Development of the Transition Shock Scale for Newly Graduated Nurses

Eun-Young Kim; Jung Hee Yeo; Kyeong Im Yi

doi:10.4040/jkan.2017.47.5.589

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Kim, Yeo, and Yi: Development of the Transition Shock Scale for Newly Graduated Nurses

Original Article

J Korean Acad Nurs 2017;47(5):589-599.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.589

Development of the Transition Shock Scale for Newly Graduated Nurses

Eun-Young Kim, Jung Hee Yeo, Kyeong Im Yi

Department of Nursing, Dong-A University, Busan, Korea

Address reprint requests to : Yeo, Jung Hee Department of Nursing, Dong-A University, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2784 Fax: +82-51-240-2920 E-mail: jheeyeo@dau.ac.kr

Received 10 February 2017 Revised 9 August 2017 Accepted 29 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to develop a scale to assess the transition shock experienced by newly graduated nurses, and test the validity and reliability of the scale.

Methods

The initial items were identified through a review of literature and in-depth interviews with nine newly graduated nurses. Content validation of the items was evaluated by five nurse professors and three nurses. Participants were 269 newly graduated nurses who worked at six acute care hospitals in Busan, Ulsan, and Yangsan, South Korea. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion related validity, and internal consistency.

Results

The final scale consisted of 18 items and six factors (conflict between theory and practice, overwhelming workload, loss of social support, shrinking relationship with co-workers, confusion in professional nursing values, and incongruity in work and personal life), which explained 71.3% of the total variance. The six subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total items was. 89. Convergent validity was evaluated by analyzing total correlation with burnout (r=.71, p<.001) and turnover intention (t=5.84, p<.001).

Conclusion

This scale can be used in the development of nursing interventions to reduce the transition shock experienced by newly graduated nurses.

Keywords: Professional practice gaps, Reproducibility of results, Factor analysis, Psychometrics

References

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Table 1.

Characteristics of Participants (N=269)

Variables	Categories	Exploratory (n=134)	Confirmatory (n=135)
		n (%)/M±SD
General characteristics of nuurses
Age (yr)		23.28±1.61	23.21±1.15
Gender	Female	127 (94.8)	127 (94.1)
	Male	7 (5.2)	8 (5.9)
Education level*	Diploma	26 (19.4)	29 (21.6)
	Bachelor	108 (80.6)	105 (78.4)
Living arrangement*	Parent	80 (60.6)	71 (54.2)
	Alone	45 (34.1)	51 (38.9)
	Dormitory	5 (3.8)	5 (3.8)
	Others	2 (1.5)	4 (3.1)
Working characteristics
Clinical career (months)		6.46±2.41	6.83±2.41
Type of employment	Full-time job	88 (65.7)	88 (65.2)
	Part-time job	46 (34.3)	47 (34.8)
Monthly income	<200	62 (45.5)	61 (45.5)
(10,000 won)*	≥200	70 (54.5)	73 (54.5)
Type of unit	Medical	36 (26.9)	38 (28.2)
	Surgical	38 (28.4)	40 (29.6)
	ICU	27 (20.1)	18 (13.3)
	ER	14 (10.4)	13 (9.7)
	OR	4 (3.0)	8 (5.9)
	Others	15 (11.2)	18 (13.3)
Desired working unit*	Yes	83 (61.9)	82 (61.2)
	No	51 (38.1)	52 (38.8)
Pre-education*	Yes	128 (97.0)	134 (99.3)
	No	4 (3.0)	1 (0.7)
Pre-education period (wk)		2.51±1.45	2.84±1.75
Training with a preceptor	Yes	129 (96.3)	130 (96.3)
	No	5 (3.7)	5 (3.7)
Period of training with		6.06±2.57	6.02±2.77
a preceptor (wk)

^*Excluding missing data; ICU=Intensive care unit; ER= Emergency oom; OR=Operating room; Others=Obstetric&Gynecology unit, Pediatric unit, Outpatient department, etc.

Table 2.

Factor Loadings from Exploratory Factor Analysis (N=134)

Item	Factor						Communality
	1	2	3	4	5	6
10. I am more overwhelmed by excessive workload than I thought I would be.	0.85	0.15	0.18	0.16	0.08	0.02	0.81
11. I am pressed for time during work.	0.80	0.04	0.20	0.10	−0.07	0.19	0.73
9. It is difficult for me to handle various tasks as a nurse.	0.66	0.03	0.23	0.36	0.15	0.08	0.65
12. I do not provide enough care for patients due to administrative tasks.	0.61	0.42	−0.05	0.05	−0.09	0.20	0.61
30. I think my future as a nurse is uncertain.	0.09	0.78	0.13	0.16	0.21	−0.13	0.73
29. The image of a nurse I had in mind was different from the reality.	0.16	0.63	0.31	0.01	0.33	0.17	0.67
28. My expectations of professional nurses have collapsed since I started working.	0.17	0.61	0.33	−0.02	0.30	0.29	0.69
31. I wonder if I can practice ideal nursing care at the hospital.	0.12	0.69	0.08	0.28	0.04	0.29	0.67
25. I feel scared of being scolded by senior nurses.	0.17	0.14	0.83	0.09	0.06	0.16	0.78
24. I feel frustrated with the nurses’hierarchy.	0.20	0.23	0.77	−0.01	0.22	−0.09	0.75
26. I am conscious of other people’gaze during work.	0.11	0.12	0.71	0.23	−0.02	0.33	0.71
1. I feel the limitations of professional knowledge in nursing care.	0.28	0.11	0.01	0.82	0.14	0.01	0.78
2. I am bewildered that I do not know how to prioritize patient care.	0.13	0.02	0.06	0.81	0.09	0.30	0.78
6. I doubt whether I am doing my job well.	0.08	0.29	0.22	0.59	−0.12	0.08	0.52
18. I find it hard to find someone to share my feelings with at the hospital.	0.02	0.18	0.05	−0.01	0.81	0.09	0.71
19. I feel alienated from my family and friends after I started working.	−0.02	0.16	0.11	0.11	0.78	0.14	0.68
34. I am too nervous to think about going to work tomorrow.	0.24	0.08	0.22	0.26	0.11	0.77	0.79
33. After I leave work, I cannot do anything due to excessive hospital work.	0.16	0.27	0.11	0.14	0.35	0.65	0.69
Eigen value	2.53	2.41	2.30	2.13	1.82	1.62
Explained variance (%)	14.06	13.40	12.81	11.84	10.11	9.02
Cumulative (%)	14.06	27.46	40.27	52.12	62.23	71.26

Table 3.

Confirmatory Factor Analysis Findings and Final Items (N=135)

	Item	B	β	S.E.	Factor						AVE	CR
					1	2	3	4	5	6
Conflict between theory and practice	Item1	1.00	.63		1						.70	.87
	Item2	0.98	.64	0.23
	Item6	1.64	.74	0.34
Overwhelming workload	Item9	1.00	.72		.69	1					.73	.91
	Item10	1.20	.82	0.14
	Item11	1.07	.76	0.13
	Item12	0.90	.63	0.14
Loss of social support	Item18	1.00	.79		.19	.21	1				.72	.83
	Item19	1.03	.82	0.15
Shrinking relationship with co-workers	Item24	1.00	.70		.62	.63	.36	1			.76	.90
	Item25	0.98	.73	0.13
	Item26	0.88	.75	0.12
Confusion in professional nursing values	Item28	1.00	.85		.41	.48	.62	.67	1		.68	.89
	Item29	1.01	.82	0.09
	Item30	0.75	.63	0.10
	Item31	0.69	.68	0.08
Incongruity in work and personal life	Item33	1.00	.75		.49	.57	.51	.70	.64	1	.75	.86
	Item34	0.97	.77	0.13
Model fitness: χ²=159.67(p<.001), χ²/df=1.33, SRMR=.06, GFI=.90, NNFI=.94, CFI=.95, RMSEA (90% CI)=.05 (.03~.07)

AVE=Average variance extracted; CR=Construct reliability; SRMR=Standardized Root Mean Square Residual; GFI=Goodness of Fit Index; NNFI=Non

Normed Fit Index; CFI=Comparative Fit Index; RMSEA=Root Mean Square Error of Approximation.

Table 4.

Relationships between Transition Shock with Burnout and Turnover Intention (N=269)

		Transition shock (M±SD)	t or r (p)
Burnout			.71 (<.001)
Turnover intention	Yes (n=32)	3.08±0.39	5.84 (<.001)
	No (n=237)	2.65±0.36

Table 5.

Reliability Coefficients (N=269)

Subscales	Cronbach’s alpha	M±SD
Conflict between theory and practice	.68	2.91±0.45
Overwhelming workload	.80	2.92±0.51
Loss of social support	.73	2.18±0.64
Shrinking relationship with co-workers	.78	2.77±0.54
Confusion in professional nursing values	.81	2.53±0.55
Incongruity in work and personal life	.73	2.73±0.65
Total	.89	2.70±0.39

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