Award Date


Degree Type


Degree Name

Doctor of Nursing (ND)



First Committee Member

Lori Candela

Second Committee Member

Rachell Ekroos

Third Committee Member

Joseph Morgan

Number of Pages



Global nursing shortages, increasingly complex patients, and rapidly evolving medical knowledge and technology make it necessary for today’s new graduate nurse (NGN) to enter practice with an already well developed set of skills (clinical judgment, technical skills, and a sound knowledge base). The protracted nursing shortage has prompted health care organizations to hire NGN’s directly into intensive care units (ICU), a rare, and previously unheard-of occurrence. Many NGN’s are unprepared for the highly complex, critically unstable patient in the ICU or the fast paced, independent, yet simultaneously collaborative nature of the ICU workplace. These deficits can quickly compromise patient safety and negatively impact both the new nurse graduate and those who work with them.

The widespread use of NGN transition-to-practice (TTP) residency programs, has done little to improve the readiness of NGNs hired directly into ICU settings. Even after completing residency programs, many NGNs feel under-prepared and under-supported. It is of little wonder that many NGNs hired into ICU settings make more mistakes and feel more isolated. Experienced nurse colleagues feel additional pressure to manage their own patient loads and those of the NGN’s. The NGN’s can quickly become dissatisfied and, too often, choose to leave the job in the first year.

The purpose of this doctor of nursing practice (DNP) project was to develop a 4-month pediatric intensive care unit (PICU) Specialty Transition Educational Program for New Graduate Nurses (STEP-NGN), featuring simulation and the use of mentors. The aim was to assist NGN’s in developing the knowledge, clinical judgment, and skills specific to this population of critically ill patients. A large PICU in a Level 1 trauma hospital in the Southwest was the site of the program. Experienced PICU nurses (n = 4) agreed to serve as mentors and received specific mentor training. NGNs (n = 2), in their first year of employment, completed the first month of the STEP-NGN. Participants completed a combination of established, validated tools and student investigator developed measures. Results indicated that although NGN participants had participated in a TTP program and clinical area orientation, they were still deficient in critical care knowledge and skill to competently manage various PICU clinical patient care simulated situations. The participants in the program indicated and demonstrated by the end of the first month increased competence and confidence to care for pediatric critical care respiratory emergencies. These results indicated the necessity to develop the remaining three months of the program.

The initial findings indicate that there is value in using an additional transition program, specific to the patient situations common to the area where the NGN works, that includes active teaching strategies and mentor support.


New graduate nurse competence; New graduate nurses; New graduate nurses in ICUs; Pediatric intensive care; Precepting new graduate nurses; Transition to practice programs



File Format


File Size

2.4 MB

Degree Grantor

University of Nevada, Las Vegas




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