and Guidance, (4) Emergence of Professional Self as a Nurse in Long‐Term Care and Home and Community Care.

Conclusion

This review emphasized the need for addressing clinical and emotional aspects of transition, including proper orientation, tailored nurse residency programs, and workload management for facilitating integration and supporting development of nurses' professional identity.

Implications for the Profession and/or Patient Care

This review may guide healthcare leaders in refining support systems for new nurses, ultimately elevating patient care standards in these sectors.

Impact

Addressing challenges new nurses face when assimilating into long‐term care and home and community care environments may enhance nurse confidence, job satisfaction, recruitment, and retention.

Reporting Method

The EQUATOR guidelines for PRISMA‐ScR.

Patient or Public Contribution

No patient or public contribution.

Protocol Registration

https://doi.org/10.17605/OSF.IO/YD4GB, https://osf.io/gjdfz

What Does This Paper Contribute to the Wider Global Clinical Community?

• Understanding of facilitators to onboarding new nurses in long‐term and home and community care.

• Underscored unique challenges in transitioning to practice into long‐term and home and community care.

1. Introduction

The nursing shortage is a global issue contributing to a mounting health crisis (Buchan and Catton 2023; Canadian Nurses Association 2019; World Health Organization 2022). Long‐term care (LTC) and home and community care (HCC) sectors have had parallel trends with severe staffing challenges, which were further exacerbated by the pandemic (Denny‐Brown 2021; Ontario Ministry of Long‐Term Care 2020; RNAO 2024). Evidence from Canadian workforce data indicates that nursing shortages are systemic and span LTC and HCC sectors, rather than occurring in isolation (RNAO 2024). Nursing in LTC and HCC, comprised primarily of older adults, shares similarities in fundamental care provision—including hygiene, mobility, skin care, and daily living support—which are becoming increasingly complex and challenging (Nordaunet et al. 2024). Nurses in these sectors face shared structural challenges in their abilities to provide meaningful person‐centered care as the systems in place have been chronically underfunded, undervalued, and disintegrated (Nordaunet et al. 2024). Other contributing factors to the scarcity of nurses in these two sectors include heavy workloads, stressful working conditions, an increasingly aged population, rising demand for care, a surge in nurse retirements, and a shortage of new graduate nurses (NGNs) joining these healthcare sectors (Ganann et al. 2019; Fick et al. 2022). There is a notable impact on the health and morale of staff, patient safety, healthcare quality, and a growing perception of LTC and HCC as less desirable work sectors compared to acute care settings and other healthcare environments among nursing students and NGNs (Tamata and Mohammadnezhad 2023; White et al. 2021).

In Ontario, Canada, Registered Nurses (RNs) and Registered Practical Nurses (RPNs) are core healthcare human resources in both LTC and HCC sectors (Drost et al. 2023). The work of these two categories of nurses shares similarities in the philosophical foundations of nursing care, both completing professional regulatory examinations and representation by professional associations, and expectations of working together as a collaborative workforce (Whitmore, Baxter, et al. 2019). While academic preparation and scopes of practice differ, the roles of RPNs and RNs are organizationally and socially linked (Balcom et al. 2024). Their roles are co‐constructed in practice and shaped within the systems and settings of LTC and HCC (Balcom et al. 2024). For the purposes of this scoping review, NGNs were considered as inclusive of both RPN and RN designations to enable a broader mapping of the evidence in a clinically significant manner with both nursing designations together as they work pragmatically in LTC and HCC settings in the real world.

Recent studies underscore factors contributing to turnover and low retention in LTC and HCC. In Canada, turnover rates for regulated nurses have been estimated to be up to 31.4% in LTC (Drost and Sweetman 2023) and 25% in HCC (Ontario Community Support Association 2024). Job satisfaction among nurses in LTC facilities is generally low due to heavy workloads, inadequate staffing levels, and insufficient supervisor support (Aloisio et al. 2021; Hoshino et al. 2025). Two systematic reviews suggest that job satisfaction is significantly associated with nurse turnover in LTC, with individual factors such as age, health status, empowerment, and work stress consistently linked to job satisfaction (Aloisio et al. 2021; Lee 2022). A third qualitative systematic review suggests aspects relating to recruitment and retention of nurses in LTC include: organizational influence on nursing, pride in relationship cultivation, recognizing LTC nursing as more than task‐based skills, valuing autonomy and independent work, and confronting challenges of societal views of LTC (Compton et al. 2023). In HCC, nurse job retention is statistically associated with work meaningfulness, role clarity, care quality, financial compensation, and work‐life balance. These associations directly affect nurses' intentions to remain with their current employers over a 5‐year period (Hallaran and Jessup 2023; Lee et al. 2021; Tourangeau et al. 2017). In light of the pressing demand for nursing professionals within LTC and HCC, the imperative for research to pinpoint and comprehend the factors influencing recruitment and retention cannot be overstated.

Post‐pandemic recovery of the nursing workforce in healthcare necessitates investing in support (Buchan and Catton 2023). In Kramer (1975) initiated attention to ‘reality shock’ frequently experienced by NGNs, which was supported by the finding of ‘transition shock’ by Duchscher (2009). Both terms describe the stress and potential for early burnout due to a disparity between theoretical knowledge and practical application. Similarly, the transition‐to‐practice for NGNs has been described as a complex interchange between individual, interpersonal, and external influences (Hale et al. 2024). This turbulent transition experience often leads to high turnover rates, with many new nurses considering leaving the profession within their first 2 years, even without the added pressures of a pandemic (Beswitherick 2022; Brown et al. 2015; Duchscher and Corneau 2023a, 2023b; Kramer et al. 2013; Rudman and Gustavsson 2011; Wah et al. 2023).

The challenges inherent for new nurses as they adapt to new roles and responsibilities in transitioning to professional practice may be further heightened in LTC and HCC settings. These patient care settings may pose challenges related to requiring a broad skill set and a high level of autonomy (Patterson et al. 2013; Johnson 2021) often without adequate transition support programs (McCloskey et al. 2023; Whitmore 2017). These sectors demand nurses who are proficient in specialized skills and possess comprehensive insights into patient care (Munanga 2020). Nonetheless, existing studies examining the integration of NGNs into LTC and HCC roles often lack a detailed exploration of these specific skill sets and insights (Whitmore, Kaasalainen, et al. 2019).

1.1. The Review

The significance of conducting this scoping review lies in its potential to identify key factors influencing the recruitment, retention, and job satisfaction of NGNs in LTC and HCC settings. Supporting NGNs during their transition process is critical to their development into competent, confident, and satisfied healthcare professionals (Chang and Daly 2016). Understanding the challenges and facilitating factors in role transition, the process through which NGNs adapt to their professional roles and responsibilities to the LTC and HCC workforce, is crucial in devising effective strategies for smooth integration into the nursing profession within these fields.

1.2. Aim

This scoping review sought to summarize available research on NGNs transitioning into LTC and HCC sectors. The purpose of this review was to identify gaps in current knowledge and practice regarding the challenges and opportunities NGNs encounter when transitioning to work in LTC and HCC. By highlighting these gaps, the review may inform future research, nursing education, and clinical practice. Guided by three main questions: (1) What have studies shown about transition experiences of NGNs in LTC and HCC? (2) What are the gaps in current knowledge about NGN transition in LTC and HCC? and (3) What are future directions for research, education, and practice in NGN transition in LTC and HCC?

2. Methods

This scoping review drew from both the Joanna Briggs Institute's (JBI) framework for scoping reviews (Peters et al. 2020) and the foundational principles laid out by Arksey and O'Malley (2005). The five‐stage framework developed by Arksey and O'Malley (2005) includes (i) identifying the research question, (ii) identifying relevant studies, (iii) selecting studies, (iv) charting the data, and (v) collating, summarizing, and presenting findings. A combination of the JBI guidance and the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) checklist (Tricco et al. 2018; see Supporting Information) provided a structured blueprint for devising the research aim, developing the search strategy, and directing data analysis. This comprehensive approach ensured a broad coverage of all pertinent literature, including non‐traditional sources or grey literature.

2.1. Design

After registering our protocol with the Open Science Framework (Connelly et al. 2023), we embarked on the JBI three‐step search strategy. This review consulted the extension of Arksey and O'Malley (2005) framework proposed by Levac et al. (2010), which supports incorporating an interdisciplinary research team throughout the scoping review process: throughout study screening, qualitative data analysis, and presentation of the findings. This scoping review was conducted by a team of researchers, trainees, and educators. [MH] and [HK] conducted literature searches and, alongside [GT], reviewed and screened all articles based on inclusion criteria. Through regular meetings, these trainees were supported by an experienced researcher, [DC].

2.2. Search Methods

The JBI methodology was deployed to identify search terms from keywords and indexed phrases in pertinent articles (Peters et al. 2020). A Teaching & Learning Librarian from the University of Western Ontario assessed the search terms and strategy. Initially, limited searches were performed on Medline and CINAHL, where the team identified and honed search terms from relevant article titles and abstracts, using the Participants, Concept, and Context (PCC) mnemonic as a relevance filter (Peters et al. 2020). Primary search terms centred on three main elements: nursing roles (e.g., ‘Recent graduate nurse,’ ‘Registered Nurse’ (RN), ‘Registered Practical Nurse’ (RPN) for participants), care settings (e.g., ‘Long‐term care,’ ‘Home care,’ ‘Elder care’ for context), and the roles' scope (e.g., ‘Role transition,’ ‘Experience,’ ‘Role adaptation’ for concept). Subsequently, these refined terms were applied across all selected databases. For a comprehensive understanding, data sources spanned multiple databases: Medline, EMBASE, CINAHL, PsycINFO, and Scopus. Google Scholar aided in finding both published and unpublished works. Due to the large volume of results and limited reproducibility of the Google Scholar platform, only the first 200 results were reviewed. Google searches were conducted to identify relevant grey literature, including newsletters, government reports, organizational documents, policy papers, and professional resources that may not be indexed in the academic database searches. For grey literature, one researcher [HK] screened the titles/headlines and description snippet for the first 200 Google search results to determine relevancy using the PCC pneumonic of inclusion criteria. Lastly, reference lists from pertinent articles were manually searched by a team member ([HK]). Searches were completed in February 2026. An example of the complete search strategy for one database is provided in the Supporting Information. Various quantitative and qualitative designed studies were included. There were no language restrictions, and the timeframe for the final search was up to February 5, 2026. The search strategy, including keywords and index terms, was adapted according to the individual database requirements under the guidance of a qualified resource librarian.

2.3. Inclusion and Exclusion Criteria

In shaping the inclusion criteria for this review, the JBI framework's PCC mnemonic was employed (Peters et al. 2020). Participants encompassed recent nurse graduates, both RNs and RPNs, who were within 3 years post‐graduation (Laschinger et al. 2016). While some conceptions of “recent nurse graduate” in the literature may limit the timeframe to within 12 months of graduation, the authors herein chose to conceptualize “recent nurse graduate” as within 3 years of graduation to broaden the reach of potential relevant research and reflect the notions put forth by Benner (1984) and others (Masso et al. 2022) that practice readiness, competence and confidence may take up to 3 years of situational exposure after graduation for new nurses. This operational definition has also been employed to study transition‐to‐practice for NGNs in Canadian hospital contexts (Laschinger et al. 2016). In Ontario, Canada, the term RPN is categorically utilized; however, the authors recognize that varying terms are employed internationally. Similar categories of nurse roles, which may share similar scopes, include Licensed Practical Nurses (LPNs) from the United States (Jones 2016) and provinces other than Ontario in Canada (CCPNR 2026), Enrolled Nurses (ENs) from Australia (Brown et al. 2015), and Assistant Practitioners, Associate Degree, or Associate Nurses (AP, ADN, AN) from the United Kingdom (King et al. 2022). Herein, the titles RPN, LPN, EN, AP, ADN, and AN were collectively referenced as “RPNs and similar” nurse categories. The Concept covered transition‐to‐practice, role experiences, and scope, while the Context focused on NGN transitions into LTC and HCC settings. While LTC and HCC settings predominantly serve older adults, paediatric community contexts were included because the operational role transition experiences—such as working alone, isolation, and systemic time pressures—are conceptually equivalent across these sectors.

Exclusion criteria remained conservative to facilitate a broad search of available and potentially relevant sources. Studies lacking elements of the PCC mnemonic and those focusing solely on acute care or hospital settings were excluded. Studies of various designs, encompassing primary and secondary research, were included. There were no restrictions on publication date or language.

2.4. Search Outcome

The study selection was streamlined using Covidence software. All potential citations from databases were uploaded to Covidence, with duplicates removed. Three researchers ([MH, HK, GT]) independently screened titles and abstracts of the uploaded potential citations. Following this, full‐text articles were assessed for relevance against set criteria. Exclusion reasons were recorded. It was determined a priori that disagreements about inclusion would be settled through discussions until a majority (two out of three) agreed. The team achieved full agreement on included articles before data extraction. The selection process was illustrated using the PRISMA‐ScR flow diagram (Figure 1).

FIGURE 1.

PRISMA flow diagram. [Colour figure can be viewed at wileyonlinelibrary.com]

2.5. Quality Appraisal

Rigour was demonstrated through consistency and coherence of the methodological approach with the research methods chosen, along with transparency of the research process in design, data collection, analysis, and presentation of the findings. The findings of this scoping review are considered to be cross ‘verified’ from multiple sources. Moreover, three researchers with different backgrounds brought different perspectives in analysing the articles retrieved. Reflexivity was employed through interrogation of interpretation; thus, having the research team critically evaluate how assumptions shaped understandings and generation of knowledge. Quality appraisal of individual articles was not included.

2.6. Data Abstraction

Data abstraction was standardized with a template table created a priori by the research group. NVivo 14.0 facilitated a collaborative qualitative data analysis, and results were articulated through tables, figures, and a descriptive summary (QSR International Pty Ltd 2023). Data extraction was guided by a predefined table to address the three main questions: (1) What have studies shown about transition experiences of NGNs in LTC and HCC?, (2) What are the gaps in current knowledge about NGN transition in LTC and HCC?, and (3) What are future directions for research, education, and practice in NGN transition in LTC and HCC?, focusing on information including authorship, publication year, study location, design, purpose, participant details, characteristics of transition experiences, context(s) of transition, and key findings (Table 1).

TABLE 1.

Characteristics of included studies (n = 27).

Study	Country	Method	Aim	Participants	Findings
Aggar et al. (2018)	Australia	Cohort Questionnaires	Comparing primary health care vs. acute care	NGNs: Community (n = 12), Acute Care (n = 13)	No difference in perceived competence between settings
Brooks (2025)	United Kingdom	Personal perspective, interviews	Sharing perspectives of NGNs working in HCC	NGNs in Home and Community Care (HCC; n = 2)	Four main themes were described, including: (1) significance of attaining community placements while in nursing program to influence career choice; (2) rewards of HCC nursing; (3) overcoming unique challenges in HCC including independent practice; (4) advice to nursing students including the importance of flexibility, independence, and effective decision‐making skills
Burgess and D'Hondt (2007)	Canada	Practice‐focused article	Discuss challenges NGNs face in long‐term care (LTC) and its impact on retention	NGNs transitioning to practice in LTC settings	Positive impact on retention with adequate orientation (1–4 months) Unique challenges in LTC: high patient ratios, complex cases Empowerment linked to job satisfaction and retention
Chemutai and Rithara (2010)	Kenya	Personal perspective	To identify challenges of new palliative care nurses in Kenya	NGNs	80% of newly trained nurses lack knowledge on palliative care
Connelly et al. (2024)	Canada	Hermeneutic phenomenology	To explore the experiences of new graduate RPNs and RNs from a tuition reimbursement program supporting students enrolled in nursing bridging education during transition to practice in LTC and HCC	NGNs including Registered Practical Nurses (RPNs) and Registered Nurses (RNs)	Experience was embedded in a sense of fulfilment, illustrated through themes of benevolence; growth, eagerness, and anticipation to learn; building from within; and work‐life balance The first phenomenological study to explore the meaning of the experience of transitioning to practice for NGNs from bridging education programs as they (re)enter the workforce in LTC and HCC
Coyne et al. (2016)	Australia	Interpretive phenomenology with 2 focus groups	Investigate the transition experience of I‐Kiribati nurses in residential aged care facilities (RACF)	I‐Kiribati nursing graduates (n = 6) transitioning into RACFs, practicing for 1 year	Three themes: (1) uncertainty of expectations, (2) understanding practice responsibilities, (3) stepping into RN role Initial challenges: managing clinical situations, language/cultural barriers, dealing with death & dying
Darvill (2013)	United Kingdom	Interviews Participant observation Field notes	Explore the experience of NGNs transitioning into children's community nursing teams	NGNs (n = 8) recruited into children's community nursing teams, working full‐ or part‐time	Home and community care was perceived as a ‘different world’ from acute care, especially lone working
Darvill et al. (2014)	United Kingdom	Semi‐structured interviews and fieldwork observation, and analysed using a combination of thematic analysis	To explore transition experiences of new children's nurses in the community	Newly qualified children's nurses in the community (n = 8)	Key facilitators for development: physical presence of a preceptor, opportunity for job‐specific competencies under supervision, colleague support
Fadilah and McKenna (2019)	Indonesia	Semi‐structured interviews	Explore the educational preparation of new Indonesian nurses for community‐based maternal care	New nurses in community settings in Gowa District	New nurses often perform roles typically done by midwives Nurses might lack adequate educational prep for this role, causing insecurity and anxiety
Fukuyama and Akiyama (2019)	Japan	Semi‐structured interviews, analysed using the Steps for Coding and Theorization (SCAT) Method	Understand difficulties faced by NGNs starting as home‐visit nurses	Newly graduated home‐visit nurses (n = 11) directly entering the field after graduation.	Key difficulties: Understanding client needs Providing daily‐life care Providing medical assistance Collaborating with other stakeholders
Fussell et al. (2009)	Australia	Semi‐structured interviews, Thematic analysis	To explore experiences of graduate RNs in aged care/LTC settings	Graduate RNs in aged care/LTC settings (n = 11)	Work can be monotonous, leading to dissatisfaction Lower level of professional support compared to other settings Role confusion and lack of clarity in job roles
Generous (2024)	Canada	Case study	To investigate the transition experience of a NGN in rural HCC context	New graduate RN
Guli et al. (2017)	USA	Descriptive study with survey methods using Hinshaw and Atwood's Anticipated Turnover Scale (ATS)	Identify factors impacting newly hired nurses' plans to leave LTC positions.	New graduate RNs, experienced RNs, new graduate Licensed Practical Nurses (LPN), and experienced LPNs in five LTC facilities	NGRNs without dependents were most likely to anticipate leaving Younger, well‐educated nurses respond well to reward‐based climates and promotional opportunities
Howard‐Vernet (2022)	USA	A descriptive phenomenology, using semi‐structured interviews and thematic analysis.	Understand the lived experienced of novice LPNs transitioning to LTC	Novice LPNs (n = 5) in LTC settings	Challenges included inadequate staffing, unsuitable nurse–patient ratios, time management issues, and heavy workloads Participants felt nervous, inexperienced, and incompetent in their first 30 days of practice
Jones (2016)	USA	Semi‐structure interviews	Explore the lived experience of transition‐to‐practice for new graduate LPNs in LTC settings	Newly graduated LPNs (n = 3) practicing in their first job	(1) Negative aspects: Witnessed intimidating and disruptive behaviour Experienced humiliation, lack of respect, and powerlessness Emotional distress (2) Positive aspects: Felt valued and supported in relationships Motivated and satisfied with LTC practice (3) Transition‐to‐practice: Glad to be LPNs in LTC Motivated to continue education
Maxwell et al. (2011)	United Kingdom	Interviews	To explore challenges and transition experiences of newly qualified community nurses	10 NGNs within 18 months of qualification (n = 7 in community, n = 3 in intermediate care)	Essential factors for transition: supportive preceptors, structured induction, nurturing environment New nurses value patient relationships and teamwork
McMurray (1992)	Australia	Participant observation, individual interviews, and written retrospective accounts of critical incidents (clinical episodes)	Explore characteristics and factors influencing clinical expertise in community health nursing	Novice and expert community health nurses in district nursing, school health, and child health	Novice nurses tended to rely on pre‐encounter information and stereotyped situations, seeking confirming data rather than recognizing cue patterns, potentially limiting their ability to effectively navigate clinical situations
Miyata et al. (2022)	Japan	One‐year longitudinal observational study	Clarify the status of novice public health nurses home‐visit skills in their first year	Novice public health nurses from three Japanese regions	Novices perceived strong skills in developing a trusting relationship Novices didn't perceive full independence even with frequent visits
Patterson et al. (2013)	Canada	Semi‐structured interviews and thematic analysis	Explore experiences of NGNs in home care using phenomenological methodology	NGNs in home care	Challenges faced by NGNs in home care include feeling inexperienced, working independently, and dealing with unexpected job realities Support from preceptors, colleagues, and clients was crucial for their success, while lack of support posed a major challenge
Rolt and Gillett (2020)	United Kingdom	Semi‐structured interviews and thematic analysis	Explore NGNs' experiences in hospices	NGNs in United Kingdom hospices	Opportunities for NGNs' skill development in communication, end‐of‐life care, and symptom management Challenges: Lack of clinical training, negative attitudes from staff
Roziers et al. (2014)	South Africa	Husserlian descriptive phenomenology	To explore the experience of newly qualified nurses transitioning to community service nurse	Newly qualified nurses completing compulsory community service placements in community health facilities	Themes: (1) a sense of achievement, (2) uncertainty and fear in anticipation of reality, and (3) reality shock
Sneltvedt and Bondas (2016)	Norway	Phenomenological hermeneutic	To explore experiences of professional pride in recently graduated nurses in municipal health care settings	Recently graduated nurses in municipal health care settings	Themes: (1) doing right & good, (2) recognition & confirmation, (3) thriving in practice communities Graduated nurses value relationships with patients/families, deriving pride & purpose
Sneltvedt et al. (2010)	Norway	Semi‐structured interviews	Explore the experiences of NGNs in HCC	NGNs working in HCC	Challenges include extensive competence requirements, working alone in users' homes, and limited freedom to choose nursing procedures Positive experiences include a feeling of thriving, pride, mastery, and influence
Sneltvedt and Sørlie (2012)	Norway	Hermeneutic phenomenology with narrative interviews	To highlight what is most important to NGNs during their transition‐to‐practice in community health care/HCC to assist leaders and colleagues to create supports	Nine NGNs (eight female, one male) in community health care/HCC	Five themes were identified for nursing leaders to consider in supporting NGNs during onboarding: (1) taking the initiative, (2) understanding the nurses' professional pride, (3) providing competence time, (4) showing the nurses trust, and (5) clarifying the professional role
Wangensteen et al. (2008)	Norway	Individual interviews	To explore how recently graduated nurses experience their first year	12 recently graduated nurses in hospital and home care setting	First year characterized by uncertainty and chaos Importance of feedback, supportive environment, and structured induction programs
Whitmore, Baxter, et al. (2019) and Whitmore, Kaasalainen, et al. (2019)	Canada	Explanatory case‐study	Describe the transition‐to‐practice experience of NGNs in LTC settings	New graduate RNs and LPNs' transitioning experiences in LTC	Five processes accelerated the transition experience: (a) struggling to meet expectations, (b) practicing in isolation, (c) relying on others, (d) developing skill and confidence amid challenges, and (e) recognizing complexity and value in LTC
Whitmore, Baxter, et al. (2019) and Whitmore, Kaasalainen, et al. (2019)	Canada	Explanatory case‐study	To explore the similarities and difference between new graduate RNs and LPNs in LTC	New graduate RN and LPNs in LTC	Transition experience of NGN LPNs in LTC was comparable to that of RNs, with variations stemming from leadership roles LPNs had autonomy in LTC due to the absence of specific staffing ratios Challenges were noted for NGN RNs taking on leadership and charge nurse roles in LTC

2.7. Synthesis of Results

Using NVivo software, the research team engaged deeply with the data, repeatedly reading articles. Initial codes were developed from important text segments in each article. These codes were then grouped into broader sub‐themes and themes (Braun and Clarke 2006). An inductive thematic analysis helped organize diverse narratives into coherent patterns, shedding light on the transition experiences of nurses in LTC and HCC settings (Braun and Clarke 2006). Analysis was iterative, continually revisiting articles, codes, and emerging themes. Through team discussions with all authors, these themes were refined, ensuring rich representation of the data. Thematic maps were drafted and adjusted, ensuring a comprehensive representation of article insights. Writing of the final report further interpreted the findings, delving deeper than the initial data insights (Braun and Clarke 2006).

3. Findings

A total of 27 articles met the inclusion criteria for data extraction and analysis. Six of the articles investigated transition‐to‐practice into LTC and/or HCC within Canada, while 21 were conducted in other countries. A total of 21 articles (77.7%) focused on role transition for RNs, while two addressed RPNs (7.41%). An additional four included both RPN and RN designations (14.8%). All of the included articles were qualitative studies. Evidence included 26 (96.3%) descriptive qualitative studies, and one practice‐focused article (3.7%) published in a professional nursing publication. The selection process for the 27 included articles involved screening a total of 1995 articles from databases. Seventy‐eight articles were screened in full‐text, and 51 were excluded for not meeting inclusion criteria, leaving 27 articles for data extraction and analysis (Figure 1).

3.1. Characteristics of Included Studies

Included studies were conducted in the following countries: Canada (6), United States (3), Australia (4), United Kingdom (4), South Africa (1), Kenya (1), Indonesia (1), Norway (4), and Japan (2). Settings reported in the included articles were: Long‐Term Care (LTC) (8 articles) and Home and Community Care (HCC) (18 articles); one article referenced both LTC and HCC. A summary of the included studies may be found in Table 1.

Thematic analysis of the included articles led to the recognition of themes and subthemes in response to the research aim of understanding the process of transition‐to‐practice for NGNs into LTC and HCC settings. Four major themes included ‘A Different World: Contextual Challenges of LTC and HCC Sectors,’ ‘Navigating as a New Graduate Nurse,’ ‘Support and Guidance,’ and finally, ‘Emergence of Professional Self as a Nurse in LTC and/or HCC.’

3.2. A Different World: Contextual Challenges of LTC and HCC

3.2.1. Academic World Versus Real‐World Practice

The shift from academia to professional practice emerged as a significant challenge for NGNs in LTC and HCC settings. Nine articles identified dissonance between theoretical knowledge acquired in academia and the practical demands of real‐world jobs (Darvill 2013; Darvill et al. 2014; Fadilah and McKenna 2019; Fussell et al. 2009; Howard‐Vernet 2022; Maxwell et al. 2011; Patterson et al. 2013; Roziers et al. 2014; Whitmore, Kaasalainen, et al. 2019). A phenomenology of new graduate nurses in community health services described a discrepancy between expectations and reality for the complexities of patient care and clinical conditions that felt “substandard” (Roziers et al. 2014, 97). Another qualitative study by Maxwell et al. (2011) investigating NGNs in community practice highlighted substantial new post‐graduate learning required to understand the specific attributes of working in HCC—content not explicitly addressed within their nursing programs. NGNs indicated a mismatch between expectations and actual preparedness, feeling they were “expected to take on tasks for which they did not feel equipped” (Maxwell et al. 2011, 283).

Findings from the present review suggested that curricular revisions, including expanded simulation labs and clinical rotations, may better equip NGNs for the complexities of scope and practice in LTC and HCC. Simulation labs and clinical rotations provide practical, hands‐on experiences that help bridge the theory‐practice gap and enhance preparedness for LTC and HCC settings (Fussell et al. 2009). Drawing on experiences as NGNs in a Kenyan hospice, Chemutai and Rithara (2010) underscored gaps in palliative knowledge, stating that “80% of newly trained nurses lack knowledge in palliative care, while 20% have little” (p. S125). Participants in a qualitative study by Coyne et al. (2016) of nurses' transition‐to‐work in residential LTC in Australia acknowledged that, despite being taught how to handle challenging situations, the application in real‐world scenarios was often problematic. As one NGN explained, “We know in theory but in practice, it's really different” (Coyne et al. 2016, 465). While evidence remains inconclusive regarding whether emphasizing LTC in curricula influences attitudes or career choices (Fussell et al. 2009), targeted simulation and clinical exposure may strengthen NGNs' confidence and preparedness for these roles.

3.2.2. Workplace Environment and Team Dynamics

Contextual factors within LTC and HCC may intensify the sentiment that NGNs are transitioning to practice in a different world. Ten studies highlighted distinct aspects of out‐of‐hospital environments (Burgess and D'Hondt 2007; Darvill 2013; Darvill et al. 2014; Fussell et al. 2009; Guli et al. 2017; Howard‐Vernet 2022; Patterson et al. 2013; Rolt and Gillett 2020; Whitmore, Baxter, et al. 2019; Whitmore, Kaasalainen, et al. 2019). Unique to these settings are the high resident/client‐to‐nurse ratio that NGNs must manage, in some instances cited as 80:1 in LTC in Ontario (Office of the Auditor General of Ontario 2023), contrasting with provincial hospital mandates of 4:1 for inpatient and palliative care (Legislative Assembly of Ontario 2024). This workload is compounded by NGNs often being the only registered nursing staff present, limiting access to immediate guidance (Burgess and D'Hondt 2007; Howard‐Vernet 2022; Whitmore, Baxter, et al. 2019).

A qualitative study of newly qualified paediatric nurses transitioning to community settings identified logistical challenges, including transportation between clients and working alone, which intensified the responsibility of independent practice (Darvill 2013; Darvill et al. 2014). Similarly, Brooks' (2025) interviews with two NGNs in HCC noted that the demands of autonomous work and independently managing patient caseloads in HCC may be unnerving; one NGN stated, “the realisation that ‘it was all on me’ was a very real challenge” (p. 63). Regular supervisory meetings, effective delegation, work‐life boundaries, and preceptorship programs were suggested as strategies to ensure smoother transition‐to‐practice in community settings (Brooks 2025).

Team dynamics often intensified NGNs' challenges. Some articles noted that experienced nurses appeared unwelcoming due to NGNs' youth and inexperience. Rolt and Gillett (2020) noted, “hostility from some established hospice staff members presented a challenge. [NGNs] revealed that established nurses were not always welcoming and suggested that this was due to a range of factors including being newly qualified, young and having a perceived lack of life experience” (p. 1722). Maxwell et al. (2011) similarly discovered that stress intensified when colleagues held “unrealistic expectations” (p. 286). Casual or part‐time workforce status further compounded transition difficulties, contributing to feelings of disengagement and disconnection (Guli et al. 2017; Whitmore, Baxter, et al. 2019).

3.2.3. Systemic Barriers to Transition

Six articles discussed systemic challenges affecting NGNs' transition to professional roles in LTC and HCC (Burgess and D'Hondt 2007; Fussell et al. 2009; Patterson et al. 2013; Rolt and Gillett 2020; Whitmore, Baxter, et al. 2019; Whitmore, Kaasalainen, et al. 2019). Time constraints limited opportunities to provide comprehensive care and engage in thorough orientation. Systems which prioritize efficiency and task completion over education and mentorship further impeded smooth transition. In a phenomenological exploration of HCC transition, one participant reflected, “It takes up so much of my time when I come home at night… Some days I come home and I'm so tired and it's like I'm not done my day!” (Patterson et al. 2013, 151). Several articles emphasized that pressures to complete tasks often occurred at the expense of orientation and resident care (Patterson et al. 2013; Whitmore, Baxter, et al. 2019; Whitmore, Kaasalainen, et al. 2019), leaving NGNs feeling their professional development and provision of care were compromised. One NGN noted, “You are so tight for time that I think that the residents aren't getting the care or the services that they need when they need them, and that this impacts their health” (Whitmore, Kaasalainen, et al. 2019, 1278).

Limited financial resources increased stress, occasionally requiring NGNs to work before completing their orientation to meet staffing needs. Senior nurses consequently had less time to mentor new graduates, heightening role uncertainty experienced by NGNs (Burgess and D'Hondt 2007; Rolt and Gillett 2020). Job insecurity and unpredictable schedules—particularly in competitively managed home care models—further contributed to intentions to leave HCC (Patterson et al. 2013). Irregular income and inconsistent hours compounded financial strain, especially as many NGNs incurred unreimbursed expenses, such as personal vehicles and cellphone usage (Patterson et al. 2013).

3.3. Navigating as a New Graduate Nurse

3.3.1. Self‐Efficacy and Self‐Doubt

NGNs experience a complex interplay of self‐efficacy and self‐doubt when transitioning to LTC and HCC. Nine articles recounted these sentiments during role transition (Burgess and D'Hondt 2007; Coyne et al. 2016; Darvill 2013; Darvill et al. 2014; Fukuyama and Akiyama 2019; Maxwell et al. 2011; Patterson et al. 2013; Rolt and Gillett 2020; Whitmore, Kaasalainen, et al. 2019). Feelings of under‐preparedness seemed internalized as personal shortcomings, undermining confidence (Whitmore, Kaasalainen, et al. 2019). Fear of others' perceptions of competence was described in LTC and hospice settings (Burgess and D'Hondt 2007; Rolt and Gillett 2020). Self‐efficacy improved with experience; one Japanese home care nurse expressed, “My anxiety to perform basic nursing techniques decreases with each new experience” (Fukuyama and Akiyama 2019, S80). Confidence also increased with repeated task performance (Coyne et al. 2016). Accountability for care decisions was another source of anxiety, though structured orientation processes and mentorship were identified as mitigating supports (Darvill et al. 2014).

NGNs were described as ‘resilient’, adapting to heavy workloads, autonomy, and limited support (Maxwell et al. 2011; Whitmore, Baxter, et al. 2019; Whitmore, Kaasalainen, et al. 2019). Nevertheless, many expressed apprehension about medication administration, underscoring awareness of professional responsibility (Maxwell et al. 2011). Inexperience led some to question their abilities, occasionally to the extent of leaving their positions (Whitmore, Kaasalainen, et al. 2019). One participant attributed her decision to leave HCC to an inability to “overcome the negative feelings associated with being inexperienced” (Patterson et al. 2013, 149). Overall, NGNs balanced developing self‐efficacy with persistent self‐doubt, shaping their clinical confidence, emotional well‐being, and career trajectories.

3.3.2. Skills and Knowledge

NGNs transitioning into LTC and HCC face varying challenges and opportunities in skills and knowledge acquisition. Five articles discussed the requisite skills needed for entry‐to‐practice and their concerns with the timely acquisition of these competencies (Darvill et al. 2014; Fussell et al. 2009; Maxwell et al. 2011; Rolt and Gillett 2020; Whitmore, Kaasalainen, et al. 2019). Effective communication—with staff, LTC residents, and families—was consistently highlighted as essential (Darvill et al. 2014; Fussell et al. 2009; Maxwell et al. 2011; Rolt and Gillett 2020; Whitmore, Kaasalainen, et al. 2019). Hospice settings, specifically, fostered “very open and very honest conversations” (p. 1720) and enhanced end‐of‐life communication skills (Rolt and Gillett 2020).

Conversely, some NGNs feared becoming deskilled compared to hospital peers. In a case study of 11 NGNs in LTC, participants reported limited exposure to varied conditions; one stated, “I wasn't learning a lot there. It was a rehab[ilitation unit] so people were pretty stable” (Fussell et al. 2009, 216). Tension emerged between preferences for fast‐paced, acute environments and the stable, routine care typical of LTC. Similarly, Whitmore, Kaasalainen, et al. (2019) found NGNs feared that LTC employment might compromise preparedness for future acute care roles (Whitmore, Kaasalainen, et al. 2019).

Limited access to advanced medical technology was another concern, with some suggesting this could deter nurses from these settings (Fussell et al. 2009). As one NGN in LTC stated, “If you don't use it, you lose it” (Whitmore, Kaasalainen, et al. 2019, 1277). Although NGNs valued the relational and communication skills gained in LTC and HCC, many expressed reservations about reduced opportunities to develop technical and acute clinical competencies (Fussell et al. 2009; Maxwell et al. 2011; Rolt and Gillett 2020). Together, these factors created a complex skills landscape for NGNs in these sectors.

3.3.3. Responsibility and Role Confusion

The initial months of practice were particularly stressful, with many NGNs uncertain about expectations. Seven studies discussed the sentiment of role confusion upon transition‐to‐practice (Coyne et al. 2016; Fussell et al. 2009; Jones 2016; Maxwell et al. 2011; Sneltvedt et al. 2010; Wangensteen et al. 2008; Whitmore, Baxter, et al. 2019). An interpretive phenomenology of NGNs in Australian residential LTC homes illustrated this sentiment: “Sometimes you don't even know yourself, what you are expected to do, or what they are asking; you don't know the answer to most things” (Coyne et al. 2016, 465). Uncertainty extended to clinical tasks as NGNs were often expected to perform procedures they lacked confidence in, make decisions in unfamiliar contexts, or assume unanticipated leadership roles (Coyne et al. 2016; Maxwell et al. 2011; Whitmore, Baxter, et al. 2019).

Role confusion was exacerbated in LTC settings, creating ethical and emotional dilemmas as NGNs struggled to define responsibilities and boundaries. Lack of clarity affected care delivery and heightened stress, particularly when immediate decisions were needed without adequate support (Fussell et al. 2009). Some participants assumed duties beyond their comfort, while others felt underutilized. One shared, “Initially they would treat you just like a student…no, I'm a nurse” (Fussell et al. 2009, 218). Additional participants described challenges with broad competencies and task delegation (Sneltvedt et al. 2010; Wangensteen et al. 2008). Ethical dilemmas—especially around death and dying—were common, and unclear expectations from patients and colleagues further heightened feelings of overwhelm.

3.4. Support & Guidance

3.4.1. Formal Support Systems

One of the most prominent aspects of support for NGNs transitioning into LTC and HCC was preceptorship. Fourteen articles included in the review specifically addressed the significance of formal support in transition (Aggar et al. 2018; Burgess and D'Hondt 2007; Darvill 2013; Darvill et al. 2014; Fussell et al. 2009; Guli et al. 2017; Jones 2016; Maxwell et al. 2011; McMurray 1992; Miyata et al. 2022; Patterson et al. 2013; Rolt and Gillett 2020; Sneltvedt and Sørlie 2012; Wangensteen et al. 2008). NGNs valued formal support, observation, and assessment by supervisors as part of their onboarding process (Darvill 2013). New graduates transitioning to practice in community health care suggested it was important to be, “[…] met and taken care of by leaders and colleagues when they started working in home care nursing.” (Sneltvedt and Sørlie 2012, 15). One newly qualified children's community nurse recounted, “We never had to do visits on our own […] It's really good, really structured.” (Darvill 2013, 124).

Careful selection and training of preceptors was emphasized. Jones (2016) noted that some NGNs experienced negative interactions during orientation, with one recounting: “I understand everybody doesn't like to orient, but she was just mean. […] it was awful” (Jones 2016, 66). Burgess and D'Hondt (2007) recommended rigorous screening, and that preceptors should be willing volunteers, to ensure their suitability for this critical role. Additionally, those authors advocated for rewarding preceptors for their time and commitment, enhancing the overall quality of the mentorship experience (Burgess and D'Hondt 2007). Preceptorship also benefited senior staff, helping them understand NGNs' skills and fostering acceptance (Rolt and Gillett 2020). Miyata et al. (2022) stated senior Public Health Nurses could guide novices in reflective practices during and after home visits, enhancing skills acquisition.

Orientation programs received significant attention. Burgess and D'Hondt (2007) found 70% of nurses viewed a 1–4‐month orientation period was adequate. Extended shadowing eased initial anxieties (Maxwell et al. 2011; Patterson et al. 2013) and an atmosphere that encouraged questions was beneficial (Wangensteen et al. 2008). Novices asked many questions to build evidence, though limited exposure left them doubting their competence (McMurray 1992; Darvill 2013). A thematic analysis of NGNs in LTC underscored gaps in formal support and access to senior clinicians/advisors (Fussell et al. 2009). Structured transition programs, including clinical education and preceptorship, could improve competence, job satisfaction, and retention rates (Aggar et al. 2018).

3.4.2. Peer and Colleague Support

In NGNs' transitions to LTC and HCC, peer and colleague support were pivotal. Nine studies discussed the benefits of a strong support network, including positive professional relationships with preceptors and peers (Aggar et al. 2018; Burgess and D'Hondt 2007; Coyne et al. 2016; Darvill 2013; Maxwell et al. 2011; Patterson et al. 2013; Rolt and Gillett 2020; Wangensteen et al. 2008; Whitmore, Baxter, et al. 2019). Emotional support from fellow NGNs helped them navigate sector‐specific challenges. One home care nurse stated, “We really support each other… which is really nice” (Patterson et al. 2013, 151).

NGNs in LTC and home care often reported greater satisfaction with support than peers in acute care. One participant highlighted, “From speaking to some of my friends who have been dumped right into the deep end basically and left to it, I'm glad [to be in the community], because I'd rather have somebody there for support and do things right than to be left to my own devices and do something wrong” (Darvill 2013, 115). Co‐workers played a critical role in ‘cheering up’ NGNs and debriefing after difficult events, such as a patient death (Rolt and Gillett 2020; Wangensteen et al. 2008, 1880), fostering NGNs' confidence. Conversely, lack of peer support hindered some NGNs; one noted, “There weren't other new grads […] and I think that really hindered my feeling of how much support I was receiving” (Patterson et al. 2013, 151). Overall, team and peer support eased the transition to independent practice while providing emotional relief and shared understanding.

3.4.3. Recognition

Recognition from colleagues and patients was critical to NGNs' professional development and confidence in LTC and HCC. Recognition was considered to include both formal and informal acknowledgements of nurses' contributions, competencies, prior experience, and professional value by fellow nurses, patients, leaders, and their organization. This validation could be verbal, written, or implied through rewards. Five studies highlighted its role in facilitating transition‐to‐practice (Darvill 2013; Fussell et al. 2009; Roziers et al. 2014; Sneltvedt and Bondas 2016; Wangensteen et al. 2008). A phenomenology of newly qualified nurses in community settings emphasized positive feedback from clinical managers regarding their performance enhanced a sense of achievement, confidence, self‐rating of competence, and positive attitude toward their workplace for NGNs (Roziers et al. 2014). In a qualitative study of first‐year HCC nurses, participants felt corrections from senior staff were constructive: “It was just done in a friendly way – promoting the process of learning” (Wangensteen et al. 2008, 1880). Patient and family recognition also enhanced pride and confidence: “Getting a positive response from the patients and their relatives seems to be a source of pride for the nurses” (Sneltvedt and Bondas 2016, 560). This recognition validated NGNs' skills, knowledge, and professional qualities.

Some NGNs expressed frustration that prior experience was overlooked. One children's community nurse noted, “It's almost like putting down what I have achieved in three years at University […] not really being seen as being able to do anything really […] you're the newly qualified, and it is talked about in like a negative tone” (Darvill 2013, 118). This disconnect between self‐perception and others' recognition could undermine confidence. Overall, recognition—through feedback, patient and family acknowledgment, or valuing prior experience—emerged as essential for supporting NGNs' transition. Initiatives enhancing recognition may boost confidence, job satisfaction, and retention in LTC and HCC.

3.5. Emergence of Professional Self as a Nurse in LTC and/or HCC

3.5.1. Growth and Development

Growth and development were integral to NGNs' emergence into professional roles in LTC and HCC. Six articles described advancement in knowledge and maturity through exposure to new situations during role transition (Burgess and D'Hondt 2007; Darvill 2013; Maxwell et al. 2011; Sneltvedt and Sørlie 2012; Wangensteen et al. 2008; Whitmore, Kaasalainen, et al. 2019). In a case study of NGNs' transitions in LTC, participants detailed a drive to continue learning: “It just keeps me on my toes. […] Not knowing what I am doing some days is hard but it just really makes me want to become a better nurse … and so I take the time to learn new things” (Whitmore, Kaasalainen, et al. 2019, 1278). Skill development and confidence were key to professional growth. Maxwell et al. (2011) noted that skills became intuitive over time: “I used to think, oh how does she do that? But now it's just second nature really” (p. 283). This consolidation enabled a more relaxed and organized approach to daily duties. NGNs in HCC suggested that employers should uphold frameworks of protected time for competence development to meet the complexities of care that the sector demands (Sneltvedt and Sørlie 2012).

Empowerment was crucial for NGNs' growth and retention. Burgess and D'Hondt (2007) suggested that empowerment with effective mentorship boosts confidence, job satisfaction, and retention, benefiting both residents and LTC organizations. In children's community settings, observing experienced nurses improved NGNs' confidence in developing their own practices. Spending time with senior nurses and controlling the pace of learning further reinforced their sense of support and professional growth (Darvill 2013).

3.5.2. Emotional Transition

Emotional transition was a significant sub‐theme in NGN's journey toward professional self in LTC and HCC. Seven articles offered insight into this evolution (Connelly et al. 2024; Darvill 2013; Darvill et al. 2014; Maxwell et al. 2011; Patterson et al. 2013; Roziers et al. 2014; Whitmore, Kaasalainen, et al. 2019). Roziers et al. (2014) highlighted a sense of uncertainty at the outset, describing “turbulent emotions before the clinical placement in anticipation of a difficult transition” (p. 97). Participants described a transformative arc, from uncertainty to assurance. Patterson et al. (2013) noted HCC nurses progressed from “overwhelmed and unsure about their abilities to feeling ‘comfortable’ with their work and ‘good about’ what they were doing” (p. 149). Integration into teams was reflected in the use of collective language like ‘we’ (Darvill et al. 2014). Growth extended beyond technical competence to emotional and attitudinal change, as initial scepticism evolved into leadership and advocacy. Whitmore, Kaasalainen, et al. (2019) captured this transformation: “I really didn't think it would be like this here… I didn't think I would love it [LTC] but now I think I would call myself an advocate of LTC” (p. 1279).

This emotional transition supported professional development and retention. Patterson et al. (2013) revealed that “progression from self‐doubt to increased confidence” (p. 149) increased the likelihood of remaining in HCC. Emotional growth also shaped professional behaviour. Maxwell et al. (2011) linked emerging self‐assurance to developing professional identity, with one nurse reflecting, “You are a totally different person to what you were when you first started” (p. 285). Connelly et al. (2024) further described NGNs from bridging programs entering LTC or HCC as experiencing a transformative process that enabled fulfilment of lifelong goals, enactment of benevolence, continued growth, and balance with life outside work. This fulfilment was rooted in an intrinsic commitment to compassionate care. One participant described the transition as “It's affirming. It's taken me a lot to get there. […] It's been a nice growth, a nice self‐realization of coming to terms with all the work that I've done. And it was a nice moment of catharsis” (p. 894).

3.5.3. Identity Development

Identity development was central to NGNs' journey into LTC and HCC. Four articles examined how professional identity evolved, highlighting challenges, supportive structures, and the emerging sense of self as NGNs integrated into practice (Darvill 2013; Darvill et al. 2014; Maxwell et al. 2011; Sneltvedt et al. 2010). Discernible shifts from student to professional nurse were commonly reported. In children's community care, participants “no longer identified themselves as newly qualified” by the end of their first year (Darvill 2013, 181). One HCC nurse stated, “I think it was to become a nurse. The pride, which followed. Being able to offer something.” (Sneltvedt et al. 2010, 265). This perceptual shift toward being recognized as qualified staff was described as “subtle and difficult to explain” (Darvill et al. 2014, 17). Symbolic markers—such as wearing a badge labelled “nurse” rather than “student” – signified completion of the transition: “I am a qualified nurse” (Sneltvedt et al. 2010, 265).

Narratives provided by NGNs further illuminated the internal process of identity development. For example, Maxwell et al. (2011) found that despite difficulties or challenges, NGNs relished the opportunities to provide care and build effective relationships with patients, which became a core component of their self‐image as professional nurses. Relationships with colleagues and enmeshing as part of the team led to NGNs in children's community settings reimagining their sense of ‘self’ and ultimately identifying as part of the group of experienced nurses; as “we” instead of “I” (Darvill et al. 2014). ‘Identity Development’ as a sub‐theme elucidated the intricacies and multi‐dimensional aspects involved in NGNs' journey from student to professional. Self‐perception converged to shape an evolving professional identity as a nurse in the context of LTC and HCC.

4. Discussion

This scoping review aimed to offer an overview of current understandings surrounding transition‐to‐practice experiences for NGNs entering LTC and HCC. This review included both nurse designations—RNs and RPNs—and similar nurse categories—working within LTC and HCC who were within 3 years of graduation. This scoping review broadly maps existing evidence on transition‐to‐practice for NGNs in a clinically significant manner. In including both RN and RPN designations, this review offers new insight, which is methodologically and conceptually congruent with nursing practice in Ontario, Canada, as both nursing categories work together within overlapping practice environments and contribute collectively within integrated staffing models to the delivery of patient care in LTC and HCC settings (CNO 2014). This lens may facilitate understanding of transition experiences, professional identity formation, workload stressors, and organizational support structures that could enhance nurse retention in the future. Key findings included (a) contextual challenges specific to LTC and HCC settings; (b) knowledge, skills, and behaviours required and acquired for navigating as an NGN; (c) the significance of support and guidance for facilitating the transition; and (d) emergence of a professional sense of ‘self’ as a nurse in LTC and/or HCC.

The results of this review support other findings that suggest transitioning to practice for NGNs can be a challenging experience for many, especially in the LTC/HCC sectors (Compton et al. 2023; Eckerson 2018; Reebals et al. 2022; Rudman et al. 2023). Estimates indicate 18%–30% of NGNs switch jobs within their first year, up to 57% leave within 2 years, with more nurses leaving than entering LTC (CIHI 2025; Eckerson 2018; Lyu et al. 2024). The current scoping review findings highlight the complexities NGNs felt upon exiting academic nursing programs and entering the workforce in these sectors. As NGNs evolve from Novices to Advanced Beginners, as Benner (1984) described, they also work on defining their professional roles. It has been suggested that this identity is solidified during academic and clinical nurse education, and early careers (Johnson et al. 2012; Prosen and Ličen 2023; Lin et al. 2024). Furthermore, it has been proposed that the initial transition into practice time period is pivotal for forming professional ideals, consolidating professional identity, and connecting to the nursing career (Akomeng Aryeequaye et al. 2025). This stresses the importance of support in shaping NGNs' evolving professional roles.

NGNs frequently express eagerness to become independent but feel ambiguity and confusion regarding their roles (Akhter et al. 2023). This aligns with findings from hospital settings where there is often a mismatch between nurses' expectations and the reality of patient care demands (Halpin et al. 2017; Parker et al. 2014). Personal factors such as confidence and person‐job fit—referring to the compatibility between an individual's abilities, values, and interests—influenced the trajectory of experience as NGNs navigate into their new roles (Hallaran et al. 2023; Spence Laschinger et al. 2019).

In this review, the NGNs' work environment was described as ‘a different world’ when compared with academic nursing programs; however, the sentiment has also been employed to further distinguish LTC and HCC practice settings from work in other nursing sectors (Darvill 2013; Darvill et al. 2014). This review suggests that the perception that work was a ‘different world’ was due to their limited academic exposure, as observed in a study of an out‐of‐hospital nurse residency program (Cadmus et al. 2023). Similarly, a study investigating the implementation of an undergraduate nursing fellowship reported that targeting curricular content toward specific sectors, particularly primary care, enhanced understanding, outlooks, and proficiencies related to primary care and population health (Lawlor et al. 2023). The findings of this scoping review note a gap between academic training and the real‐world challenges of LTC and HCC. Job stress in NGNs is often exacerbated by demanding workloads (Labrague and McEnroe‐Petitte 2018) and specific factors such as high staff turnover (Neller et al. 2021) and lack of mentorship (Regan et al. 2017).

The current review highlights the importance of orientation programs and both formal and informal supports, including preceptorships, in aiding NGNs' transitions to work in LTC and HCC. Past studies underscore the value of supportive environments and mentor‐preceptor relationships for NGNs (Hallaran et al. 2023; Reebals et al. 2022). Key enablers include good communication, structured preceptorship programs, and mentorship, leading to greater job satisfaction and retention (Reebals et al. 2022). However, barriers such as under‐preparedness, unsupportive workplace cultures, and increased workloads hinder smooth transitions (Hallaran et al. 2023; Reebals et al. 2022). Opportunities for structured support, including training on specific patient populations (i.e., older adults), along with compassionate work environments and encouragement for leadership advancement, may support longevity for nurses working in the LTC sector (Fitzpatrick et al. 2023). Interestingly, a qualitative descriptive study investigating RNs re‐entering nursing work similarly suggested that workplace conditions, which support work‐life balance and encourage career growth, may be essential in retaining and sustaining the nursing workforce (Yamamoto et al. 2024).

Supportive teams are crucial for NGNs, aiding in their transition and in developing their professional identity (Hallaran et al. 2023). In addition to fostering clinical competence, preceptors should address NGNs' emotional needs. A supportive environment, characterized by reassurance and encouragement, can boost NGNs' health, decrease stress, and foster belonging (Generous 2024; Lewis and McGowan 2015; Lin et al. 2014; Spence Laschinger et al. 2019; Tracey and McGowan 2015). Yet, many NGNs lack formal orientation support (Kopf et al. 2018). Constraints, including heavy workloads and staffing shortages, limit experienced nurses' capacity to provide quality preceptorship (Reebals et al. 2022). The turnover in LTC and HCC diminishes the pool of qualified mentors for NGNs (Neller et al. 2021). Thus, changes must be made at both policy and organizational levels to ensure mentors have resources, including manageable workloads, to facilitate smooth NGN transitions (Regan et al. 2017). A recent systematic review of nurses' experiences in transitioning from school into practice recommended formal standardized transition programs, including compassionate colleagues and enduring preceptors along with suitable caseloads which match patient acuity with NGNs' abilities, for enhanced confidence development and continued learning without compromising patient safety (Wah et al. 2023). Thus, LTC and HCC environments should focus on fostering both clinical skills and NGNs' professional identity.

The findings of this scoping review stress the unique challenges NGNs confront when transitioning to practice in LTC and HCC, attributed to issues like staffing concerns, the intricacies of patient care, and systemic constraints. Given the demanding care requirements and the perceived novice status of NGNs, there have historically been limited hiring opportunities for them in the community (Linscheid and Bell 2021). Addressing these challenges, nurse residency programs have emerged, aiming to bolster sector‐specific knowledge, leadership capabilities, and attitudes toward geriatric care to prepare NGNs better and, in turn, enhance their retention (Linscheid and Bell 2021). While most of these programs were initially in hospitals, recent trends show their introduction in non‐hospital settings, often pairing NGNs with experienced nursing mentors (Spector et al. 2015; Cadmus et al. 2016, 2023; Salmond et al. 2017; Linscheid and Bell 2021; Neller et al. 2021; Harris 2025). Early assessments of these LTC‐based programs reveal their efficacy in enhancing NGNs' confidence, communication, geriatric care proficiency, and notably, their retention rates (Spector et al. 2015; Cadmus et al. 2016; Salmond et al. 2017; Hart et al. 2022). For example, the efficacy of an out‐of‐hospital nurse residency program for NGNs in non‐hospital settings like home health and LTC has been explored (Cadmus et al. 2023). This innovative program spanned 8 months, offering both in‐person and virtual training sessions for new graduates and their preceptors. Central to the program was the NGNs' involvement in a quality improvement project and the provision of post‐residency university funding. Preceptor training was enriched with insights into the ‘reality shock’ NGNs often face, alongside guidance on feedback and critical thinking (Cadmus et al. 2023). Distinguishing features of this program were the additional support from a program‐affiliated nurse faculty and career counselling for NGNs, covering resume writing and job interviews (Cadmus et al. 2023). The added support layers reportedly played a key role in community recruitment. Evaluations highlighted the program's success in bolstering NGNs' confidence, competence, and job satisfaction.

Similarly, Linscheid and Bell (2021) introduced a year‐long HCC nurse residency program, prioritizing critical thinking and experiential learning to prepare NGNs for independent home visits. This program incorporated didactic seminars and, crucially, simulation labs that replicated HCC scenarios (Linscheid and Bell 2021). These simulations offered NGNs a risk‐free environment to hone practical skills, enhancing their readiness for real‐world situations. The program also highlighted the significance of skilled preceptors, complemented by regular guidance and monthly mentorship.

The literature from both hospital and more recent LTC and HCC contexts solidly affirms the value of structured nurse residency programs in fostering NGNs' confidence, competence, and professional identity, while boosting job satisfaction and retention (Eckerson 2018; Reebals et al. 2022). This scoping review's findings reinforce the significance of nurse residency programs and offer insight into the role transition experiences of NGNs in LTC and HCC. This understanding could improve the development of tailored residency programs and, ultimately, enhance recruitment and retention strategies for new nurses in these sectors.

While this scoping review identified a breadth of research on transition‐to‐practice experiences for recently graduated nurses, the findings also point to gaps remaining within the current evidence relating to new graduate nurse transitions in LTC and HCC. Although the studies included consistently emphasized workload intensity, staff shortages, and limited mentorship as stressors within the transitional experience, there was limited evidence offering insight into the specificities of how structural and organizational contexts influence transition experiences. For instance, gaining insight into the impact of staffing ratios, funding mechanisms, and different models of care could offer more actionable next steps for organizations and policy‐makers to create workplace environments and systems that best support new graduates. Further, the majority of studies included herein were based in qualitative methodological designs, which offered rich insight into perceptions of nurses themselves and identified experiential challenges of transitioning to practice. However, there is limited evidence employing intervention‐based, implementation science, or longitudinal study designs; these methodological approaches could highlight the impact of transition supports on outcomes of interest including nurse retention, leadership development, and professional identity formation over time. There is an opportunity for future research to move beyond identifying challenges toward designing, evaluating, and refining support strategies specific to LTC and HCC contexts.

4.1. Implications for Research, Practice and Policy

The ongoing nursing shortage, marked by rapid turnover and heightened levels of stress, is particularly severe in the LTC and HCC sectors (Labrague and McEnroe‐Petitte 2018). The intricate care requirements of LTC residents and community patients necessitate longer direct nursing hours per individual (Neller et al. 2021). Additionally, LTC homes increasingly serve as intermediary care points post‐hospital stays, resulting in higher care demands (Neller et al. 2021). The concomitant nurse deficit heightens stress levels, contributing to burnout for nurses, irrespective of their experience. Given the frequent mentions of overwhelming workloads as a transitional barrier, particularly in LTC and HCC, addressing workload becomes pivotal to improve job contentment and retention for new entrants in these areas. It is important to recognize that transitioning NGNs into practice is both an individual and organizational process, which requires supports that extend beyond clinical skill acquisition alone. Developing standardized onboarding frameworks, supported by adequate funding and resources, which integrate clinical and emotional support during the first few years of practice may be essential in enhancing NGNs' feelings of preparedness and willingness to remain working in LTC and HCC settings.

Recent work by Duchscher and Corneau (2023a, 2023b) details a ‘Nursing the Future’ initiative to investigate and disseminate knowledge surrounding the NGN transition experience to better represent the experience and process to new nurses and incite dialogue among nursing scholars, educators, and leaders to more adequately support new graduates through their professional role transition. In their two‐part series, Duchscher and Corneau (2023a, 2023b) emphasize the impact of a scarcity of standardized supports relating to NGN transition programs. The most recently released Canadian standard for LTC put forth guidance to LTC organizations, leaders, and governing bodies recommending, among other things, working as a team to deliver high‐quality care, supporting the health and wellbeing of the LTC workforce, and upholding governance practices focused on quality improvement (CAN/HSO 2023). While there are not currently national standards available for HCC, it may be presumed that similar quality criteria apply for supporting compassionate, meaningful care and supporting the health and safety of the nursing workforce. The findings of this scoping review add valuable information toward understanding how to support the workforce through supporting NGNs in transition‐to‐practice. Further research may build on these findings to develop and evaluate standardized nurse residency programs for entry‐to‐practice in LTC and HCC with attention to measurable outcomes such as retention.

4.2. Limitations

Using five diverse databases empowered the research team to comprehensively delve into the existing published works. This search depth was augmented by manual exploration of references within the shortlisted articles, though this raises the possibility of selection bias. While a predefined criteria guided the article screening, it became evident that many pertinent articles discussing transition‐to‐practice in LTC and/or HCC did not segregate findings based on practice settings; thus, analysis could not elucidate sector‐specific findings from those studies. Furthermore, the team's decision to consider both RPN (and similar terms) and RN roles under the “Participant” umbrella introduced ambiguity, as some articles remained silent on the distinctive transition experiences between these designations. Given the probable unique nuances in transitioning between these roles, a granular comparison of RPNs and RNs falls outside this review's purview. Lastly, despite the rigorous efforts of three independent reviewers assessing articles for relevance, discrepancies in the criteria application might have inadvertently omitted significant materials.

5. Conclusion

This scoping review addressed an identified knowledge gap in that we did not previously have a summary of existing literature about the role transition from student to novice nurse within LTC and HCC settings. Findings support the significance of meaningful, prolonged preceptorship periods attending to both clinical competence and NGNs' emotional needs. Moreover, the findings of this review suggest the importance of attending to sector‐specific expectations during orientation and onboarding to mitigate stress and confusion among NGNs. Integrating the findings from this scoping review with existing evidence offers strong support for structured preceptorship or nurse residency programs specifically for LTC and HCC settings, which include emotional support for NGNs, role clarification to abate confusion, sector‐specific skill development, and realistic workloads.

Author Contributions

Melissa E. Hay: conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing – reviewing and editing. Denise M. Connelly: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing – original draft, writing – reviewing and editing. Hailey Killeen: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – original draft. George Triantafillakis: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – original draft.

Funding

This work was supported by the Registered Practical Nurses Association of Ontario (WeRPN) Bridging Educational Grants in Nursing (BEGIN) Program.

Ethics Statement

Ethical review and approval were not sought for this scoping review as the information rests in the public domain. Informed consent was not required in this instance, as there were no human participants in this study.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Prisma Checklist.

Data S2: Electronic search strategy example, PsychINFO (Proquest) database.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.