A STUDY ON THE DIFFICULTIES FACED BY NEWLY INDUCTED NURSES DURING NIGHT SHIFTS AT GENERAL HOSPITAL OWERRI, IMO STATE

CHAPTER ONE INTRODUCTION 1.1 Background of the Study In healthcare environments, one recurring concern is the phenomenon of reality shock, especially among nurses who have just graduated. This shock usually emerges within three to six months of starting clinical practice and manifests as a feeling of disconnect between the practical skills they were taught and the actual demands of the clinical setting. Recently, the term "transition shock" has become widely used to describe the confusion, disorientation, and sense of loss that new graduates often experience as they adjust from being students to becoming practicing nurses [Duchscher, 2019]. The first year of employment is a critical period during which these new nurses begin shaping their career paths, and how well they navigate this phase greatly influences their long-term professional development and job satisfaction. If reality shock is not properly managed during this time, it can seriously hinder nurses’ career progression and increase turnover rates, which also has significant financial consequences for healthcare organizations [Yang et al., 2024]. Several factors contribute to reality shock for new nurses, including low confidence and competence, the heavy responsibilities of patient care, challenges in communicating with patients to meet their psychological needs, and the difficulty of balancing work with personal life demands [Epstein et al., 2020]. Additionally, starting night shifts—which typically occurs at a vulnerable time for new nurses—intensifies these challenges [Kubo et al., 2022]. Therefore, it is essential for newly graduated nurses to adjust effectively to night shifts as a key way to reduce reality shock. Nursing schedules vary widely. Some use a three-shift system with 8-hour rotations, while others employ two shifts per day, where day shifts last 8 hours and night shifts can be as long as 16 hours, running from late evening to early morning [Kubo et al., 2022]. Regardless of the schedule, nurses working night shifts must adapt to a lifestyle quite different from their daytime colleagues. This shift in routine often leads to sleep disorders characterized by shorter sleep durations and poor sleep quality, due to irregular sleep patterns and insufficient recovery time between shifts [12–14]. Many newly graduated nurses report disturbances in their sleep-wake cycles, particularly those assigned to night duties [Han, Kim, Lee & Lim, 2019]. The consequences of such sleep disruptions include cognitive decline and reduced work productivity [Han et al., 2019]. Furthermore, night-shift nurses often care for more patients compared to day-shift nurses, adding to the workload burden. For new nurses who must independently prioritize and assess patient needs, this increased responsibility can be especially challenging. Night shifts are typically understaffed, meaning that novice nurses must decide whether patient issues are serious enough to escalate to senior staff, a responsibility that can be stressful. Consequently, night shift work involves significant and demanding duties for recently inducted nurses. Various support programs have been introduced to assist new nurses during their transition, including preceptorships that provide emotional and practical support and simulation training to improve clinical skills. These initiatives have been linked with increased competence, greater confidence, higher job satisfaction, and reduced turnover among new nurses [Han et al., 2019]. However, research specifically targeting support for newly graduated nurses during night shifts remains limited. In some Japanese hospitals, for example, graduating students may undergo orientation night shifts supervised by experienced nurses, receiving step-by-step guidance until they can work independently. Despite this, the overall effectiveness of such orientation programs remains unclear, and there has been little progress in establishing comprehensive night shift support systems. Without formal support, new nurses often rely on personal coping strategies that frequently fall short in alleviating sleep problems and fatigue [Han et al., 2019]. Understanding the unique challenges faced by newly graduated nurses on night shifts is therefore crucial for designing effective support programs that facilitate a smoother adjustment. Yet, only a handful of studies have explored these specific difficulties. Identifying these challenges will help determine the necessary preparation level for night shifts and inform policies aimed at easing the transition. By implementing such support measures, healthcare institutions can reduce the strain associated with night work, ultimately lowering the risks of reality shock and turnover. For these reasons, this study aims to investigate the challenges that newly inducted nurses face during night shifts at General Hospital Owerri, Imo State. 1.2 Statement of the Problem Newly graduated nurses play a vital role in healthcare delivery, yet they face numerous challenges when transitioning from theoretical learning to clinical practice, especially during night shifts. While night shifts are essential to ensuring round-the-clock patient care, they present distinct difficulties for inexperienced nurses. These challenges can negatively impact their efficiency, job satisfaction, and overall well-being (Lin et al., 2019). Common problems reported by new nurses working nights include fatigue due to disrupted sleep patterns, limited mentorship, and reduced access to resources and support systems (Baumberger-Henry, 2021). Fatigue impairs cognitive function and increases the risk of mistakes in patient care, putting both nurses and patients at risk (Scott et al., 2019). Irregular sleep habits only worsen this fatigue. Moreover, the scarcity of experienced staff during night shifts can lead to feelings of isolation and lack of support among novice nurses, which raises stress and anxiety levels (Andrews & Djukic, 2020). The limited availability of resources and support services during these hours further exacerbates these feelings, making it difficult for new nurses to manage complex cases (Manookian, Cheraghi, & Nasrabadi, 2020). The combined effect of these factors can cause early burnout, dissatisfaction, and attrition; research shows that many new nurses leave the profession within their first year (Hutchinson et al., 2020). If these issues remain unresolved, healthcare organizations risk losing skilled nurses at a time when global shortages are already critical. Therefore, this study seeks to explore the specific challenges faced by newly inducted nurses during night shifts at General Hospital Owerri, Imo State. 1.3 Objectives of the Study The main aim of this study is to explore the challenges encountered by newly inducted nurses during night shifts at General Hospital Umuahia, Abia State. The specific objectives are: i. To identify the physical challenges newly inducted nurses face during night shifts. ii. To examine the effects of night shift work on the mental health and well-being of newly inducted nurses. iii. To investigate the coping mechanisms employed by newly inducted nurses in managing the difficulties associated with night shifts. 1.4 Research Questions This study is guided by the following research questions: i. What physical challenges do newly inducted nurses face during night shifts? ii. How does night shift work affect the mental well-being of newly inducted nurses? iii. What coping strategies do newly inducted nurses use to manage the challenges of night shifts? 1.5 Significance of the Study The findings from this study will be valuable to hospital administrators and managers by providing deeper insight into the specific stressors affecting newly graduated nurses during night shifts. This understanding can help shape policies and interventions aimed at creating a more supportive work environment. Enhancing supervision, mentorship programs, and access to resources could reduce job-related stress, lower turnover, and improve patient care quality. Furthermore, this study will contribute to academic literature, expanding library resources and guiding future research in this area. 1.6 Scope of the Study This research focuses on the challenges newly inducted nurses encounter during night shifts at General Hospital Umuahia, Abia State. Empirically, the study will identify the physical challenges, explore the mental health impacts, and investigate coping strategies used by these nurses. Geographically, the research is limited to General Hospital Owerri in Imo State. 1.7 Limitations of the Study As with any research, this study faced certain constraints: Time: The researcher had to balance this study alongside other academic commitments such as lectures and coursework. Finance: Costs incurred included printing, typesetting, sourcing relevant materials, and conducting data collection. Availability of Materials: Finding sufficient literature on this specific topic was challenging due to its niche nature, which limited the depth of review. 1.8 Definition of Terms Newly Graduated Nurses: Nurses who have recently completed their formal nursing education and training and are within their first year of professional practice. Night Shifts: Work schedules that generally start in the evening and end the following morning, often between 7 p.m. and 7 a.m., forming part of rotating shift patterns in healthcare settings. Fatigue: A state of physical and mental exhaustion resulting from extended working hours, lack of adequate rest, and disrupted sleep cycles, which can impair a nurse’s performance. Supervision: The guidance and oversight provided by experienced nursing staff or healthcare managers to support newly graduated nurses in clinical decision-making and patient care.