Authors: (including presenting author): :
CHAN CSS(1)
Affiliation: :
(1) Intensive Care Unit, Ruttonjee and Tang Shiu Kin Hospitals
Keyword 1: :
Journey Mapping
Keyword 2: :
Career Adaptability
Keyword 4: :
Workforce Sustainability
Keyword 5: :
Junior nurses
Keyword 6: :
Transition shock
Introduction: :
The transition from academic learning to clinical practice represents a critical and challenging phase for newly graduated nurses. This period is frequently characterised by “transition shock”, marked by emotional distress, role uncertainty, and a perceived mismatch between theoretical preparation and clinical realities. Internationally, junior nurses experience high turnover rates, and in Hong Kong, nurses with less than three years of experience account for a disproportionate share of workforce attrition. The COVID-19 pandemic further exacerbated these challenges by disrupting clinical training and accelerating entry into high-pressure clinical environments. Adaptability has emerged as a core competency underpinning successful transition. Beyond technical skills, adaptability encompasses emotional regulation, cognitive flexibility, coping strategies, and the ability to function effectively within complex healthcare systems. While existing onboarding and preceptorship programs provide essential structural support, they often insufficiently address the lived, temporal, and emotional dimensions of early-career adaptation. Journey mapping offers an innovative qualitative approach to capturing these dimensions. By visually and narratively tracing key milestones, emotional inflection points, and support mechanisms over time, journey mapping enables a deeper understanding of how junior nurses experience, interpret, and respond to early professional challenges. Despite its growing use in service design and patient experience research, journey mapping remains underutilised in studies of nursing workforce adaptation. This study addresses this gap by applying journey mapping to explore the adaptability of junior nurses during their transition to clinical practice within a Hong Kong public hospital. By centring nurses’ lived experiences, the study seeks to generate actionable insights to inform mentorship design, organisational support strategies, and workforce sustainability initiatives.
Objectives: :
The overarching aim of this study was to explore and understand how newly graduated nurses adapt to clinical practice during the early stages of their professional careers within a public hospital setting in Hong Kong. Specifically, the study pursued the following objectives: 1. To explore the lived experiences, perceptions, and emotional responses of junior nurses as they transition from academic training to independent clinical practice. 2. To identify critical milestones, touchpoints, and pain points that shape adaptability, confidence development, job satisfaction, and professional identity formation during the first one to two years of practice. 3. To examine the roles of mentorship, peer dynamics, coping strategies, systemic pressures, and self-directed learning in influencing adaptation trajectories. 4. To generate evidence-based recommendations for enhancing mentorship structures, institutional support systems, and workplace culture to improve retention and workforce sustainability. Guided by the PICo framework, the study focused on junior nurses with less than three years of experience (Population), explored adaptability as the phenomenon of interest (Interest), and was situated within the context of the Hong Kong public hospital system (Context). By integrating thematic analysis with journey mapping, the study aimed not only to describe adaptation experiences but also to illuminate when and how organisational interventions could most effectively support junior nurses.
Methodology: :
A qualitative descriptive design was employed to explore junior nurses’ adaptation experiences during early clinical practice. The interview was conducted in a single public hospital in Hong Kong between May and September 2025. Purposive and maximum variation sampling were used to recruit newly graduated nurses from the 2023–2024 and 2024–2025 cohorts. Inclusion criteria comprised locally trained, full-time registered nurses within their first two years of practice. Eighteen participants were recruited, with data saturation achieved. Data collection involved individual, semi-structured, in-depth interviews lasting approximately one hour. Interviews explored participants’ transition experiences, challenges, coping strategies, and perceptions of support. All interviews were audio-recorded, transcribed verbatim, anonymised, and verified for accuracy. Journey mapping was subsequently employed as both an analytic and interpretive tool. Individual journey maps were constructed by identifying key events, emotional highs and lows, learning milestones, and sources of support across time. These individual maps were synthesised into a collective journey map representing shared patterns and divergent adaptation trajectories. Data analysis followed Braun and Clarke’s six-step thematic analysis framework, supported by NVivo 15 software. Ethical approval was obtained from the Central Institutional Review Board, and measures were implemented to ensure confidentiality, voluntary participation, and psychological safety.
Result & Outcome: :
Analysis revealed a dynamic, non-linear adaptation process characterised by six interrelated themes: (1) transition shock and adaptive emergence, (2) mentorship as both enabling and constraining, (3) reciprocal peer dynamics, (4) systemic pressures as a double-edged sword, (5) technology-mediated self-directed coping, and (6) professional identity consolidation. Transition shock was a near-universal early experience, marked by anxiety, fear of errors, and self-doubt, particularly during the first three months. Adaptation progressed through experiential learning, repeated exposure, and incremental confidence building, although ward rotations often re-triggered elements of shock. Mentorship played a pivotal but inconsistent role. Supportive mentors fostered psychological safety and confidence, whereas heavy workloads and variable engagement limited mentorship effectiveness. Peer relationships provided emotional validation and informal learning but also introduced social comparison and performance pressure. A distinct generational coping pattern emerged, with participants frequently relying on digital self-directed learning tools, including online resources and AI platforms, as psychologically safe alternatives to direct questioning. While this enhanced autonomy and adaptability, it also reflected concerns regarding hierarchical culture and psychological safety. Over time, most participants demonstrated growing clinical autonomy and professional identity consolidation, shifting from a survival mindset toward a sense of belonging and competence. Journey mapping highlighted critical intervention windows where structured mentorship, peer support, and workload moderation could meaningfully enhance adaptation and retention.
