背景
新進護理人員進入獨立臨床實務的過程中，常面臨臨床不確定性、角色責任、時間管理、病人安全壓力與人際互動挑戰所形成的工作相關壓力。復原力被視為重要的自我保護資源，然而，復原力在護理師到職初期的時間動態變化，及復原力與各項工作壓力面向的關聯的時間交互作用，目前尚缺乏縱貫性與混合方法的驗證。
研究目的
本研究旨在：探討新進護理師於入職初期(第 1、3 及 6 個月)之工作相關壓力與復原力的縱貫變化，首先，驗證復原力與整體工作壓力及其七個次構面的關聯性是否具有時間差異；其次，分析復原力與整體工作相關壓力之關聯，並檢驗此關聯是否隨到職月份改變。進一步質性訪談新進護理人員的工作壓力與復原力的經驗。最後綜整上述量/質性結果，形成混合方法後設推論。
研究方法
本研究採用縱貫性聚合式混合方法設計，以量性與質性資料互補解釋新進護理人員在臨床轉銜初期之工作相關壓力與復原力變化。量性研究追蹤78名新進護理人員，分別於到職第1、3及6個月進行資料收集，共取得167筆有效觀察資料。研究工具包括25題Connor–Davidson Resilience Scale及涵蓋七個面向的新進護理人員工作相關壓力量表。量性資料採用廣義估計方程式進行分析，以檢驗工作相關壓力與復原力隨到職月份之縱貫變化，並進一步分析復原力與工作相關壓力之關聯是否隨時間而改變。
質性研究採滾雪球取樣，共納入18名新進護理人員，透過半結構深度訪談資料蒐集其在不同就業階段所經驗之工作壓力來源、因應與復原的歷程。質性資料採內容分析法進行編碼、歸納與主題形成。量性與質性資料分別完成分析後，於詮釋階段透過三角檢證與聯合詮釋進行整合，以比較、補充與擴展兩類研究發現，並據此形成混合方法後設推論。
研究結果
新進護理人員的整體工作相關壓力於到職第 1 個月最高（M = 3.89, SD = 0.65），並於第 3 個月（M = 3.41, SD = 0.69）及第 6 個月（M = 3.30, SD = 0.82）下降。七個工作壓力次面向中，知識、技能、工作流程、工作量、環境及病人／家屬相關壓力隨時間顯著下降，但同儕相關壓力未達統計顯著變化。復原力平均分數於第 1、3 及 6 個月分別為 54.72 分（SD = 12.96）、56.58 分（SD = 11.64）及 55.56 分（SD = 11.86），未隨到職時間顯著增加。較高復原力與較低整體工作相關壓力及七個壓力次面向均呈負向關聯；然而，到職月份與復原力之時間交互作用未達統計顯著差異，表示復原力與工作相關壓力的負向關聯未隨時間顯著改變。相對地，工作相關壓力與復原力之負向關聯於第 3 與第 6 個月較第 1 個月減弱。
質性分析形成四個主題：工作負荷的演變、臨床判斷及洞察力的發展、工作掌握與流程整合，以及專業能力與能力界限的反思性覺察。第 1 個月壓力主要來自不熟悉臨床流程、臨床判斷不足及害怕犯錯；第 3 個月轉向獨立照護責任、工作優先順序與多重任務管理；第 6 個月則仍受夜班責任、突發病情變化、高病情嚴重度、病人轉入轉出、人力限制及複雜交班影響。新進護理人員主要採取安全導向及問題為導向的因應策略，包括主動詢問、尋求協助、再次核對與重新確認臨床決策。
混合方法整合推論顯示，工作相關壓力下降並不代表臨床壓力消失或復原力顯著成長。新畢業護理師到職前六個月的轉銜歷程主要反映工作壓力強度下降，壓力內容由廣泛性不確定轉為較具體且高風險的臨床情境。然而，復原力指標在不同時間點皆維持在相對偏低的穩定狀態。復原力與工作相關壓力之間的負向關聯在六個月內未呈現時間差異；相對的，工作相關壓力與復原力之間的負向關聯於第3個月及第6個月較第1個月減弱，質性結果顯示，新畢業護理師逐漸熟悉臨床常規、並發展出求助、重複確認及工作流程組織等因應策略，其工作掌握與功能維持逐步提升。然而，同儕相關壓力、害怕犯錯及複雜情境下的臨床判斷困難仍持續存在。整體而言，新畢業護理師雖逐步建立常規照護工作的功能性掌控，但在高風險及不可預期的臨床情境中仍持續面臨挑戰；其因應反應較偏向問題焦點因應、臨床學習與功能性維持，而心理復原力在測量結果上並未呈現明顯提升。
結論
新畢業護理師到職後六個月內的工作相關壓力雖隨時間下降，但復原力未顯著增加，顯示工作壓力下降無法直接解釋為心理復原力成長。此轉銜歷程主要反映臨床熟悉度、工作掌握與功能維持能力的提升，同時壓力內容由早期的廣泛性不確定，轉向較具體且高風險的臨床情境。因此，臨床管理與新進護理人員臨床實務銜接培訓方案應提供分階段、情境化且組織層級的支持，包括即時臨床指導、心理安全、合理工作量及高風險情境支援，以促進新畢業護理師安全進入獨立臨床實務

Background
The transition from nursing education to independent clinical practice frequently exposes newly graduated nurses (NGNs) to occupational stress stemming from clinical uncertainty, role responsibilities, time management demands, patient safety concerns, and interpersonal challenges. While resilience is widely recognized as a critical personal protective resource, there remains a paucity of longitudinal and mixed-methods evidence detailing how resilience fluctuates during early employment, its relationship with distinct work-related stress domains, and how these associations evolve over time.
Aim
This study aimed to: (1) examine longitudinal pattern in work-related stress and resilience among NGNs at Months 1, 3, and 6 of employment; (2) analyze the associations between resilience and overall work-related stress and its seven domains, and determine whether these associations varied across employment months; (3) explore NGNs’ experience of work-related stress and resilience, including perceived stressors and coping strategies; and (4) integrate the quantitative and qualitative strand findings to develop mixed-methods meta-inferences.
Methods
A longitudinal convergent mixed-methods design was employed. The quantitative component included 78 NGNs who contributed 167 observations across Months 1, 3, and 6 of employment. Data collection was obtained using the 25-item Connor–Davidson Resilience Scale and a seven-domain work stressor scale for NGNs. Generalized estimating equations (GEEs) were applied to examine longitudinal pattern in work-related stress and resilience and to determine whether the association between these variables changed over time. For the qualitative component, 18 NGNs were recruited using snowball sampling, and the interview data were analyzed using content analysis. Themes were developed through coding and inductive categorization. Quantitative and qualitative findings were integrated during the interpretation phase through triangulation and joint interpretation.
Results
Overall work-related stress was highest at Month 1 (M = 3.89, SD = 0.65) and gradually declined at Month 3 (M = 3.41, SD = 0.69) and Month 6 (M = 3.30, SD = 0.82). Six of the seven work-related stress domains decreased significantly over time, whereas the change in peer-related stress was not statistically significant. Mean resilience scores showed only minor fluctuations across Month 1 (M = 54.72, SD = 12.96), Month 3 (M = 56.58, SD = 11.64), and Month 6 (M = 55.56, SD = 11.86), indicating no significant temporal growth. Nevertheless, resilience demonstrated a significant inverse association with work-related stress, and comparable negative associations were observed across all seven stress domains. However, the interactions between employment month and resilience were not statistically significant, indicating insufficient evidence that the strength of the inverse association between resilience and work-related stress differed across Months 1, 3, and 6.
Four qualitative themes were identified: the evolution of workload, the development of clinical judgement and insight, work mastery and workflow integration, and reflective awareness of professional capabilities and limits. At Month 1, stress arose primarily from unfamiliar clinical workflows, limited clinical judgement, and fear of making errors. By Month 3, stress had shifted towards independent care responsibilities, prioritization, and the management of multiple simultaneous tasks. At Month 6, night-shift responsibilities, unexpected changes in patients' conditions, high-acuity and complex care needs, patient admissions and transfers, staffing limitations, and complex handovers remained important sources of stress. NGNs primarily adopted safety-oriented and problem-focused coping strategies, including asking questions, seeking assistance, double-checking, and reconfirming clinical decisions. Through accumulated clinical experience, they also increasingly reflected on their performance and distinguished between situations they could manage independently and those that required assistance from more experienced nurses.
The mixed-methods meta-inference indicated that reduced work-related stress did not signify the resolution of clinical stress or a significant enhancement of resilience. Across the first six months of employment, NGNs experienced a decline in stress intensity, while stress sources shifted from broad uncertainty to more specific, high-risk clinical situations. NGNs developed work mastery through help-seeking, repeated confirmation, and workflow organization. Despite this progress, peer stress, fear of errors, and challenges in complex clinical judgment persisted. Overall, their transition reflected problem-focused coping, clinical learning, and functional maintenance rather than a clear improvement in measured psychological resilience.
Conclusion
Resilience did not increase significantly over time, and there was insufficient evidence that the inverse association between resilience and work-related stress became stronger with increasing employment duration. Therefore, the maintenance of clinical functioning, work mastery, and workflow integration should not be interpreted as evidence of completed resilient reintegration or psychological growth. Support for NGNs should address both individual and organizational needs by strengthening personal coping and resilience-related resources, providing real-time clinical guidance, ensuring access to preceptors and experienced nurses, making standardized care procedures readily accessible at the point of care, fostering psychologically safe learning environments, and offering timely emotional and psychological support. Such multilevel support may help reduce avoidable work-related stress and facilitate a safer transition into independent clinical practice.

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