A phenomenological study was conducted to investigate graduate nurses' transition experiences during orientation. A purposive sample of 10 graduate nurses participated. Ten theme clusters emerged when the formulated meanings were organized into categories. Graduates experienced mixed emotions as they began orientation. Preceptors played a key role in the transition process, affecting participants' thoughts and progress. Graduates quickly realized the many differences between work and school, and were surrounded by feelings of stress as they assumed the new role of RN. For some, coping with death and dying was an emotionally difficult experience for which they felt unprepared. Finding a rhythm brought graduates confidence and feelings of accomplishment, and self-reflection emerged as an important and integral part of the transition process. Despite the challenges and stress of orientation, graduates found great meaning in their work, and most expressed readiness to be on their own by the end of 12 weeks.

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Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients experienced no significant cognitive decline during their 12-month study period, helping explain why outcomes did not change. Given widespread acceptability, future tests of this PCP-enhancing intervention should include patients with more progressive cognitive decline at study entry. NPs with geropsychiatric expertise are ideal interventionists for this rapidly growing target population.

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Nurses' perceptions of well-managed pain were significantly correlated with training, use of appropriate and accurate pain tools, and clear and research-based protocols. Barriers to effective pain management emerged as resistance to change, lack of knowledge, perceived fear of side effects of pain medication and incorrect interpretation of pain signals, lack of time, and lack of trust in the pain assessment tools. Gaps exist in knowledge, evidence, and practice in neonatal assessment and management.