Author Identifiers

Amanda Clair Graf
ORCID: 0000-0001-9741-2738

Date of Award


Degree Type


Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Advisor

Professor Di Twigg

Second Advisor

Associate Professor Elisabeth Jacob

Third Advisor

Dr Barbara Nattabi


Aim: To determine if the current rural graduate programs in Western Australia adequately support new graduate nurses transitioning into rural and remote practice.

Background: Graduate nurse transition to employment is a time of significant change and challenges often results in periods of transition shock. These challenges are magnified in rural areas when graduates have limited rural nursing experience and move to commence their career. Supportive graduate nursing programs are essential for enabling nursing transition to practice and assist in reducing attrition rates. Graduate programs were developed to smooth the transition for university trained bachelor’s degree registered nurses into the workforce.

Design: A parallel convergent mixed method design which was informed by Duchscher’s Stages of Transition Theory, the conceptual framework chosen to guide the study.

Method: Through a purposive sample of graduate and senior nurse participants were invited from rural and remote Western Australia during 2015 to mid-2016. The quantitative tool was applied three times to new graduate registered nurses of which a total of 34 completed the survey. The survey was applied once to senior nurses, 40 of whom completed the survey. Semi structured interviews were conducted for both cohorts at three separate time intervals. Ten new graduate registered nurses and 15 senior nurses were interviewed throughout the 12-month timeframe. Braun and Clarke thematic analysis was applied to analyse the qualitative data. Descriptive statistics and content analysis were used to analyse the surveys.

Results: In the first three months new graduates cycled through both transition shock and honeymoon periods resulting in a high level of satisfaction overall, however less satisfaction with the preceptorship. The level of satisfaction dropped significantly at seven months resulting in transition crisis before the adjustment period began. The transition occurred in a linear manner over three distinct timeframes. Limited resources were highlighted as an obstacle to providing adequate support in the rural graduate programs.

Conclusion: Graduate programs need to be structured but flexible to allow for individual differences in graduates and clinical situations. The honeymoon stage coexisted with transition shock which may hide the need for adequate support to continue. Inadequate and/or a lack of preceptorship was evident throughout the Western Australian rural graduate programs.

Relevance to clinical practice: Graduate programs need to be structured but flexible to allow for individual differences in graduates and clinical situations. New graduate nurses would benefit from a break midway through their transition year to assist and overcome the transition crisis stage. Development of the preceptor role through education is required to deliver adequate support to graduate nurses and decrease transition shock. Emphasis on the transition journey is required in undergraduate final semesters to help better prepare new graduates to manage the change from students to registered nurse.

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