Abstract
Background
Transition shock is common among new nurses during the transition from nursing education to clinical practice. Existing studies have mainly examined organisational and work-related factors, while less attention has been paid to how individual psychosocial characteristics combine within new nurses. Social inhibition and psychological inflexibility may reflect external interpersonal and internal psychological vulnerabilities during early professional adjustment, but their combined patterns remain unclear.
Objective
To identify latent profiles of social inhibition and psychological inflexibility among new nurses and examine their associations with transition shock.
Design
A cross-sectional study.
Setting(s)
Three tertiary hospitals in Xi’an, China.
Participants
A total of 627 full-time clinical nurses within five years after graduation were included.
Methods
Social inhibition, psychological inflexibility and transition shock were assessed using validated Chinese instruments. Latent profile analysis was conducted using three indicators of social inhibition and six indicators of psychological inflexibility. Hierarchical linear regression was used to examine the associations between latent profile membership and transition shock after covariate adjustment.
Results
Four latent profiles were identified: low-vulnerability profile (31.84%), psychological inflexibility-dominant profile (8.47%), moderate-vulnerability profile (47.25%) and high-vulnerability profile (12.45%). Compared with nurses in the low-vulnerability profile, nurses in the psychological inflexibility-dominant profile reported higher transition shock total scores (B = 13.90, 95% CI: 8.79 to 19.01), as did those in the moderate-vulnerability profile (B = 28.56, 95% CI: 25.52 to 31.59) and high-vulnerability profile (B = 57.07, 95% CI: 52.61 to 61.54). The final regression model explained 59.6% of the variance in transition shock total scores.
Conclusions
New nurses showed distinct psychosocial profiles based on social inhibition and psychological inflexibility, and these profiles were differentially associated with transition shock. The findings suggest that early transition support may benefit from brief psychosocial screening and profile-informed strategies, particularly for nurses with elevated psychological inflexibility or combined interpersonal and internal psychological-resource vulnerability.
Registration
Not registered.
Keywords: Latent profile analysis, Nurses, Psychological inflexibility, Social inhibition, Transition shock
What is already known
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Transition shock is common during new nurses’ role transition.
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Social inhibition and psychological inflexibility may affect adjustment.
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Variable-centred studies may miss psychosocial heterogeneity.
What this paper adds
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New nurses showed four psychosocial profiles of vulnerability.
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Higher-vulnerability profiles reported higher transition shock.
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Inflexibility-dominant nurses showed higher transition shock.
1. Background
Nurses’ psychological well-being and professional adaptation are closely related to the quality of clinical care, patient safety, and the stability of the nursing workforce (Pereira et al., 2024). For new graduate nurses, the move from academic training to independent clinical practice is often accompanied by uncertainty, emotional strain, and difficulty adjusting to new professional responsibilities (Yao et al., 2023). Previous studies have reported that 35%–60% of new nurses experience transition shock (Zhao et al., 2024). Duchscher (2009) described transition shock as a state of cognitive, emotional, physical, and sociocultural disequilibrium that occurs when newly graduated nurses encounter a gap between educational preparation and the realities of clinical practice. When this experience persists, it is associated with lower job satisfaction, stronger turnover intention, and compromised clinical decision-making (Denollet, 2013, Kim and Yeo, 2021). Identifying psychosocial profiles linked to transition shock is therefore important for recognising new nurses who may need early support.
Research on transition shock has mainly examined organisational and environmental factors, including workload, staffing conditions, preceptor support, and organisational climate (Yang et al., 2024, Wang et al., 2024a). These factors are clearly important, but they do not fully explain why new nurses exposed to similar clinical environments may experience different levels of transition shock. Transition shock theory provides a starting point for addressing this issue, as it conceptualises transition shock as an adaptation response that emerges when new nurses confront discrepancies between educational preparation, professional expectations, and the realities of clinical practice (Duchscher, 2009). This perspective also suggests that the intensity of transition shock depends partly on how new nurses appraise, respond to, and cope with these discrepancies. Social cognitive theory extends this explanation by emphasising the reciprocal links among personal characteristics, behavioural responses, and environmental demands (Bandura, 1986). From this perspective, psychosocial traits may function as personal factors that shape how new nurses interpret clinical stressors, communicate with others, seek support, cope with challenges, and regulate their behaviour during role transition. Therefore, this study focused on two psychosocial traits that may be particularly relevant to early clinical adaptation: social inhibition and psychological inflexibility.
Social inhibition is conceptualised as a broad and stable personality trait marked by the inhibition of behavioural and emotional expression in interpersonal situations (Denollet, 2005). According to the multidimensional model of adult social inhibition, this construct includes three related facets: behavioural inhibition, interpersonal sensitivity, and social withdrawal (Denollet and Duijndam, 2019, Treffers et al., 2021). Behavioural inhibition involves reduced conversational behaviour and difficulty initiating social contact. In nursing practice, this may appear as reluctance to initiate communication, ask questions, or seek help during clinical interactions. Interpersonal sensitivity involves heightened concern about social evaluation, including fear of negative judgement and expectations of adverse reactions from others. For new nurses, this may involve excessive worry about being judged by patients, senior nurses, physicians, or colleagues. Social withdrawal refers to keeping others at a distance and withdrawing from intensive social engagement, often with restricted emotional expression. Taken together, these facets describe behavioural, cognitive, and withdrawal-related manifestations of the broader construct of social inhibition. In team-based clinical settings, socially inhibited nurses may be less willing to initiate task-related communication, disclose uncertainty, ask for help, or engage in supportive interactions with preceptors, colleagues, patients, and families. These patterns may limit their access to guidance and social support, increase interpersonal strain, and make it more difficult to manage the emotional and role-related demands of early clinical practice.
Psychological inflexibility is a maladaptive cognitive-behavioural process in which behaviour is rigidly guided by internal psychological reactions, such as distressing thoughts, emotions, bodily sensations, or self-evaluative narratives, rather than by direct situational demands or personally valued goals (Levin et al., 2014). Within the Hexaflex-based psychological inflexibility framework, it comprises six core processes: experiential avoidance, lack of contact with the present moment, self-as-content, fusion, lack of contact with values, and inaction (Rolffs et al., 2018, Stabbe et al., 2019). Experiential avoidance refers to attempts to avoid, suppress, or distract oneself from unwanted thoughts, feelings, bodily sensations, or experiences (Ciarrochi et al., 2014). Lack of contact with the present moment reflects reduced attention to and awareness of ongoing experience (McCracken and Velleman, 2010). Self-as-content refers to rigid and evaluative identification with one’s thoughts, feelings, or self-narratives (Goodall et al., 2012). Fusion describes becoming entangled with unwanted thoughts and feelings to the extent that they dominate attention and behaviour (Werner et al., 2012). Lack of contact with values refers to disconnection from personally meaningful and important life directions (Rolffs et al., 2018). Inaction refers to difficulty initiating or persisting in adaptive action when confronted with unwanted internal experiences (Buckner et al., 2014). In early clinical practice, these processes may appear as avoidance or suppression of distressing emotions after errors or criticism, difficulty maintaining attention to current clinical tasks under pressure, rigid identification with self-critical thoughts or narratives such as “I am not competent enough”, becoming entangled with unwanted thoughts and feelings that dominate attention and behaviour, losing sight of professional values under workload pressure and becoming focused mainly on getting tasks done rather than on the broader meaning of patient-centred care, and hesitation to take corrective or help-seeking action. These patterns are particularly relevant in high-pressure nursing settings, where new nurses must learn rapidly, communicate with multiple professional groups, and manage emotional responses while maintaining patient safety. Prior studies among nurses have linked cognitive fusion and psychological inflexibility processes to negative emotions, sleep difficulties, mental health problems, and burnout (Zhang et al., 2021, Wang et al., 2022). These findings suggest that psychological inflexibility may constrain adaptive coping during the transition from student to registered nurse and may be associated with greater vulnerability to transition shock.
Social inhibition and psychological inflexibility capture different aspects of new nurses’ psychosocial vulnerability, and Conservation of Resources theory provides a useful framework for integrating them into a theory-informed model of transition shock. This theory proposes that stress is more likely when individuals lack, lose, or cannot effectively mobilise important resources (Hobfoll, 1989, Hobfoll, 2011). From this perspective, social inhibition may represent an external interpersonal-resource vulnerability, as it can limit access to peer support, preceptor feedback, collaborative communication, and timely clarification of clinical uncertainty. Psychological inflexibility may represent an internal psychological-resource vulnerability, as it can limit nurses’ capacity for present-moment awareness, willingness to experience difficult emotions, flexible relating to thoughts and self-evaluations, and values-consistent action. These two traits were selected as core variables because they capture two theoretically distinct but clinically relevant vulnerability pathways during new nurses’ professional adjustment: difficulty mobilising external interpersonal resources and difficulty using internal psychological resources to respond flexibly to stress. When these two vulnerabilities co-occur, new nurses may have difficulty both obtaining support from the clinical environment and using internal resources to respond adaptively to stress. Their different combinations may therefore form identifiable psychosocial profiles that are differentially associated with transition shock.
Most previous studies have examined psychological traits using variable-centred approaches, which focus on average associations between individual variables and outcomes. However, this approach may overlook heterogeneity within the new nurse population. New nurses may not simply differ in the level of a single trait; rather, they may show different combinations of interpersonal and cognitive-behavioural characteristics. Latent profile analysis offers a person-centred method for identifying subgroups based on multiple psychological indicators (Brusco et al., 2017). This approach is well suited to the present theoretical model because it allows social inhibition and psychological inflexibility to be examined as co-occurring patterns rather than isolated variables. It is also useful for detecting profiles that may be missed in single-variable analyses, such as nurses with low social inhibition but high psychological inflexibility, or nurses with high levels of both traits.
Based on transition shock theory, social cognitive theory, and conservation of resources theory, we expected new nurses to show multiple theoretically meaningful profiles reflecting different degrees and configurations of external interpersonal-resource vulnerability and internal psychological-resource vulnerability. These profiles may include, but are not limited to, low-vulnerability, moderate-vulnerability, dual-high vulnerability, and asymmetric patterns in which one vulnerability is more pronounced than the other. Although these theoretically informed expectations guided the analysis, the final number and structure of profiles were determined empirically according to model fit, classification quality, profile size, and theoretical interpretability. We further expected that nurses in profiles characterised by greater resource-related vulnerability, especially profiles with elevated levels of psychological inflexibility, social inhibition, or both, would report higher levels of transition shock than nurses in low-vulnerability profiles.
Accordingly, this study aimed to identify latent profiles of new nurses based on indicators of social inhibition and psychological inflexibility, and to examine how these profiles were associated with transition shock. The specific objectives were: (1) to identify and describe distinct latent profiles of new nurses based on three facets of social inhibition and six dimensions of psychological inflexibility; and (2) to compare transition shock across the identified profiles. The research question was: What latent profiles of social inhibition and psychological inflexibility can be identified among new nurses, and how are these profiles associated with transition shock?
2. Methods
2.1. Design, setting and participants
This was a cross-sectional study conducted between January and March 2024 in three tertiary hospitals in Xi’an, China. The hospitals were selected using convenience sampling based on accessibility and willingness to participate. At the participant level, convenience sampling was also used to recruit eligible nurses. Nursing managers in the selected hospitals helped distribute the survey link to potentially eligible nurses, and nurses who met the inclusion criteria and were willing to participate completed the questionnaire voluntarily and anonymously. Eligible participants were required to: (1) hold a valid registered nurse licence; (2) be engaged in full-time clinical nursing work; and (3) be within five years after graduation. Nurses who were on leave during the data collection period or who were not engaged in clinical nursing work at the time of the survey were excluded.
Sample size considerations were based on methodological recommendations for latent profile analysis. Previous simulation and methodological studies suggest that sample size requirements for latent profile analysis depend on the number of indicators, profile separation, profile proportions, and model complexity (Tein et al., 2013, Nylund-Gibson and Choi, 2018). In applied latent profile analysis research, a sample size of approximately 500 has also been suggested as a useful rule of thumb for supporting more accurate identification of latent profiles (Spurk et al., 2020). In the present study, 627 valid questionnaires were included in the final analysis. This study was reported in accordance with the STROBE statement.
2.2. Measures
Sociodemographic and work-related characteristics included age, gender, only-child status, marital status, region, educational level, pre-registration clinical internship modality, clinical nursing experience, current department, average number of night shifts per month, and average daily sleep duration. Pre-registration clinical internship modality referred to the way in which participants completed their clinical internship during nursing education before becoming full-time clinical nurses. Hybrid online-offline clinical internship mainly reflected COVID-19-related disruptions, during which some internship activities were completed at home through online case-based teaching and video-guided nursing skills practice, while the remaining components were completed through on-site hospital practice.
Social inhibition was assessed using the Chinese version of the 15-item Social Inhibition Questionnaire. The original scale was developed by Denollet and Duijndam (2019), and the Chinese version was translated and validated by Li and Jiang (2022). The scale assesses social inhibition as an overarching construct and includes three facet-level indicators: behavioural inhibition, interpersonal sensitivity, and social withdrawal. Items are rated on a 4-point Likert scale ranging from 1 (completely disagree) to 4 (completely agree), with higher scores indicating higher social inhibition. In this study, the Cronbach’s alpha coefficient for the total scale was 0.978.
Psychological inflexibility was assessed using the psychological inflexibility subscale of the Chinese short form of the Multidimensional Psychological Flexibility Inventory. The original Multidimensional Psychological Flexibility Inventory was developed by Rolffs et al. (2018), and the Chinese short form was translated and validated by Liu et al. (2023). The psychological inflexibility subscale covers six dimensions: experiential avoidance, lack of contact with the present moment, self-as-content, fusion, lack of contact with values, and inaction. Items are rated on a 6-point Likert scale ranging from 1 (never true) to 6 (always true), with higher scores indicating higher psychological inflexibility. In this study, the Cronbach’s alpha coefficient for the psychological inflexibility subscale was 0.945.
Transition shock was assessed using the Transition Shock of Newly Graduated Nurses Scale. This scale was developed and psychometrically tested among Chinese newly graduated nurses based on the conceptual framework of transition shock theory (Xue et al., 2015). It includes four dimensions: physical, psychological, knowledge and skills, and sociocultural and developmental aspects. The scale contains 27 items rated on a 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree), with higher scores indicating higher transition shock. In this study, the Cronbach’s alpha coefficient for the scale was 0.972.
2.3. Data collection
Data were collected anonymously through an online questionnaire platform (https://www.wjx.cn/). After hospital approval was obtained, nursing managers distributed the questionnaire link to potentially eligible nurses through institutional communication platforms. Before completing the questionnaire, participants were informed about the study purpose, voluntary participation, anonymity, and confidentiality. Electronic informed consent was obtained before the questionnaire could be accessed. A pilot test was conducted with 10 nurses to assess item comprehension and identify technical problems. During data collection, three trained investigators monitored the online platform and reviewed response quality. The online questionnaire was set to require responses to all items before submission. To improve data validity, responses were screened before analysis, and questionnaires were excluded if respondents showed invariant responses across all scale items.
2.4. Data analysis
Latent profile analysis was conducted using Mplus 8.0 to identify subgroups of new nurses based on nine indicators: three facet-level indicators of social inhibition and six dimensions of psychological inflexibility. Models with one to five profiles were estimated. Model selection was based on statistical fit, classification quality, profile size, and theoretical interpretability. The Akaike information criterion, Bayesian information criterion, and sample-size adjusted Bayesian information criterion were used to evaluate model fit, with lower values indicating better fit. Entropy was used to assess classification accuracy, with values closer to 1.0 indicating better classification quality (Yang et al., 2022, Ma et al., 2026). The Lo-Mendell-Rubin likelihood ratio test and bootstrap likelihood ratio test were used for model comparison; statistically significant results indicated that a k-profile model fitted the data better than a k−1 profile model (Yang et al., 2022, Ma et al., 2026).
All other analyses were conducted using SPSS 27.0, with statistical significance set at α = 0.05. Descriptive statistics were used to summarise participant characteristics and key variables. For transition shock, the mean item score (calculated by dividing the total score by 27) was reported in the descriptive summary to facilitate interpretation on the original 1–5 response scale, whereas the total score was used in univariate analyses and hierarchical linear regression. Independent-samples t-tests, one-way analysis of variance, and correlation analysis were used for univariate analyses, as appropriate. Hierarchical linear regression was then conducted to examine the associations between latent profile membership and transition shock, using the total score of the 27-item scale as the dependent variable. The unstandardised regression coefficients (B) were therefore expressed in transition shock total-score points. Average daily sleep duration and average number of night shifts per month were entered in the first block as covariates. Latent profile membership was entered in the second block as dummy variables, with the low-vulnerability profile used as the reference group.
2.5. Ethical considerations
This study was conducted in accordance with the Declaration of Helsinki and was approved by the research ethics committee of Xi’an Jiaotong University (No.2024-1846). Participation was voluntary and anonymous. Before completing the questionnaire, participants were informed about the study purpose, confidentiality, and their right to withdraw. Electronic informed consent was obtained from all participants before they accessed the questionnaire.
3. Results
3.1. Participant characteristics and descriptive statistics
A total of 635 questionnaires were returned. Because the online questionnaire required responses to all items before submission, no missing data were present in the returned questionnaires. After excluding eight questionnaires with invariant responses across all scale items, 627 valid questionnaires were included in the final analysis, yielding a valid questionnaire rate of 98.7%. The mean age of participants was 25.23 years (standard deviation = 2.84), and the mean clinical nursing experience was 1.79 years (standard deviation = 1.37). Most participants were female (91.90%) and unmarried (76.90%). Regarding educational level, 49.10% had graduated from junior colleges and 49.80% held bachelor’s degrees. More than half of the participants worked in internal medicine or surgical departments (58.10%). Regarding pre-registration clinical internship modality, 92.2% of participants completed their nursing internship mainly through on-site hospital practice, whereas 7.8% reported a hybrid online-offline clinical internship.
The overall mean item scores for social inhibition, psychological inflexibility, and transition shock were 1.99 ± 0.78, 2.95 ± 1.09, and 2.78 ± 0.97, respectively. The mean item scores for behavioural inhibition, interpersonal sensitivity, and social withdrawal were 2.02 ± 0.80, 1.99 ± 0.80, and 1.98 ± 0.81, respectively. The mean item scores for lack of contact with the present moment, experiential avoidance, fusion, self-as-content, inaction, and lack of contact with values were 2.55 ± 1.28, 3.89 ± 1.38, 2.77 ± 1.34, 2.90 ± 1.33, 2.71 ± 1.31, and 2.85 ± 1.37, respectively. The mean item scores for the psychological, physical, knowledge and skills, and sociocultural and developmental dimensions of transition shock were 2.74 ± 1.03, 3.19 ± 1.10, 2.76 ± 1.04, and 2.51 ± 1.07, respectively. See Table 1 for details.
Table 1.
Participant characteristics and descriptive statistics.
| Variable | Mean ± SD / n (%) |
|---|---|
| Age (years) | 25.23 ± 2.84 |
| Gender | |
| Female | 576 (91.9) |
| Male | 51 (8.1) |
| Education level | |
| Junior college | 308 (49.1) |
| Bachelor’s degree | 312 (49.8) |
| Master’s degree or above | 7 (1.1) |
| Only child | |
| Yes | 153 (24.4) |
| No | 474 (75.6) |
| Region | |
| Rural | 471 (75.1) |
| Urban | 156 (24.9) |
| Marital status | |
| Single | 482 (76.9) |
| Married | 145 (23.1) |
| Pre-registration clinical internship modality | |
| On-site hospital-based clinical internship | 578 (92.2) |
| Hybrid online-offline clinical internship | 49 (7.8) |
| Department | |
| Internal medicine | 245 (39.1) |
| Surgery | 119 (19.0) |
| Obstetrics and gynaecology | 17 (2.7) |
| Paediatrics | 19 (3.0) |
| Emergency | 47 (7.5) |
| Operating room | 19 (3.0) |
| Outpatient | 24 (3.8) |
| Others | 137 (21.9) |
| Average daily sleep duration | |
| < 6 hours | 249 (39.7) |
| 6-8 hours | 354 (56.5) |
| > 8 hours | 24 (3.8) |
| Clinical nursing experience (years) | 1.79 ± 1.37 |
| Average number of night shifts per month | 5.16 ± 3.55 |
| Social inhibition | 1.99 ± 0.78 |
| Behavioural inhibition | 2.02 ± 0.80 |
| Interpersonal sensitivity | 1.99 ± 0.80 |
| Social withdrawal | 1.98 ± 0.81 |
| Psychological inflexibility | 2.95 ±1.09 |
| Lack of contact with the present moment | 2.55 ± 1.28 |
| Lack of contact with values | 2.85 ± 1.37 |
| Experiential avoidance | 3.89 ± 1.38 |
| Self-as-content | 2.90 ± 1.33 |
| Fusion | 2.77 ± 1.34 |
| Inaction | 2.71 ± 1.31 |
| Transition shock | 2.78 ± 0.97 |
| Psychological | 2.74 ± 1.03 |
| Physical | 3.19 ± 1.10 |
| Knowledge and skills | 2.76 ± 1.04 |
| Sociocultural and developmental | 2.51 ± 1.07 |
3.2. Latent profiles of social inhibition and psychological inflexibility
Latent profile analysis was conducted using nine indicators: behavioural inhibition, interpersonal sensitivity, social withdrawal, experiential avoidance, lack of contact with the present moment, self-as-content, fusion, lack of contact with values, and inaction. Models with one to five profiles were estimated. As shown in Table 2, the four-profile solution was selected as the optimal model. This model had high classification quality, with an entropy value of 0.958. The Akaike information criterion, Bayesian information criterion, and sample-size adjusted Bayesian information criterion decreased across successive models and began to stabilise after the four-profile solution. In addition, the Lo-Mendell-Rubin likelihood ratio test and bootstrap likelihood ratio test supported the four-profile solution, whereas the five-profile solution did not show sufficient improvement. Considering statistical fit, classification quality, profile size, and theoretical interpretability, the four-profile solution was retained.
Table 2.
Fit indices for latent profile models.
| Model | AIC | BIC | aBIC | Entropy | pLMR | pBLRT | Profile proportions |
|---|---|---|---|---|---|---|---|
| 1-profile | 17395.58 | 17475.51 | 17418.37 | - | - | - | - |
| 2-profile | 15397.56 | 15521.91 | 15433.01 | 0.95 | <0.001 | <0.001 | 0.77, 0.23 |
| 3-profile | 14378.07 | 14546.83 | 14426.19 | 0.91 | 0.04 | <0.001 | 0.31, 0.52, 0.17 |
| 4-profile | 13656.22 | 13869.39 | 13716.99 | 0.96 | <0.001 | <0.001 | 0.32, 0.08, 0.48, 0.12 |
| 5-profile | 13289.72 | 13547.29 | 13363.15 | 0.95 | 0.45 | <0.001 | 0.31, 0.41, 0.14, 0.08, 0.06 |
The first three indicators represented the three facets of social inhibition, namely behavioural inhibition, interpersonal sensitivity, and social withdrawal. The remaining six indicators represented the six dimensions of psychological inflexibility. The four profiles were labelled according to their indicator patterns, as shown in Fig. 1.
Fig. 1.
Latent profiles of social inhibition and psychological inflexibility among new nurses.
Class 1 accounted for 31.84% of the sample and showed below-average scores across all nine indicators. This class was labelled the low-vulnerability profile, reflecting low social inhibition and low psychological inflexibility. Class 2 accounted for 8.47% of the sample. This class showed below-average scores on the three social inhibition indicators but above-average scores on the psychological inflexibility indicators. It was therefore labelled the psychological inflexibility-dominant profile. Class 3 accounted for 47.25% of the sample and showed moderate levels across the social inhibition and psychological inflexibility indicators. This class was labelled the moderate-vulnerability profile. Class 4 accounted for 12.45% of the sample and showed the highest scores across the nine indicators. This class was labelled the high-vulnerability profile, reflecting elevated social inhibition and elevated psychological inflexibility.
3.3. Univariate analyses of transition shock
As shown in Table 3, transition shock total scores were positively correlated with the average number of night shifts per month (r = 0.133, p < 0.001). Transition shock total scores also differed significantly across average daily sleep duration groups (F = 29.11, p < 0.001) and latent profiles (F = 265.88, p < 0.001).
Table 3.
Univariate analyses of transition shock total scores.
| Variable | Statistic | p - value |
|---|---|---|
| Gender | -0.47 | 0.64 |
| Age | 0.03 | 0.44 |
| Region | 0.56 | 0.58 |
| Marital status | 1.10 | 0.33 |
| Educational level | 1.14 | 0.32 |
| Only child | 1.14 | 0.26 |
| Clinical internship model | -1.38 | 0.17 |
| Clinical nursing experience | 0.01 | 0.78 |
| Department | 0.82 | 0.57 |
| Average number of night shifts per month | 0.13 | <0.001 |
| Average daily sleep duration | 29.11 | <0.001 |
| Latent profile membership | 265.88 | <0.001 |
3.4. Associations between latent profile membership and transition shock
Hierarchical linear regression was conducted to examine the associations between latent profile membership and transition shock, using the transition shock total score as the dependent variable. Average daily sleep duration, and average number of night shifts per month were entered in the first block as covariates. Latent profile membership was entered in the second block, with the low-vulnerability profile as the reference group. No multicollinearity was detected, as all tolerance values were greater than 0.10 and variance inflation factors were below 5.0. The final model explained 59.6% of the variance in transition shock. After adjustment for covariates, latent profile membership was significantly associated with transition shock. Compared with nurses in the low-vulnerability profile, nurses in the psychological inflexibility-dominant profile (B = 13.90, 95% CI: 8.79 to 19.01, p < 0.001), moderate-vulnerability profile (B = 28.56, 95% CI: 25.52 to 31.59, p < 0.001), and high-vulnerability profile (B = 57.07, 95% CI: 52.61 to 61.54, p < 0.001) reported significantly higher levels of transition shock. The results of the hierarchical regression analysis are shown in Table 4.
Table 4.
Hierarchical linear regression analysis of transition shock total score.
| Variable | Model 1 |
Model 2 |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| B (95% CI) | β | t | p | VIF | B (95% CI) | Β | t | p | VIF | |
| Intercept | 110.89 (101.23, 120.55) | 22.55 | <0.001 | 72.35 (65.01, 79.69) | 19.36 | <0.001 | ||||
| Average number of night shifts per month | 0.66 (0.12, 1.21) | 0.09 | 2.40 | 0.02 | 1.02 | 0.63 (0.26, 1.00) | 0.09 | 3.31 | <0.001 | 1.02 |
| Average daily sleep duration | -14.98 (-18.29, -11.67) | -0.34 | -8.88 | <0.001 | 1.02 | -8.55 (-10.87, -6.23) | -0.19 | -7.25 | <0.001 | 1.07 |
| Psychological inflexibility-dominant profile | 13.90 (8.79, 19.01) | 0.15 | 5.34 | <0.001 | 1.19 | |||||
| Moderate-vulnerability profile | 28.56 (25.52, 31.59) | 0.55 | 18.47 | <0.001 | 1.35 | |||||
| High-vulnerability profile | 57.07 (52.61, 61.54) | 0.72 | 25.11 | <0.001 | 1.27 | |||||
Note. The dependent variable was the transition shock total score. Unstandardised regression coefficients (B) are expressed in total-score points. Psychosocial profiles were entered using the low-vulnerability profile as the reference group.
Model 1: R² = 0.128, adjusted R² = 0.125, F change = 45.746, p < 0.001.
Model 2: R² = 0.596, adjusted R² = 0.593, ΔR² = 0.468, F change = 239.706, p < 0.001.
4. Discussion
4.1. Principal findings
This study identified four latent profiles of social inhibition and psychological inflexibility among new nurses: a low-vulnerability profile, a psychological inflexibility-dominant profile, a moderate-vulnerability profile, and a high-vulnerability profile. The low-vulnerability profile was characterised by low levels of both social inhibition and psychological inflexibility. The psychological inflexibility-dominant profile showed low social inhibition but elevated psychological inflexibility. The moderate-vulnerability profile was characterised by moderate levels of both traits, whereas the high-vulnerability profile showed elevated levels of both social inhibition and psychological inflexibility. Compared with nurses in the low-vulnerability profile, nurses in the other three profiles reported significantly higher levels of transition shock.
These findings suggest that new nurses are not homogeneous in their psychosocial characteristics during professional transition, but show distinct configurations of interpersonal and cognitive-behavioural vulnerability. Previous studies have mainly examined psychological traits using variable-centred approaches, which are useful for estimating average associations between individual variables and outcomes but may obscure subgroups with different combinations of psychosocial characteristics. This study contributes to previous research by using a person-centred approach to identify distinct psychosocial profiles formed by the co-occurrence of social inhibition and psychological inflexibility, and by showing that these profiles are differentially associated with transition shock. This contribution is particularly illustrated by the psychological inflexibility-dominant profile, which showed low social inhibition but elevated psychological inflexibility. Nurses in this profile still reported higher transition shock than those in the low-vulnerability profile, suggesting that lower social inhibition alone may not correspond to lower transition shock when psychological inflexibility is elevated. This asymmetric profile would be difficult to capture by examining social inhibition and psychological inflexibility only as separate variables. Taken together, the profile-based findings suggest that transition shock may be associated not only with the overall level of psychosocial vulnerability, but also with the specific configuration of interpersonal and cognitive-behavioural characteristics (Brusco et al., 2017, Yang et al., 2022).
4.2. Psychosocial profile heterogeneity and transition shock
The identified profiles are consistent with the view that transition shock may be a heterogeneous adaptation experience rather than a uniform response among newly graduated nurses. Conservation of resources theory provides a useful lens for interpreting this heterogeneity. According to this theory, stress is more likely to occur when individuals lack, lose, or cannot effectively mobilise important resources (Hobfoll, 1989, Hobfoll, 2011). From this perspective, social inhibition may represent an external interpersonal-resource vulnerability, whereas psychological inflexibility may represent an internal psychological-resource vulnerability. Their different combinations therefore provide a resource-based perspective for interpreting why new nurses may report different levels of transition shock during early professional adjustment.
Social inhibition, as an overarching interpersonal trait, includes related facets such as behavioural inhibition, interpersonal sensitivity, and social withdrawal (Denollet and Duijndam, 2019, Duijndam et al., 2021). These facets are associated with reduced initiation of social contact, heightened concern about social evaluation, and withdrawal from interpersonal engagement. In clinical settings, such patterns may make it more difficult for new nurses to obtain guidance, feedback, emotional support, and collaborative problem solving. Psychological inflexibility, by contrast, involves processes such as experiential avoidance, lack of contact with the present moment, self-as-content, fusion, lack of contact with values, and inaction within the Hexaflex-based framework (Rolffs et al., 2018, Stabbe et al., 2019). These processes are relevant to early clinical practice because new nurses often face unfamiliar responsibilities, performance evaluation, emotional labour, and patient-safety demands (Wang et al., 2024b, Yingnan et al., 2024). Nurses with higher psychological inflexibility may have more difficulty staying attentive to current clinical tasks, accepting distressing emotions, stepping back from self-critical thoughts, maintaining contact with professional values, and taking adaptive action under pressure.
The low-vulnerability profile may reflect relatively favourable interpersonal and internal psychological-resource conditions, which is consistent with its lower level of transition shock. The moderate-vulnerability profile, which accounted for the largest proportion of the sample, may represent a common transitional state in which both interpersonal and internal psychological-resource vulnerabilities are present but not extreme. The high-vulnerability profile can be interpreted as a combined vulnerability pattern involving both external interpersonal-resource vulnerability and internal psychological-resource vulnerability. Nurses in this profile may face difficulties both in obtaining support from the clinical environment and in using internal psychological resources to respond adaptively to stress.
The psychological inflexibility-dominant profile deserves particular attention because it showed an asymmetric pattern: low social inhibition but elevated psychological inflexibility. Nurses in this profile still reported higher transition shock than those in the low-vulnerability profile, suggesting that lower social inhibition alone does not necessarily correspond to lower transition shock when psychological inflexibility is high. One possible explanation is that social engagement does not automatically translate into effective support utilisation. Nurses with low social inhibition may be willing to communicate with colleagues, ask questions, and participate in clinical interactions. However, when psychological inflexibility is elevated, they may still have difficulty processing feedback, tolerating uncomfortable emotions, and translating interpersonal support into adaptive coping. For example, corrective feedback from a preceptor may be interpreted as evidence of personal incompetence rather than as guidance for professional development. Similarly, reassurance or practical suggestions from colleagues may be less helpful if the nurse remains entangled with self-critical thoughts, avoids distressing emotions, or hesitates to take corrective action. Another possible explanation is that active interpersonal engagement itself can become demanding during early professional transition. New nurses with low social inhibition may interact more frequently with patients, families, preceptors, physicians, and colleagues. These interactions provide opportunities for learning and support, but they may also require new nurses to respond to feedback or criticism, manage different expectations from patients, families, and colleagues, and deal with emotionally stressful situations. When psychological inflexibility is elevated, these interpersonal experiences may be more difficult to integrate and manage. In this context, the potential advantage of low social inhibition may be weakened when nurses have difficulty responding flexibly to distressing internal experiences. This interpretation highlights that interpersonal openness and adaptive cognitive-behavioural responding are not interchangeable; new nurses may require both supportive social engagement and flexible responding skills to manage transition-related stress.
4.3. Implications for tailored support
The findings suggest that early transition support for new nurses may benefit from brief psychosocial screening during the early months after employment, such as during orientation or early preceptorship, when the gap between academic preparation and clinical practice becomes more apparent (Rush et al., 2013, Watkins et al., 2016). Such screening should be framed as supportive rather than evaluative, and used to guide mentoring, education, and psychological support rather than performance assessment.
Support strategies should be matched to different vulnerability patterns. For nurses in the low-vulnerability profile, periodic check-ins may be appropriate to maintain contact and detect later changes in support needs. Some nurses in this profile may also serve as peer supporters by sharing practical coping and communication experiences with other new nurses. For nurses in the moderate-vulnerability profile, support should be embedded in routine transition programmes, as this was the largest subgroup. Brief communication rehearsal, feedback-seeking practice, and preceptor-guided reflection on uncertainty, role expectations, and patient communication may be appropriate for addressing moderate difficulties early in the transition process. For nurses in the psychological inflexibility-dominant profile, support should focus on strengthening the use of internal psychological resources under clinical stress rather than on basic social participation. Acceptance and Commitment Therapy-informed micro-interventions may be particularly relevant. Brief exercises could be embedded into orientation programmes, simulation training, or post-shift debriefings, helping new nurses notice distressing thoughts without treating them as facts, accept uncomfortable emotions after mistakes or criticism, and identify small values-consistent actions for the next shift (Frögéli et al., 2016, Prudenzi et al., 2022). For nurses in the high-vulnerability profile, support should be more intensive and coordinated because both interpersonal and internal psychological-resource difficulties may be present. These nurses may benefit from scheduled preceptor check-ins, protected opportunities to ask questions without fear of negative evaluation, guided reflection after difficult clinical events, and timely referral to psychological support services when needed. Overall, the practical value of the profile-based approach lies in matching support strategies to different vulnerability patterns. Nurses with psychological inflexibility-dominant difficulties may not benefit sufficiently from social-skills training alone, whereas nurses with elevated levels of both traits may require integrated interpersonal and psychological support. Future intervention studies are needed to examine the feasibility and effectiveness of such profile-informed support in early professional adjustment programmes.
4.4. Limitations
Several limitations should be acknowledged. First, this study used a cross-sectional design. Therefore, the findings indicate associations between psychosocial profiles and transition shock, but they cannot establish temporal order or causal relationships. Longitudinal studies are needed to examine how these profiles develop over time and how they are associated with changes in transition shock. Second, the latent profiles were identified based on the present sample and selected indicators. Although the four-profile solution was statistically acceptable and theoretically interpretable, profile structures may differ across healthcare systems, hospital levels, specialties, and cultural contexts. Future studies should examine the stability and generalisability of these profiles in larger and more diverse samples. Third, all variables were measured using self-report questionnaires, which may be influenced by recall bias or current emotional state. Future studies could incorporate multi-source data, such as preceptor evaluations, behavioural observations, or physiological indicators of stress, to provide a more comprehensive understanding of new nurses’ adaptation.
5. Conclusions
This study identified four latent profiles of social inhibition and psychological inflexibility among new nurses: a low-vulnerability profile, a psychological inflexibility-dominant profile, a moderate-vulnerability profile, and a high-vulnerability profile. Compared with nurses in the low-vulnerability profile, those in the other three profiles reported higher levels of transition shock. These findings highlight the psychosocial heterogeneity of new nurses during professional transition and suggest that transition shock is associated not only with the overall level of individual psychological traits, but also with their specific configurations. Profile-informed screening may help identify new nurses with different support needs during early professional adjustment, and tailored support may be useful for addressing these needs.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Research Ethics Committee of Xi’an Jiaotong University (No. 2024-1846). All participants were informed about the study purpose, voluntary participation, anonymity, confidentiality, and their right to withdraw before completing the questionnaire. Electronic informed consent was obtained from all participants prior to data collection.
Consent for publication
Not applicable. This manuscript does not contain any individual person’s identifiable data.
Availability of data and materials
The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions, but are available from the corresponding author on reasonable request.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Dandan Zheng: Writing – original draft, Methodology, Investigation, Conceptualization. Hongmei Zhang: Writing – original draft, Methodology, Investigation, Conceptualization. Xiaoyan Zhang: Investigation, Data curation. Jing Zhang: Investigation, Data curation. Zhenjie Xia: Methodology, Data curation. Haixia Yang: Writing – review & editing, Supervision, Conceptualization.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
The authors would like to thank all nurses who participated in this study. We also thank the participating hospitals and nursing managers for their support during data collection.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions, but are available from the corresponding author on reasonable request.