Justin Fontenot, Fuqin Liu, Jincy Immanuel
Confidence-building is a multifaceted and ongoing process influenced by mentorship, targeted training, reflection, team integration, and organizational culture. A comprehensive approach is necessary to help newly graduated nurses transition successfully into acute care practice.
AIM: To synthesize evidence on strategies and contextual factors that influence confidence development among newly graduated nurses in acute care settings and to propose an integrated conceptual framework to guide practice, policy, and research.
DESIGN: Integrative literature review.
METHODS: This integrative review followed Whittemore and Knafl's framework and PRISMA 2020 reporting guidance. Two reviewers screened studies, extracted data, and applied design-specific JBI critical appraisal tools. Disagreements were resolved by consensus and consultation with a third reviewer. Data were synthesized through constant comparison and coded by outcome tier (direct confidence/self-efficacy, related capacity, and proxy transition outcomes).
DATA SOURCES: Five databases (Academic Search Complete, PubMed/Medline, CINAHL Complete, and PsycINFO) were searched from inception through June 30, 2024, with an updated search in May 2025.
RESULTS: Forty studies met the inclusion criteria, representing qualitative, quantitative, and mixed methods designs. Five mechanism-based domains were identified: support, skill development, reflection, integration, and organizational culture. Organizational culture functions as a conditioning context that can strengthen or constrain mentorship, skill development, reflection, and integration. These findings informed a conceptual framework illustrating the cyclical and dynamic relationships between individual strategies and organizational conditions.
CONCLUSION: Confidence-building is a multifaceted and ongoing process influenced by mentorship, targeted training, reflection, team integration, and organizational culture. A comprehensive approach is necessary to help newly graduated nurses transition successfully into acute care practice.
IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a central role in shaping the conditions that allow newly graduated nurses to develop professional confidence during transition to practice. The findings from this review suggest that confidence-building strategies are most effective when supported by psychologically safe unit cultures, protected preceptor time, constructive feedback, manageable workloads, and structured opportunities for reflection and team integration. Rather than treating confidence as an individual trait, nursing management should approach it as a workforce outcome influenced by staffing, leadership practices, mentorship infrastructure, and organizational socialization. Strengthening these conditions may improve transition experiences, support retention, and contribute to safer, more stable acute care environments.