Background: Stress is often associated with being exposed to pressure usually in the working environment. Numerous researches were establishing
in health care professional specifically among nurses the negative impact of job-related stress. Among the many factors, communication
and workload have been as major factors that contribute to stress. Over the years, simulation training has been used an alternative clinical
experience to assess clinical competence for new graduate nurses in response to specific clinical situations. Simulation learning is envisaged
to be a novel route towards reducing stress and gaining access to relevant clinical experience that may be essential to new graduate nurses.
Objective: The aim of this study was to explored stressors among new graduate registered nurses in the intensive care units (ICUs) in one
hospital in Saudi Arabian and explores the use of a complex intervention of simulation-based learning exercise (SBLE) to assist in reducing stress.
Methods: This research was designed based on mixed method design with interventions. The research involved three studies, which
incorporated both quantitative and qualitative approaches, whereby a sequential exploratory design was explored. Study 1: 189 Saudi
new graduate registered nurses were surveyed about their experiences of stress in their units using the expanded nurse stress scale
(ENSS) and perceived stress scales (PSS). Study 2: Interviewed 5 nurse educators in one group discussion about their educational
support for graduates in their units. Study 3: Individual interviews of 10 new graduate registered nurses of their experiences in ICUs.
Results: The results from both the approaches were then integrated using complementarity and triangulation techniques and was designed a
complex intervention which was Simulation Based Learning (SBL) but not implemented to potentially better manage these stressors. The results
showed that the Saudi new graduate registered nurses were indeed exposed to a plethora of high-level stressors working in such a challenging
Conclusion: As consequence the SBLE has been designed based on this finding and in the future will be tested. This research has contributed new
knowledge regarding to the stressors experienced by Saudi new graduate nurses working in the ICUs. This study offers important recommendations
and insight for the further to the new graduate nurses to be considered.