An online study of Australian Enrolled Nurse conversion

Bridging Educational Grant in Nursing (BEGIN) students' intentions for retention in long-term, home and community care: A survey protocol

INTRODUCTION

Retention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses' intentions for retention in these sectors. However, perspectives of nursing students preparing to enter the workforce, and their intentions for short-term and long-term retention, remain unknown. This study aims to explore relationships between short-term and long-term intentions for retention with psychological empowerment, work engagement, career commitment, burnout, prosocial motivation, self-care and personal resilience among students enrolled in nursing educational bridging programs supported by the Bridging Educational Grant in Nursing (BEGIN) program in Ontario, Canada.

METHODS AND ANALYSIS

This cross-sectional design study will use an open online survey to investigate perspectives of current nursing students enrolled in educational bridging programs on factors relating to psychological empowerment, work engagement, career commitment, resilience, burnout, prosocial motivation, self-care and intentions for retention. Additionally, the survey will collect demographic information, including age, gender, ethnicity, citizenship, income, family status, nursing role, and years of employment and/or education. Open-ended questions will elicit participants' perspectives on financial considerations for career planning and other factors impacting intentions for retention. Descriptive data will be presented for contextualisation of participants' demographic characteristics to enhance generalisability of the cohort. Descriptive statistics will be used to summarise participants' scores on various assessment measures, as well as their short-term and long-term intentions for retention in LTC and HCC after completion of BEGIN. A Pearson's product moment r correlation will determine relationships between intentions for retention and other measures, and linear regression will determine whether any potential correlations can be explained by regression.

ETHICS AND DISSEMINATION

This research protocol received ethical approval from a research-intensive university research ethics board (#123211). Findings will be disseminated to nursing knowledge users in LTC and HCC through publications, conferences, social media and newsletters.

The voice of the second-level regulated nursing role: a qualitative approach

BACKGROUND

With an international nursing shortage, there is a need to navigate towards an improved nursing workforce structure where each nursing role is valued and recognised for the work they contribute. The second-level regulated nursing role is seen as integral; however, there is role confusion, especially with the registered nurse, and high attrition. To implement strategies to retain an integral nursing workforce, there is a need to better understand the role from the experiences and expectations of the second-level regulated nursing role.

AIM

To gain a better understanding of the second-level regulated nursing role in the Australian nursing workforce.

DESIGN

Qualitative descriptive study from a larger mixed methods study.

METHOD

Five focus groups in 2018. The findings were analysed through the lens of organisational behaviour.

RESULTS

The findings identified that enrolled nurses' intrinsic and extrinsic motivators influenced levels of job satisfaction and sense of feeling valued. The findings also identified key determinants that influence job satisfaction and occupational stress: enrolled nurses' understanding of their role and scope of practice; the registered nurses' understanding of the enrolled nurses' role and their role when working with the enrolled nurse; and the organisation's understanding and recognition of their role. When these determinants align, there is job satisfaction, less occupational stress and enrolled nurses feel valued. At a professional level, the title does not reflect the role, and there are no career pathways.

CONCLUSION

This study explained why recurrent challenges impact the role and what contributes to those in the role feeling valued. Challenges that affect job satisfaction and occupational stress for the second-level (enrolled) nurse are related to the working environment and with whom the nurse works. From a professional level, there are limited career opportunities that recognise and retain the enrolled nurse in their role.

Healthcare professionals' perspectives on enrolled nurses, practical nurses and other second-level nursing roles: A systematic review and thematic synthesis

BACKGROUND

Significant workforce shortages and economic pressures have led to the expanded scope and reintroduction of new roles for second-level nurses in many Organization for Economic Co-operation and Development countries. Given this, there is a need to understand the emic and etic perspectives of second-level nurses, to ensure collaborative teamwork and safe patient care.

OBJECTIVE

This review aimed to systematically identify, appraise, and synthesize qualitative research evidence on healthcare professionals' perspectives on second-level nursing roles in the healthcare workforce. These findings inform recommendations that would influence the development and implementation of these roles in healthcare organisations.

DESIGN

A systematic review and thematic synthesis of qualitative research was conducted. Six databases were systematically searched and forward and backwards searching completed. Included studies focused on healthcare professionals' perspectives (including views of second-level nurses themselves) on second-level nursing roles. All included articles were from Organization for Economic Co-operation and Development countries. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the evidence quality. The results section of each included article was coded and descriptive themes were developed. An interpretative and iterative process led to the final analytic themes.

FINDINGS

Twenty-six qualitative studies were identified from five countries over 26 years. Four analytic themes were identified: undifferentiated role; efficient but limited; subordinated task-doers; and broadening scope and strengthened identity. The synthesis demonstrated dichotomies wherein some second-level nursing roles were devalued, and others had increasing scope and responsibility. Role and boundary confusion was evident and had not decreased over time. Hierarchies in nursing practice underlined the split between critical thinking and hands-on approaches to care which, in some cases, debased the second-level nursing role because of its association with practical hands-on care.

CONCLUSIONS

The analytic themes in this synthesis suggest that second-level nurses have faced the same issues over decades with little change. Perceptions of second-level nursing roles are primarily influenced by meso (organisational level) factors and micro (individual, behavioural) factors. The synthesis concludes that a cultural shift in valuing the hands-on care provided by second-level nursing is necessary, along with systems-level shift that clarifies the role of second-level nursing within healthcare teams to enhance collaborative practice. Further research should attend to macro-level influences on perceptions of second-level nurses, the work they do, and how this is valued or institutionally embedded. Tweetable abstract: Healthcare professionals' perspectives on second-level nursing roles: a systematic review and thematic synthesis.

Juggling employment and studies: Nursing students' perceptions of the influence of paid employment on their success

BACKGROUND

Undergraduate nursing students are participating in part-time employment to finance their way through their studies despite evidence that working while undertaking study negatively impacts on their academic performance.

METHOD

A mixed method research design was used to collect data for this study. Thematic analysis was used to analyse the data. The survey was completed by 58 students enrolled in a three-year Bachelor of Nursing (BN) programme across two campuses at Toi Ohomai Institute of Technology in the Bay of Plenty, New Zealand.

RESULTS

Findings from this study showed student nurses undertake part-time work to reduce financial hardship and avoid student debt. Students reported their employment whether it be in health care, retail or hospitality, provided them with skills to support their nursing studies. An important finding was irrespective of the number of hours worked, students reported their work impacted negatively on their academic success as it diminished the amount of time they had to study.

CONCLUSION

Although this is a small-scale study, the results provide valuable insight into nursing students' perceptions of the influence of paid employment on their academic success within the nursing programme. This research has national and international relevance given there is evidence that significant numbers of nursing students across many countries participate in part-time employment to reduce financial hardship and avoid excessive debt.

Practical Nurses' Lived Experience of Returning to School

The lived experience of licensed practical nurses (LPNs) pursuing Bachelor of Nursing (BN) education is not commonly studied in Canada. The aim was to understand the transition experience of LPNs who bridged into a BN program. Max van Manen's phenomenological methodology was used through use of a semistructured interview guide to explore the lived experience of LPNs who pursued baccalaureate nursing education. Five themes were found: seeking advancement; stepping back into the student role; juggling work, school, and family; struggling to be understood; and seeing things differently. In summary, LPN-to-BN students have a well-developed sense of identity as nurses. These students can benefit from a specifically designed, stand-alone bridge course to situate them within a BN program that leads to successful fulfillment of entry-to-practice competencies for RN licensure.

Using Online Meeting Software to Facilitate Geographically Dispersed Focus Groups for Health Workforce Research

Focus groups as a data collection method in qualitative research have been used for several decades with great effect. Recent developments in online mechanisms for communication have prompted several researchers to explore alternate means of facilitating focus group participation. However, much of the online focus group literature has explored the use of text-based communication; there are few reports on the application of real-time online video-enabled software. In this article, we seek to inform the growing use of online-meeting software-mediated focus groups by reporting and analyzing its application within the context of a health workforce study among geographically dispersed radiation therapy professionals.

Understanding the enrolled nurse to registered nurse journey through a model adapted from Schlossberg's transition theory

BACKGROUND

Substantial numbers of Enrolled Nurses (ENs) enrol in higher education programs to undergo the transition to Registered Nurse (RN) with the experience described as containing numerous challenges.

OBJECTIVES

This paper reports on a synthesis of the literature that explores the experiences of ENs undertaking a program of study to convert to RN. Consequently, a model is developed to identify educational interventions and resources to enable a successful transition for these students.

DESIGN

A narrative review was completed with thematic synthesis of the literature guided by Schlossberg's Transition Theory, and Thomas and Harden's framework for systematic analysis of qualitative studies.

DATA SOURCES

CINAHL, Scopus, ProQuest Central and Health Collection were searched.

REVIEW METHODS

The databases were searched for English language journal articles, theses and grey literature published from 1987 to 2016 from Australia, New Zealand, the United Kingdom, Canada and the USA. The key search words included truncations of: "enrolled nurse", 'licensed practical nurse', "transition", "conversion" and "experience". This resulted in the identification of 33 related articles for review.

RESULTS

Themes and sub-themes developed from the literature synthesis were integrated into an 'EN to RN Transition model.' The four stages of the model reflect the experiences of the ENs as they overcame the various challenges they encountered during their transition to RN. The model was used to develop recommendations that may improve their transition experience and decrease attrition.

CONCLUSION

This paper reports on a synthesis of the literature, and presents a four stage model, that reflects the experiences of ENs in their transition to RN. Recognising the elements within each stage can assist educators develop strategies and provide educational resources to enhance the EN journey.

EN2RN - transitioning to a new scope of practice

BACKGROUND

In Australia, newly graduated registered nurses enter the workforce and a number of these have previous experience as enrolled nurses. For all newly graduated registered nurses, transitioning to the new role can be challenging.

AIM

The aim of this study was to explore the experiences of enrolled nurses transitioning to the role of registered nurses to support the development of effective transition programs.

DESIGN

An exploratory qualitative design.

METHODS

In-depth interviews with a purposive sample from one health service in South East Queensland, Australia. Data were analysed thematically.

FINDINGS

The three main themes emerging from analysis: a new scope of practice, perceptions of capability, building on experience and knowledge.

CONCLUSIONS

We recommend assessment of individual learning needs and support during the transition period which acknowledges previous experience and recognises learning required to effectively transition to the role of a registered nurse.

Australian rural, remote and urban community nurses' health promotion role and function

Community nurses have often been 'touted' as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content

Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse whom complete either a certificate or diploma program. Recent changes to educational preparation and resulting scope of practice for enrolled nurses have resulted in increased confusion between roles and expectations of the different levels. Aim: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. Method: Course coordinators from nine organisations offering pre-registration nursing programs completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. Results: Comparative analysis of survey responses identified similarities and differences between registered and enrolled nurse programs. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programs appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two enrolled nurse programs. Conclusions: Findings further add to confusion regarding registered and enrolled nurses in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Does the choice of pre-registration paid employment impact on graduate nurse transition: an Australian study

The process of transition for newly qualified registered nurses in their first year of practice remains a difficult and onerous proposition. Aside from well-documented issues pertaining to orientation, preceptorship, appropriate patient allocation, indifferent communication and feedback from senior nursing staff, other influences can determine how new graduates adjust to the role of beginning registered nurse. The dataset from a large Australian study, that examined the impact of pre-registration paid employment on graduate nurse transition, contained a significant amount of data that indicated that undergraduate work choice might influence how senior colleagues view graduate nurses during their transition to registered nurse practice. Although this issue was beyond the scope of the original study, the volume of data and recurrence of this issue provided a strong rationale for further exploration. A secondary study was designed to explore the research question does previous undergraduate work choice influence how graduate nurses are viewed by senior colleagues during their transition to registered nurse? Using secondary analysis, and an interpretive descriptive approach, two qualitative data sets arising from focus groups and open ended questionnaire responses were analysed and three organising themes identified; drawing on prior learning, the burden of employment choice and outside the setting. The global theme "confidence and perceptions" describes graduate nurses' views about their prior paid employment choice being beneficial to them and perceived to assist them in the process of transition. Findings suggest that depending on the choice of prior paid employment, new graduates (particularly those who were formerly enrolled or second level nurses) are treated differently by their senior colleagues; in terms of the level of support offered in transition, whether prior skills and experiences from previous paid employment are acknowledged, made light of or dismissed. For successful transition to registered nurse practice it is recommended that senior nursing staff treat each new graduate equally, not based on prior paid employment experiences, and that all new graduates regardless of their prior work experiences require a period of adjustment to their new role.

Expanding the scope of practice for enrolled nurses working in an Australian rural health service - implications for job satisfaction

Career opportunities have been limited for enrolled nurses (ENs) working in small, rural health services. Medication endorsement offers ENs expanded scope of practice which may lead to improved job satisfaction. This small study compared job satisfaction between a group of ENs with recent medication endorsement and a group who elected not to undertake the course in a small, isolated health service. A questionnaire was designed to measure job satisfaction containing the measure of job satisfaction (MJS) scale and other information regarding the course in medication administration. Interviews were also conducted with medication endorsed nurses to gain a greater understanding about the course and their expanded scope of practice. Medication endorsed nurses were newer to nursing and their current job, and reported higher job satisfaction on all five factors. Non-medication endorsed nurses cited lack of confidence and ability as key reasons for not undertaking the course while medication endorsed nurses reported professional and personal reasons for expanding their scope of practice. Most enjoyed the responsibility and reported satisfaction from distributing medications and responding to pain while one viewed it as added work. The findings from this small study suggest that providing local education will improve job satisfaction of ENs.

Enrolled nurse to registered nurse: is there a link between initial educational preparation and course completion?

There is a shortage of registered nurses (RN) globally and equally in rural areas of Australia. The sparsely populated areas of rural Australia prompted the development of an external-mode EN-to-RN pathway course for enrolled nurses (EN) who want to complete a nursing degree. However, the awarding of advanced standing for EN clinical experience, regardless of educational background, is a new initiative that needs to be evaluated. Hence, this paper reports on the link between initial EN educational preparation and its impact on course completion. This exploratory correlation study used existing course data from four cohorts between 2000 and 2003. The comparisons included educational background, years of experience, and location of the EN-to-RN students. Significant differences were not found between rural and metropolitan students who completed or who withdrew from the course. Logistic regression analysis indicated that ENs in this sample with a hospital-based certificate rather than a technical college qualification were more likely to complete the course: Location and years of experience as an EN did not contribute significantly to course completion. The findings provide support for the same recognition of prior learning, regardless of educational background, for ENs entering a bachelor level nursing degree. The findings have relevance for Australia and other countries with similar challenges for ENs who want to become RNs without relocating to a city.

University and Health Service Partnership: A Model to Deliver Undergraduate Nurse Education in Rural Australia

A serious shortage of registered nurses at four hospitals in the Moira Shire in northern Victoria resulted in these communities forming the Moira Nurse Education Consortium to address this problem. This group approached the School of Nursing and Health Science at Charles Sturt University to deliver the Bachelor of Nursing (BN) by distance education to 25 enrolled nurses (ENs) currently employed by the participating hospitals. Development of this collaborative partnership is discussed, and findings of an evaluation study are included in the paper. Specifically the experiences of the students and the Director's of Nursing (DONs) of the participating hospitals are explored. The findings indicated that overall the participants were satisfied with the quality of the first year of the course and the functioning of the partnership. Highlights and challenges of the project are presented and directions for the future considered. This successful partnership represents innovative nursing education between rural hospitals and the School of Nursing and Health Science at Charles Sturt University. The emerging model is presented as a way to address the shortage of registered nurses in rural Australia.

Managing patients at risk of deterioration in rural hospitals: A qualitative study

OBJECTIVE

This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia.

DESIGN

A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift.

SETTING

Smaller rural hospitals in Victoria.

PARTICIPANTS

Registered Nurses (Division 1).

MAIN OUTCOME MEASURE

Observed and reported strategies used to manage deteriorating patients.

RESULTS

Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service.

CONCLUSIONS

We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery.

Interaction in cyberspace: an online focus group

AIM

This paper reports a study that explored whether active engagement and group interaction could be captured in an online environment.

BACKGROUND

Focus groups have become a common means of capitalizing on group interaction to collect rich responses to questions posed. Whilst their use is well established in the repertoire of qualitative researchers, with changing technology there is the opportunity to use a computer program that facilitates online engagement and interaction to bring together a group of people to explore issues, attitudes and perceptions.

METHOD

Using a qualitative descriptive method and purposive sampling, 38 Australian Enrolled Nurses participated in an online focus group. WebCT, a program that facilitates online engagement and interaction, was used to enable participants to interact from any computer, from any location, at any time.

FINDINGS

The experience of conducting an online focus group was a positive one. Advantages such as cost savings and convenience for both researcher and participants were identified. This study demonstrated that participants could be actively engaged over a 2-month period and that group interaction could be achieved to collect richly detailed research data.

CONCLUSION

Whilst online focus groups may not be suitable in every situation, the potential exists to capitalize on technology to bring together a group of people separated by distance in an online environment that encourages interactive discussion.