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New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

Aim New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. Method A classical Delphi technique in four rounds was used. A purposeful sample and snowball technique was used and generated an expert panel of 32 registered nurses with 12–36 months of EMS experience. In round one telephone interviews were undertaken to identify what support professionals new to the EMS desire during their first year. Content analysis of the transcribed interviews yielded 70 items which were developed into a questionnaire. In subsequent three rounds the experts graded each item in terms of perceived importance on a 5-graded likert scale. Consensus level was set at 75 percent. Results Desirable support was categorised into eight areas: Support from practical skills exercises, support from theoretical knowledge, support from experiences based knowledge, theoretical support, support from an introduction period, support from colleagues and work environment, support from management and organisation and other support. The experts agree on the level of importance on 64 items regarding desirable support. Of these, 63 items were considered important, graded 4 or 5. One item was considered not important, graded 1 or 2. Conclusion Even with requested formal competence of the professionals, the EMS context poses challenges where a wide variety of desirable forms of support is needed. Support structures should address both personal and professional levels and be EMS context oriented. Conflict of interest None Funding Academic EMS in Stockholm.