Implementing a Professional Development Programme (ProDeveloP): an Introduction for Newly Graduated Nurses
Phase: NA
Conditions: Professional Fulfillment, Professional Identity Formation, Professional Quality of Life, Support Program, Development, Nurse Role
Sponsor: Mälardalen University

 
 
 
NCT06742047 
A PROFESSIONAL DEVELOPMENT 
PROGRAMME (PRODEVELOP) 
FOR NEWLY GRADUATED NURSES 2023 
Magdalena Lindblom 
Magdalena.lindblom@mdu.se 
Summary 
Pre-speciﬁed study protocol and statistical analysis plan (SAP) 
Update review 2026-02-18 
Project Leader 
Margareta Asp, Professor 

Sustainable Professional Development – Introduction Program for Newly 
Graduated Nurses 
1. Background 
A newly graduated nurse (NGN) entering their first workplace may experience significant 
uncertainty and considerable stress. Common stressors include being exposed to challenges 
such as work overload and feeling alone and uncertain in the new situation (Duchscher, 
2012). Studies show that one-fifth of NGN reported frequent symptoms of burnout, and an 
equal number had thoughts of leaving the profession (See et al., 2023). In Region 
Västmanland, 20% of newly hired nurses leave their first position after three years. After 
three years, 42% remain in their first position (Törnqvist, 2020).  
To support NGN in their transition to practice, healthcare organizations offer 
introduction programs and other initiatives intended to promote learning and integration, 
thereby creating a sustainable start in the profession. Previous research shows that such 
introduction programs for NGN can contribute to competence development, but they are not 
always based on scientific evidence (Rush et al., 2019). Earlier research on introduction 
programs for several professional groups, including NGNs, showed positive effects on 
perceptions of uncertainty and stress. Implications for continued development include 
creating more targeted interventions that promote role clarity, action capacity, recovery, and 
social acceptance (Frögéli et al., 2023). 
Sick leave among nurses in Region Västmanland is currently around 7.5% of 
approximately 1,000 registered nurses, potentially related to stress and uncertainty in the 
profession. Many choose to leave the profession, placing additional strain on those who 
remain. Supporting sustainable professional development is therefore crucial. Creating, 
implementing, and evaluating an evidence-based introduction program may contribute to 
increased job satisfaction. 
 
2. Interventions of ProDeveloP 
In this project, a professional development program (ProDeveloP) is developed and will be 
implemented based on existing research in the field, particularly results from earlier research 
on sustainable working life focusing on new professionals such as NGNs (Frögéli et al., 
2022; Gustavsson et al., 2020), funded by AFA. Based on these findings, ProDeveloP will be 
developed with targeted components with a special focus on reflection and recovery, which 
were specifically highlighted as needed (Widarsson et al., 2020), to optimize its effect and 
support job satisfaction and health among NGN. The project will be conducted in 
collaboration with Region Västmanland and Mälardalen University (MDU). 
ProDeveloP was developed based on the previous introduction programme and existing 
research. ProDeveloP will be implemented in 2023 through a collaboration between a 
university and a regional education centre and will be conducted in Swedish. It consisted of 
eight educational days delivered over the first four months (the same as in the previous 
introduction programme in 2022), however also incorporated simulation exercises for acute 
and trauma situations, as well as skills training in various clinical procedures. It also included 
additional components such as four focus areas—role clarity, task mastery, social acceptance, 

and recovery—and integrated structured reflection facilitated through dialogue groups, 
addressing ethical and emotional challenges.  
 
3. Purpose and Research questions 
The purpose of the project is to develop, implement, and evaluate a digital professional 
development program aimed at strengthening newly graduated nurses’ role clarity, capacity 
for action, social acceptance, reduction of stress, and improvement of recovery, thereby 
increasing job satisfaction.  
 
1. What does the development of role clarity, task mastery, social acceptance, and stress 
look like during the first quarter of employment? 
2. What are newly graduated nurses’ experiences of recovery, and how does it develop 
during their first year when participating in ProDeveloP? 
3. What are their experiences of reflection sessions, supervisors, and support for 
professional development? 
4. To what extent are newly graduated nurses satisfied with their work, feel confident in 
their competence, and want to remain in their workplace after completing the 
ProDeveloP? 
5. What are supervisors' and managers’ experiences of ProDeveloP? 
 
4. Method  
Research participants 
All newly hired NGN participating in ProDevelop will be invited to participate in the studies. 
Two groups (January 2023 and June 2023), each with 40–50 participants. One control group 
of NGNs participating in the prior introduction programme will be invited to participate in 
November 2022, with approximately 40-50 participants.  
 
Design and Data Collection 
The project has a prospective, longitudinal design. Both qualitative and quantitative methods 
will be used to answer the research questions. The questionnaires used in the study are based 
on validated instruments (Frögéli et al., 2019), which helps ensure the reliability of the data 
collected. The questionnaires will be distributed digitally via Survey and Report. One control 
group measurement is planned before intervention starts. Self-assessments via questionnaire 
are planned to be completed by the NGNs. Thereafter, self-assessments are conducted once a 
week during the first quarter for the intervention group. Follow-up measurements are then 
carried out once per quarter for up to one year after graduation. The individual interviews 
with NGNs and managers, and the focus groups with NGNs and supervisors, are planned to 
be conducted after the program has been completed. The qualitative interviews will be 
audio-recorded and transcribed. An overview is presented in Table 1.  
Table 1. A detailed table of data collection and data analysis  

Research 
question 
Data collection 
Data analysis 
1 
Self-assessment instruments 
 
Descriptive statistics, regression 
analyses 
2 
a) Individual interviews  
b) Self-assessment instruments 
a) Phenomenology 
b) Descriptive statistics, ANOVA, χ² 
3 
Focus group interviews  
Content or thematic analysis 
4 
a) Self-assessment instruments 
b) Individual interviews 
a) Descriptive statistics, ANOVA, χ² 
b) Content analysis or phenomenography 
5. 
Focus group interviews and individual 
interviews 
Content or thematic analysis  
 
Timeline 
Once the analyses and results have been completed and the journal editors have approved the 
publication; the results will be made public. Publications will take place continuously, but the 
doctoral thesis work is planned to be completed with a defence at the end of 2027. 
 
Ethical Considerations 
All NGN entering the introduction year will receive written and oral information about the 
project. Participation is voluntary and can be withdrawn at any time. A consent form will be 
provided. Data will be handled confidentially, and a data management plan will be prepared. 
An application is approved by to the Swedish Ethical Review Board (Dnr.2022-05682-01).  
 
5. Pre-specified statistical analysis plan  
The plan comprehends a statistical analysis plan for self-assessment instruments. 
 
Study design and study population 
A quantitative intervention design with a non-randomised design with a two-arm structure is 
planned. The study's first arm (control group) is all eligible NGNs who participates in the 
previous introduction programme in September 2022. The survey for this group will be 
administered in late November 2022. The second arm (intervention group) comprise all 
eligible NGNs participating in the ProDeveloP starting either in February or in September 
2023, depending on their graduation date. The surveys for group comparison will be  
distributed digitally in early May or December, aligned with the same time frame as the 
control group. Longitudinal surveys will also be collected during the intervention group’s 
first year in ProDeveloP however this is not possible for the control group.  
Inclusion criteria were newly employed NGNs who participated either in the previous 
introduction programme in 2022 or in ProDeveloP in 2023. Specifically, all eligible NGNs 
employed in 2022 who participated in the September introduction programme were included 
in the control group. All eligible NGNs employed in 2023 who participated in ProDeveloP, 

starting in either February or September, were included to the intervention group. No explicit 
exclusion criteria were applied. 
 
Outcome measures 
Primary outcomes include perceived stress, role clarity, task mastery, and social acceptance. 
These outcomes will be measured during the first 13 weeks for the intervention group and at 
week 13 for the control group. All instruments use five-point Likert scales in Swedish, based 
on questionnaires previously validated in the Swedish context. Secondary outcomes include 
recovery, intentions to stay, and job satisfaction. These will be measured at months 4, 8, and 
12 for the intervention group. The instruments use five- or seven-point Likert scales in 
Swedish, based on measures previously validated in the Swedish context.  
 
Covariates  
Covariates will include variables related to the outcomes such as role clarity, task mastery, 
social acceptance and demographic factors, such as prior clinical experience before 
participation in the programme.  
 
Definition of combined measures 
Scale scores will be computed by summing items response format (0 - 4 or 0- 6 depending on 
the instrument). 
 
Missing Data 
The extent and pattern of missingness will be described. If indicated, sensitivity analyses may 
be performed. 
 
Plan of statistical analyses 
Statistical analyses will be conducted using SPSS Statistics, with support from experienced 
researchers and statisticians. All procedures and results will be verified for accuracy. The data 
will be checked for deviations from normality. The plan is to analyse and report data with 
descriptive statistics, ANOVA, and χ². This to compare the mean scores of the study 
variables, including Cl and p-values, to determine differences between control and 
intervention groups. A two-sided significance level of p = .01 will be applied. Bonferroni 
correction to control the family-wise error rate (FWER) will be used, adjusting the 
conventional threshold of p = .05 by dividing it by the number of tests. The effect size of 
mean differences could be included. To further examine differences between the control and 
intervention groups, linear regression analysis will be conducted. The models will include 
covariates. Consort guidelines will be used to support the analysis process.  
  
6. Utilization, Dissemination, and Communication Plan 
The interventions are expected to contribute to a sustainable working life for nurses by 
strengthening competence, reducing stress, and promoting retention. Results will be utilized 
to inform healthcare policy and organizational practices aimed at improving nurse retention 
and well-being. Results will be disseminated regionally, nationally, and internationally 

through peer-reviewed scientific articles, conference presentations and to stakeholders and 
health care professionals. The project will result in the production of a doctoral thesis, where 
findings from all study components will be synthesized. To ensure broader communication, 
key outcomes will also be shared via media and networks. 
 
References 
Duchscher, J. (2012). From surviving to thriving. Navigating the ﬁrst year of professional nursing 
practice. Nursing the future, the voice of the new graduates.  
Frögéli, E., Annell, S., Rudman, A., Inzunza, M., & Gustavsson, P. (2022). The Importance of Eﬀective 
Organizational Socialization for Preventing Stress, Strain, and Early Career Burnout: An 
Intensive Longitudinal Study of New Professionals. International Journal of Environmental 
Research and Public Health, 19(12). https://doi.org/10.3390/ijerph19127356  
Frögéli, E., Jenner, B., & Gustavsson, P. (2023). Eﬀectiveness of formal onboarding for facilitating 
organizational socialization: A systematic review. PLOS ONE, 18(2), e0281823. 
https://doi.org/10.1371/journal.pone.0281823  
Frögéli, E., Rudman, A., & Gustavsson, P. (2019). The relationship between task mastery, role clarity, 
social acceptance, and stress: An intensive longitudinal study with a sample of newly 
registered nurses. International Journal of Nursing Studies, 91, 60-69. 
https://doi.org/10.1016/j.ijnurstu.2018.10.007  
Gustavsson, P., Agrenius, B., Frögéli, E., & Rudman, A. (2020). Nya professionella: Organisatoriska 
strategier för att stödja vitalitet och lärande under första anställningstiden i yrken med höga 
emotionella krav. AFA försäkring, Hållbart Arbetsliv, Slutrapport nya professionella dnr 
150596. (New professionals: Organisational strategies to support vitality and learning during 
the ﬁrst period of employment in professions with high emotional demands). https://afa-
forskning.cdn.prismic.io/afa-forskning/541e1c5b-649c-4959-adc5-
a284fd86b6c8_Petter+Gustavsson+slutrapport.pdf  
Rush, K. L., Janke, R., Duchscher, J. E., Phillips, R., & Kaur, S. (2019). Best practices of formal new 
graduate transition programs: An integrative review. International Journal of Nursing Studies, 
94, 139-158. https://doi.org/10.1016/j.ijnurstu.2019.02.010  
See, E. C. W., Koh, S. S. L., Baladram, S., & Shorey, S. (2023). Role transition of newly graduated nurses 
from nursing students to registered nurses: A qualitative systematic review. Nurse Education 
Today, 121, 105702. https://doi.org/10.1016/j.nedt.2022.105702  
Törnqvist, C. (2020). Staﬀ turnover among newly qualiﬁed nurses. A report of the ﬁrst four years in 
Region Västmanland.  
Widarsson, M., Asp, M., Letterstal, A., & Södersved Källestedt, M. L. (2020). Newly Graduated 
Swedish Nurses' Inadequacy in Developing Professional Competence. Journal of Continuing 
Education in Nursing, 51(2), 65-74. https://doi.org/10.3928/00220124-20200115-05