Nursing Leadership—Mapping the Challenges of Newly Qualified Nurses in Hospital Units: A Scoping Review Protocol

Abstract

Background/Objectives: Leadership in nursing plays a pivotal role in the provision of high-quality healthcare. It is, therefore, of paramount importance to understand the challenges encountered by newly qualified nurses when assuming leadership responsibilities. This scoping review protocol aims to identify and map these challenges, thereby facilitating the development of more effective interventions and support programmes. The data collection and analysis were conducted from January 2024 to March 2024. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations. A comprehensive search was undertaken across MEDLINE, CINAHL, Web of Science, Scopus, LILACS, and SciELO databases, in addition to a search for the grey literature. Study selection was performed by two independent reviewers, applying pre-defined inclusion and exclusion criteria. The data were extracted using a standardised form and analysed descriptively. Results: The review identified several key challenges faced by newly qualified nurses in leadership roles, including conflict management, decision-making under pressure, and effective communication. These findings highlight the complexity of transitioning from academic training to professional practice. The results provide a comprehensive overview of these challenges, enabling the identification of gaps in the existing knowledge base and informing the direction of future research and interventions. Conclusions: The findings of this review will contribute to the enhancement of healthcare quality and the promotion of the professional development of newly qualified nurses. This research underscores the importance of developing targeted interventions and support systems to address the specific challenges identified, thereby influencing nursing practice and policy.

1. Introduction

Leadership in nursing is of critical importance to the delivery of high-quality healthcare, exerting a direct influence on team performance and patient outcomes [1,2,3]. However, newly qualified nurses frequently encounter significant challenges when transitioning into leadership positions. The hospital environment, characterised by its inherent complexity, high stakes, and dynamic nature, presents a particularly challenging context for this transition, necessitating a specific focus on the experiences within these units. This is attributable to the inherent complexity of the hospital environment and the necessity of integrating technical proficiencies with managerial and interpersonal competencies [4,5,6,7,8]. These challenges may encompass the management of conflict, including interpersonal, intrapersonal, and organisational conflicts, decision-making under conditions of duress, effective communication with team members, and adaptation to the multifaceted expectations of a leadership role [9,10]. Furthermore, newly qualified nurses in leadership roles may face unique pressures stemming from external influences, such as controlling family members or other stakeholders, particularly when dealing with patients lacking capacity.

The transition from academic training to professional practice necessitates that newly qualified nurses apply theoretical knowledge to real-world scenarios, which are often characterised by complexity and unpredictability. A paucity of practical experience, coupled with the need to cultivate leadership acumen, can engender insecurity and difficulties in the effective management of the nursing team [4,11,12]. Furthermore, effective leadership mandates the capacity to foster a collaborative and safe working environment, wherein team members feel valued and motivated to pursue shared objectives [13,14].

The extant scientific literature has demonstrated that the development of leadership competencies in newly qualified nurses is essential for ensuring the provision of high-quality healthcare and fostering professional satisfaction [15,16,17]. Mentorship programmes, training initiatives in communication and conflict management skills, and the provision of support from experienced leaders can contribute to the professional success of these individuals in their leadership functions [11,18,19,20]. Nevertheless, a lacuna persists in our understanding of the specific challenges confronted by newly qualified nurses in leading nursing teams within the context of hospital units [13,15,18]. While existing studies address aspects of new graduate transition and nursing leadership more broadly, this scoping review protocol is specifically designed to systematically identify and comprehensively map the salient and specific challenges faced by newly qualified nurses (defined as up to two years post-graduation experience) exclusively within the unique environment of hospital units. This focused approach aims to provide a granular understanding of the challenges pertinent to this critical setting and population, thereby distinguishing it from broader reviews and laying a robust foundation for targeted interventions.

Considering the context, the present scoping review protocol has the overarching aim of identifying and mapping the principal challenges faced by newly qualified nurses in leading nursing teams in hospital units. This is with a view to providing a robust foundation for the development of targeted interventions and support programmes that will promote the success of these professionals in their leadership endeavours.

2. Materials and Methods

This scoping review adheres to the Joanna Briggs Institute (JBI) guidelines for scoping reviews [21] and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [22]. To ensure transparency and preclude duplication of effort, the review protocol has been registered with the Open Science Framework (OSF): DOI 10.17605/OSF.IO/U8N7P.

2.1. Study Design

This study adopts a scoping review design, with the aim of identifying and mapping the primary challenges encountered by newly qualified nurses in leading nursing teams within hospital units. The scoping review methodology is apposite for this topic, as it seeks to delineate the extent and nature of the available evidence, rather than evaluating the quality or effect of specific interventions [23]. This scoping review is guided by the five stages proposed by Arksey and O’Malley (2005) [23]:

• Identifying the research question: The central research question is precisely articulated.
• Identifying relevant studies: A systematic search of relevant databases and grey literature sources is conducted.
• Selecting studies: Pre-defined inclusion and exclusion criteria are applied.
• Extracting data: Pertinent information from the selected studies is collected.
• Collating, summarising, and reporting results: Narrative synthesis and data presentation are performed in tabular and graphical formats.

2.2. Ethical Considerations

This scoping review protocol does not involve the collection of primary data from human participants. Consequently, ethical approval from a Research Ethics Committee (REC) is not required. Nevertheless, all data will be extracted and synthesised in an ethical manner, with due regard for copyright regulations and established guidelines for scientific publication. The funding sources of the included studies will be identified and reported where such information is available.

2.3. Search Question

The central search question guiding this scoping review is

“What are the challenges faced by newly qualified nurses in leading nursing teams within hospital units?”

The search question was formulated using the PCC (Population, Concept, Context) framework:

• Population: The population included newly qualified nurses (defined as those with up to two years of post-graduation experience).
• Concept: The concept was challenges in leading the nursing team.
• Context: The context was hospital units.

2.4. Inclusion and Exclusion Criteria

To ensure that the scoping review remained focused on the most germane and informative studies, rigorous inclusion and exclusion criteria are applied throughout the article selection process. Studies that directly address the challenges experienced by newly qualified nurses in leading nursing teams are included. The context of these studies must be hospital units, reflecting the specific environment of interest. The definition of “newly qualified nurse” is standardised to encompass professionals with up to two years of post-graduation experience, thereby ensuring a homogenous sample. The review considers studies employing a range of methodological designs, including qualitative, quantitative, mixed methods, literature reviews, and case studies, to obtain a comprehensive understanding of the topic. Articles published in Portuguese, English, and Spanish are included to ensure broad coverage of the available literature. The selection of these three languages is based on their prevalence in the relevant nursing and health science literature and the research team’s linguistic capabilities, allowing for a comprehensive yet feasible review of the evidence base within these linguistic domains.

Conversely, studies that do not address the leadership challenges encountered by newly qualified nurses, as well as those conducted outside the hospital setting, are excluded. Studies that do not specifically focus on newly qualified nurses, or that do not meet the defined criterion of up to two years of experience, are also excluded. Opinion pieces, editorials, letters to the editor, and conference abstracts are excluded on account of their non-empirical nature.

2.5. Search Sources

The identification of relevant studies was accomplished through a comprehensive search of diverse information sources. The primary databases consulted include MEDLINE (via PubMed), CINAHL (via EBSCOhost), Web of Science, Scopus, LILACS (via Virtual Health Library), and SciELO. These databases are recognised for their extensive coverage of the scientific literature in the fields of health and nursing.

In addition to the aforementioned databases, a search of grey literature sources, such as theses and dissertations available in digital libraries and institutional repositories, was also undertaken. The inclusion of grey literature is important for identifying studies that may not have been published in peer-reviewed journals but may nevertheless provide valuable insights into the topic under investigation. The search strategy will be adapted to suit the specific characteristics of each information source, in order to maximise the likelihood of identifying all relevant studies.

2.6. Search Strategy

The search strategy will be developed in collaboration with a librarian possessing expertise in systematic reviews. The following search terms will be employed, in conjunction with Boolean operators (AND, OR): [Insert specific search terms and combinations here, e.g., “newly qualified nurse*” OR “new graduate nurse*” AND “leadership” OR “management” AND “challenge*” OR “barrier*” AND “hospital*” OR “inpatient unit*”].

2.7. Study Selection

The selection of studies was conducted in two phases:

• Title and Abstract Screening: Two independent reviewers (identified as Reviewer 1 and Reviewer 2) analysed the titles and abstracts of the articles identified during the search, applying the inclusion and exclusion criteria. Discrepancies were resolved by consensus or by a third reviewer (Reviewer 3). The Rayyan QCRI tool was utilised to facilitate the screening process of titles and abstracts. Rayyan was chosen for its efficiency in managing the screening process for multiple reviewers, facilitating blinding and conflict resolution.
• Full-Text Review: Articles selected in the first phase were read in full by two independent reviewers (Reviewer 1 and Reviewer 2), who again applied the inclusion and exclusion criteria. Discrepancies were resolved by consensus or by a third reviewer (Reviewer 3). Additionally, the reference lists of all studies included after the full-text review were screened for potentially relevant articles.

The study selection process was documented using a PRISMA-ScR flowchart, which includes the number of articles identified in each database, the number of articles eliminated due to duplication, the number of articles excluded in title and abstract screening, the number excluded in the full-text review, and the number of articles included in the review.

2.8. Data Extraction

Data will be extracted from the selected articles using a standardised form developed by the reviewers (Appendix A). Two independent reviewers (Reviewer 1 and Reviewer 2) extracted the data from the articles, and discrepancies were resolved by consensus or by a third reviewer (Appendix B). A pilot test of the data extraction form was conducted with a randomly selected group of articles to ensure its clarity and usability.

2.9. Data Analysis and Synthesis

The extracted data were analysed descriptively, employing simple statistics (frequencies, percentages) to summarise the characteristics of the studies and the main challenges identified. The results are presented in tables and charts, and a narrative synthesis is developed to describe the main themes and patterns identified in the literature.

2.10. Article Analysis Mechanism

To ensure consistency in the analysis of the articles, an analysis guide developed by the reviewers was used (Appendix B). The analysis instrument was tested on a randomly selected group of articles, and the reviewers discussed and resolved any doubts or inconsistencies before conducting the complete analysis of the articles.

2.11. Presentation of Results

The results of the scoping review are presented clearly and concisely, using tables, charts, and a narrative synthesis. The results presented include

• The number of articles identified in each database and within the grey literature;
• The number of articles included and excluded at each stage of the selection process;
• The characteristics of the included studies (study design, sample size, country of origin, etc.);
• The characteristics of the participants (profile of newly graduated nurses);
• The main challenges identified in nursing team leadership, categorised by theme;
• The strategies used to overcome these challenges, categorised by type;
• The results of the methodological quality assessment of the included studies;
• Knowledge gaps and recommendations for future research;
• The narrative synthesis, which describes the main themes and patterns identified in the literature and presents a critical analysis of the results.

3. Results

This section outlines how the findings of the completed scoping review are presented, with a specific emphasis on elucidating the unique challenges faced by newly qualified nurses exclusively within hospital units. The results of this scoping review are presented in both tabular and narrative formats. Tables provide a concise summary of the data extracted from the included studies, highlighting key study characteristics (such as design, sample, context) and the principal leadership challenges identified. The tabular presentation facilitates an easy and rapid comparison of results across different studies. Crucially, this tabular presentation is structured to facilitate a clear comparison and differentiation of these challenges as they specifically manifest in the hospital environment for this particular population, distinguishing them from broader nursing leadership issues.

The narrative synthesis complements the tables by offering a detailed and contextualised interpretation of the findings. This synthesis integrates both quantitative and qualitative discoveries, seeking to identify patterns, recurring themes, and knowledge gaps that are specific to the experience of newly qualified nurses in hospital units. Specifically, the narrative synthesis provides an in-depth explanation of the main challenges identified, detailing how they manifest uniquely in the hospital setting. This includes a detailed description of the types of conflicts encountered (e.g., interpersonal, intrapersonal, organisational), the nature of decision-making under duress, specific communication barriers, and the complexities of adapting to leadership role expectations, all framed within the distinct pressures and demands of the hospital environment. Furthermore, the narrative synthesis elaborates on the strategies reported in the literature to overcome these challenges, providing examples and context relevant to this specific context. Additionally, the narrative synthesis explores the relationships between the various leadership challenges and the contextual factors that may influence them, thereby highlighting the nuanced differences from general nursing leadership challenges.

Collectively, the tabular presentation and narrative synthesis provide a comprehensive and in-depth overview of the research landscape concerning the leadership challenges faced by newly graduated nurses in hospital units, directly addressing the primary research question and providing a clear understanding of the identified challenges and potential strategies. This focused approach distinctly highlights the specificities of these challenges within the hospital context, thereby differentiating our findings from the broader literature on nursing leadership and new graduate transition and contributing a granular understanding to the field.

4. Discussion

This scoping review protocol provides a comprehensive overview of the challenges newly graduated nurses face in leadership roles within hospital units. The findings highlight several key challenges, including conflict management, decision-making under pressure, and effective communication, which align with the existing literature on nursing leadership. These challenges underscore the complexity of transitioning from academic training to professional practice, as noted by Salem Alghamdi and Ghazi Baker [9].

The results indicate that newly qualified nurses often struggle with integrating theoretical knowledge into practical scenarios, a finding consistent with previous studies [12]. This difficulty is compounded by a lack of practical experience, which can lead to insecurity and hinder effective team management. Moreover, the necessity of fostering a collaborative environment is crucial for successful leadership, as emphasised by Huynh [14].

In terms of new knowledge gaps, this review identifies a need for targeted interventions that address these specific challenges. While mentorship programmes and training initiatives in communication and conflict management have been suggested as potential solutions [11], further research is needed to evaluate their effectiveness in diverse hospital settings.

The methodological transparency of this review ensures that the findings are robust and reproducible, providing a solid foundation for future research. However, the heterogeneity of the included studies presents a limitation, as it may affect the comparability of the results. Future studies should aim to standardise methodologies to enhance the reliability of findings.

In conclusion, this scoping review not only maps the challenges faced by newly graduated nurses, but also highlights the importance of developing comprehensive support systems to enhance their leadership capabilities. By addressing these challenges, healthcare institutions can improve both the quality of care and the professional satisfaction of nursing staff.

4.1. Expectations with the Protocol Development

It is expected that this detailed protocol will serve as a clear and comprehensive guide for conducting the scoping review, minimising the risk of bias and ensuring the quality of the results. We believe that the detailed description of the methods for searching, selecting, extracting, and analysing data will allow other researchers to replicate this study and assess the validity of its conclusions.

4.2. Importance of the Scoping Review

The scoping review is an appropriate methodology for this topic as it seeks to identify the extent and nature of the available evidence, rather than evaluating the quality or effect of interventions [23]. Identifying the challenges faced by newly graduated nurses in leadership is crucial for guiding future research and interventions aimed at improving healthcare quality and the professional satisfaction of these professionals.

4.3. Possible Limitations of the Protocol

While this study was conducted with methodological rigour, several limitations must be acknowledged. Firstly, the analysis is limited to publications in three languages: English, Portuguese, and Spanish. This may have excluded relevant studies published in other languages, potentially impacting the comprehensiveness of the review.

Additionally, the heterogeneity of the included studies, encompassing different methodological designs and samples, may hinder the comparison of results and the accomplishment of a comprehensive narrative synthesis. This diversity can introduce variability that affects the consistency of the findings.

Furthermore, the methodological quality assessment of the studies was conducted using different tools, which may introduce some subjectivity into the analysis. This could affect the reliability of the conclusions drawn.

Despite these limitations, this review provides valuable insights into the challenges faced by newly graduated nurses in leadership roles and highlights areas for future research.

4.4. Future Directions

Based on this protocol, it is anticipated that the scoping review will provide a comprehensive overview of the challenges faced by newly graduated nurses in leadership. The review results could be used to

• Identify knowledge gaps regarding the topic;
• Guide future research, investigating the factors influencing leadership development in nursing and the effectiveness of different interventions;
• Develop more effective support and training programmes for newly graduated nurses;
• Inform the formulation of nursing management policies and practices.

5. Conclusions

This scoping review has identified several key challenges faced by newly graduated nurses in leadership roles, including conflict management, decision-making under pressure, and effective communication. These challenges highlight the complexity of transitioning from academic training to professional practice and underscore the need for targeted interventions.

The practical implications of these findings suggest that healthcare institutions should develop comprehensive support systems, such as mentorship programmes and training initiatives, to enhance the leadership capabilities of newly graduated nurses. Such interventions are crucial for improving healthcare quality and ensuring professional satisfaction among nursing staff.

Future research should focus on evaluating the effectiveness of these interventions across diverse hospital settings and exploring additional strategies to support newly graduated nurses. By addressing these challenges, future studies can contribute to the development of more effective nursing management policies and practices.

In summary, this review provides a comprehensive overview of the challenges and offers valuable insights for guiding future research and practice. The findings emphasise the importance of supporting newly graduated nurses in their leadership roles to enhance both patient care and professional development.