From Classroom to Chaos: A Concept Paper on Transitional Dissonance in the Nursing Profession
Submitted by Marie Cecille Liberty Soliven-Varilla
Tags: challenges nurse burnout Nurse Education
Introduction
The nursing profession involves continuous role transitions, which are vital for professional growth but often come with challenges (Aryeequaye et al., 2025). Newly licensed nurses, despite rigorous training, frequently experience transitional dissonance, a gap between expected and actual competencies, that affects their confidence and performance (Kavanagh & Sharpnack, 2021; Bornhaupt & Mulder, 2025; Purabdollah et al., 2024).
This phenomena was even more intensified by the COVID-19 pandemic, which limited clinical exposure and heightened feelings of unpreparedness (Spector & Silvestre, 2024; Haanes et al., 2024). Ongoing shifts in healthcare and technology further contribute to this dissonance, especially during transitions into leadership or academic roles (Prosen & Ličen, 2025; Chicca, 2019). Addressing transitional dissonance calls for competency-based education and structured support to better prepare nurses for evolving professional demands.
Behind the Struggle: Causes of Role Transition Dissonance
Role transition dissonance among nurses, particularly when moving from academic settings to clinical practice, stems from multiple interconnected factors. A primary cause is the mismatch between structured, theory-focused academic preparation and the unpredictable, fast-paced realities of clinical work that demand quick thinking, multitasking, and emotional resilience—skills often underdeveloped during training (Saara Kertu & Nuuyoma, 2019; Watson et al., 2025; Tieleman & Cable, 2021). Additionally, role ambiguity and the sudden increase in responsibility, such as managing complex patient care with limited supervision, contribute to feelings of overwhelm and uncertainty (Tsai et al., 2025; Wakefield, 2018).
Moreover, inadequate organizational support, including insufficient orientation and mentorship, intensifies this dissonance by fostering isolation and stress, which can lead to job dissatisfaction and attrition (Lanahan et al., 2022; Hallaran et al., 2023; Holtz et al., 2024). Emotional dissonance also plays a critical role, as nurses must often suppress genuine feelings to display empathy and calmness, a form of emotional labor linked to exhaustion and burnout, especially during the COVID-19 pandemic (Chen et al., 2022; Alnazly & Hjazeen, 2021; Fiabane et al., 2019). This cycle may result in presenteeism and compromised patient care (Flaubert et al., 2021).
Cultural and interpersonal challenges, such as language barriers and discrimination, further hinder social integration and confidence (Chen et al., 2021; Hallaran et al., 2023; Tieleman & Cable, 2021). Finally, rapid technological advancements, including electronic health records and telehealth, require continuous adaptation. Without adequate training and support, many nurses feel overwhelmed, a problem worsened by the pandemic-driven acceleration of digital healthcare and the digital divide affecting rural or under-resourced areas (Altmiller & Pepe, 2022; Bornhaupt & Mulder, 2025; Chan et al., 2021; Maravilla et al., 2023).
Collectively, transitional dissonance arises from educational gaps, unclear roles, limited support, emotional strain, cultural challenges, and rapid technological change. Understanding these causes is essential, as they affect not only individual nurse adjustment but also the quality of care and workplace dynamics.
Feeling the Strain: The Impact of Dissonance on the Nursing Role
Transitional dissonance profoundly affects nurses as they navigate evolving roles and increasing demands. Initially, this manifests as emotional exhaustion, anxiety, and self-doubt—early warning signs of burnout and compassion fatigue (Fiabane et al., 2019; Alnazly & Hjazeen, 2021). This emotional strain stems largely from the constant emotional labor required in caregiving, where nurses must often display emotions that conflict with their true feelings, leading to emotional dissonance that drains energy and impairs clinical performance (Bakker et al., 2006; Zapf, 2002). Consequently, persistent stress also undermines cognitive functions such as focus and decision-making, which in turn contributes to job dissatisfaction and intentions to leave the profession (Rasoal et al., 2025; Gustafsson & Hemberg, 2022).
Moreover, burnout has become a global issue, affecting over a third of nurses and driving absenteeism, low productivity, and turnover, especially in high-pressure settings (Getie et al., 2025; Hutsell, 2023). This situation is further worsened by diminishing emotional rewards from meaningful work, heavy workloads, poor staffing, and insufficient mental health support (Nadarajan et al., 2025; Zakeri et al., 2021). In addition, repeated exposure to trauma and moral dilemmas accelerates compassion fatigue and disengagement, deepening the emotional toll on nurses (Yeşil & Polat, 2023; Xie et al., 2021).
For newly licensed nurses, the strain is even more pronounced. They face heavy caseloads and limited mentorship, which leads to turnover rates ranging from 12% to 34% in acute care settings (Bae, 2023; NSI Nursing Solutions, 2024). As a result, high turnover exacerbates staffing shortages, increases healthcare costs, and disrupts continuity of care (Shaffer & Curtin, 2020; People Element, 2024). Furthermore, cognitive overload from excessive responsibilities raises the risk of clinical errors and patient safety incidents (Collins, 2020; Leary et al., 2024; Dela Cruz, 2023).
Compounding these challenges are systemic issues such as poor interprofessional communication and chronic resource shortages, which further erode nurse confidence and morale (Pérez-Francisco et al., 2020; Leary et al., 2024). Taken together, the emotional, cognitive, and systemic burdens of transitional dissonance place significant strain on nurses, threatening both their well-being and the quality of patient care. Therefore, addressing this complex issue through targeted interventions is critical to breaking the cycle of stress, disengagement, and turnover.
A call for A-C-T-I-O-N: Advocate, Create, Train, Improve, Offer, and Nurture!
Addressing transitional dissonance in the nursing profession requires a multifaceted approach that includes educational reform, structured support systems, and a strong commitment to fostering a positive work environment. Proactive strategies that empower newly licensed nurses to navigate the complexities of their roles effectively are essential and should be promoted to uplift and support the nursing workforce.
Advocate for Competency-Based Education. Implement competency-based education (CBE) which aligns theoretical instruction with real-world clinical demands. CBE emphasizes critical thinking, clinical judgment, and emotional resilience, and has been endorsed by the American Association of Colleges of Nursing as essential for preparing nurses for evolving healthcare roles (Kavanagh & Sharpnack, 2021; Lewis et al., 2022).
Create Enhanced Orientation and Mentorship Programs. Equally important are enhanced orientation and mentorship programs, which have been shown to reduce turnover, increase job satisfaction, and ease the transition from student to practitioner by fostering professional identity and confidence (Gill-Bonanca, 2024; Paul, 2024).
Train for Emotional Support and Mental Health Resources. To mitigate emotional dissonance and psychological strain, healthcare institutions must also invest in mental health resources and resilience training, which are critical for preventing burnout and compassion fatigue (Melnyk et al., 2021; Wood, 2024).
Improve Workplace Culture. Workplace culture plays a pivotal role in either exacerbating or alleviating stress. Positive organizational cultures characterized by teamwork, recognition, and psychological safety are associated with lower stress levels and improved retention (Kiptulon et al., 2024).
Offer Technology Training and Support. Technology training and support are essential to ensure nurses feel competent and confident in using digital tools, thereby reducing cognitive overload and transitional strain (Nerud & Smith, 2025).
Nurture Cultural Competence and Diversity. Cultural competence and diversity training are vital for equipping nurses to navigate multicultural care environments and reduce interpersonal dissonance (Kaihlanen et al., 2019; Ličen & Prosen, 2023).
By integrating A-C-T-I-O-N, healthcare organizations can systematically address transitional dissonance among newly licensed nurses, ultimately leading to better job satisfaction, retention, and patient care outcomes.
Conclusion
Transitional dissonance in new nurses arises from the gap between their academic training and the complex demands of clinical practice, causing stress, role confusion, and emotional strain. This often leads to burnout, high turnover, and increased risks to patient safety. The call for A-C-T-I-O-N addresses these challenges by advocating for competency-based education, creating strong mentorship programs, providing training in emotional resilience, improving workplace culture, offering technology support, and nurturing cultural competence. Together, these strategies help ease transitions, reduce dissonance, and improve nurse retention and patient care.
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