Exploring the Experiences and Perspectives of new Graduate Nurses on the Push-Pull Factors of Nursing Workforce Crisis Post COVID-19

For nursing students

Study summary

Canada is facing a serious nursing shortage, with projections warning of a shortfall of more than 117,000 nurses by 2030. New graduate nurses (NGNs) are especially likely to leave the profession early, so understanding why they stay or go matters for the future of the health system. This qualitative study, published in the Canadian Journal of Nursing Research, explored the experiences of 15 new graduate nurses working in publicly funded acute care hospitals in the Greater Toronto Area. Most participants (14 of 15) were registered nurses, one was a registered practical nurse, ages ranged from 23 to 32, 93% were women, and 60% worked full-time. The researchers ran four virtual focus groups between December 2023 and January 2024, each lasting 60 to 90 minutes with three to five participants, using an 18-question semi-structured interview guide. To analyze what participants said, the team used two frameworks together: the Social Ecological framework, which looks at personal, interpersonal, organizational, and structural levels of influence, and an Intersectionality framework, which examines how social identities and power relationships shape people's experiences.

The findings were organized around the professional journey of a new nurse, described as four connected phases. The first phase covered nursing education and clinical placements. Participants who trained during the COVID-19 pandemic described reduced clinical hours and virtual placements that left them feeling underprepared, on top of highly competitive program admissions. A bright spot was that consolidation placements (the final clinical rotation before graduation) sometimes led directly to a job offer at the same hospital.

The second phase covered orientation and mentorship when starting a first nursing job. Many participants described orientation as rushed, inconsistent, or cut short. One nurse explained that after receiving only a basic orientation that was pulled back early, she still had not gotten those missed orientation shifts back nearly three years later. Isolation, heavy workloads, and insufficient mentorship compounded the problem. Where orientation went well, participants pointed to supportive teams, dedicated clinical educators, and structured programs such as Ontario's Nursing Graduate Guarantee, which pairs new nurses with extended, precepted orientation shifts.

The third and largest phase concerned the transition to independent practice, which participants described using the language of structural violence operating at multiple levels. Because so many experienced, mid-career nurses resigned during the pandemic, new graduates were often pushed into senior-level responsibilities far earlier than they expected. One nurse with only about a year and a half of experience described nights where she was the most senior nurse on the unit, calling it 'pretty scary.' Participants also described chronic understaffing, excessive workloads, horizontal violence such as gossip and bullying from colleagues, and workplace violence from patients or family members, all contributing to moral distress and burnout. When asked what would help them stay, participants pointed to mandatory nurse-to-patient ratios, more flexible and equitable scheduling, mental health supports, regular manager check-ins, and visibly supportive leadership.

The fourth phase looked at how participants saw their long-term careers. Many described a generational shift away from the traditional 20-to-30-year bedside nursing career. Instead, they talked about pursuing graduate education in nursing, public health, or health informatics, taking travel or agency nursing positions for better pay and flexibility, or leaving healthcare altogether. Opportunities for clinical leadership and advanced practice roles were identified as a pull factor that could keep some nurses in acute care.

The authors concluded that new graduate nurses face compounding challenges across their education and early career, and that systemic reform is needed to support, develop, and retain them. They called for stronger partnerships between nursing schools and clinical placement sites, better-resourced orientation programs, leadership development pathways, and policy action on staffing and workload. For nursing students and new graduates, this study is a reminder that the challenges of the first few years are widely shared, not a personal failing, and that specific, structural supports (adequate orientation, safe staffing, and mentorship) make a measurable difference in whether nurses stay in the profession.

For educators

Teaching and appraisal notes

This qualitative descriptive study by Metersky, Al-Hamad, Ruzgar, Tan, Crasto, and Wong, published in the Canadian Journal of Nursing Research (2024/2025), addresses new graduate nurse (NGN) retention in the context of Canada's projected nursing shortfall of over 117,000 nurses by 2030 and post-COVID-19 workforce attrition. The study is a strong classroom example of applied qualitative inquiry using an explicit theoretical framework pairing, and it lends itself well to appraisal exercises on rigor, transferability, and the use of theory to structure thematic analysis.

Methodologically, the researchers recruited 15 NGNs from publicly funded acute care facilities in the Greater Toronto Area (14 RNs, 1 RPN; ages 23-32; 93% female; 60% full-time) and conducted four virtual focus groups (three to five participants each, 60-90 minutes) between December 2023 and January 2024, guided by an 18-item semi-structured interview protocol. Analysis was informed jointly by the Social Ecological framework (personal, interpersonal, organizational, structural levels of influence) and an Intersectionality framework attentive to social identities and power relations. This dual-framework approach is worth discussing with students: it allowed the team to locate individual-level distress (e.g., burnout, isolation) within organizational and structural conditions (e.g., staffing policy, pandemic-driven attrition of senior staff) rather than treating retention as solely a matter of individual resilience.

Findings are organized into four professional-development phases, each with identifiable push and pull factors. Phase one (education/placement) surfaced pandemic-related disruptions to clinical hours and virtual placements as push factors, with consolidation placements leading to direct hire as a pull factor. Phase two (orientation/mentorship) found inconsistent, truncated orientation and insufficient mentorship as major push factors, illustrated by a participant who, nearly three years post-hire, had never received the orientation shifts cut from her original onboarding; structured programs such as Ontario's Nursing Graduate Guarantee and dedicated clinical educators were identified as protective. Phase three (transition to independent practice) was the richest theme, framed by participants as multi-level structural violence: pandemic-driven resignation of experienced nurses forced NGNs into de facto senior roles prematurely, compounded by chronic understaffing, horizontal violence (gossip, bullying) and external workplace violence, producing moral distress and burnout. Participant-generated retention strategies here included mandatory nurse-to-patient ratios, flexible/equitable scheduling, mental health supports, and consistent managerial engagement. Phase four (professional trajectory) captured a generational shift away from long-tenure bedside careers toward graduate education, travel/agency nursing, or exit from healthcare altogether, with advanced practice and clinical leadership pathways identified as retention levers.

For appraisal discussion, the authors themselves note limitations: the sample is drawn from a single geographic region (Greater Toronto Area), constraining transferability to rural, remote, or other provincial contexts; RN participants substantially outnumbered the single RPN participant, limiting insight into RPN-specific experiences; and gender-based inequities, despite the near-uniformly female sample, were not deeply explored despite the intersectional framing. Faculty may want to prompt students to distinguish focus-group qualitative description (rich, context-bound, not intended to be statistically generalizable) from the policy-level recommendations the authors draw from it — namely stronger education-practice placement partnerships, individualized orientation and self-scheduling, mandatory staffing ratios, and structured leadership pathways. This tension between small-sample qualitative depth and system-level policy recommendations is a productive discussion point for research methods and health policy seminars alike, as is the framework's implicit critique of individualizing burnout without naming structural drivers.