In 2022, the turnover rate of new nurses in Korea increased from 47.7% in 2021 to 52.8%, and the rate of resignations within one year of appointment also increased from 15.6% to 17.9% [1]. The most common reason for turnover was work maladjustment [1]. New nurses may resign from their positions if they find it hard to adapt to clinical life or struggle with the stress of working in a hospital [2]. In general, new clinical nurses must adapt to clinical work while caring for patients. This makes the transition from student to nurse challenging and stressful [3]. Previous studies have reported that new nurses experienced a reality shock due to differences between their expectations and the reality of the clinical environment during their third month of hospital work [4].

Maladjustment among new nurses arises from a complex interplay of factors, including inadequate communication skills with both patients and health personnel, suboptimal job performance, and the burden of work responsibilities [5, 6, 7]. These challenges can significantly hinder their ability to adapt to the clinical environment, impacting both their personal growth and patient care outcomes [8]. Providing a structured educational framework, nurse residency programs (NRPs) contribute positively to enhancing retention rates, competency, self-confidence, and the quality of patient safety [8]. However, in the context of South Korea, NRPs typically span an average of 57.3 days, markedly shorter than the 6-month to 1-year programs commonly reported internationally [9]. This discrepancy underscores the urgent need for NRPs tailored to the unique healthcare landscape of Korea.

Moreover, reflective journaling about clinical experiences offers a powerful tool for new nurses to introspect and navigate their adjustment to clinical duties. Engaging in self-reflection allows them to explore their experiences, including their emotions, thoughts, and behaviors, fostering personal and professional growth [10]. Nurse educators play a pivotal role in guiding and mentoring this reflective process, thereby enhancing workplace adaptability [11]. Within the nursing context, such reflective practices not only promote professional development but also lead to improved patient care and outcomes [10]. The analysis of self-reflection diaries from new nurses can provide valuable insights into the root causes of maladjustment and turnover, offering directions for enhancing their professional experiences [10, 11, 12, 13].

Text network analysis (TNA) can be used to analyze self-reflection diaries written by new nurses with the intention of strengthening their adaptability to clinical practice. TNA is useful for exploring information and phenomena within documents, identifying trends, and suggesting future research directions [14]. Thus, a TNA of self-reflection diaries can offer insights useful for understanding learners’ characteristics, needs, and priorities and thus for developing effective educational programs. TNA has been used in a variety of disciplines to explore knowledge structures, quantify key research concepts, and identify contextual structures [15]. Recently, scholars in the field of nursing used TNA to analyze the knowledge structure of specific topics, such as pain management and trends in nursing informatics [14, 15]. However, most existing research on new nurses’ experiences is qualitative and exploratory, often relying on interviews and surveys for data collection [7, 16].

Although scholars have already explored how to reduce turnover among new nurses and help them better adapt to the clinical field, these studies have often involved nurses who had started working within the last year without classifying them by period [17, 18]. However, the difficulties new nurses face after joining a hospital change over time [7]. Educational programs designed to help new nurses adapt to hospital work should involve a step-by-step fostering strategy that considers their development across different working periods.

This study aimed to analyze the critical reflection journals in which new nurses recorded their clinical experiences during the three periods of their first year working at a hospital: specifically, 1~3, 4~6, and 7~12 months into hospital work. We expect the findings to reveal new nurses’ educational needs and provide insights into how NRPs can be tailored to better prepare new nurses for clinical practice.

We examined the clinical experiences of new nurses across three phases of their first year of hospital work based on insights from their online critical reflective journals. Our analysis reveals distinct themes and challenges unique to each phase, emphasizing the evolving nature of their adaptation and learning experiences.

During their first three months working in the hospital, new nurses confront a myriad of challenges that profoundly shape their early professional experiences. In the journals written by new nurses, a noticeable gap was observed between the theoretical knowledge acquired during their education and its actual application in clinical settings. The journals also confirmed a willingness among these nurses to learn and grow as experts. However, due to unfamiliar tasks and the use of medical equipment, frequent mistakes were made. These errors led to corrective feedback from senior nurses and highlighted the need for continued efforts to reduce mistakes. Prior research corroborates this finding, indicating that new nurses often perceive themselves as unqualified professionals due to inadequate knowledge and skills, a sentiment that is most acute during the first two months of their practice [27]. This phenomenon has been attributed to the challenges in training and securing clinical practice instructors for Korean nursing students, and to a clinical practice approach that emphasizes observation over active practice [28]. Nevertheless, despite these initial challenges, the emergence of the keyword “growth” during this period indicates a determination to surmount these obstacles and evolve professionally. During this period, educational programs are primarily conducted for preceptor education and the acquisition of theoretical knowledge [28, 29]. Consequently, there is a need to harmonize theoretical knowledge with practical application to foster an environment where nursing skills can be methodically honed through simulation-based education and comprehensive manuals detailing essential clinical nursing competencies [30]. However, most medical institutions in Korea lack simulation centers for nurse education, indicating a need for government support to improve the education system and ensure high-quality education.

In addition, new nurses experienced difficulties using the unfamiliar EMR system, and frequent errors were noted due to insufficient patient understanding during the handover process. To address these issues, they emphasized the importance of conducting thorough rounds in their journals. This aligns with the findings of a study indicating that new nurses, at the onset of their employment, were not accustomed to EMR and experienced significant stress primarily associated with task performance [7]. In order to facilitate effective adaptation to each hospital’s EMR system, it is essential to provide practical computer training from the initial stages of employment and to establish a more systematic and integrated adaptation process. This process should include a mentoring program to understand the difficulties faced by new nurses and to discuss improvement strategies tailored to individual characteristics. A study that provided a mentoring program to newly graduated nurses highlighted its significance in transitioning to a nurse role and offered a career opportunity to develop new nursing competencies from a mentor [31]. Such a system is essential to understand the challenges encountered by new nurses and to offer guidance tailored to each nurse’s unique circumstances. Comprehending the experiences of new nurses during this initial period is necessary to develop strategies that foster their resilience, competency, and well-being. Currently, many medical institutions in Korea are implementing clinical nurse educator projects. Therefore, it is necessary to utilize the clinical nurse educators to develop and implement a mentoring program tailored to the characteristics of each institution.

During their first 4 to 6 months of hospital work, new nurses confront evolving challenges that mark a significant phase in their professional growth. This period is marked by an in-depth understanding of their roles and responsibilities, accompanied by a critical self-assessment of their skills and competencies. In this phase, new nurses often perceive their “nursing skills” as “insufficient,” which can cause them to experience feelings of “stress.” This sentiment is echoed in a journal entry by a new nurse: “After gaining independence and caring for patients on my own, the demands placed on me are overwhelming, yet my skills do not seem to improve, causing me significant stress.” This reflects a discrepancy between the abilities of new nurses and the high standards expected in clinical settings. According to previous research, after 4 months of employment, it is the time to work independently, and new nurses’ organizational commitment significantly decreases and burnout increases [32]. In particular, when job competency, such as clinical performance, has not significantly grown, the burden, fear, and anxiety due to excessive work increase, and negative feedback increases, which adds to stress [32, 33, 34]. In the Korean context, new nurses are often assigned a heavy workload and face challenges before they acclimate to their roles due to the constraints of the new nurse education program [28]. In Korea, the typical education programs for new nurses focus predominantly on the technical aspects of nursing tasks and procedures, with less emphasis on emotional support and coping mechanisms for stress management [35]. New nurses’ perceived lack of empathy is notably linked to lower job satisfaction and a higher intention to leave the position, further highlighting the need for emotional support alongside practical training [36]. There is a lack of studies directly assessing the effectiveness of emotional support programs for new nurses, highlighting a significant gap in current training protocols. Given these challenges, there is a pressing need for a supportive educational environment tailored to the unique needs of new nurses. Such an environment should not only aim to bridge the gap in technical skills but also provide emotional support through structured programs that address the psychological aspects of transitioning into a demanding and often stressful role.

During this period, new nurses increasingly participate in complex procedures and are often required to explain medical conditions and treatments to patients or their guardians. This not only demands a higher level of procedural knowledge but also necessitates strong communication skills to ensure that explanations are clear and accurate. The appearance of keywords such as “explanation” and “concern” suggests that new nurses not only execute tasks but are also involved in educating patients, which requires a comprehensive understanding of medical conditions and treatments. Research indicates that continual skill acquisition is vital for new nurses. Prior research has similarly noted that new nurses are continually striving to acquire the nursing skills they lack and to improve their work performance [17]. However, in Korea, the formal training period averaging less than 2 months is notably shorter than in many other countries, where training typically extends beyond 6 months [35, 37]. This discrepancy indicates a potential gap in the breadth and depth of training provided to Korean nurses, possibly impacting their readiness and confidence in performing complex clinical tasks. To address these challenges, it is essential to leverage existing dedicated nurse training programs in Korea. These programs should focus on spreading shared knowledge through structured and step-by-step practical training. Implementing team education programs and offering ongoing learning opportunities are crucial strategies that can help bridge the gap between theoretical knowledge and practical application. These methods ensure that new nurses not only learn specific skills but also understand the context and rationale of their actions, which is essential for holistic patient care.

Seven to twelve months into their hospital roles, new nurses face a critical phase marked by increasingly complex challenges, compounded by the pressure to enhance performance efficiency. A report indicates that it can take between eight and twelve months for new nurses to adjust to the realities of their roles and to become fully operational [38]. In Korea, nurses frequently encounter considerable workloads before they have had sufficient time to become proficient in their duties [38]. New nurses experience significant pressure as they attempt to manage a demanding workload, adapt to the complexity of their role, and meet higher expectations, which can ultimately lead to burnout [34]. This often leads them to engage in repetitive checks to minimize errors as a coping strategy to address their concerns about falling behind in their learning and skill acquisition [39, 40]. In order to solve this problem, continuous support must be provided to increase confidence in work and performance ability by continuing practical training through a nurse in charge of education for up to 12 months to strengthen competency. Moreover, the development of self-regulated internal management programs to reduce workload and burden is essential, alongside organizational-level management efforts to support new nurses’ integration into the healthcare environment as competent professionals. New nurses still complained of difficulties in handover. Handover is one of the important tasks of a nurse as it saves time in checking and understanding the patient’s key information [41]. However, for new nurses, omission of important information during handover, questions from peer or senior nurses, or lack of preparation due to busy ward environment can result in work burden and frustration [41]. A standardized handover process is necessary to systematically and accurately convey information, and a simulation process needs to be included for realistic practice.

Nevertheless, this study has a few limitations. This study analyzed reflective journals from new nurses at a single university hospital, necessitating caution in generalizing the results. The free text format may influence the interpretation of words and expressions, and the lack of data analysis specific to departmental characteristics necessitates careful interpretation of the data. Despite these limitations, our findings underscore the need for a dynamic, integrative approach in nursing education that harmonizes theoretical knowledge with practical skills. To facilitate this, nursing curricula should be restructured to include simulation-based training and real-world clinical scenarios, fostering a seamless transition from classroom learning to clinical application. Notably, healthcare organizations play a pivotal role in this adaptive process. Establishing a nurturing work environment, replete with resources for continuous learning and professional development, can significantly reduce job stress and enhance job satisfaction among new nurses. Future research should explore the long-term impact of such integrative educational and organizational strategies on the professional development and psychological well-being of new nurses. Additionally, future studies should conduct group-specific analyses to examine the characteristics of various departments, such as intensive care units, general wards, and operating rooms.

This study crucially identifies the evolving challenges faced by new nurses during their first year in a hospital setting. It highlights the need for educational reforms that bridge the gap between academic theory and clinical practice and the importance of creating a supportive work environment. The distinct phases of adaptation—from grappling with basic clinical skills to managing complex patient care and emotional labor—call for targeted support strategies to enhance resilience and competence; specifically, such strategies may include structured mentoring, practical training, and emotional support mechanisms. Further, our findings clarify the need to implement an integrated approach in nursing education and organizational support designed to improve the overall well-being and professional development of new nurses. The insights from this study contribute to the broader discourse on effective strategies for nurse induction and retention and have implications for healthcare quality and patient care.