Facilitators and barriers to newly graduated registered nurses' entry to practice in acute care: An integrative review

Purpose This integrative review synthesized evidence on facilitators and barriers influencing newly graduated registered nurses' entry to practice during orientation and early transition in acute care settings in North America. Methods CINAHL, MEDLINE, and Scopus were searched for peer-reviewed studies published from 2014 to 2026. Thirty studies met inclusion criteria. Study quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesized using constant comparison and thematic analysis. Results Five themes emerged: organizational structure of orientation programs; support systems; education-practice readiness gaps; effects of orientation interventions on confidence and competence; and the interaction of organizational and individual factors. Successful transition was supported by structured, adaptable orientation programs, consistent mentorship, psychological safety, and ongoing developmental support. Barriers included inadequate support, workload pressures, poor unit fit, and inconsistent orientation experiences. Conclusion Orientation should be viewed as a practice-based educational intervention that supports clinical development, professional transition, and workforce retention.