Facilitators and Barriers to Role Adaptation in Newly Graduated Nurses in Medical-Surgical Units: A Qualitative Content Analysis Study : Short title: Role Adaptation in Newly Graduated Nurses.

Background: The high turnover rate among newly graduated nurses (NGNs) is a significant concern globally, particularly in medical-surgical units (MSUs). Identifying the key facilitators and barriers to their professional role adaptation is crucial for improving retention and facilitating a smoother transition into clinical practice. This study explored facilitators and barriers to professional role adaptation among NGNs in MSUs. Materials and Methods: A qualitative study was conducted using inductive content analysis. Twenty-one NGNs with less than one year of clinical experience were purposively selected from teaching hospitals affiliated with Tehran University of Medical Sciences. Data were gathered through semi-structured in-depth interviews and analyzed using Graneheim and Lundman's five-step approach with MAXQDA software. Results: The findings revealed that multiple interacting factors shape role adaptation at three levels: individual, interpersonal, and organizational. Facilitating factors included personal motivation, clinical preparedness, supportive colleagues, and structured organizational support. In contrast, barriers such as stress, lack of structured orientation programs, negative work culture, and excessive workload hindered adaptation. Conclusion: This study revealed that the adaptation of NGNs to professional roles in MSUs is shaped by individual, interpersonal, and organizational factors. Enhancing structured support at all three levels - through targeted educational programs, professional communication, and organizational infrastructure - can improve transition outcomes, reduce early turnover, and promote workforce retention in healthcare settings.