An integrative review of Enrolled Nurse recruitment and retention

Critical soft skill competencies that clinical nurse educators consider important to evaluate in nurses

AIM

Guided by Benner's framework, From Novice to Expert, this study aimed to identify (1) critical soft skills to be evaluated in nurses and (2) levels of nursing behaviour indicating achievement of soft skills to provide a framework for developing a soft skills rubric.

BACKGROUND/INTRODUCTION

Nurse shortages are often attributable to high turnover rates among nurses. To improve this situation, healthcare facilities implement transition programmes and continuing education with a primary focus on developing and maintaining nurses' knowledge and performance (hard skills). However, balancing hard and soft skills (beliefs, values and attitudes) is key to nurses' quality of care and ultimately to their retention. Despite the importance of soft skills, their intangible nature creates problems in evaluating nurses' attainment of these skills and in providing constructive feedback to help them set concrete goals for improving their practice.

METHODS

This qualitative descriptive study described critical soft skills in the nursing context. A purposeful sampling strategy was used to enrol 13 clinical nurse educators from multiple hospital units; each had more than 2 years of clinical nurse educator experience and had completed preceptor training. One-to-one interviews with these individuals were audio recorded, transcribed and subjected to direct content analysis using NVivo 12. The study follows the Consolidated criteria for reporting qualitative research (COREQ) guidelines for qualitative studies.

FINDINGS

Five main competencies, comprising 20 subcompetencies, were identified: personal growth, effective interactions, professionalism, teamwork and the caring role. For each subcompetency, four skill levels were delineated using clinical indicators.

CONCLUSION

This study's findings can enhance understanding of clinical nurse educators' perceptions regarding soft skills required of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The soft skills identified can be incorporated into a rubric to be used by clinical nurse educators to evaluate and guide nurses' professional development and contribute to improving quality of care. No patient or public contribution is required for this study.

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

Promoting Academic Success in Nursing Education Through Academic Coaching: A Scoping Review

BACKGROUND

Academic support services can improve undergraduate and graduate nursing program outcomes such as program completion and passing the NCLEX. Academic success coaching complements traditional support strategies by providing study skills and time management tools, promoting goal setting and self-efficacy, and referring students to support resources. This review examined interventions that academic success coaches use to improve student success and retention, licensing examination pass rates, and academic success.

METHOD

A scoping literature review identified types of interventions that resulted in significant improvement in student academic and holistic success.

RESULTS

Four classes of interventions were identified as effective in supporting student success: (1) academic support; (2) social and emotional support; (3) clinical guidance; and (4) course and program design.

CONCLUSION

Academic coaches are educated to identify student needs, provide support, and refer students to resources to improve academic outcomes. Future research should evaluate the need for academic success coaches to promote academic nursing student success. [J Nurs Educ. 2024;63(8):515-524.].

Learning in the workplace: Development of a simple language statement assessment tool that supports second-level nurse practice

AIM

To focus learning through clarity of the enrolled nurse (EN) role (a second tier nurse position) through development of a user-friendly workplace performance assessment tool commensurate with EN standards for practice.

BACKGROUND

Internationally, the nursing workforce comprises regulated and unregulated staff. In Australia, similar to other western countries, there are two tiers of regulated workforce, namely Registered Nurses (RNs) and Enrolled Nurses (ENs). Differences in RN and EN standards based on the education preparation are not always clearly differentiated in workplace practice. Roles are often seen as interchangeable: Improved clarity of both regulated and unregulated roles, when numbers of healthcare workers are burgeoning, assists performance assessment that guides further learning and safe practice.

DESIGN

Two phase sequential, non-experimental design.

METHODS

Phase one used focus groups (n=48), expert reference panel (n=8) and end-users (n=16) to develop simple language statements. Phase two involved field testing of the statements.

FINDINGS

A 30-item, criterion-based workplace performance tool was developed. Principal component analysis of completed tools indicated work could be organised around three key areas of practice, namely, higher order thinking and problem solving, routine daily activities of care and personal and social attributes.

DISCUSSION

Participants reported the statement items assisted in determining suitable activities and accompanying cues in discussing learning needs. Analysis assisted with discriminating broader elements of EN workplace performance.

CONCLUSIONS

Workplace learning is important for nurses to continue to build their capacity to deliver optimum care. Assessment tools that describe professional capability in plain language statements and provide examples of supportive behavioural cues help guide on-going learning through improving the validity and thereby consistency of assessment processes. Furthermore, comprehensible and meaningful statements and cues can readily be adopted by students and educators to target learning and feedback thereby enhancing clarity of the EN role, to distinguish from other nursing roles.

Well-being, turnover intention, and stigma attitudes of mental health transition-to-practice nurses: A cross-sectional study

There is global recognition that mental health nursing can be stressful and have detrimental effects on nurses' well-being and retention. With substantial nursing shortages, there is an urgent need to attract and retain nurses to sustain this workforce and provide effective mental healthcare. Mental health transition programs provide vital recruitment pathways and support novice registered nurses, enrolled nurses and experienced registered generalist nurses moving into this field. There is little evidence, however, on the well-being, resilience, and retention of nurses transitioning into mental health. The primary aims for this cross-sectional study were to describe demographic characteristics, perceived stress, well-being, resilience, mental illness stigma attitudes, work satisfaction, and turnover intention of four nurse cohorts entering mental health transition programs: generalist registered nurses, graduate and post-graduate registered nurses, and enrolled nurses; to explore relationships between these variables; and explore differences between these four nurse cohorts. Findings (n = 87) included overall moderate perceived stress, moderate well-being and resilience, high work satisfaction, low stigma, and low turnover intention. Higher turnover intention was associated with lower age and work satisfaction, and higher perceived stress. Generalist RNs had significantly higher stress and stigmatizing attitudes than Enrolled Nurses. Secondary analysis of well-being scores identified 14 nurses with scores indicating depression, with significantly lower resilience and work satisfaction, and significantly higher stress than the rest of the sample. To help prevent attrition, it is vital that mental health services provide tailored well-being initiatives during transition and intervene early to provide support for nurses with mental distress.

Factors Influencing Generation Z Bachelor of Nursing Students' Decision to Choose Nursing as a Career: A Pilot Study

Introduction

Despite nurses representing the largest healthcare professional group, the number is not enough for global health coverage. Understanding Generation Z students' intrinsic and extrinsic motivations, internal and external influences, and beliefs in choosing nursing education is crucial. This knowledge empowers universities to enhance nursing program enrollment through targeted promotion and recruitment strategies.

Objective

The aim was to understand why Italian students of Generation Z choose the Nursing Degree Course.

Methods

In this pilot study, a cross-sectional design was used. A survey with closed and open answers analyzing demographics, opinions, and motivations among new enrolled nursing students was administered on the first day of the Bachelor of Nursing Degree course. Descriptive statistics were used. Quantitative data were analyzed with Chi-square and ANOVA tests and qualitative data underwent content analysis and coding. Correlation analysis explored relationships between qualitative and quantitative results.

Results

Forty first-year students (85% female, average age 22) completed the questionnaire. The choice of the degree pathway, as the first or second option, is influenced by intrinsic and extrinsic motivations, the student's opinions, and family and social influences. Significant positive and negative associations were evidenced. Negative factors affecting choice included location and the responsibility for nursing care, while positive factors included role models, family advice, passion, curiosity for healthcare, the desire to help others, and family influences on decision-making.

Conclusions

Among Italian generation Z students, the choice of the nursing degree pathway is influenced by social models, family advice, passion, the desire to help others, and curiosity. Universities should be more proactive in their recruitment and promotion efforts, transforming these events into vibrant meeting points for professionals from diverse nursing specialties. They should also implement robust information policies that highlight career possibilities spanning clinical practice, management, education, and research areas within the field.

Reasons for choosing and completing nursing studies among incoming and outgoing students: A qualitative study

BACKGROUND

The shortage of nurses is causing instability and crisis in health systems and will continue. The WHO reinforced the importance of recruiting and retaining new students. Authors of various studies recommend the need to identify and understand the reasons for pursuing a nursing degree.

OBJECTIVES

To determine students' preference for nursing studies and to identify the reasons for choosing, continuing, and completing a bachelor's degree in nursing.

DESIGN

Qualitative, descriptive study.

PARTICIPANTS

106 nursing students at the University of Huelva (Spain) participated during their first year (2017) and final year (2021) of the nursing degree.

METHODS

This study was conducted with the same group of students in two phases. Data were collected in writing in a document with open-ended questions and no maximum wordcount. The responses were analysed using content analysis.

RESULTS

A total of 76.4 % of participants stated that nursing had been their first choice. The main reasons for choosing a nursing degree were associated with fulfilment, and a desire to help others and interact with them. The reasons for completing their studies were primarily related to an interest in providing professional care, showing a deeper and more concrete knowledge of nursing care work.

CONCLUSION

For most participants, nursing was their first choice due to a strong intrinsic motivation related to self-satisfaction in helping others. The reasons for completing this degree had extrinsic motivations linked to nursing activity in hospital. Areas such as management, teaching, or research were not interesting to our students. Knowing the causes of this lack of interest could help us attract them to these areas.

Transition and pathway programs from second to first level nursing: A scoping review

BACKGROUND

Second-level nurses comprise a large proportion of the nursing workforce in many countries. Despite differences in nomenclature, these nurses work under the supervision of first-level registered nurses and possess a more restricted scope of practice. Transition programs facilitate second-level nurses upgrading their qualifications to become first-level nurses. Globally, the impetus for transition of nurses to higher levels of registration has been to increase the skill mix demands in health care settings. However, no review has sought to explore these programs internationally and experiences of those making the transition.

OBJECTIVES

To explore what is known about transition and pathway programs from second to first level nursing.

DESIGN

Scoping review informed by the work of Arksey and O'Malley.

DATA SOURCES

Four databases were searched, CINAHL, ERIC, Proquest Nursing and Allied Health and DOAJ, using defined search strategy.

REVIEW METHODS

Titles and abstracts were uploaded into the online program Covidence for screening, followed by full-text screening. Two members of the research team screened all entries at both stages. Quality appraisal was performed to assess overall quality of research.

RESULTS

Transition programs are often undertaken to open up career pathways, job and financial advancement. These programs can be challenging as students seek to maintain dual identities, grapple with academic requirements and juggle work, study and personal demands. Despite their prior experience, there is a need for students to receive support as they adjust to their new role and scope of practice.

CONCLUSION

Much of the existing research around second to first-level nurse transition programs is dated. There is a need for longitudinal research to examine students' experiences as they transition across the roles.

Exploring the role of the second-level regulated nurse in the Australian nursing workforce: An integrative review

BACKGROUND

The enrolled nurse is the second-level regulated nursing role in Australia, with similar roles in other Organisation for Economic Co-operation and Development countries. A plethora of reports and research papers indicate that this role is seen as integral but under scrutiny by the nursing profession and government bodies. Despite changes such as national accreditation and registration requirements there is a lack of role clarity and delineation, especially between the registered nurse and enrolled nurse roles. As a key nursing role there is the need to ensure it is understood and used to its potential in the nursing workforce.

AIM

To explore key issues that may impact the role of the EN in the Australian nursing workforce.

DESIGN

An integrative review.

METHODS

A seven-step framework was used to review peer-reviewed research papers, scholarly and published government documents, grey literature and government data.

RESULTS

The review identified three themes from 24 documents: understanding the enrolled nurses' scope of practice, standardised practice, and career development.

DISCUSSION

It is posited that a lack of understanding of the enrolled nurses' scope of practice creates confusion between the nursing roles and a lack of standardised practice. There is also an expectation that the enrolled nurses' career progression is to become a registered nurse, which is supported by the high dual registrations. Collectively these factors contribute to the enrolled nurse not feeling valued. Similar challenges to the equivalent role are found internationally.

CONCLUSION

The literature demonstrates a lack of understanding of the enrolled nurse role by the nursing profession. Further work is required to better understand the role and its place in the Australian nursing workforce.

IMPACT STATEMENT

Better understanding of the enrolled nurses' role and its place in the nursing workforce is needed to progress this role.

The community nurse in Australia. Who are they? A rapid systematic review

AIM

This study aimed to profile the community nurse in Australia.

BACKGROUND

The need for nurses in the community health care sector is increasing in response to shorter hospital stays, an aging population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector.

EVALUATION

MEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010 and 2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, 2 databases and 2 reports) were included in the review. Abstracted data followed the principles of workforce planning and included demographics, qualifications and roles.

KEY ISSUES

Inconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work.

CONCLUSION

A lack of concrete data has overshadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan.

IMPLICATIONS FOR NURSING MANAGEMENT

There is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce.

Soft Skills Teaching by Top-Ranked U.S. Nursing Faculty

BACKGROUND

Although prior studies demonstrate that "soft skills" are necessary for workplace success, few consider the emphasis faculty place on teaching soft skills. This study reports how top-ranked U.S. nursing faculty prepare students for success by incorporating soft skills training into their courses.

METHOD

Data were collected with an online survey distributed in spring 2020 to approximately 2,000 faculty at 25 top-ranked nursing schools. Responses were solicited from those who have taught bachelor's and master's students within the past 2 years. Of 165 respondents who started the survey, 144 finished (7%).

RESULTS

Most nursing faculty view soft skills as important and feel at least some responsibility for teaching those skills.

CONCLUSION

This study indicates that a majority of faculty are teaching a range of soft skills and that when they teach those skills, they are also likely to provide students with feedback. [J Nurs Educ. 2021;60(8):437-443.].

A systematic review of activities undertaken by the unregulated Nursing Assistant

AIM

To identify activities performed by Nursing Assistants in acute and primary healthcare.

DESIGN

Systematic review.

DATA SOURCES

The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants.

REVIEW METHODS

From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories.

RESULTS

Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision.

CONCLUSION

Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training.

IMPACT

Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.