Levels of transition shock and associated factors among newly graduated nurses: A systematic review and meta-analysis

To estimate systematically the levels of transitional shock and associated factors among newly graduated nurses.

Transition from students to professional nurses is stressful and challenging. Transition shock negatively affects newly graduated nurses, patients and healthcare organizations.

Systematic review and meta-analysis.

PubMed, Embase, CINAHL and Web of Science were searched from inception to July 31, 2025. Two researchers independently conducted study selection, data extraction and quality assessment. Pooled mean scores of transition shock and its dimensions were analyzed using Stata 12.0. Subgroup analysis, publication bias and sensitivity analysis were also conducted.

A total of 31 studies were included, involving 1,3210 newly graduated nurses. The pooled mean score of transition shock was 2.82 (95%CI=2.63-3.01) in studies using a 5-point Likert scale and 2.48 (95%CI=2.31-2.64) in studies using a 4-point Likert scale. The review identified a variety of factors influencing transition shock, including intrapersonal (e.g., educational level, self-efficacy and resilience), interpersonal, (e.g., leadership behaviors and social support) and organizational (e.g., nursing work environment and frequency of night shifts) factors.

Transition shock was moderate among newly graduated nurses, with intrapersonal, interpersonal and organizational factors identified as key influencing factors. These findings may guide the optimization of transition interventions for newly graduated nurses to maintain the future nursing workforce.