Analysis of Support System For Newly Hired Staff Nurses in Cavite, Philippines

**A RANDOMIZED CONTROLLED TRIAL ON THE IMPACT OF SUPPORT SYSTEM ON CLINICAL CONFIDENCE AND WELL-BEING AMONG NEWLY HIRED STAFF NURSES** **BSN 2G** **GROUP 4** **Bermudez, Patricia** **Guese, Shaweh Mikee** **Lingling, Mark** **Revellame, Leila Gwen** **Villamin, Cirene Jem** **CHAPTER 2** **...

**A RANDOMIZED CONTROLLED TRIAL ON THE IMPACT OF SUPPORT SYSTEM ON CLINICAL CONFIDENCE AND WELL-BEING AMONG NEWLY HIRED STAFF NURSES** **BSN 2G** **GROUP 4** **Bermudez, Patricia** **Guese, Shaweh Mikee** **Lingling, Mark** **Revellame, Leila Gwen** **Villamin, Cirene Jem** **CHAPTER 2** **REVIEW OF RELATED LITERATURE AND STUDIES** The researchers present the relevant literature and studies they have found in this section. The literature and studies are categorized based on their foreign and local origins. Additionally, this shows the views and statements of the authors to offer additional information on the subject. **FOREIGN LITERATURE** Research from recent years highlights how structured support programs can positively impact new nurses, helping them build clinical confidence and manage stress more effectively. For instance, Chen et al. (2020) shows that three-month programs, involving simulation-based and practical teaching, increased confidence and reduced stress in newly hired nurses. This kind of training is especially effective for nurses handling high-stress environments and emergencies. The American Nurses Foundation\'s (2023) survey also emphasizes the need for mental health support, as many nurses report burnout due to high workloads. McKinsey & Company (2023) adds that limited access to mental health resources contributes to stress and burnout, showing that healthcare settings need structured programs to support both the emotional and practical needs of new nurses. According to Anderson and Stewart (2023) peer support reduces anxiety, improves job satisfaction, and fosters a sense of belonging, ultimately aiding new nurses in their transition to clinical practice. These underscore that well-designed orientation programs lead to higher job satisfaction, better mental health, and improved retention rates among new nurses (Meese et al., 2021). As a result, supporting new nurses ultimately benefits patient care and healthcare systems by fostering confident, resilient professionals. **LOCAL LITERATURE** Several literatures in the Philippines emphasize the critical importance of support systems in enhancing the clinical confidence and overall well-being of newly hired nurses, underscoring the need for comprehensive institutional practices that foster a supportive environment. As local literature has consistently shown, the transition from student to practicing nurse is often challenging, and support systems play a crucial role in facilitating this transition. For instance, Santos et al. (2024) demonstrated that mindfulness-based interventions not only significantly alleviate anxiety and improve mental health outcomes among newly hired nurses but also provide them with the psychological tools to handle stress and meet the demands of their roles effectively. Similarly, research by Gonzales and Rojas (2024) highlights the importance of emotional intelligence in enhancing resilience and work performance. Their study indicates that nurses with higher levels of emotional intelligence have stronger clinical confidence, which is necessary for making wise decisions in high-stakes situations in addition to having better coping skills. The researchers suggest that emotional intelligence training could be incorporated into professional development programs for newly hired nurses, as training may enhance self-awareness and interpersonal skills, ultimately improving patient care and job satisfaction. Additionally, the work of Dela Cruz and Villanueva (2024) further emphasizes the significance of a supportive work environment, specifically in the form of strong mentorship and peer support. Their findings reveal that new nurses who have access to mentors and feel supported by their colleagues report higher job satisfaction, lower levels of workplace stress, and an increased sense of confidence in their clinical abilities. This research supports the idea that fostering a culture of mentorship and collaboration within healthcare institutions is vital for helping new nurses feel valued and competent. Such an environment can mitigate feelings of isolation and self-doubt that are common among new nurses, particularly in resource-constrained settings. The study illuminates the unique challenges that these nurses face, including feelings of inadequacy, anxiety, and stress related to their clinical competencies. In response to these challenges, De Guzman et al. (2019) advocate for structured mentorship programs that foster collaborative and supportive environments. They argue that healthcare institutions, especially those in rural areas, should prioritize mentorship to help new nurses develop the skills and confidence needed to provide high-quality patient care under difficult conditions. The study's insights suggest that when new nurses are provided with emotional and practical support, they are more likely to thrive and remain in their positions, reducing turnover rates that can strain healthcare systems further. According to the research by the International Nurses Association (2020) underscores the importance of support systems, specifically highlighting the need for integrating mechanisms that enhance both emotional and professional well-being. This study supports the notion that healthcare institutions should implement comprehensive strategies to address the unique challenges encountered by new nursing professionals, not only to improve individual job satisfaction but also to ensure better patient care outcomes. By focusing on holistic support mechanisms, institutions can help new nurses develop resilience and adaptability, which are particularly important in the demanding healthcare landscape of the Philippines. Lastly, the findings from a study by Reyes and Villanueva (2022) reaffirm the importance of continuous education and support for newly hired nurses. Their research demonstrates that ongoing training and development programs can significantly empower new nurses, fostering a culture of lifelong learning within the nursing profession. Such programs provide nurses with opportunities to refine their clinical skills and stay updated on best practices, leading to improved patient care outcomes. The study concludes that continuous education not only enhances clinical competence but also instills a sense of purpose and dedication among new nurses, facilitating their successful integration into the healthcare system. **FOREIGN STUDY** According to Tawash et al. (2024) recognizing the important aspects of work readiness for newly graduated nurses (NGNs) is vital for improving nurse retention, a major challenge in healthcare worldwide. Additionally, understanding the emotional needs of NGNs and enhancing the support from experienced nurses and managers is crucial for reducing their stress. Healthcare leaders should promote discussions that focus on building a respectful, supportive, and open environment. These elements are essential for boosting the skills and confidence of NGNs. The study found that self-directed support is important for improving the connections between preceptors and trainees, as it helps newly hired nurses feel both practically and emotionally supported. As a result, this research delivers useful practical recommendations for nursing education and practice, detailing techniques that preceptors can adopt to enhance their effectiveness. Furthermore, it provides theoretical insights into how different forms of support can uniquely influence this relationship (Alonso et al., 2022). Support from clinical nurse educators is essential for assisting newly graduated nurses in effectively transitioning to clinical environments and maintaining their dedication to the profession.​ This mentorship facilitates organizational integration, encouraging the sharing of knowledge and the development of teamwork. A well-structured mentorship program is vital for helping new nurses enhance their skills and adapt to their roles (Moon et al., 2024) Kreedi et al. (2021) stated that for newly graduated registered nurses (NGRNs) worldwide, entering the nursing field can be a challenging and stressful experience. Numerous problems, including insufficient educational preparation and a lack of support from the company and coworkers, are the cause of this stress. Because of this, NGRNs frequently struggle with stress and confidence, which can increase their risk of quitting the field. Based on the study of Gadin, R. (2022), there are numerous challenges that newly hired nurses encounter in their workplace such as lack of confidence, role expectation, workload, environment, and relationships within the workplace. These various factors influenced the development of the newly hired nurses in practice demonstrating the need for healthcare system improvements in order to meet the developmental requirement that the newly hired nurses in the clinical setting lacks. It is recommended to provide support strategies during transition challenges and utilizing international clinical practice standards that are effective and relevant. **LOCAL STUDY** It showed on the findings of Gadin (2022) that newly hired nurses in the clinical setting face significant transition challenges, particularly in role expectation, lack of confidence, high workload, and ineffective orientation. These nurses expressed their dissatisfaction with their work environment, system support, and interpersonal relationships, highlighting the need for a more structured orientation process. In order to improve this transition, Gadin suggests increasing job satisfaction, enhancing orientation programs, and most importantly, creating a positive workplace to create an environment of support for these nurses for them to feel ease and confidence in the working environment. Similarly, in a descriptive cross-sectional study by Ubas-Sumagasyay and Oducado (2020) in the Philippines, the research explored the perceived competence and transition experience of new graduate Filipino nurses. The study surveyed 79 newly hired nurses, using self-administered questionnaires to assess their nursing skills, core competencies, and transition challenges. Their data revealed that while new graduates rated their fundamental skills and core competencies highly, they were still confronted by challenges, particularly with peer support, with 74.7% expressing difficulties in this area as satisfying workplace elements, although a significant portion (55.7%) viewed the nursing environment negatively. These findings suggest that even though new nurses feel equipped with essential skills, the gap in the support system and negative environment can hinder their transition, which eventually will lead to dissatisfaction and possible burnout. This implies that there is a visible need for support from supervisors, mentors, and peers to ease the transition for new nurses. ​Still, on the matter of retention and well-being, a similar descriptive, cross-sectional study by Adajar et al. (2022) in Metro Manila, examined factors affecting nurses\' intention to stay or leave their current hospital positions. By surveying 297 nurses, they aimed to understand the roles of practice environment, job satisfaction, organizational commitment, job stress, and job opportunities in nurses\' career choices. They found that a positive practice environment, encompassing safe staffing conditions, supportive leadership, and career advancement, was the main reason staff nurses remained with their organizations. Job satisfaction, particularly compensation and benefits, was also a key retention factor, especially for nurse managers. These findings raised and laid out just how critical the role of a supportive workplace in retaining nurses, which suggest that hospitals should focus on improving work conditions and recognizing staff achievements. This study is relevant as it highlights how a robust support system, particularly in the practice environment and job satisfaction, can influence nurses to stay, signifying a core factor that aligns with the focus of this present study on retention strategies for nursing staff. In regard to the best formal transition programs for new graduate nurses in clinical settings, an integrative review by Rush et al. (2019), where examined the strategies that support their integration and growth. The study reviewed literature from 2000 to 2018 across multiple databases, narrowing it down to 76 articles that met inclusion criteria. Using Cooper\'s five-stage approach, along with PRISMA guidelines, they analyzed themes like education, support, competency, and workplace environment. In their result, they revealed that programs supporting new graduate nurses often include mentorship, peer support, and designated resources for guidance, all of which positively impact nurses' confidence and competency over time. These best practices mainly implied the necessity of quality in preceptor support over quantity, and bundled preceptor strategies were especially effective, suggesting that focused, ongoing support enhances critical thinking and retention among new nurses. This simply reinforces the value of support systems as an essential aspect contributing to the success and well-being of newly hired nurses in clinical settings, which is the primary focus of this research. In the matter of clinical confidence, the integrative review conducted by Acosta et al. (2022), where Walker & Avant\'s concept analysis to explore the impact of support systems on nurses. They have indicated in the findings that nurses who had access to a strong and reliable support system, including peer collaboration and management assistance, experienced for their self-esteem and resilience to increase significantly, which are all essential for handling the pressures of their roles. Aside from this, a positive work setting creates stronger rapport with colleagues and patients, suggesting that when support is managed well, it builds nurses\' confidence and helps them deliver better patient care. This study is relevant as it laid out that a structured support system is substantial for newly hired staff nurses to gain clinical confidence. Effective support mechanisms can reduce stress and absenteeism which will directly contribute to job satisfaction and competency in clinical settings. **SYNTHESIS** The transition from student to clinical nurse is a challenging phase for newly hired nurses, often fraught with stress, anxiety, and self-doubt. Support system plays an important role in helping newly hired nurses build clinical confidence, improve well-being, and reduce stress. Support systems, including peer support and encouragement, are important in helping newly hired nurses have the complexities of their roles, cope with workplace stress and feel confident with clinical skills. Chen et al. (2020) and McKinsey and Company (2023) highlights the importance of structured programs that combine practical skills training with emotional and mental health support. Furthermore, the American Nurses Foundation states that burnout and high stress levels among nurses affects mental health, underscoring the need for healthcare institutions to offer support to address both emotional and professional challenges. Peer support is also an important part of the support system. Anderson and Stewart (2023) and Meese et al. (2021) showed that peer support is important in reducing anxiety and having a sense of belongingness among new nurses, which leads to higher job satisfaction and better mental health. Peer support also promotes retention, as nurses who feel supported are more likely to stay in their positions, which benefits patient care and healthcare systems as a whole. Santos et al. (2024) found that mindfulness-based interventions helped newly hired nurses manage stress and anxiety, providing them with the psychological tools necessary to grow with their roles. Additionally, Gonzales and Rojas (2024) emphasized the importance of emotional intelligence in building flexibility and clinical confidence. Nurses with higher emotional intelligence can handle pressures of clinical decision-making and cope with stress better. Gadin (2022) highlights issues such as role expectation, lack of confidence, and insufficient orientation, which contribute to dissatisfaction and stress among newly hired nurses. To address these issues, Gadin and other researchers advocate for more structured, supportive, and comprehensive orientation programs that not only help with clinical skills but also create a positive and supportive work environment. Similarly, Ubas-Sumagasyay and Oducado (2020) found that newly hired nurses experience issues with peer support and report negative work environments, which makes it harder to enter clinical practice. This shows the need for healthcare organizations to prioritize support systems as part of their retention and well-being strategies. Tawash et al. (2024) similarly shows the importance of addressing emotional needs and fostering supportive work environments to reduce stress and build confidence among newly hired nurses. Kreedi et al. (2021) and Moon et al. (2024) also show the necessity of support from preceptors to help new nurses adapt to clinical settings and develop confidence needed to achieve their roles. In conclusion, support systems are essential to the clinical confidence and overall well-being of newly hired nurses. These support mechanisms promote retention by helping new nurses navigate their roles with greater confidence and resilience, not only enhance job satisfaction and reduce stress. By having support systems, healthcare institutions can have a more positive work environment, improve both nurse retention and patient care outcomes. **CHAPTER 3** **RESEARCH METHODOLOGY** This chapter covers the research design, locale, population and sampling, research instrumentation, data gathering procedure, ethical considerations, and the data analysis procedure that the researchers will be using in the research. **RESEARCH DESIGN** This study is a Quantitative research that is a Randomized Controlled Trial (RCT), which is one of the most reliable methods for testing the effectiveness of an intervention. In this study, newly hired nurses are randomly assigned to two groups: an intervention group and a control group. The intervention group will receive additional support, such as structured peer mentorship sessions and extra administrative guidance, while the control group will only go through the standard onboarding process with no extra support. By using an RCT, the study can more accurately see if added support truly makes a difference in the nurses' confidence and well-being, without other factors interfering too much. After a set period, both groups will be assessed for clinical confidence, stress levels, and overall well-being using specific measurement tools. Comparing the outcomes between the intervention and control groups will help determine whether structured support significantly impacts these factors. This design ensures that the findings are reliable, allowing us to see if providing extra support to newly hired nurses is a strategy that could improve their adaptation to the clinical environment. **RESEARCH LOCALE** The study will be conducted in selected healthcare institutions within the province of Cavite, located south of Metro Manila in the Philippines. Cavite was chosen as the research locale due to its diverse range of hospitals, clinics, and healthcare centers, which offer a broad spectrum of clinical experiences for newly hired nurses. This diversity provides an excellent backdrop for examining the impact of support systems on clinical confidence and well-being among this group. **POPULATION AND SAMPLING** The researchers utilized a randomized controlled trial to determine the impact of support on the clinical confidence and well-being of newly hired staff nurses in the province of Cavite, Philippines. The targeted population of this research is 100 newly registered nurses from different healthcare institutions within Cavite. This population is particularly significant because newly hired nurses may face many challenges in adapting to their roles, which can especially affect their clinical confidence and overall well-being. For the sampling process, a Stratified Random Sampling Technique will be used to represent the diversity of the nursing workforce in the area. Therefore, the nurses will include those with different specialties and levels of experience thus making the finding more generalized. Indeed, the technique includes other variables like the type of the health institution (public or private), specialization (Med Surg, Pediatrics, Oncology, etc.) and the demographic element such as age and gender for an in-depth insight into the experiences of newly employed nurses. Clinical confidence and well-being among the participants will be measured through valid instruments before and after implementing the interventions. Through the RCT design, the intervention will be allowed to get a thorough evaluation because the outcome of the participants supported under the program will be compared with the outcomes in which participants in the control group did not get support. **RESEARCH INSTRUMENTATION** The instrument that will be used in the study is a survey questionnaire, which will be designed by the researchers for the respondents to answer. The researchers will use a 5-point Likert scale as the type of matrix question for the survey questionnaire. The questionnaire will also use a multiple-response type of questions wherein respondents can choose several choices on how support impacts their clinical confidence and well-being. This will help the researchers in determining if there is a significant relationship between the level of support to clinical confidence and well-being of newly hired nurses. **DATA COLLECTION** The researchers will construct a series of questions concerning the main objective of the study, which aims to assess the impact of support systems on clinical confidence and well-being among newly hired staff nurses. The researchers will then ask research advisers, as well as teachers and professors who have a background in writing to validate the questions that will be produced. After having the questions validated, the researchers will be collecting data from 100 newly hired nurses in Cavite using Google form. The researchers will make sure that they will ask for their chosen respondents' consent forms first. As the respondents agree to participate in the study, the researchers will then give them the survey questionnaire that they need to answer. The data that will be collected will be handled with the utmost confidentiality to respect the respondents' privacy. **ETHICAL CONSIDERATIONS** In this research, the researchers will follow ethical standards to protect the rights of the participants. This research will get informed consent, keeping personal information private, and reduce any possible risks. **Informed Consent.** The respondents will be fully informed about the purpose of the study, procedures, and benefits before agreeing to participate. **Confidentiality.** All personal information will be kept confidential. **Voluntary Participation.** Participation will be entirely voluntary, and the participants will have the right to withdraw from the study at any time. **Equitable Treatment.** Participants will be treated fairly and equitably, ensuring that all individuals have equal access to the support system. **DATA ANALYSIS PROCEDURE** ​In this study, the data will be treated using both descriptive and inferential statistical methods to analyze the effective strategies to improve the transition experience and overall performance of new nurses. Descriptive statistics such as means, frequencies, and percentages will be used to summarize and describe the results of the demographic profile of the nurses, including their age, sex, and area of clinical exposure. It will be used to assess the level of peer support, administrative support, and stress of newly hired nurses. These will provide a clear understanding about the effectiveness of the support system on the development of the nurses. In order to determine the statistical significance of the relationship between the level of support to clinical confidence and well-being of newly hired nurses, inferential statistics will be applied. Specifically, T-test will be conducted to compare the means of the two groups, which is the support system-clinical confidence and support system well-being. In this way, the researchers will be able to assess whether the relationships observed are statistically significant or due to chance. The results from the tests will help in generating conclusions about the impact of a randomized controlled trial on supporting nurses in terms of clinical confidence and improving their health. This research will also use the Pearson R correlation. It has been said that the Pearson R correlation is the most widely used to measure the degree of relationship between variables, it also assumes that variables should be normally distributed (statisticssolution, n.d.). Since the Pearson R correlation is a parametric test, it would be fit for the study assuming the data gathered is normally distributed. With this, the data can be plotted to the formula in order for the researchers to find the strength and direction of the relationship between the variables (support system and clinical confidence and well-being of newly hired nurses). **REFERENCE LIST:** Santos, J., Garcia, L., & Reyes, A. (2024). *Transition experiences of newly graduated nurses in rural healthcare settings. 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