Constructing Nursing Professional Identity in Impossible Situations: A Longitudinal Narrative Study of New Nurses' Transition to Practice.

Newly graduated nurses are expected to develop a strong professional identity during transition to practice, yet considerable research describes a gap between the ideals taught in nursing school and the realities of clinical work. Mounting evidence suggests that the transition to practice has become more complex in recent years, despite the widespread implementation of precepted orientation programs. Using a narrative analysis approach, this longitudinal qualitative study examined 4 months of the transition to work among 10 newly licensed nurses who accepted positions in medical-surgical units across 5 hospitals in a single U.S. state. In stories they told about hospital life, the nurses rhetorically presented themselves as they believed nurses should be seen, but also conveyed profound disappointment with institutions that constrained their ability to enact values they ascribed to nursing, such as honesty, collaboration, forthright communication, and serious analytic engagement with complex problems. Portraying healthcare institutions as places that render these aspects of nursing impossible, their narratives illuminate how contemporary practice conditions frame processes of identity construction. Our findings enrich understanding of contemporary retention trends and offer a window into the concerns of an emerging generation of nurses.