Concerns of Novice Nurses in the First Year of Work: A Qualitative Content Analysis

Abstract

Introduction

Novice nurses face many concerns at the beginning of their professional careers. The majority of novice nurses have been challenged with stress, inability to work autonomously, insecurity, inexperience, and unpreparedness to work in a clinical setting at the early of their work.

Objective

This study aims to explain novice nurses’ experiences to understand their concerns. This was a qualitative study using conventional content analysis.

Methods

Unstructured in-depth open individual interviews were used for data collection. Sixteen nurses were selected by purposeful sampling. The data were analyzed using the Graneheim and Lundman content analysis approach. After data collection, all interviews were transcribed and reviewed, and categories were extracted.

Results

After analyzing the data obtained from the experiences of novice nurses, three major themes and 11 subthemes were identified. The major themes were initial uncertainty in the novice nurse, loneliness and helplessness alongside colleagues, and concerns about workplace discrimination by managers.

Conclusion

Since the results of this qualitative study showed that novice nurses have such important concerns as confusion, feelings of loneliness and helplessness, and feelings of worry about discrimination at the beginning of their work, so, it is necessary to pay attention to these issues in planning by providers to assist them transitioning in clinical settings.

Introduction

Nurses are the main part of the human resources of the healthcare systems (Tastan et al., 2013). They play an important role in promoting community health (Jafari et al., 2013). About 35% of the nurses are novices (Lee et al., 2013) who face many difficulties when starting work in a clinical environment (Newton & McKenna, 2007).

Novice nurses often must work in specialized wards. However, they have not well-skilled to work in these wards which caused may disrupt health care services and compromise patients (Johnstone et al., 2008). The scientific knowledge of new graduate nurses meets their work needs, but their clinical skills are not yet competent enough for specialized wards (Yang et al., 2015). In other words, novice nurses have limited competency to deal with patient problems and critical conditions (Ortiz, 2016). Studies conducted on the challenges of novice nurses have shown that insufficient skills and competency result in stressful working conditions for novice nurses (Washington, 2012).

Indeed, it has been well-documented that novice nurses experience a gap between practice and theory as they shift from the relatively safe environment of the university to the clinical setting (Washington, 2012). They encounter a disparity between trained and applicable care in the clinical environment, which made them confused when starting their career (Flinkman et al., 2013). Most novice nurses also have low self-esteem and show poor practice in patient care (Maria et al., 2020).

It has been well established that novice nurses cannot adapt to the actual conditions because of conflicts between workplace expectations and realities, resulting in adverse physical and psychological reactions, fatigue, lack of motivation, and job dissatisfaction (Caliskan & Ergun, 2012).

It is also important to consider that Iranian values and the meaning of the family in traditional Iranian society are different compared with modern cultures. In traditional societies such as Iran, female employees may face more demanding family roles. The majority of Iranian women are responsible for housework, childcare, and all other aspects of household management (Hussein et al., 2017). So, Iranian nurses especially women who are nurses face a challenging work environment. Since there is a shortage, nurses face heavy workloads and low salaries (Emami & Nasrabadi, 2007). Due to traditional women's role pressure, the situation for Iranian female employees in terms of family and work demands is more complicated, especially for nurses who do shift work and those who have recently entered the workforce. This issue may result in conflict between job and family life.

All the above, despite the importance of the novice nurses’ concerns, to the best of our knowledge, no qualitative study explored their concerns, also the effects of their problems and concerns in light of their own experiences still need to be investigated. Most quantitative studies could not explain the key aspects of such experiences (Mohajan, 2018). However, a qualitative study with in-depth interviews is required to discover the experiences of novice nurses and explain the dimensions of their concerns that are affected by various factors such as social and cultural trends (Sotodeh Asl et al., 2014). Qualitative studies focus on individuals’ lived experiences and try to examine the dimensions of those experiences in the cultural and social context of that community. Therefore, this study aimed to explain the concerns of novice nurses at the beginning of their professional careers.

Review of Literature

According to Urban and Barnes (2020), new graduate nurses start their transition with high motivation, however, they are expected to provide care for all patients on their own as skilled nurses (Urban & Barnes, 2020). On the other hand, they will be unable to adapt to those conditions when performing clinical skills and will experience conflicts between workplace expectations and the realities (Kovner et al., 2014b).

Moreover, Gardiner and Sheen (2017) reported that novice nurses experienced stress and anxiety due to a lack of adequate training in stressful and challenging situations of patient care (Gardiner & Sheen, 2017). They often report a sense of inadequacy and anxiety to provide care to patients in complex environments (Wu et al., 2012). Hence, novice nurses often experience worried and anxiety when faced with the realities of the clinical environments (Martin & Wilson, 2011). In addition, novice nurses may undergo enormous stress associated with accountability, novel role-plays, new communication with others, as well as adaptation to long working hours, professional rules, and obligations (Halimi et al., 2023).

A recent study (Urban & Barnes, 2020) showed that novice nurses experienced difficulty working independently, insecurity, inexperience, and unpreparedness to work in the clinical environments (Urban & Barnes, 2020), resulting in more mistakes compared to experienced nurses. Spector et al. (2015) reported that 49–53% of nurses with less than one year of experience made errors, with drugs accounting for approximately 75% of the errors (Spector et al., 2015) showing that dissatisfaction is a key factor in job abandonment. Solutions (2019) by investigating 221 hospitals throughout 48 US states reported that 22.9 and 32.4% of novice nurses quit their jobs within their first and second working years, respectively (Solutions, 2019). About 80% of novice nurses work in hospitals, and the rate of job abandonment is higher among novice nurses, which is worrisome (Kovner et al., 2014a).

Since novice nurses are considered to be essential factors in care in the nursing profession and a large number of novice nurses face the concerns mentioned above, therefore, addressing the experiences of novice nurses in the field of identifying their concerns and trying to resolve the underlying causes helps them to provide effective care. Therefore, this study aimed to explain the concerns of novice nurses at the beginning of their professional careers.

Methods

Study Design, Inclusion Criteria, and Sample

The present study was designed and implemented qualitatively with the content analysis approach, including the process of perception, interpretation, and understanding of the internal meanings of qualitative data. According to the research objectives, the selection of participants was purposeful. In-depth, unstructured interviews were conducted with a convenient sample of Iranian novice nurses. Unstructured interviews were preferred because this is an effective research method where few data are available, allowing participants to focus on areas they perceive as most influential, and permitting interviewers to probe issues that may be of interest but are not specifically addressed by the interview guide (Corbin & Strauss, 2014). A qualitative descriptive study with a conventional content analysis approach was used to analyze data and extract concepts. In this study, which lasted from August 2021 to June 2022, participants were selected from three hospitals. According to the research objectives, participants were selected by purposeful sampling in which the researcher seeks individuals who have rich experiences of the studied phenomena and want to express them 16 novice nurses were interviewed. Inclusion criteria were clinical nurses with six months to one year of work experience who wanted to explain their experiences. Participants of a variety of ages were included in the study. The withdrawal criterion includes people who did not want to participate in the study and can withdraw from the study at any time.

Research Question

In this study, the research question was “Would you please express your concerns at the beginning of your work?”

Interview Structure

After explaining the given information of the purpose, they asked all the chosen participants. Individual, unstructured in-depth interviews were conducted. All participants were given a written information sheet about the study and its context and received an oral explanation of the research plan. They then signed a consent form. Before the interview, participants were asked about the preferred location and time for the interview. Depending on the participant's preferences, the interview location (home or work) was chosen and confidentiality was respected. After explaining the purpose of the study to the participants, an unstructured and in-depth interview was conducted with them, and participants were asked to start the discussion based on the qualitative studies interview method. Interviews started with a general question such as “Please explain the first days of your work?” or “How was your emotional status at the beginning?” Would you please describe your first experience when entering your workplace?” then other questions were asked according to the participants’ conversations. Also, according to the necessity, to clarify and resolve the ambiguities, follow-up questions such as “Explain more favors” and so on, in addition to recording interviews with tape recorders, other methods of observation, memos in the field, and remembering were used. Interviews then were about 20–45 min. The recorded interviews were then copied. After interview 14, no new concept was obtained; however, two more interviews were conducted to ensure data saturation. Interviews and their analysis were conducted continuously by researchers who were proficient in qualitative data analysis. This process continued until data saturation, after which the text of each interview was written verbatim and then encoded and, after analyzing each interview, the next interview was conducted. All interviews were recorded by digital voice recorder and transcribed verbatim carefully and immediately. Data were analyzed by the conventional content analysis method, and themes and subthemes were extracted directly from raw data (Corbin & Strauss, 2014).

Analysis

Traditional qualitative content analysis by Graneheim and Lundman was used for data analysis. Based on the guidelines, interviews were initially transcribed. The researchers then listened to the recordings and reviewed the transcriptions several times to identify units of meaning. In the third step, codes were extracted and formed from the semantic units. In the fourth step, the researchers categorized the codes according to their conceptual similarities. Finally, categories and subcategories emerged considering the unit's continuous analysis. (Graneheim et al., 2017) The criteria introduced by Lincoln and Guba (2016) have been used to increase the rigor of this study. Credibility was confirmed by the researcher's prolonged data engagement and five participants’ data revisions. Participants were asked to confirm transcribed interviews as well as the concepts extracted from the text. The research team members coded several interviews separately, checked the similarity of the codes, and reached a consensus when there was a difference. To ensure dependability, the research steps were accurately recorded and reported, allowing other researchers to audit and follow up on the research. The study transferability was ensured by a rich and complete description of the research results and steps. In addition, the demographic characteristics of the participants and the study objective were expressed in detail so that the reader could make an informed decision about how to use the study results. Confirmability was measured when external experts familiar with qualitative research checked the data (Lincoln & Guba, 2016).

Results

Sample Characteristics

Sixteen novice nurses were included in the study, ranging in age from 22 to 30 years. Five participants were male and 11 were female; 90% of them were married and had work experience between 6 months and 1 year (Table 1).

Table 1.

Demographic Characteristics of the Participants.

Participant code	Age	Gender	Duration of work experience	Ward
P1	22	Man	6 Month	Emergency
P2	24	Female	7 Month	Emergency
P3	25	Female	7 Month	Emergency
P4	30	Man	9 Month	children
P5	28	Female	1 Year	Neonatal
P6	27	Female	7 Month	Neonatal
P7	26	Female	9 Month	children
P8	25	Female	8 Month	ICU
P9	25	Man	7 Month	ICU
P10	23	Man	11 Month	Surgery
P11	24	Female	10 Month	Surgery
P12	25	Female	8 Month	CCU
P13	23	Female	9 Month	CCU
P14	24	Man	10 Month	children
P15	24	Female	8 Month	Medical
P16	23	Female	11Month	ENT

Research Question Results

After the interviews were coded, duplicate codes were removed and similar codes were merged, 2015 open codes were obtained, which were finally divided into three major themes and 11 subthemes, including: (Table 2). Most of the participants stated that they experience many concerns at the beginning of the work and identifying these concerns is the first effective step to help resolve them. Therefore, the authors tried to identify many of these concerns from the perspective of the participants. The obtained themes and 11 subthemes are stated in Table 2. Three major themes and 11subthemes were extracted by data analysis, including:

Table 2.

Major and Minor Themes Related to Identifying Concerns of Novice Nurses.

Major themes	Subthemes
Initial uncertainty	Bafflement of dealing with critically ill patients Doubt and confusion caused by inexperience Poor confidence due to a lack of mastery
Loneliness and helplessness alongside colleagues	Imposing experienced nurses’ own duties on the novice nurse Imposing some off-duty matters Colleagues’ reluctance to give information Inadequate support of a novice nurse in caring.
Concerns about workplace discrimination by managers	Dissatisfaction with giving compulsory work shift when planning Displeasure of some privileges deprivation Disillusionment with discriminatory communication Scheduled overtime for novice nurses

Theme 1: Initial uncertainty in the novice nurse, included three subthemes the bafflement of dealing with critically ill patients, doubt and confusion caused by inexperience, and poor performance due to a lack of mastery.

Theme 2: Loneliness and helplessness alongside colleagues, with four subthemes imposing experienced nurses’ duties on the novice nurse, imposing some off-duty matters, colleagues’ reluctance to give information, and inadequate support of a novice nurse in caring.

Theme 3: Concerns about workplace discrimination by managers include four subthemes of dissatisfaction with discrimination in giving compulsory work shift when planning, displeasure of some privileges deprivation, disillusionment with discriminatory communication, and scheduled overtime for novice nurses.

Theme 1: Initial uncertainty in the novice nurse, included three subthemes the bafflement of dealing with critically ill patients, doubt and confusion caused by inexperience, and poor confidence due to a lack of mastery.

The Bafflement of Dealing with Critically ill Patients

The majority of participants in the present study reported feelings of loneliness and anxiety upon their first meeting with critically ill patients. When critically ill patients were transferred from one hospital to another, novice nurses accompanied them, so they experienced a sense of panic and loneliness when dealing with critically ill patients.

“I was on the emergency shift and a critically ill patient needed to be transferred to a well-equipped hospital. As a new nurse, I had to accompany the patient. I had never cared for an intubated patient, so I was nervous. I told the head nurse that I had never been dispatched with a critically ill patient, but she insisted that I accompany him. Along the way, I prayed for the patient's safety.” (P6)

Doubt and Confusion are Caused by Inexperience

Most of the participants in the present study had doubts about deciding to care for patients.

“In the surgery ward, there was a patient with metastatic cancer. The doctor directed that if the patient went into cardiorespiratory arrest, no code for CPR should be called. When I was on the night shift, a patient required cardiopulmonary resuscitation. I was initially hesitant to call for CPR; I eventually did so out of concern that the escorts would protest to me afterward. In short, it would be extremely difficult for a person to doubt and be unsure what to do.” (P4).

Poor Confidence Due to a Lack of Mastery

Based on the participants’ experiences, mastery of skills requires clinical experience. Due to their lack of experience and exposure to a variety of settings, novice nurses lack the abilities necessary to provide effective patient care.

According to the participants, since novice nurses do not have enough clinical experience, they lack the skills and abilities necessary to provide effective patient care, and this makes them lack confidence in a variety of settings. And they go toward uncertainty:

“I tried once or twice to take blood from a patient, but I could not, and the patient's companion treated me quite insultingly. I was quite unhappy since I could not take blood from the patient, I had lost my confidence, I felt inadequate” (P7).

Theme 2: Loneliness and helplessness alongside colleagues, with four subthemes imposing experienced nurses’ duties on the novice nurse, imposing some off-duty matters, colleagues’ reluctance to give information, and inadequate support of a novice nurse in caring.

Imposing Experienced Nurses’ Duties on the Novice Nurse

Based on the experiences of the participants in this study, some experienced nurses were imposing their duties on them. In fact, they imposed their duty on novice nurses. That was one of the extravagant behaviors of the novice nurse’ colleagues. One of them said:

“On the first days of my career, I was sharing a shift with an experienced colleague in the medical department. My colleague asked me to check the vital signs of her patients. I had to check the vital signs of all patients, which totaled 30. I had something else to do, and I was very anxious during that shift” (P9).

Imposing Some Off-Duty Matters

Based on the experiences of the participants in this study, other extravagant behaviors of colleagues were imposing off-duty matters.

“I was once on a shift with an experienced colleague, and we needed to take an arterial blood sample from a patient, but we did not have an ice bag in the ward. My colleague asked me to go and bring an ice bag from the other ward. I did not want to go, but I was obligated to. My colleague should not ask me to do the duties of a nursing assistant” (P3).

Colleagues’ Reluctance to Give Information

Based on the experiences of the study participants, the novice nurses’ colleagues were not eager to share information with them. They even complained that their coworkers did not communicate well with them at work, that they did not talk to them about the information they needed, or that they did not answer their questions appropriately.

“I lacked information about certain subjects and my colleagues did not assist me in comprehending them. For example, a patient was scheduled for a CT scan of the abdomen and pelvis, and I was unsure how to prepare the patient. My colleagues embarrassed me with their tone of voice; I was devastated and forced to search for answers on my own via the internet and books” (p 11).

Inadequate Support of a Novice Nurse in Caring

According to the participants in this study, colleagues’ inadequate support from novice nurses in providing care causes loneliness and helplessness.

“I once had to do a venipuncture for a patient. The mechanically ventilated patient developed edema. I was unable to perform venipuncture. As a result, I requested one or two of my colleagues to assist me, but they advised me to try it a few more times so that if I failed, they could come and assist me” (P5).

Theme 3: Concerns about workplace discrimination by managers include four subthemes of dissatisfaction with discrimination in giving compulsory work shift when planning, displeasure of some privileges deprivation, disillusionment with discriminatory communication, and scheduled overtime for novice nurses.

Dissatisfaction with Giving Compulsory Work Shift When Planning

Participants in this study observed discrimination in the interaction between the head nurse and novice nurses, with novice nurses receiving difficult shifts and experienced nurses receiving light shifts. They also experienced discrimination and injustice during the monthly shift planning. Therefore, discrimination in giving compulsory work shift when planning was a source of concern for novice nurses.

“Our head nurse always pays attention to the shift planning requests of experienced nurses and arranges it according to their preferences, while assigning novice nurses to the shifts that are infrequently filled, such as public holidays. She does not assign experienced staff any shifts during these holidays, and novice nurses are responsible for covering the ward during the holidays” (P14).

The Displeasure of Some Privileges Deprivation

Based on the experiences of the participants in this study, deprivation of some privileges was one of the concerns of novice nurses in the workplace.

“The participants were dissatisfied with the granting of facilities for the purchase of housing to experienced nurses, while novice nurses are not given facilities” (P11).

Disillusionment with Discriminatory Communication

According to the participants’ experiences, head nurses acted indifferent, cold, unfriendly, and discriminatory toward novice nurses and did not engage them in information exchange.

“Our head nurse has a much better relationship with the hired nurses than she does with novice nurses. When experienced staff makes a mistake she does not become angry with them, but when novice nurses make a mistake, she calls them loudly and warns them about the mistake, leading our colleagues to believe we are illiterate, and they do not trust us” (P16).

Scheduled Overtime for Novice Nurses

Based on the experiences of the participants in this study, scheduled overtime for novice nurses was another extravagant behavior of the head nurse.

“Most of the extra work is given to novice nurses, and we do not dare to protest. If we protest, our head nurse will tell us that because we are a novice, we must put up with extra work. Most of the time, we had to attend the evening shift following a night shift, or they would give us morning-night shifts, and many head nurses would rearrange the work schedule of novice nurses into two 8-h shifts on some days, which was not ideal” (P 2).

Discussion

This content analysis study was conducted to identify the concerns of novice nurses in the first year of their work.

The findings revealed three major themes included initial uncertainty in the novice nurse, loneliness and helplessness alongside colleagues, and concerns about workplace discrimination by managers, and 11 subthemes regarding concerns of novice nurses.

Participants in the present study had stress and anxiety after graduation and experienced bafflement in dealing with critically ill patients according to Ebrahimi et al. (2016) and Tastan et al. (2013), novice nurses experienced feelings of loneliness in the face of critically ill patients (Ebrahimi et al., 2016; Tastan et al., 2013). The results of the studies mentioned above support the results of the present study. Most of the participants considered a lack of clinical work experience to reduce their self-confidence. Ortiz (2016) discovered that participants’ experience of lack of competency led to anxiety and stress, lack of confidence, feelings of insecurity, and performance anxiety (Ortiz, 2016). Also, Marks-Maran et al. (2013) showed that 83% of novice nurses were not alone when dealing with patients, and colleagues helped them with care, which reduced their stress and anxiety so participants suggested teamwork as an effective factor in reducing the stress of novice nurses (Marks-Maran et al., 2013). The presence of experienced colleagues alongside novice nurses in the workplace can greatly reduce the amount of stress and bafflement of dealing with patients and improve the quality of care.

Doubt and confusion caused by inexperience were other major concerns experienced by novice nurses in this study. Making uncertain decisions due to insufficient experience and knowledge exposes them to several clinical mistakes. Gillespie showed that novice nurses made uncertain decisions in the form of decision errors and conflict in the selection so they had difficulty making decisions (Gillespie & Peterson, 2009). However, Ten Hoeve et al. (2018) reported that although novice nurses had doubts in some situations, they made the right choice, and were satisfied with their decision in those situations (Ten Hoeve et al., 2018). Due to the fear of making wrong decisions in clinical settings, nurses face conflicts in choosing decisions, especially in critical situations (Saintsing et al., 2011), which was pointed out by novice nurses in the current study.

In line with our findings, regarding poor performance due to lack of mastery, it is well known that the training course could prepare nursing graduates for clinical practice by providing them with functional knowledge and clinical skills (Meleis, 2010). Moreover, Parker et al. (2014) also suggested that novice nurses were not ready to work in clinical settings due to a lack of practical skills, which posed many challenges for novice nurses in their first years of service (Parker et al., 2014).

Regarding imposing experienced nurses’ duties on the novice nurse, Duchscher (2008) found that interacting with colleagues who had unprofessional conduct increased novice nurses’ stress and anxiety and caused them to think about job abandonment (Duchscher, 2008). Negative behaviors of experienced colleagues led to the novice nurses’ reluctance to ask for help and affected patient care (Gardiner & Sheen, 2017). The novice nurses in the present study considered imposing some off-duty matters as one of their concerns. Maria et al. (2020) also found that novice nurses faced unreasonable conduct from experienced nurses, which made them helpless and frustrated (Maria et al., 2020). Ghasemi et al. and Aiken et al. (2001) showed that 68.7% of the nurses had to do practices that were outside of their domains and diminished the primary role of the nurse in caring for patients (Aiken et al., 2001; Quassemi et al., 2005). The results of the studies were similar to that of the present study so that performing unprofessional tasks led to dissatisfaction and lack of motivation among novice nurses.

Another concern of the participants in the present study was colleagues’ reluctance to give information. Ebrahimi et al. (2016) reported that experienced nurses were less interested in helping novice nurses (Ebrahimi et al., 2016). In addition, Hussein et al. (2017) found that experienced nurses were unable to accept and respect novice nurses properly (Hussein et al., 2017). According to Laschinger et al. (2016), if supportive resources, access to information, resources, and opportunities for growth and occupational learning were available, violent behavior against novice nurses would be reduced (Laschinger et al., 2016). The mentioned studies are comparable to the present study and the novice nurses expressed their colleagues’ reluctance to give information.

Regarding inadequate support of a novice nurse in caring as another of our participants’ concerns, many studies have focused on the supportive and nonsupportive roles of colleagues and head nurses. Colleagues’ support is a necessary factor in reducing job stress, increasing job satisfaction and self-confidence, and creating a favorable work environment, while the lack of support from colleagues is a factor in job abandonment, poor motivation, and the quality of care (Walker & Campbell, 2013). Chen and Dong (2021) also showed that when the expected support was not received, self-confidence and job satisfaction were reduced (Chen et al., 2021). It has been reported that insufficient support is one of the main reasons for novice nurses to quit their jobs (Boamah & Laschinger, 2016). However, Ebrahimi et al. (2016) showed that novice nurses did not accept minor criticisms from colleagues and even responded aggressively to them, which prevented interaction and communication between novice nurses and experienced colleagues, Therefore, experienced nurses perceived novice nurses to be lazy and disinterested, so refuse to support them (Ebrahimi et al., 2016). Ghasemi et al. showed that interaction with unsupportive colleagues increased stress and anxiety in nurses, which caused novice nurses to think about job abandonment (Quassemi et al., 2005).

Dissatisfaction with discrimination in giving compulsory work shift when planning is another concern raised by novice nurses. Smythe and Carter (2022) showed that novice nurses had to provide care for a large number of patients. Other colleagues had high expectations of novice nurses, preventing them from providing optimal patient care due to their heavy workload (Smythe & Carter, 2022). This imposed extra work on novice nurses, which prevented them from providing optimal care for patients who were considered victims of high workloads. Managers must provide basic measures to compensate for the shortage of human resources by allocating funds as well as recruiting new staff.

The displeasure of some privilege's deprivation was another concern mentioned in this study. Flinkman et al. (2013) reported that the low salary of novice nurses was one of the factors in leaving the job (Flinkman et al., 2013). In line with this finding, novice nurses believe that despite overtime and high workload, they have little salary and their hard work is often ignored.

Another concern of the study participants was disillusionment with discriminatory communication. Parker et al. (2014) showed that the head nurse's inappropriate relationship with novice nurses, such as criticizing them in front of other colleagues, patients, and companions, failing to consider their scientific abilities and knowledge, reprimanding and discontinuing merit pay caused the nurse to feel humiliated and threatened (Parker et al., 2014). Based on the experiences of the participants in the present study, fair behavior in the workplace, no discriminatory communication between novice nurses and experienced staff, reduced workload, and low expectations of nurses in the first year of their work increased novice nurses’ motivation. Most of the participants in this study reported refusing to communicate with their experienced colleagues in the first months due to mistrust or unfamiliarity with colleagues and fear of being considered illiterate by their colleagues.

Scheduled overtime for novice nurses is also among the concerns of novice nurses in this study. Novice nurses in the present study were assigned heavy shifts and had no right to give their opinions about shift planning, which was associated with reduced satisfaction, motivation, and quality of care. Ghasemi et al. reported that 62% of novice nurses had to work overtime (Quassemi et al., 2005). Parker et al. (2014) showed that imposing extra work on novice nurses was one of their challenges and causes of dissatisfaction (Parker et al., 2014). Kox et al. (2020) also believe that the high workload among novice nurses was a factor in job abandonment. Therefore, unsupportive colleagues and head nurses reduce the interest in work and physical and mental practice among novice nurses. As nurses face many challenges during their professional lives, they are more likely to quit their jobs, and managers and planners should try to identify these challenges and take effective measures to reduce them so that they can help retain novice nurses.

Strengths and Limitations

The small sample size in this study is considered as a limitation and reduces the generalizability of the results. Another limitation of this study is that some participants did not want to use a tape recorder to record the conversation between the participant and the researcher during the interview. Another limitation of this study is that some participants did not want to use a tape recorder to record the conversation between the participant and the researcher during the interview. As a result, because the use of the audio recorder should be done with satisfaction, it wastes the researcher's time, and as a result, the interview should be conducted with a larger number of participants.

Another limitation of this research is that since this study was conducted in Iran and Iran is different from other countries in terms of cultural context; therefore, the generalization of the results to other societies is limited. According to the findings of the present study, novice nurses experience many concerns, such as anxiety, fear of inability to care, confusion, imposing off-duty matters, workplace discrimination, deprivation of certain privileges, discriminatory communication, and inadequate support. Reducing the concerns of novice nurses at the beginning of their work is an effective factor in their satisfaction with the nursing job, so encouraging nursing executives and officials to reduce these challenges and provide the necessary facilities for novice nurses can provide patient care and promote community health.

Implications for Practice

Considering that nurses have a very important role in ensuring the health of patients, novice nurses form a large part of the nursing staff and since the present study showed they have concerns such as uncertainty, loneliness and helplessness, and worry about some discriminations in their workplace, so nursing managers should prioritize effective measures to reduce these concerns and help them care for patients without worry.

Conclusions

The present study was designed with the aim of explaining concerns of novice nurses in the first year of work. According to the findings, it seems that novice nurses have such experiences as bafflement, doubt, confusion, and poor confidence at the beginning of their work. They state that experienced nurses impose their duties and even some off-duty matters on them and do not support them enough in patient care. In addition, novice nurses expressed disapproval of mandatory shift work when scheduled, denial of certain privileges, discriminatory communications, and scheduled overtime. Knowing these experiences of novice nurses, which are unpleasant for them, can reveal a more realistic image of their perceptions and emotions to their managers and colleagues so that they act more realistically in the interactions and decisions they make for them.