{"paper_id":"1fd8e165-a2ca-4083-99c8-9ec47d583b09","body_text":"Predictors of Transition Shock Among Newly Graduated Nurses, Sri Lanka: A Descriptive Cross- Sectional Study on the Roles of Self-Efficacy, Professional Nursing Values, and Practice Environment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of Transition Shock Among Newly Graduated Nurses, Sri Lanka: A Descriptive Cross- Sectional Study on the Roles of Self-Efficacy, Professional Nursing Values, and Practice Environment Oshini Dharmajeewa, Nirosha Priyadarshani Edirisinghe, Thamara Amarasekara This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7362651/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background South Asian countries, including Sri Lanka, face some of the most severe shortages of nurses globally, creating significant challenges for healthcare delivery. One contributing factor to this crisis is the high dropout rate of newly graduated nurses worldwide, often attributed to an unsuccessful transition from the role of nursing student to that of a practicing clinical nurse. This critical transition period can be influenced by multiple personal, professional, and organizational factors, directly impacting retention and job satisfaction. Objective This study aimed to assess the factors influencing the transition period to professional roles among newly graduated nurses with a Bachelor of Science degree in Nursing, with a particular focus on identifying predictors of transition shock. Methods A descriptive cross-sectional study was conducted in government hospitals within the Colombo District. A consecutive sample of 102 newly graduated nurses from six universities, all employed in hospitals in Colombo, was recruited. Data were collected using four standardized, pre-tested (N = 10), and self-administered instruments: the General Self-Efficacy Scale, the Professional Nursing Values Scale, the Practice Environment Scale of the Nursing Work Index, and the Transition Shock Scale. Data were analyzed using descriptive statistics to summarize demographic and contextual variables, followed by multivariate statistical analyses to determine significant predictors of transition shock. Results Graduate transition shock was found to be significantly associated with monthly income (p = 0.005), type of hospital (p = 0.017), hospital bed capacity (p = 0.021), and the personal motivation or reason for becoming a nurse (p = 0.007). Furthermore, self-efficacy and professional nursing values emerged as significant predictors of transition shock, indicating that higher self-efficacy and stronger professional values are associated with lower transition-related stress. Conclusion The findings highlight the urgent need for targeted interventions to facilitate smoother professional transitions for newly graduated nurses. Strategies such as workload reduction, structured reward and recognition systems, the establishment of formal preceptorship and mentorship programs, and initiatives to enhance general self-efficacy and strengthen professional nursing values are recommended. Implementing such measures could not only reduce transition shock but also improve job satisfaction, retention, and the overall stability of the nursing workforce in Sri Lanka and similar contexts. Newly graduated nurses Self-efficacy Transition shock Sri Lanka Background Nurses and midwives constitute nearly 50% of the global health workforce [ 1 ]. According to the World Health Organization [ 2 ], an estimated nine million additional nurses and midwives will be required by 2030 for countries to achieve Sustainable Development Goal 3, which focuses on health and well-being. Despite this urgent need, a global shortage of health workers persists, with nurses and midwives accounting for more than half of the deficit. Notably, the South-East Asian and African regions, including Sri Lanka, contribute significantly to this shortage [ 2 , 3 ]. Despite global calls to increase nursing numbers, Sri Lanka has seen a decline, with 34,221 nurses reported in 2017 compared to 38,506 in 2014 [ 4 ]. In 2018, the nurse and midwife density was 2.18 per 1,000 population [ 5 ]. This shortage has been further exacerbated by the challenging working conditions during the COVID-19 pandemic [ 6 ]. ‘Transition’ is recognised as a central concept in nursing, particularly in relation to professional role changes such as the shift from student to practicing nurse [ 7 , 8 ]. Situational transitions, including those experienced by new graduates entering the workforce, are critical to professional development. The transition period is generally defined as the first 12 months of practice, although it may extend up to two to three years depending on the context [ 9 ]. In Sri Lanka, nursing education is delivered through three-year diploma programs at nursing schools and four-year bachelor's programs at universities, both of which meet national curricular standards and lead to professional registration [ 10 ]. While previous research in Sri Lanka has identified a significant relationship between emotional labour and turnover intention among nurses [ 11 ], the study did not consider the length of clinical experience. Therefore, it is not possible to conclude the specific challenges encountered by new graduates during their transition period, including potential risks of burnout or early attrition. Newly graduated nurses experience a critical adjustment phase when transitioning from student to clinical nurse [ 12 ]. Upon entering the clinical setting as staff nurses, feelings of unpreparedness are common due to changes in role expectations and unfamiliar work environments. Evidence suggests that such feelings often emerge during the final year of training [ 13 , 14 ]. During this transition, graduates must manage time effectively, integrate theoretical knowledge into clinical practice, and adapt through occupational socialization [ 14 ]. A persistent theory–practice gap has been reported, whereby newly qualified nurses perceive a mismatch between academic instruction and the realities of clinical care. Duchscher (2009) describes transition shock as the most immediate and acute phase in the process of professional role adaptation for newly graduated nurses, encompassing elements of transition theory, reality shock, cultural adjustment, and professional development [ 9 ]. According to Sargis and Kramer (1975), reality shock comprises four distinct phases: honeymoon, shock, recovery, and resolution [ 15 ]. In the honeymoon phase, newly graduated nurses experience optimism and enthusiasm upon entering the workforce, anticipating the application of ideal nursing practices learned during training. The shock phase follows as graduates are confronted with the discrepancies between theoretical instruction and actual clinical practice. This phase is often accompanied by emotional responses such as disillusionment, fatigue, rejection, and, at times, hostility [ 16 , 17 ]. Nurses who successfully navigate the shock phase may enter the recovery phase, during which they begin to adjust by developing coping mechanisms and reducing anxiety. The final phase, resolution, can result in either a successful integration into the professional role or an increased intention to leave the profession due to persistent stress and maladaptation [ 18 , 17 ]. Newly graduated nurses commonly face eight key challenges during the transition period: workload, lack of knowledge, communication issues, role expectations, role change, working environment, lack of support, and a culture of blame and complaints [ 19 ]. Among these, workload is identified as the most significant challenge [ 1 , 20 ]. This is often attributed to staffing shortages, with nurse-to-patient ratios frequently exceeding the internationally recommended standard of 1:6 [ 21 ]. The clinical learning environment plays a crucial role, influencing both the undergraduate experience and the early professional period. Pearcey and Elliott (2004) emphasized its impact on student nurses[ 22 ], while Clare and van Loon (2003) reported that nearly half of newly registered nurses in their study had encountered or observed unprofessional conduct, including instances described as 'horizontal violence' and bullying [ 23 ]. Similar findings were reported by McKenna et al. (2003) and Pellico et al. (2009), who noted that new graduates often experienced poor interpersonal relationships and nurse-to-nurse hostility during their first year[ 24 , 25 ]. These adverse experiences further hinder their ability to adapt and thrive during the critical transition phase. Role ambiguity is a predominant stressor experienced by newly graduated nurses during the initial months of the transition period [ 26 ]. It is defined as “the lack of clear, consistent information about the behavior expected in a role” [ 27 ], often resulting from poorly defined responsibilities assigned to new graduates. Additional stress-inducing factors include excessive workload, limited confidence in prioritizing care, inadequate time management, perceived failure to meet senior staff expectations, continuous scrutiny, fear of errors, and a perceived lack of professional competence [ 20 ]. As the transition progresses, by approximately 10 months, role overload surpasses role ambiguity as the primary stressor [ 26 ]. Collectively, these stressors significantly impact the ability of novice nurses to adjust and function effectively during their early clinical practice. High turnover rates among new graduate nurses are well-documented, with estimates indicating that 17.7%, 33.4%, and 46.3% leave the profession within their first, second, and third years, respectively [ 28 ], consistent with earlier findings [ 25 ]. In South Korea, these elevated attrition rates have been attributed primarily to 'transition shock' experienced during the early phase of clinical practice[ 29 ]. Key contributing factors include discrepancies between theoretical knowledge and clinical practice, excessive workload, diminished social support, weakened collegial relationships, uncertainty regarding professional values, and challenges balancing work and personal life [ 30 ]. Additionally, dissatisfaction with long working hours and inadequate remuneration further exacerbates the difficulty of the transition period. To address the shortage of nurses in the health workforce, several studies have recommended expanding enrolment into undergraduate nursing programmes. This expansion not only aims to increase workforce numbers but also to equip students with essential competencies such as critical thinking, leadership, interpersonal communication, decision-making, and professionalism—skills imparted through engagement with highly qualified academic staff. These competencies are expected to facilitate smoother adaptation to the staff nurse role, thereby mitigating transition shock [ 10 ]. The literature identifies several strategies to alleviate transition or reality shock in new graduates. These include gradual workload allocation, structured orientation phases, assignment of mentors or preceptors, regulation of working hours (including minimizing overtime), reduced patient loads, close supervision during the initial months, and enhancement of self-concept, self-assessment, and self-esteem throughout the transitional period [ 31 ]. The present study assessed factors influencing the transition to professional roles among newly graduated nurses from six selected universities in Sri Lanka. The Transition Shock Scale, developed by Kim et al. (2017) was used for this purpose [ 30 ]. In addition, the study examined the influence of pre-graduation characteristics and the work environment on transition experiences, guided by the framework presented by Kim and Yeo (2019)[ 29 ]. The predictive effects of self-efficacy, professional nursing values, and the practice environment on transition shock were also evaluated. Methods Design and Sample The study employed a quantitative, descriptive cross-sectional survey design. The target population consisted of newly graduated nurses from six state universities in Sri Lanka, currently employed in any working unit within government, semi-government, or private hospitals located in the Colombo District. Inclusion criteria required participants to have obtained a Bachelor of Science (B.Sc.) degree in Nursing (internal stream) from a recognized state university and to have a maximum of two years of post-qualification clinical experience. Individuals with prior nursing experience before completing their B.Sc. degree—specifically lateral entry students—were excluded to ensure homogeneity of the sample in terms of clinical exposure post-qualification. All the participants who fulfilled the inclusion and exclusion criteria were recruited using a consecutive sampling method. The ethical approval was granted for this study by the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka (App No: Nur/03/20) in accordance with the Declaration of Helsinki. All participants provided informed consent through an embedded agreement option ('agree to participate/disagree to participate') at the end of the Google sheet before enrolment in the study. Additional permissions were obtained from relevant authorities. Subsequently, the researchers requested and received the contact information of eligible graduates from each participating university. Initial contact with potential participants was made via telephone to introduce the study and confirm eligibility. Study Instruments The questionnaire consisted of five main sections, integrating four validated scales as per Kim and Yeo (2019) [ 30 ]. Section I included three domains: socio-demographic characteristics (7 items), pre-graduation characteristics (5 items), and working status (14 items). Key elements under pre-graduation characteristics included Grade Point Average (GPA) and the primary reason for selecting nursing. The working status section explored variables such as the reason for becoming a staff nurse, hospital type and bed strength, clinical career trajectory, employment type, monthly working hours and income, current working unit, receipt of pre-education, and presence of a trained preceptor. The remaining four sections incorporated scales measuring General Self-Efficacy, Professional Nursing Values, Nursing Work Environment, and Transition Shock. Scale on General Self-Efficacy (GSE) was developed by Schwarzer et al. (1997)[ 31 ]. The initial German version, developed in 1979, was later revised and adapted to English (Schwarzer & Hallum, 2008) [ 32 ]and 25 other languages by various co-authors [ 31 ]. This scale comprises ten items measured on a 4-point scale from 'not true at all to 'exactly true,' with a higher score indicating higher Self-Efficacy. The Cronbach's alpha of the original scale was 0.88 [ 31 ]. In this study, it was 0.926. Scale on Professional Nursing Values (PNV) comprising 29 items was developed by Yeun et al. (2005)[ 33 ]. Five main factors/subscales identified in this scale are \"the self-concept of the profession,\" \"social awareness,\" \"professionalism of nursing,\" \"the roles of nursing service,\" and \"the originality of nursing.\" The items assessed these five subscales on a 5-point scale from 'Strongly Disagree' to 'Strongly Agree,' with a higher score indicating higher professional nursing values. The Cronbach's alpha of the original scale was 0.9168 [ 33 ]. In this study, it was 0.911. The Practice Environment Scale of the Nursing Work Index (PESNWI) was used to measure the nurses' work environment. This scale comprises 29 items measured using a 4-point scale from 'very unlikely' to 'very likely' under five subscales, a higher score indicating a better work environment. The five subscales were \"nurse participation in hospital affairs,\" \"nursing foundation for quality of care,\" \"nurse manager ability, leadership and support of nurses,\" \"staffing and resource adequacy,\" and \"collegial nurse-physician relationship\" [ 34 , 35 ]. The Cronbach's alpha of the Korean PES-NWI was 0.93 [ 34 ]; in this study, it was 0.936. Scale on Transition Shock (TS) for newly graduated nurses, developed initially in the study by Kim et al. (2017)[ 30 ], was used in this study to assess the transition shock. The scale comprises 18 items in total assessing six subscales: \"conflict between theory and practice,\" \"overwhelming workload,\" \"loss of social support,\" \"shrinking relationship with co-workers,\" \"confusion in professional nursing values,\" and \"incompatibility in work and personal life,\" using a 4-point scale, with a higher score indicating a greater transition shock [ 30 ]. The Cronbach's alpha of the original scale was 0.89 [ 30 ], and in this study, it was 0.915. Data collection The eligibility of participants was determined through five initial screening questions aligned with the inclusion criteria. Among those eligible, their willingness to participate and preferred mode of receiving the online questionnaire (WhatsApp, Viber, Messenger, or Email) were documented. Data collection was conducted via a pre-tested (n = 10) self-administered questionnaire, disseminated online using Google Forms. Participants received a detailed information sheet explaining the study's purpose, and informed consent was obtained through an embedded agreement option ('agree to participate/disagree to participate') at the end of the sheet. Out of 116 distributed questionnaires, 102 responses were obtained, yielding a response rate of 87.9%. Permissions to use the respective standardized questionnaires were obtained from their original authors. Informed consent was secured from all participants, and anonymity was maintained throughout the study. Data Analysis Data sheets were checked for completeness and coded and entered into the IBM SPSS version 26.0. Descriptive statistics were used to examine the basic features of the dataset, including linearity. Participant characteristics were summarized using means, standard deviations, frequencies, and percentages. Differences in general self-efficacy, professional nursing values, nurse work environment, and transition shock across socio-demographic, pre-graduation, and work-related variables were analyzed using t-tests and ANOVA. Post hoc tests were conducted where significant differences were identified. Pearson’s correlation coefficients assessed associations among the four scales, as well as with GPA, clinical career, and working hours. Hierarchical multiple regression was employed to examine the predictive effects of GSE, PNV, and PESNWI on transition shock. Results Socio-demographic, Pre-graduation, and Working Characteristics Supplementary table S1 shows that the majority of the participants (N = 32) were 27 years of age (31.4%), single (N = 90, 88.2%), and female (N = 67, 65.7%), living at the hospital quarters the most (N = 60, 58.8%). More than 95% of the participants had a GPA less than 3.5. In this study, 27.5% of the participants stated that the reason to follow the nursing degree was that 'The Z-Score at General Certificate of Examination Advanced level (GCE A/L) was not high enough to follow any other majors' and the reason for deciding to be a ‘staff nurse’ after obtaining the degree was ‘To obtain clinical experience that is necessary to apply for employment overseas.' More than 65% of the participants had neither trained with a preceptor nor received any pre-education at a hospital. Self-efficacy, Professional Nursing values, Practice environment, Transition Shock, and their significant associations Table 1 shows the mean values for each category in the TS Scale, Scale on PNV, and PESNWI. As tabulated in Table 2 , the highest and the lowest means of 2.69 ± 0.83 and 2.40 ± 0.76 in a 4-point scale were obtained for the categories 'Confusion in Professional Nursing Values' and ‘Conflict between Theory and Practice’, respectively, in the Transition shock scale. In the Scale on Nursing professional values, the highest and the lowest mean of 4.10 ± 0.78 and 3.03 ± 1.16 in a 5-point scale were obtained for the categories, ‘Professionalism in Nursing’ and ‘Originality of Nursing’, respectively. As far as the nursing work environment was concerned, the highest and the lowest means of 2.91 ± 0.71 and 2.48 ± 0.85 in a 4-point scale were obtained for the categories ' Collegial nurse-physician relationship’ and ‘Staffing and resources’, respectively. GSE was assessed via ten statements, where the highest and lowest means of 2.90 ± 0.91 and 2.53 ± 0.92 were obtained for ‘I can solve most problems if I invest the necessary effort’ and ‘If someone opposed me, I can find means and ways to get what I want’, respectively. Table 1 The mean values for each category in the TS Scale, Scale on PNV, and PESNWI. Categories (6) of TS Scale Mean ± SD. Categories (5) of Scale on PNV Mean ± SD. Categories (5) of PESNWI Mean ± SD. Conflict between Theory and Practice 2.40 ± 0.76 Self-Concept of Profession 3.86 ± 0.88 Nurse Participation in Hospital Affairs 2.58 ± 0.83 Overwhelming Workload 2.45 ± 0.77 Social Awareness 3.70 ± 0.99 Nursing foundations for quality of care 2.75 ± 0.76 Loss of Social support 2.66 ± 0.88 Professionalism in Nursing 4.10 ± 0.78 Nurse manager ability, leadership, and support of nurses 2.80 ± 0.77 Shrinking relationship with Co-workers 2.63 ± 0.78 The Roles of Nursing Service 3.87 ± 0.83 Staffing and resources 2.48 ± 0.85 Confusion in Professional Nursing Values 2.69 ± 0.83 Originality of Nursing 3.03 ± 1.16 Collegial nurse-physician relationship 2.91 ± 0.71 Incongruity in work and Personal life 2.50 ± 0.94 Table 2 Scales and their categories with the highest and lowest mean values (N = 102) Overall Mean ± SD. Category/ Factor with the Highest mean Mean ± SD. Category/ Factor with the Lowest mean Mean ± SD TS 2.55 ± 0.52 Confusion in Professional Nursing Values 2.69 ± 0.83 Conflict between Theory and Practice 2.4 ± 0.76 PNV 3.77 ± 0.50 Professionalism in Nursing 4.10 ± 0.78 Originality of Nursing 3.03 ± 1.16 PESNWI 2.68 ± 0.49 Collegial nurse-physician relationship 2.91 ± 0.71 Staffing and resources 2.48 ± 0.85 GSE 2.71 ± 0.69 I can solve most problems if I invest the necessary effort 2.90 ± 0.91 If someone opposed me, I can find means and ways to get what I want. 2.53 ± 0.92 According to supplementary table S2, Gender has a significant effect on one's practice environment ( p = 0.040). Transition shock ( p = 0.000), professional nursing values ( p = 0.039), and practice environment ( p = 0.042) were significantly influenced by the graduate’s reason to choose nursing as a career. The type of hospital significantly affected one’s general self-efficacy ( p = 0.015). Moreover, transition shock ( p = 0.015), where hospital bed strength ( p = 0.021) significantly influenced the transition shock. Monthly income affected one’s nursing professional values ( p = 0.033) and transition shock ( p = 0.005). Having received pre-education significantly affected professional nursing values and ( p = 0.019) practice environment ( p = 0.000). Finally, having trained under a preceptor had a significant effect on one’s self-efficacy ( p = 0.033). Table 3 shows that in this study, high statistically significant negative correlations were found between the two variables: TS and PNV (r= -0.314, n = 102, p = 0.001), GSE and TS (r= -0.366, n = 102, p = 0.000). These significant correlations imply that an increase in nursing professional values or higher general self-efficacy among the participants decreases the transition shock significantly. A high statistically significant positive correlations were found between PNV and PESNWI (r = 0.442, n = 102, p = 0.000), where the increase in PESNWI leads to an increase in the professional nursing value score is statistically significant. Table 3 Correlation between the scales (N = 102) TS PNV PESNWI GSE Pearson Correlation TS 1.000 -0.314 -0.053 -0.366 PNV -0.314 1.000 0.442 0.163 PESNWI -0.053 0.442 1.000 0.078 GSE -0.366 0.163 0.078 1.000 Sig. (1-tailed) TS. - 0.001 0.299 0.000 PNV 0.001 - 0.000 0.051 PESNWI 0.299 0.000 - 0.219 GSE 0.000 0.051 0.219 - According to Table 4 , the results after performing a Hierarchical multiple regression indicated that the addition of GSE and PNV was statistically significant, while the addition of PESNWI was not found to be significant. GSE as a predictor (F (1, 98) = 12.726, p = 0.001), explained an additional 10.3% of the variance (R 2 change = 0.103) and PNV as a predictor, explained an additional 7.6% of the variance (R 2 change = 0.076) in Transition Shock, beyond that is explained by the remaining two independent variables together. Both PNV ( p = 0.005 at 95% confidence level, standardized Beta Co-efficient of -0.261 at t= -2.871) and GSE ( p = 0.001 at 95% confidence level, standardized Beta Co-efficient of -0.324 at t= -3.557) were associated with negative standardized beta co-efficient, which simply implies that one-unit increase in the predictor variable (PNV or GSE), the outcome variable (Transition shock) will decrease by an amount corresponding to the magnitude of the Beta co-efficient value. Therefore, out of PNV and GSE, the latter is the stronger unique predictor of the Transition shock. Table 4 Hierarchical Regression Statistical Model Step Predictor Unstandardized coefficients Standardized coefficients R² R² change F p B SE. β p A 1 0.108 0.108 5.985 0.004 PNV -0.376 0.110 -0.361 0.001 PESNWI 0.114 0.113 0.107 0.315 2 0.210 0.103 8.705 0.000 PNV -0.32 0.105 -0.310 0.003 PESNWI 0.117 0.107 0.109 0.278 GSE -0.25 0.069 -0.325 0.001 B 1 0.135 0.135 7.715 0.001 GSE -0.276 0.071 -0.365 0.000 PESNWI -0.026 0.100 -0.024 0.795 2 0.210 0.076 8.705 0.000 GSE -0.245 0.069 -0.325 0.001 PESNWI 0.117 0.107 0.109 0.278 PNV -0.322 0.105 -0.31 0.003 C 1 0.201 0.201 12.437 0.000 GSE -0.25 0.069 -0.324 0.001 PNV -0.27 0.095 -0.261 0.005 2 0.210 0.010 8.705 0.000 GSE -0.25 0.069 -0.325 0.001 PNV -0.32 0.105 -0.310 0.003 PESNWI 0.117 0.107 0.109 0.278 Discussion The present study is the first to have been done on the role transition from newly graduated nurses to professional nurses in Sri Lanka. Four validated tools have been used to collect the relevant data. In contrast to Irish nurses and Israeli Jewish and Arab nursing students, who cited a 'desire to care and help others' and 'job security' as key motivations [ 36 , 37 ], the primary reason identified in this study was ‘to obtain clinical experience necessary for overseas employment’ Structured orientation with trained preceptors is key to preparing new nurses [ 38 ], yet over 65% in this study lacked such support. In contrast, 87.2% and 78.2% of Korean nurses received pre-education and preceptor training, respectively [ 29 ]. The mean General Self-Efficacy (GSE) score was 2.70 ± 0.69, lower than in South Korea (2.80) and Iran (2.93), with significant variation by hospital type [ 29 , 39 ]. This might be because of the differences in the facilities, attitudes, and disciplines of the staff in the three types of hospitals. The mean Professional Nursing Values (PNV) score was 3.77 ± 0.50, similar to South Korean graduates (3.8) and higher than that of undergraduates [ 40 ] (Bang et al., 2011). In Iran, students showed higher PNV than nurses [ 41 ]. In this study, the highest and lowest mean scores were for ‘Professionalism in Nursing’ (4.10 ± 0.78) and ‘Originality of Nursing’ (3.03 ± 1.16), consistent with prior findings [ 40 ]. These results suggest that while new graduates view nursing as a profession, they perceive limited specialty and autonomy compared to other health professions. Though not statistically significant, literature indicates higher Professional Nursing Values (PNV) among those who choose nursing by interest or professional aspiration [ 40 ]. The mismatch between theoretical learning and clinical realities, lack of motivation, organizational support, and value recognition may explain lower PNV [ 41 ]. In contrast, significantly higher PNV scores were noted among those who received pre-education, possibly due to early and gradual hospital exposure. Low income and poor professional quality of life have prompted many graduates to migrate or leave healthcare, contributing to reduced job satisfaction and retention [ 42 ]. In this study, four of the five PES-NWI subscales had mean scores above 2.5, indicating a 'favorable' nurse work environment, consistent with previous research [ 35 , 43 – 45 ]. A significant effect of the 'reason for becoming a staff nurse' on PES-NWI scores may reflect students’ prior exposure to different hospital environments during undergraduate training. Additionally, the significant association between 'pre-education within the hospital' and PES-NWI is supported by literature, which suggests that pre-education helps new nurses adjust by allowing early, low-pressure exposure to the clinical environment [ 19 ]. The transition to professional practice is a known challenge for newly graduated nurses, often marked by stress and disillusionment [ 9 ]. In this study, the overall mean Transition Shock Scale score was lower than that reported in South Korea [ 29 ] but higher than the 2.41 reported by Kramer et al. (2013) [ 15 ]. The highest shock in this study was associated with excessive workload, consistent with Kim and Yeo’s findings, suggesting workload as a key factor in transition difficulty. ‘Loss of social support’ ranked second in this study, contrasting with its lowest ranking in the Korean study, highlighting cultural and institutional differences between Sri Lankan and South Korean hospital environments. In this study, although not statistically significant, married nurses experienced higher transition shock than single nurses, potentially due to work-life balance challenges common in female-dominated professions [ 46 ]. Transition shock was significantly influenced by hospital type and bed strength, likely reflecting variations in administration, staffing attitudes, and institutional policies across government, semi-government, and private hospitals. The reason for entering the nursing profession significantly impacted transition shock. Participants citing limited career alternatives, overseas employment goals, or genuine motivation to serve as nurses experienced varying degrees of transition stress. These findings align with literature emphasizing the role of personal preparedness and professional self-concept in easing the transition to practice [ 9 ]. Graduate nurses with trained preceptors demonstrate higher confidence in delivering safe care and show improved first-year retention [ 47 ], aligning with the findings of the current study. However, the limited number of such trained nurses in this study highlights the need to establish structured preceptorship programs led by both academically and clinically competent nurses across all healthcare sectors in Sri Lanka [ 48 ]. Identifying sources of occupational stress during transition is critical for enhancing staff retention strategies [ 49 ]. Although not statistically significant, a greater transition shock was observed among those who received hospital-based pre-education. This may be attributed to the discrepancy between the supportive orientation period and the abrupt shift to full professional responsibility. As noted by Duchscher (2009) [ 9 ], this sudden transition from guided learning to independent practice often triggers emotional distress, adjustment challenges, and heightened transition shock among novice nurses. In the present study, a statistically significant negative correlation was observed between PESNWI and transition shock, which contrasts with previous studies that reported a significant positive relationship [ 29 , 50 ]. Although this might imply a limited need to modify the nurse work environment in Sri Lankan healthcare settings, generalization is cautioned due to the study being limited to a single district. General Self-Efficacy (GSE) and Professional Nursing Values (PNV) were identified as significant predictors of transition shock, with GSE being the stronger predictor. This finding aligns with previous literature confirming self-efficacy as a consistent determinant of transition outcomes [ 51 , 29 ], while diverging from findings that emphasized the predictive role of the nurse work environment [ 29 ]. Additional variables, such as age and work unit preferences, have also been associated with transition shock. Recent research further highlights hospital classification as a key predictor, where higher transition shock levels were linked with increased adverse patient events [ 48 ]. As limitations, authors would report that the study was confined to the Colombo District and employed convenience sampling, which may limit the representativeness of the sample and the generalizability of findings to other regions or the national population of newly graduated nurses. Conclusion Transition shock among newly graduated nurses was significantly influenced by monthly income, hospital type, bed strength, and motivation for entering the nursing profession. General self-efficacy and professional nursing values emerged as significant predictors of transition shock. These findings underscore the importance of interventions such as workload reduction, implementation of incentive and reward systems, structured preceptorship programs, and targeted strategies to enhance self-efficacy and professional values to support graduates during their transition into clinical practice. Relevance for clinical practice The need to implement more practical and effective methods to introduce the new graduates to their professional roles in Sri Lanka, along with mentorship programs and support services, thereby reducing burnout while enhancing retention and job satisfaction, is emphasized in this study. Implementing strategies to elicit nursing professional values more in the hospital setting and preceptorship programs for the newly graduated B.Sc. This research strongly suggests that nurses. Further evaluation of the Transition shock and burnout rate of the graduates during their transition period is recommended for further research studies. Broadening of the study setting is suggested to get more generalized findings. Though these findings suggest the lack of need to change the nurse work environment in Sri Lankan health care, further studies are needed to confirm these findings, as the current study was confined to only one out of twenty-five districts in the country. Declarations Human Ethics and Consent to Participate declarations This study involves human participants, and ethical approval was granted for this study by the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka (App No: Nur/03/20) in accordance with the Declaration of Helsinki. All participants provided informed consent through an embedded agreement option ('agree to participate/disagree to participate') at the end of the Google sheet before enrolment in the study. Patient consent for publication Personally identifiable information is not published in this paper Data availability statement Data are available upon reasonable request. Competing interests None declared. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Author Contributions O.D. and T.A. contributed substantially to the work’s concept and design, analysis, revised the article, and approved the version to be published. N.E. analyzed and interpreted the data and drafted the article. All authors have read and approved the final manuscript and agreed to be accountable for all aspects of the work. Grammarly was used for grammar correction. Acknowledgements The authors, with great respect, appreciated the cooperation extended by all the study participants. Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research. 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Nursing Education in Sri Lanka Challenges and Vision for the Future. 3rd Annual Worldwide Nursing Conference (WNC 2015) , 15–20. https://doi.org/10.5176/2315-4330_WNC15.47 Padmasiri MKD, Lakmali AMT. Emotional Works and Turnover Intention of Sri Lankan Nurses. Kelaniya J Manage. 2018;6(2):1. https://doi.org/10.4038/kjm.v6i2.7542 . See ECW, Koh SSL, Baladram S, Shorey S. Role transition of newly graduated nurses from nursing students to registered nurses: A qualitative systematic review. Nurse Educ Today. 2023;121:105702. https://doi.org/10.1016/j.nedt.2022.105702 . Kelly S, Courts N. The professional self-concept of new graduate nurses. Nurse Educ Pract. 2007. https://doi.org/10.1016/j.nepr.2006.10.004 . Newton JM, McKenna L. The transitional journey through the graduate year: A focus group study. Int J Nurs Stud. 2007;44(7):1231–7. https://doi.org/10.1016/j.ijnurstu.2006.05.017 . Kramer M, Brewer BB, Maguire P. 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Tsang LF, Sham SYA, Law SLW, Chan YM, Sze CY. ToUCH Program on competence, occupational stress and self-efficacy of newly graduated registered nurses in United Christian Hospital: A mixed-method research study. J Nurs Educ Pract. 2016;6(8). https://doi.org/10.5430/jnep.v6n8p129 . Pearcey PA, Elliott BE. Student impressions of clinical nursing. Nurse Educ Today. 2004. https://doi.org/10.1016/j.nedt.2004.03.007 . Clare J, van Loon A. Best practice principles for the transition from student to registered nurse. Collegian. 2003. https://doi.org/10.1016/S1322-7696(08)60073-6 . McKenna BG, Smith NA, Poole SJ, Coverdale JH. Horizontal violence: Experiences of Registered Nurses in their first year of practice. J Adv Nurs. 2003. https://doi.org/10.1046/j.1365-2648.2003.02583.x . Pellico LH, Brewer CS, Kovner CT. What newly licensed registered nurses have to say about their first experiences. Nurs Outlook. 2009. https://doi.org/10.1016/j.outlook.2008.09.008 . Chang E, Hancock K. Role stress and role ambiguity in new nursing graduates in Australia. Nurs Health Sci. 2003;5(2):155–63. https://doi.org/10.1046/j.1442-2018.2003.00147.x . Levinson H, Kahn RL, Wolfe DM, Quinn RP, Snoek JD, Rosenthal RA. Organizational Stress: Studies in Role Conflict and Ambiguity. Adm Sci Q. 1965;10(1):125. https://doi.org/10.2307/2391654 . Cho E, Choi M, Kim E-Y, Yoo IY, Lee N-J. Construct Validity and Reliability of the Korean Version of the Practice Environment Scale of Nursing Work Index for Korean Nurses. J Korean Acad Nurs. 2011;41(3):325. https://doi.org/10.4040/jkan.2011.41.3.325 . Kim EY, Yeo JH. Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study. Nurse Educ Today. 2019;78(January):32–6. https://doi.org/10.1016/j.nedt.2019.04.002 . Kim EY, Yeo JH, Yi KI. Development of the transition shock scale for newly graduated nurses. J Korean Acad Nurs. 2017;47(5):589–99. https://doi.org/10.4040/jkan.2017.47.5.589 . Schwarzer R, Bäßler J, Kwiatek P, Schröder K, Zhang JX. The Assessment of Optimistic Self-beliefs: Comparison of the German, Spanish, and Chinese Versions of the General Self-efficacy Scale. Appl Psychol. 1997;46(1):69–88. https://doi.org/10.1111/j.1464-0597.1997.tb01096.x . Schwarzer R, Hallum S. Perceived Teacher Self-Efficacy as a Predictor of Job Stress and Burnout: Mediation Analyses. Appl Psychol. 2008;57(s1):152–71. https://doi.org/10.1111/j.1464-0597.2008.00359.x . Yeun EJ, Kwon YM, Ahn OH. Development of a Nursing Professional Values Scale. J Korean Acad Nurs. 2005;35(6):1091. https://doi.org/10.4040/jkan.2005.35.6.1091 . Cho SH, Lee JY, Mark BA, Yun SC. Turnover of New Graduate Nurses in Their First Job Using Survival Analysis. J Nurs Scholarsh. 2012;44(1):63–70. https://doi.org/10.1111/j.1547-5069.2011.01428.x . Lake ET. Development of the practice environment scale of the nursing work index. Res Nurs Health. 2002;25(3):176–88. https://doi.org/10.1002/nur.10032 . Halperin O, Mashiach-Eizenberg M. Becoming a nurse — A study of career choice and professional adaptation among Israeli Jewish and Arab nursing students: A quantitative research study. Nurse Educ Today. 2014;34(10):1330–4. https://doi.org/10.1016/j.nedt.2013.10.001 . Mooney M, Glacken M, O’Brien F. Choosing nursing as a career: A qualitative study. Nurse Educ Today. 2008. https://doi.org/10.1016/j.nedt.2007.07.006 . Powers K, Herron EK, Pagel J. Nurse Preceptor Role in New Graduate Nurses’ Transition to Practice. Dimensions Crit Care Nursing: DCCN. 2019;38(3):131–6. https://doi.org/10.1097/DCC.0000000000000354 . Soudagar S, Rambod M, Beheshtipour N. (2015). Factors associated with nursesâ self-efficacy in clinical setting in Iran, 2013. Iran J Nurs Midwifery Res. Bang KS, Kang JH, Jun MH, Kim HS, Son HM, Yu SJ, Kwon MK, Kim JS. Professional values in Korean undergraduate nursing students. Nurse Educ Today. 2011;31(1):72–5. https://doi.org/10.1016/j.nedt.2010.03.019 . Poorchangizi B, Borhani F, Abbaszadeh A, Mirzaee M, Farokhzadian J. Professional Values of Nurses and Nursing Students: a comparative study. BMC Med Educ. 2019;19(1):438. https://doi.org/10.1186/s12909-019-1878-2 . Tehranineshat B, Torabizadeh C, Bijani M. A study of the relationship between professional values and ethical climate and nurses’ professional quality of life in Iran. Int J Nurs Sci. 2020;7(3):313–9. https://doi.org/10.1016/j.ijnss.2020.06.001 . Parker D, Tuckett A, Eley R, Hegney D. Construct validity and reliability of the Practice Environment Scale of the Nursing Work Index for Queensland nurses. Int J Nurs Pract. 2010. https://doi.org/10.1111/j.1440-172X.2010.01851.x . Warshawsky NE, Havens DS. Global use of the practice environment scale of the Nursing Work Index. Nurs Res. 2011. https://doi.org/10.1097/NNR.0b013e3181ffa79c . Lake ET, Friese CR. (2006). Variations in nursing practice environments: Relation to staffing and hospital characteristics. In Nursing Research . https://doi.org/10.1097/00006199-200601000-00001 Lakshmi KS, Ramachandran T, Boohene D. Analysis of Work-Life Balance of Female Nurses in Hospitals - Comparative Study between Government and Private Hospital in Chennai, TN., India. Int J Trade Econ Finance. 2012;213–8. https://doi.org/10.7763/IJTEF.2012.V3.202 . Clipper B, Cherry B. From transition shock to competent practice: Developing preceptors to support new nurse transition. J Contin Educ Nurs. 2015. https://doi.org/10.3928/00220124-20150918-02 . Labrague LJ, Santos JAA. Transition shock and newly graduated nurses’ job outcomes and select patient outcomes: A cross-sectional study. J Nurs Adm Manag. 2020;28(5):1070–9. https://doi.org/10.1111/jonm.13033 . Dyess S, Parker CG. Transition support for the newly licensed nurse: a programme that made a difference. J Nurs Adm Manag. 2012;20(5):615–23. https://doi.org/10.1111/j.1365-2834.2012.01330.x . Sparacino LL. Faculty’s Role in Assisting New Graduate Nurses’ Adjustment to Practice. SAGE Open Nurs. 2016. https://doi.org/10.1177/2377960816635182 . Henderson A, Rowe J, Watson K, Hitchen-Holmes D. Graduating nurses’ self-efficacy in palliative care practice: An exploratory study. Nurse Educ Today. 2016;39:141–6. https://doi.org/10.1016/j.nedt.2016.01.005 . Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Supplementary table S1- Frequency distribution of Socio-demographic, Pre-graduation, and Working Characteristics Supplementary table S2 – Scales and their significant associations Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Sep, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviews received at journal 18 Sep, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviewers invited by journal 11 Sep, 2025 Editor invited by journal 19 Aug, 2025 Editor assigned by journal 18 Aug, 2025 Submission checks completed at journal 18 Aug, 2025 First submitted to journal 13 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7362651\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":515951976,\"identity\":\"54a31477-8363-432f-9c9d-9eabd5503319\",\"order_by\":0,\"name\":\"Oshini Dharmajeewa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Sri Jayewardenepura\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Oshini\",\"middleName\":\"\",\"lastName\":\"Dharmajeewa\",\"suffix\":\"\"},{\"id\":515951977,\"identity\":\"a2765013-9fb0-4e83-bbc3-0b3302a9e008\",\"order_by\":1,\"name\":\"Nirosha Priyadarshani Edirisinghe\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIie3PPQrCMBTA8VcK6dKYNSLoFSIBPxbPEik4iYujggUhkwfwHoI4VgpxEVwLHWwXJ4eu3YyioGBrR4f84UEI/EgegMn0j9l6LB+A2AFQfRaP2ySoQOpSvBFRRuBJmKpKug5O03w3aHKF9xHMtxNwwgTEsZj0lw7n+Ojxjqp5PVDxFNwRAxEVExYi1LCkPdyeVx1q+fHQh7H+WFZO6rlcLDbSfRJy/U0olqFg6EXo/ZXyj9kcy0N7rVzeE3oXRC8sKFufnZSV5nLWItJtR9k8nhDipUmmislnQg/SE1QFJpPJZPreDYkiTyZyv74eAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"University of Colombo\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Nirosha\",\"middleName\":\"Priyadarshani\",\"lastName\":\"Edirisinghe\",\"suffix\":\"\"},{\"id\":515951978,\"identity\":\"4a8853a4-181d-458e-add7-7179d66930ee\",\"order_by\":2,\"name\":\"Thamara Amarasekara\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Sri Jayewardenepura\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Thamara\",\"middleName\":\"\",\"lastName\":\"Amarasekara\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-08-13 08:38:09\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-7362651/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-7362651/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":91655814,\"identity\":\"fc937902-eb5c-4068-9447-5cf91c4f1fb4\",\"added_by\":\"auto\",\"created_at\":\"2025-09-18 18:06:15\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1084910,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7362651/v1/812bfe76-4ba1-4cc7-86a0-2e9d5799dc22.pdf\"},{\"id\":91655411,\"identity\":\"e632d2e2-09cf-4af4-8c72-7180dbebed56\",\"added_by\":\"auto\",\"created_at\":\"2025-09-18 17:58:14\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":23285,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSupplementary table S1- Frequency distribution of Socio-demographic, Pre-graduation, and Working Characteristics\\u003c/p\\u003e\\n\\u003cp\\u003eSupplementary table S2 – Scales and their significant associations\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Supplementarymaterial.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7362651/v1/3e4a06d24de6dd253fcfc0bf.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Predictors of Transition Shock Among Newly Graduated Nurses, Sri Lanka: A Descriptive Cross- Sectional Study on the Roles of Self-Efficacy, Professional Nursing Values, and Practice Environment\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eNurses and midwives constitute nearly 50% of the global health workforce [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. According to the World Health Organization [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e], an estimated nine million additional nurses and midwives will be required by 2030 for countries to achieve Sustainable Development Goal 3, which focuses on health and well-being. Despite this urgent need, a global shortage of health workers persists, with nurses and midwives accounting for more than half of the deficit. Notably, the South-East Asian and African regions, including Sri Lanka, contribute significantly to this shortage [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eDespite global calls to increase nursing numbers, Sri Lanka has seen a decline, with 34,221 nurses reported in 2017 compared to 38,506 in 2014 [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. In 2018, the nurse and midwife density was 2.18 per 1,000 population [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. This shortage has been further exacerbated by the challenging working conditions during the COVID-19 pandemic [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003e\\u0026lsquo;Transition\\u0026rsquo; is recognised as a central concept in nursing, particularly in relation to professional role changes such as the shift from student to practicing nurse [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Situational transitions, including those experienced by new graduates entering the workforce, are critical to professional development. The transition period is generally defined as the first 12 months of practice, although it may extend up to two to three years depending on the context [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn Sri Lanka, nursing education is delivered through three-year diploma programs at nursing schools and four-year bachelor's programs at universities, both of which meet national curricular standards and lead to professional registration [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. While previous research in Sri Lanka has identified a significant relationship between emotional labour and turnover intention among nurses [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], the study did not consider the length of clinical experience. Therefore, it is not possible to conclude the specific challenges encountered by new graduates during their transition period, including potential risks of burnout or early attrition.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eNewly graduated nurses experience a critical adjustment phase when transitioning from student to clinical nurse [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Upon entering the clinical setting as staff nurses, feelings of unpreparedness are common due to changes in role expectations and unfamiliar work environments. Evidence suggests that such feelings often emerge during the final year of training [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. During this transition, graduates must manage time effectively, integrate theoretical knowledge into clinical practice, and adapt through occupational socialization [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. A persistent theory\\u0026ndash;practice gap has been reported, whereby newly qualified nurses perceive a mismatch between academic instruction and the realities of clinical care.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eDuchscher (2009) describes transition shock as the most immediate and acute phase in the process of professional role adaptation for newly graduated nurses, encompassing elements of transition theory, reality shock, cultural adjustment, and professional development [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. According to Sargis and Kramer (1975), reality shock comprises four distinct phases: honeymoon, shock, recovery, and resolution [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn the honeymoon phase, newly graduated nurses experience optimism and enthusiasm upon entering the workforce, anticipating the application of ideal nursing practices learned during training. The shock phase follows as graduates are confronted with the discrepancies between theoretical instruction and actual clinical practice. This phase is often accompanied by emotional responses such as disillusionment, fatigue, rejection, and, at times, hostility [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eNurses who successfully navigate the shock phase may enter the recovery phase, during which they begin to adjust by developing coping mechanisms and reducing anxiety. The final phase, resolution, can result in either a successful integration into the professional role or an increased intention to leave the profession due to persistent stress and maladaptation [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eNewly graduated nurses commonly face eight key challenges during the transition period: workload, lack of knowledge, communication issues, role expectations, role change, working environment, lack of support, and a culture of blame and complaints [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. Among these, workload is identified as the most significant challenge [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. This is often attributed to staffing shortages, with nurse-to-patient ratios frequently exceeding the internationally recommended standard of 1:6 [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe clinical learning environment plays a crucial role, influencing both the undergraduate experience and the early professional period. Pearcey and Elliott (2004) emphasized its impact on student nurses[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e], while Clare and van Loon (2003) reported that nearly half of newly registered nurses in their study had encountered or observed unprofessional conduct, including instances described as 'horizontal violence' and bullying [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Similar findings were reported by McKenna et al. (2003) and Pellico et al. (2009), who noted that new graduates often experienced poor interpersonal relationships and nurse-to-nurse hostility during their first year[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. These adverse experiences further hinder their ability to adapt and thrive during the critical transition phase.\\u003c/p\\u003e\\u003cp\\u003eRole ambiguity is a predominant stressor experienced by newly graduated nurses during the initial months of the transition period [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. It is defined as \\u0026ldquo;the lack of clear, consistent information about the behavior expected in a role\\u0026rdquo; [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e], often resulting from poorly defined responsibilities assigned to new graduates. Additional stress-inducing factors include excessive workload, limited confidence in prioritizing care, inadequate time management, perceived failure to meet senior staff expectations, continuous scrutiny, fear of errors, and a perceived lack of professional competence [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. As the transition progresses, by approximately 10 months, role overload surpasses role ambiguity as the primary stressor [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Collectively, these stressors significantly impact the ability of novice nurses to adjust and function effectively during their early clinical practice.\\u003c/p\\u003e\\u003cp\\u003eHigh turnover rates among new graduate nurses are well-documented, with estimates indicating that 17.7%, 33.4%, and 46.3% leave the profession within their first, second, and third years, respectively [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e], consistent with earlier findings [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. In South Korea, these elevated attrition rates have been attributed primarily to 'transition shock' experienced during the early phase of clinical practice[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Key contributing factors include discrepancies between theoretical knowledge and clinical practice, excessive workload, diminished social support, weakened collegial relationships, uncertainty regarding professional values, and challenges balancing work and personal life [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. Additionally, dissatisfaction with long working hours and inadequate remuneration further exacerbates the difficulty of the transition period.\\u003c/p\\u003e\\u003cp\\u003eTo address the shortage of nurses in the health workforce, several studies have recommended expanding enrolment into undergraduate nursing programmes. This expansion not only aims to increase workforce numbers but also to equip students with essential competencies such as critical thinking, leadership, interpersonal communication, decision-making, and professionalism\\u0026mdash;skills imparted through engagement with highly qualified academic staff. These competencies are expected to facilitate smoother adaptation to the staff nurse role, thereby mitigating transition shock [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe literature identifies several strategies to alleviate transition or reality shock in new graduates. These include gradual workload allocation, structured orientation phases, assignment of mentors or preceptors, regulation of working hours (including minimizing overtime), reduced patient loads, close supervision during the initial months, and enhancement of self-concept, self-assessment, and self-esteem throughout the transitional period [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe present study assessed factors influencing the transition to professional roles among newly graduated nurses from six selected universities in Sri Lanka. The Transition Shock Scale, developed by Kim et al. (2017) was used for this purpose [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. In addition, the study examined the influence of pre-graduation characteristics and the work environment on transition experiences, guided by the framework presented by Kim and Yeo (2019)[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. The predictive effects of self-efficacy, professional nursing values, and the practice environment on transition shock were also evaluated.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eDesign and Sample\\u003c/strong\\u003e\\u003cp\\u003eThe study employed a quantitative, descriptive cross-sectional survey design. The target population consisted of newly graduated nurses from six state universities in Sri Lanka, currently employed in any working unit within government, semi-government, or private hospitals located in the Colombo District.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003eInclusion criteria required participants to have obtained a Bachelor of Science (B.Sc.) degree in Nursing (internal stream) from a recognized state university and to have a maximum of two years of post-qualification clinical experience. Individuals with prior nursing experience before completing their B.Sc. degree\\u0026mdash;specifically lateral entry students\\u0026mdash;were excluded to ensure homogeneity of the sample in terms of clinical exposure post-qualification. All the participants who fulfilled the inclusion and exclusion criteria were recruited using a consecutive sampling method.\\u003c/p\\u003e\\u003cp\\u003e The ethical approval was granted for this study by the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka (App No: Nur/03/20) in accordance with the Declaration of Helsinki. All participants provided informed consent through an embedded agreement option ('agree to participate/disagree to participate') at the end of the Google sheet before enrolment in the study.\\u003c/p\\u003e\\u003cp\\u003eAdditional permissions were obtained from relevant authorities. Subsequently, the researchers requested and received the contact information of eligible graduates from each participating university. Initial contact with potential participants was made via telephone to introduce the study and confirm eligibility.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStudy Instruments\\u003c/h2\\u003e\\u003cp\\u003eThe questionnaire consisted of five main sections, integrating four validated scales as per Kim and Yeo (2019) [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. Section I included three domains: socio-demographic characteristics (7 items), pre-graduation characteristics (5 items), and working status (14 items). Key elements under pre-graduation characteristics included Grade Point Average (GPA) and the primary reason for selecting nursing. The working status section explored variables such as the reason for becoming a staff nurse, hospital type and bed strength, clinical career trajectory, employment type, monthly working hours and income, current working unit, receipt of pre-education, and presence of a trained preceptor. The remaining four sections incorporated scales measuring General Self-Efficacy, Professional Nursing Values, Nursing Work Environment, and Transition Shock.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eScale on General Self-Efficacy (GSE)\\u003c/b\\u003e was developed by Schwarzer et al. (1997)[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. The initial German version, developed in 1979, was later revised and adapted to English (Schwarzer \\u0026amp; Hallum, 2008) [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]and 25 other languages by various co-authors [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. This scale comprises ten items measured on a 4-point scale from 'not true at all to 'exactly true,' with a higher score indicating higher Self-Efficacy. The Cronbach's alpha of the original scale was 0.88 [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. In this study, it was 0.926.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eScale on Professional Nursing Values (PNV)\\u003c/b\\u003e comprising 29 items was developed by Yeun et al. (2005)[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Five main factors/subscales identified in this scale are \\\"the self-concept of the profession,\\\" \\\"social awareness,\\\" \\\"professionalism of nursing,\\\" \\\"the roles of nursing service,\\\" and \\\"the originality of nursing.\\\" The items assessed these five subscales on a 5-point scale from 'Strongly Disagree' to 'Strongly Agree,' with a higher score indicating higher professional nursing values. The Cronbach's alpha of the original scale was 0.9168 [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. In this study, it was 0.911.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eThe Practice Environment Scale of the Nursing Work Index (PESNWI)\\u003c/b\\u003e was used to measure the nurses' work environment. This scale comprises 29 items measured using a 4-point scale from 'very unlikely' to 'very likely' under five subscales, a higher score indicating a better work environment. The five subscales were \\\"nurse participation in hospital affairs,\\\" \\\"nursing foundation for quality of care,\\\" \\\"nurse manager ability, leadership and support of nurses,\\\" \\\"staffing and resource adequacy,\\\" and \\\"collegial nurse-physician relationship\\\" [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. The Cronbach's alpha of the Korean PES-NWI was 0.93 [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]; in this study, it was 0.936.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eScale on Transition Shock (TS)\\u003c/b\\u003e for newly graduated nurses, developed initially in the study by Kim et al. (2017)[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], was used in this study to assess the transition shock. The scale comprises 18 items in total assessing six subscales: \\\"conflict between theory and practice,\\\" \\\"overwhelming workload,\\\" \\\"loss of social support,\\\" \\\"shrinking relationship with co-workers,\\\" \\\"confusion in professional nursing values,\\\" and \\\"incompatibility in work and personal life,\\\" using a 4-point scale, with a higher score indicating a greater transition shock [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. The Cronbach's alpha of the original scale was 0.89 [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], and in this study, it was 0.915.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eData collection\\u003c/h3\\u003e\\n\\u003cp\\u003eThe eligibility of participants was determined through five initial screening questions aligned with the inclusion criteria. Among those eligible, their willingness to participate and preferred mode of receiving the online questionnaire (WhatsApp, Viber, Messenger, or Email) were documented. Data collection was conducted via a pre-tested (n\\u0026thinsp;=\\u0026thinsp;10) self-administered questionnaire, disseminated online using Google Forms. Participants received a detailed information sheet explaining the study's purpose, and informed consent was obtained through an embedded agreement option ('agree to participate/disagree to participate') at the end of the sheet. Out of 116 distributed questionnaires, 102 responses were obtained, yielding a response rate of 87.9%. Permissions to use the respective standardized questionnaires were obtained from their original authors. Informed consent was secured from all participants, and anonymity was maintained throughout the study.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eData Analysis\\u003c/strong\\u003e\\u003cp\\u003eData sheets were checked for completeness and coded and entered into the IBM SPSS version 26.0. Descriptive statistics were used to examine the basic features of the dataset, including linearity. Participant characteristics were summarized using means, standard deviations, frequencies, and percentages. Differences in general self-efficacy, professional nursing values, nurse work environment, and transition shock across socio-demographic, pre-graduation, and work-related variables were analyzed using t-tests and ANOVA. Post hoc tests were conducted where significant differences were identified. Pearson\\u0026rsquo;s correlation coefficients assessed associations among the four scales, as well as with GPA, clinical career, and working hours. Hierarchical multiple regression was employed to examine the predictive effects of GSE, PNV, and PESNWI on transition shock.\\u003c/p\\u003e\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSocio-demographic, Pre-graduation, and Working Characteristics\\u003c/h2\\u003e\\u003cp\\u003eSupplementary table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e shows that the majority of the participants (N\\u0026thinsp;=\\u0026thinsp;32) were 27 years of age (31.4%), single (N\\u0026thinsp;=\\u0026thinsp;90, 88.2%), and female (N\\u0026thinsp;=\\u0026thinsp;67, 65.7%), living at the hospital quarters the most (N\\u0026thinsp;=\\u0026thinsp;60, 58.8%). More than 95% of the participants had a GPA less than 3.5. In this study, 27.5% of the participants stated that the reason to follow the nursing degree was that 'The Z-Score at General Certificate of Examination Advanced level (GCE A/L) was not high enough to follow any other majors' and the reason for deciding to be a \\u0026lsquo;staff nurse\\u0026rsquo; after obtaining the degree was \\u0026lsquo;To obtain clinical experience that is necessary to apply for employment overseas.' More than 65% of the participants had neither trained with a preceptor nor received any pre-education at a hospital.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eSelf-efficacy, Professional Nursing values, Practice environment, Transition Shock, and their significant associations\\u003c/h3\\u003e\\n\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows the mean values for each category in the TS Scale, Scale on PNV, and PESNWI. As tabulated in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, the highest and the lowest means of 2.69\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83 and 2.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76 in a 4-point scale were obtained for the categories 'Confusion in Professional Nursing Values' and \\u0026lsquo;Conflict between Theory and Practice\\u0026rsquo;, respectively, in the Transition shock scale. In the Scale on Nursing professional values, the highest and the lowest mean of 4.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78 and 3.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.16 in a 5-point scale were obtained for the categories, \\u0026lsquo;Professionalism in Nursing\\u0026rsquo; and \\u0026lsquo;Originality of Nursing\\u0026rsquo;, respectively. As far as the nursing work environment was concerned, the highest and the lowest means of 2.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.71 and 2.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.85 in a 4-point scale were obtained for the categories ' Collegial nurse-physician relationship\\u0026rsquo; and \\u0026lsquo;Staffing and resources\\u0026rsquo;, respectively. GSE was assessed via ten statements, where the highest and lowest means of 2.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.91 and 2.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.92 were obtained for \\u0026lsquo;I can solve most problems if I invest the necessary effort\\u0026rsquo; and \\u0026lsquo;If someone opposed me, I can find means and ways to get what I want\\u0026rsquo;, respectively.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eThe mean values for each category in the TS Scale, Scale on PNV, and PESNWI.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCategories (6) of TS Scale\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eCategories (5) of Scale on PNV\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eCategories (5) of PESNWI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eConflict between Theory and Practice\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSelf-Concept of Profession\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eNurse Participation in Hospital Affairs\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOverwhelming Workload\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.45\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSocial Awareness\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eNursing foundations for quality of care\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.75\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLoss of Social support\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.88\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eProfessionalism in Nursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e4.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eNurse manager ability, leadership, and support of nurses\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.77\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eShrinking relationship with Co-workers\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.63\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eThe Roles of Nursing Service\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eStaffing and resources\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eConfusion in Professional Nursing Values\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.69\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eOriginality of Nursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eCollegial nurse-physician relationship\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIncongruity in work and Personal life\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.94\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eScales and their categories with the highest and lowest mean values\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;102)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOverall Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCategory/\\u003c/p\\u003e\\u003cp\\u003eFactor with the Highest mean\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD.\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eCategory/\\u003c/p\\u003e\\u003cp\\u003eFactor with the Lowest mean\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eConfusion in Professional Nursing Values\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.69\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.83\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eConflict between Theory and Practice\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePNV\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eProfessionalism in Nursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eOriginality of Nursing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e3.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.16\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePESNWI\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.68\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.49\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCollegial nurse-physician relationship\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eStaffing and resources\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eGSE\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2.71\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.69\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eI can solve most problems if I invest the necessary effort\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e2.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.91\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eIf someone opposed me, I can find means and ways to get what I want.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e2.53\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.92\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eAccording to supplementary table S2, Gender has a significant effect on one's practice environment (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.040). Transition shock (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.000), professional nursing values (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.039), and practice environment (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.042) were significantly influenced by the graduate\\u0026rsquo;s reason to choose nursing as a career. The type of hospital significantly affected one\\u0026rsquo;s general self-efficacy (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.015). Moreover, transition shock (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.015), where hospital bed strength (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.021) significantly influenced the transition shock. Monthly income affected one\\u0026rsquo;s nursing professional values (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.033) and transition shock (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.005). Having received pre-education significantly affected professional nursing values and (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.019) practice environment (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.000). Finally, having trained under a preceptor had a significant effect on one\\u0026rsquo;s self-efficacy (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.033).\\u003c/p\\u003e\\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e shows that in this study, high statistically significant negative correlations were found between the two variables: TS and PNV (r= -0.314, n\\u0026thinsp;=\\u0026thinsp;102, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.001), GSE and TS (r= -0.366, n\\u0026thinsp;=\\u0026thinsp;102, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.000). These significant correlations imply that an increase in nursing professional values or higher general self-efficacy among the participants decreases the transition shock significantly. A high statistically significant positive correlations were found between PNV and PESNWI (r\\u0026thinsp;=\\u0026thinsp;0.442, n\\u0026thinsp;=\\u0026thinsp;102, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.000), where the increase in PESNWI leads to an increase in the professional nursing value score is statistically significant.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eCorrelation between the scales\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e(N\\u0026thinsp;=\\u0026thinsp;102)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eTS\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePNV\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePESNWI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eGSE\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePearson Correlation\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTS\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.314\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-0.053\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.366\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePNV\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.314\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.442\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.163\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePESNWI\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.053\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.442\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.078\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eGSE\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-0.366\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.163\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.078\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSig. (1-tailed)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTS.\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.299\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.000\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePNV\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.000\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.051\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePESNWI\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0.299\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.000\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.219\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eGSE\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.000\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.051\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.219\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eAccording to Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e, the results after performing a Hierarchical multiple regression indicated that the addition of GSE and PNV was statistically significant, while the addition of PESNWI was not found to be significant. GSE as a predictor (F (1, 98)\\u0026thinsp;=\\u0026thinsp;12.726, \\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.001), explained an additional 10.3% of the variance (R\\u003csup\\u003e2\\u003c/sup\\u003e change\\u0026thinsp;=\\u0026thinsp;0.103) and PNV as a predictor, explained an additional 7.6% of the variance (R\\u003csup\\u003e2\\u003c/sup\\u003e change\\u0026thinsp;=\\u0026thinsp;0.076) in Transition Shock, beyond that is explained by the remaining two independent variables together. Both PNV (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.005 at 95% confidence level, standardized Beta Co-efficient of -0.261 at t= -2.871) and GSE (\\u003cem\\u003ep\\u0026thinsp;=\\u003c/em\\u003e\\u0026thinsp;0.001 at 95% confidence level, standardized Beta Co-efficient of -0.324 at t= -3.557) were associated with negative standardized beta co-efficient, which simply implies that one-unit increase in the predictor variable (PNV or GSE), the outcome variable (Transition shock) will decrease by an amount corresponding to the magnitude of the Beta co-efficient value. Therefore, out of PNV and GSE, the latter is the stronger unique predictor of the Transition shock.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eHierarchical Regression\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"17\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c14\\\" colnum=\\\"14\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c15\\\" colnum=\\\"15\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c16\\\" colnum=\\\"16\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c17\\\" colnum=\\\"17\\\"\\u003e\\u003c/div\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eStatistical Model\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eStep\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003ePredictor\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e\\u003cp\\u003eUnstandardized coefficients\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c8\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003eStandardized coefficients\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c11\\\" namest=\\\"c9\\\"\\u003e\\u003cp\\u003eR\\u0026sup2;\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u003cp\\u003eR\\u0026sup2; change\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u003cp\\u003eF\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eB\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eSE.\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eβ\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e\\u003cp\\u003eA\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c7\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0.108\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c12\\\" namest=\\\"c11\\\"\\u003e\\u003cp\\u003e0.108\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c14\\\" namest=\\\"c13\\\"\\u003e\\u003cp\\u003e5.985\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c16\\\" namest=\\\"c15\\\"\\u003e\\u003cp\\u003e0.004\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c17\\\" namest=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePNV\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.376\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.110\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e-0.361\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd 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namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePESNWI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.117\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.107\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.109\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.278\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePNV\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.322\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.105\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e-0.31\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.003\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e\\u003cp\\u003eC\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c7\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0.201\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c12\\\" namest=\\\"c11\\\"\\u003e\\u003cp\\u003e0.201\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c14\\\" namest=\\\"c13\\\"\\u003e\\u003cp\\u003e12.437\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c16\\\" namest=\\\"c15\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c17\\\" namest=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGSE\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.069\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e-0.324\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.001\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePNV\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.095\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e-0.261\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.005\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c7\\\" namest=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e\\u003cp\\u003e0.210\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c12\\\" namest=\\\"c11\\\"\\u003e\\u003cp\\u003e0.010\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c14\\\" namest=\\\"c13\\\"\\u003e\\u003cp\\u003e8.705\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c16\\\" namest=\\\"c15\\\"\\u003e\\u003cp\\u003e0.000\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c17\\\" namest=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eGSE\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.069\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.325\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.001\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePNV\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-0.32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.105\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-0.310\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.003\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePESNWI\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.117\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.107\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.109\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e\\u003cp\\u003e0.278\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c13\\\" namest=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c17\\\" namest=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe present study is the first to have been done on the role transition from newly graduated nurses to professional nurses in Sri Lanka. Four validated tools have been used to collect the relevant data.\\u003c/p\\u003e\\u003cp\\u003eIn contrast to Irish nurses and Israeli Jewish and Arab nursing students, who cited a 'desire to care and help others' and 'job security' as key motivations [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e], the primary reason identified in this study was \\u0026lsquo;to obtain clinical experience necessary for overseas employment\\u0026rsquo;\\u003c/p\\u003e\\u003cp\\u003eStructured orientation with trained preceptors is key to preparing new nurses [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e], yet over 65% in this study lacked such support. In contrast, 87.2% and 78.2% of Korean nurses received pre-education and preceptor training, respectively [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe mean General Self-Efficacy (GSE) score was 2.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.69, lower than in South Korea (2.80) and Iran (2.93), with significant variation by hospital type [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. This might be because of the differences in the facilities, attitudes, and disciplines of the staff in the three types of hospitals.\\u003c/p\\u003e\\u003cp\\u003eThe mean Professional Nursing Values (PNV) score was 3.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.50, similar to South Korean graduates (3.8) and higher than that of undergraduates [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e] (Bang et al., 2011). In Iran, students showed higher PNV than nurses [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn this study, the highest and lowest mean scores were for \\u0026lsquo;Professionalism in Nursing\\u0026rsquo; (4.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78) and \\u0026lsquo;Originality of Nursing\\u0026rsquo; (3.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.16), consistent with prior findings [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. These results suggest that while new graduates view nursing as a profession, they perceive limited specialty and autonomy compared to other health professions.\\u003c/p\\u003e\\u003cp\\u003eThough not statistically significant, literature indicates higher Professional Nursing Values (PNV) among those who choose nursing by interest or professional aspiration [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. The mismatch between theoretical learning and clinical realities, lack of motivation, organizational support, and value recognition may explain lower PNV [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]. In contrast, significantly higher PNV scores were noted among those who received pre-education, possibly due to early and gradual hospital exposure.\\u003c/p\\u003e\\u003cp\\u003eLow income and poor professional quality of life have prompted many graduates to migrate or leave healthcare, contributing to reduced job satisfaction and retention [\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]. In this study, four of the five PES-NWI subscales had mean scores above 2.5, indicating a 'favorable' nurse work environment, consistent with previous research [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR44\\\" citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eA significant effect of the 'reason for becoming a staff nurse' on PES-NWI scores may reflect students\\u0026rsquo; prior exposure to different hospital environments during undergraduate training. Additionally, the significant association between 'pre-education within the hospital' and PES-NWI is supported by literature, which suggests that pre-education helps new nurses adjust by allowing early, low-pressure exposure to the clinical environment [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe transition to professional practice is a known challenge for newly graduated nurses, often marked by stress and disillusionment [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. In this study, the overall mean Transition Shock Scale score was lower than that reported in South Korea [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e] but higher than the 2.41 reported by Kramer et al. (2013) [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThe highest shock in this study was associated with excessive workload, consistent with Kim and Yeo\\u0026rsquo;s findings, suggesting workload as a key factor in transition difficulty. \\u0026lsquo;Loss of social support\\u0026rsquo; ranked second in this study, contrasting with its lowest ranking in the Korean study, highlighting cultural and institutional differences between Sri Lankan and South Korean hospital environments.\\u003c/p\\u003e\\u003cp\\u003eIn this study, although not statistically significant, married nurses experienced higher transition shock than single nurses, potentially due to work-life balance challenges common in female-dominated professions [\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]. Transition shock was significantly influenced by hospital type and bed strength, likely reflecting variations in administration, staffing attitudes, and institutional policies across government, semi-government, and private hospitals.\\u003c/p\\u003e\\u003cp\\u003eThe reason for entering the nursing profession significantly impacted transition shock. Participants citing limited career alternatives, overseas employment goals, or genuine motivation to serve as nurses experienced varying degrees of transition stress. These findings align with literature emphasizing the role of personal preparedness and professional self-concept in easing the transition to practice [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eGraduate nurses with trained preceptors demonstrate higher confidence in delivering safe care and show improved first-year retention [\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e], aligning with the findings of the current study. However, the limited number of such trained nurses in this study highlights the need to establish structured preceptorship programs led by both academically and clinically competent nurses across all healthcare sectors in Sri Lanka [\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]. Identifying sources of occupational stress during transition is critical for enhancing staff retention strategies [\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAlthough not statistically significant, a greater transition shock was observed among those who received hospital-based pre-education. This may be attributed to the discrepancy between the supportive orientation period and the abrupt shift to full professional responsibility. As noted by Duchscher (2009) [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], this sudden transition from guided learning to independent practice often triggers emotional distress, adjustment challenges, and heightened transition shock among novice nurses.\\u003c/p\\u003e\\u003cp\\u003eIn the present study, a statistically significant negative correlation was observed between PESNWI and transition shock, which contrasts with previous studies that reported a significant positive relationship [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]. Although this might imply a limited need to modify the nurse work environment in Sri Lankan healthcare settings, generalization is cautioned due to the study being limited to a single district.\\u003c/p\\u003e\\u003cp\\u003eGeneral Self-Efficacy (GSE) and Professional Nursing Values (PNV) were identified as significant predictors of transition shock, with GSE being the stronger predictor. This finding aligns with previous literature confirming self-efficacy as a consistent determinant of transition outcomes [\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e], while diverging from findings that emphasized the predictive role of the nurse work environment [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Additional variables, such as age and work unit preferences, have also been associated with transition shock. Recent research further highlights hospital classification as a key predictor, where higher transition shock levels were linked with increased adverse patient events [\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAs limitations, authors would report that the study was confined to the Colombo District and employed convenience sampling, which may limit the representativeness of the sample and the generalizability of findings to other regions or the national population of newly graduated nurses.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eTransition shock among newly graduated nurses was significantly influenced by monthly income, hospital type, bed strength, and motivation for entering the nursing profession. General self-efficacy and professional nursing values emerged as significant predictors of transition shock. These findings underscore the importance of interventions such as workload reduction, implementation of incentive and reward systems, structured preceptorship programs, and targeted strategies to enhance self-efficacy and professional values to support graduates during their transition into clinical practice.\\u003c/p\\u003e\\n\\u003ch3\\u003eRelevance for clinical practice\\u003c/h3\\u003e\\n\\u003cp\\u003eThe need to implement more practical and effective methods to introduce the new graduates to their professional roles in Sri Lanka, along with mentorship programs and support services, thereby reducing burnout while enhancing retention and job satisfaction, is emphasized in this study. Implementing strategies to elicit nursing professional values more in the hospital setting and preceptorship programs for the newly graduated B.Sc. This research strongly suggests that nurses. Further evaluation of the Transition shock and burnout rate of the graduates during their transition period is recommended for further research studies. Broadening of the study setting is suggested to get more generalized findings. Though these findings suggest the lack of need to change the nurse work environment in Sri Lankan health care, further studies are needed to confirm these findings, as the current study was confined to only one out of twenty-five districts in the country.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eHuman Ethics and Consent to Participate declarations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study involves human participants, and ethical approval was granted for this study by the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka (App No: Nur/03/20) in accordance with the Declaration of Helsinki. All participants provided\\u0026nbsp;informed consent through an embedded agreement option (\\u0026apos;agree to participate/disagree to participate\\u0026apos;) at the end of the Google sheet\\u0026nbsp;before enrolment in the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePatient consent for publication\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePersonally identifiable information is not published in this paper\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability statement\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eData are available upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eNone declared.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eO.D. and T.A. contributed substantially to the work\\u0026rsquo;s concept and design, analysis, revised the article, and approved the version to be published. N.E. analyzed and interpreted the data and drafted the article. All authors have read and approved the final manuscript and agreed to be accountable for all aspects of the work. Grammarly was used for grammar correction.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors, with great respect, appreciated the cooperation extended by all the study participants.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePatient and public involvement\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ePatients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003ePeters A, Lotfinejad N, Guitart C et al. 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Graduating nurses\\u0026rsquo; self-efficacy in palliative care practice: An exploratory study. Nurse Educ Today. 2016;39:141\\u0026ndash;6. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1016/j.nedt.2016.01.005\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.nedt.2016.01.005\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-nursing\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"nurs\",\"sideBox\":\"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/nurs/default.aspx\",\"title\":\"BMC Nursing\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Newly graduated nurses, Self-efficacy, Transition shock, Sri Lanka\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7362651/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7362651/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eSouth Asian countries, including Sri Lanka, face some of the most severe shortages of nurses globally, creating significant challenges for healthcare delivery. One contributing factor to this crisis is the high dropout rate of newly graduated nurses worldwide, often attributed to an unsuccessful transition from the role of nursing student to that of a practicing clinical nurse. This critical transition period can be influenced by multiple personal, professional, and organizational factors, directly impacting retention and job satisfaction.\\u003c/p\\u003e\\u003ch2\\u003eObjective\\u003c/h2\\u003e\\u003cp\\u003eThis study aimed to assess the factors influencing the transition period to professional roles among newly graduated nurses with a Bachelor of Science degree in Nursing, with a particular focus on identifying predictors of transition shock.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA descriptive cross-sectional study was conducted in government hospitals within the Colombo District. A consecutive sample of 102 newly graduated nurses from six universities, all employed in hospitals in Colombo, was recruited. Data were collected using four standardized, pre-tested (N\\u0026thinsp;=\\u0026thinsp;10), and self-administered instruments: the General Self-Efficacy Scale, the Professional Nursing Values Scale, the Practice Environment Scale of the Nursing Work Index, and the Transition Shock Scale. Data were analyzed using descriptive statistics to summarize demographic and contextual variables, followed by multivariate statistical analyses to determine significant predictors of transition shock.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eGraduate transition shock was found to be significantly associated with monthly income (p\\u0026thinsp;=\\u0026thinsp;0.005), type of hospital (p\\u0026thinsp;=\\u0026thinsp;0.017), hospital bed capacity (p\\u0026thinsp;=\\u0026thinsp;0.021), and the personal motivation or reason for becoming a nurse (p\\u0026thinsp;=\\u0026thinsp;0.007). Furthermore, self-efficacy and professional nursing values emerged as significant predictors of transition shock, indicating that higher self-efficacy and stronger professional values are associated with lower transition-related stress.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eThe findings highlight the urgent need for targeted interventions to facilitate smoother professional transitions for newly graduated nurses. Strategies such as workload reduction, structured reward and recognition systems, the establishment of formal preceptorship and mentorship programs, and initiatives to enhance general self-efficacy and strengthen professional nursing values are recommended. Implementing such measures could not only reduce transition shock but also improve job satisfaction, retention, and the overall stability of the nursing workforce in Sri Lanka and similar contexts.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Predictors of Transition Shock Among Newly Graduated Nurses, Sri Lanka: A Descriptive Cross- Sectional Study on the Roles of Self-Efficacy, Professional Nursing Values, and Practice Environment\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-18 17:50:10\",\"doi\":\"10.21203/rs.3.rs-7362651/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-30T07:32:36+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"43052564356926211836185827084882717022\",\"date\":\"2025-09-24T11:42:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-09-18T09:49:31+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"43737675457130852493465243971542881228\",\"date\":\"2025-09-11T16:54:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-11T11:39:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-08-19T14:52:54+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-08-18T13:37:50+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-08-18T13:37:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Nursing\",\"date\":\"2025-08-13T08:22:29+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-nursing\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"nurs\",\"sideBox\":\"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/nurs/default.aspx\",\"title\":\"BMC Nursing\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2b0fcb9a-99c7-4ba2-918a-b12fdcc0bbeb\",\"owner\":[],\"postedDate\":\"September 18th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-09-18T17:50:10+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-09-18 17:50:10\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7362651\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7362651\",\"identity\":\"rs-7362651\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}