Work readiness development during transition to practice: an exploratory longitudinal mixed-methods study of newly graduated nurses

The global nursing shortage remains critical, making the successful transition and retention of newly graduated nurses (NGNs) essential. Informed by Duchscher’s Transition Theory, which highlights the transition shock experienced by newly graduated nurses, and Walker et al.’s work readiness framework, newly graduated nurses often face significant stress when entering clinical practice. Work readiness is critical for addressing the challenge, yet its trend and stage-specific influencing factors have not been systematically examined. This study aims to explore the potential trend and influencing factors of work readiness among NGNs in China during their first year of employment. An exploratory longitudinal mixed-methods study. During the quantitative phase, 200 NGNs completed the Chinese version of the Work Readiness Scale for Graduate Nurses (WRS-GN) at entry(T0), 4 months (T1), 8 months (T2), and 12 months (T3). Changes in work readiness were examined using repeated-measures analysis of variance. Qualitative data were collected through semi-structured focus group interviews with 16 participants and analyzed using content analysis. Work readiness varied significantly over time (F = 14.11, p < 0.001), following a “rise–decline–rise” pattern. The largest improvement occurred from T0 to T1. Work readiness showed a numerical but not significant decline from T1 to T2, coinciding with reduced organizational awareness and motivation amid department shifts and independent night shifts, as well as increased workload and stress. Readiness improved again from T2 to T3 as professional identity and confidence strengthened. Qualitative data explained these trends, showing that intrinsic motivation and multilayered support helped early adaptation, while independent practice and reflection later promoted role transformation. Work readiness among newly graduated nurses demonstrates a nonlinear, stage-specific, and differentiated developmental pattern during the first year of employment. Tailored educational and managerial support is needed across transition stages, including early reinforcement of fundamental skills and supportive preceptorship, enhanced preparation for independent practice, organizational support and stress management during the mid-transition stage, and the promotion of reflective learning and career development planning in later stages, to facilitate a smoother professional transition. Such support may also have implications for retention.