Transition in high-acuity clinical learning environments: A qualitative meta-synthesis of newly graduated nurses in intensive care units and emergency departments.

AIM: To synthesise qualitative evidence on newly graduated nurses' transition experiences in intensive care units and emergency departments and identify implications for clinical education and learning-environment design.

BACKGROUND

Transition to practice among newly graduated nurses is well documented, but evidence focused on high-acuity clinical learning environments remains fragmented. Intensive care units and emergency departments combine rapid decision-making, technological complexity and emotionally demanding care.

DESIGN

A qualitative systematic review and meta-synthesis using Joanna Briggs Institute meta-aggregation.

METHODS

Ten databases and grey literature were searched from inception to 23 February 2026 and updated on 19 July 2026. Eligible reports were critically appraised, findings were meta-aggregated according to similarity of meaning and confidence in each synthesised finding was assessed.

RESULTS

Thirteen reports representing 12 unique studies from eight countries were included. Sixty-nine unique analytic finding units were aggregated into 19 categories and five synthesised findings: emotional turbulence under high acuity; education-practice incongruence; competence development as accelerated progression; relational integration and team climate; and moral commitment and professional identity. Confidence was high for three synthesised findings and moderate for two. Transition involved continuing negotiation among educational preparation, experiential learning, relational support, responsibility and professional values.

CONCLUSIONS

Transition into intensive care units and emergency departments extends beyond technical skill acquisition to include emotional adaptation, contextual clinical judgement, team integration and professional identity formation. Structured preceptorship, graduated responsibility, scenario-based simulation with debriefing and psychologically safe team cultures may support adaptation in high-acuity practice.