An Integrative review of rural and remote nursing graduate programs and experiences of nursing graduates

Document Type

Journal Article




School of Nursing & Midwifery


Originally published as : Fowler, A. C., Twigg, D., Jacob, E., & Nattabi, B. (2017). An Integrative review of rural and remote nursing graduate programs and experiences of nursing graduates. Journal of clinical nursing. Advanced online publication. Article can be found here


Aims and Objectives

To examine international studies that specifically focus on transition to practice for graduate registered nurses in rural and remote areas.


Supportive graduate nursing programs are essential for enabling nursing graduates’ transition to practice and reducing attrition rates. Literature examining support measures for nursing graduates within metropolitan areas is abundant. However, there is a paucity of evidence on effective graduate programs for rural and remote based nursing graduates.


A systematic approach was used to identify robust research within appropriate electronic databases.


Eligible articles were critically reviewed using the Mixed Method Appraisal Tool critical appraisal tool. Eligible articles were thematic analysed using the Braun and Clark approach.


Eight articles met the selection criteria for inclusion. Findings revealed that while most graduate nurses survived the transition process, they often felt overwhelmed and abandoned with intense feelings of frustration. Many suffered transition shock and did not feel ready for the role. Socialisation of graduates to the clinical environment was lacking. Support offered in many graduate programs was ad hoc and unstructured. Senior staff were inadequately supported in their roles as preceptors to assist with the transition. Critical support measures recommended included both debrief sessions and regular one on one support.


Graduate programs need to be structured yet flexible to accommodate the needs of rural and remote nurse graduates. Graduates need to be transitioned into practice with decremental support processes for both workloads and education. Preceptors require education on how to mentor before they can provide the appropriate support for graduates. Without these measures in place, a decrease in transition shock may not be possible.