New graduate registered nurse transition into primary health care roles: an integrative literature review

Perspectives of Chinese New Nurses Regarding Successful Transition: A Qualitative Study

BACKGROUND

Transition issues have been discussed for many decades, yet little is known about successful transition expectations in the context of Chinese culture.

PURPOSE

This article was designed to describe the expectations of newly graduated nurses in China regarding successful transition.

METHODS

A qualitative, descriptive study design was employed, and a purposive sampling method was used to recruit interviewees. All of the one-to-one conversations were held in a quiet room to ensure privacy. All of the interviews were transcribed and then analyzed using thematic analysis.

RESULTS

Nineteen new nurses were recruited from seven tertiary hospitals and participated in the in-depth interview process. Transition success, that is, "professional metamorphosis," was revealed through the four themes of "being competent in nursing work," "establishing a professional identity," "establishing comfortable interpersonal relationships," and "achieving balance between work and life."

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Chinese new nurses expect their successful transition to achieve a professional metamorphosis in many aspects. A successful transition is not only a journey of professionalization but also a process of socialization. New nurses expect to achieve both maturity in their work and wisdom in life. The results of this study provide a greater understanding of transition issues in the context of Chinese culture. Thus, support and strategies cannot be limited to interventions designed to improve working competence but should be individualized to help new nurses achieve a smooth transition.

Primary care nursing competencies in Canadian undergraduate nursing programs: A national cross-sectional survey

AIM

To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula.

BACKGROUND

Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce.

DESIGN

We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74).

METHODS

The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree).

RESULTS

The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication.

CONCLUSIONS

There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada.

Virtual simulation and problem-based learning enhance perceived clinical and cultural competence of nursing students in Asia: A randomized controlled cross-over study

BACKGROUND

Both clinical and cultural competencies are of paramount importance in ensuring patients' safety and high-quality care. While problem-based learning (PBL) is a widely applied pedagogy in nursing education, an emerging technology-based pedagogy, virtual simulation provides a realistic clinical learning experience for students. It can be an effective solution for continuing clinical and cultural learning across countries in the era of the pandemic.

OBJECTIVES

This study aimed to compare the effectiveness of virtual simulation and PBL on the perceived clinical and cultural competence for nursing students.

DESIGN

A randomized controlled cross-over study design was used.

SETTINGS AND PARTICIPANTS

Sixty-one undergraduate and postgraduate nursing students from five Asian regions were selected for participation.

METHODS

Participants were randomized to receive either virtual simulation (group A) or PBL (group B) for one day, followed by another intervention on the second day. Three self-reported questionnaires were used: Clinical Competence Questionnaire (CCQ), Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV), and demographic questionnaire.

RESULTS

The results revealed that students in both arms had significant improvements in CCQ total score (A: d = 21.500, P < 0.001; B: d = 16.710, P = 0.001), nursing professional behavior (A: d = 8.233, P < 0.001; B: d = 6.323, P < 0.001), and advanced nursing skills (A: d = 2.533, P = 0.008; B: d = 2.129, P = 0.029) after two interventions. In addition, both arms demonstrated significant improvements in IAPCC-SV total score (A: d = 3.467, P = 0.037; B: d = 4.032, P = 0.010) and cultural skills (A: d = 0.767, P = 0.012; B: d = 1.000, P = 0.001). No significant differences were observed between the two arms.

CONCLUSIONS

The findings indicated that both virtual simulation and PBL were effective in promoting students' perceived clinical and cultural competence. As both education modes have their own uniqueness and effectiveness in both outcomes, the combination of both could enhance the variability of learning modalities. Notably, the use of virtual simulation first could engage students better in learning and achieve better educational outcomes.

A survey on the attitudinal differences between acute and community settings

INTRODUCTION

While challenges facing community and acute care practitioners have been studied elsewhere, this is not the case for respiratory therapists (RTs). This study aimed to examine attitudinal differences amongst RTs in British Columbia regarding challenges faced by acute and community settings.

METHODS

A 40-item anonymous online survey was sent to members of the British Columbia Society or Respiratory Therapists. Of the 40 questions, 11 were relevant to the study's aim.

RESULTS

Of 1024 invitations, 197 (19.2%) responded. One-hundred and seventeen (59.4%) self-identified as working in acute care settings, 53 (26.9%) in community settings, and 27 (13.7%) as "other". Stress- and interpersonal-related challenges showed statistically significant differences (P ≤ 0.05) based on work setting. Acute care had the highest percentage of responses for challenges related to technology, stress, inter-professional collaboration, and training. Community settings had the highest percentage in challenges related to independence and education. Both being equal received the highest percentage in challenges related to problem-solving, interpersonal, communication, and resource management.

DISCUSSION

While attitudinal differences exist, they are not extreme. It did not appear that respondents' primary motivation was to vote along "party lines".

CONCLUSIONS

The setting an RT works in can influence attitudes related to stress and interpersonal challenges. Despite this, one setting is not universally more challenging. Acute care settings can have greater technological, inter-professional, and training-related challenges. Community settings can have greater independence and education-related challenges. Both settings can provide similar challenges with problem-solving, communication, and resource management.

Curricular and Clinical Innovation Engaging Undergraduate Nursing Students to Build a Resilient Primary Care Workforce

BACKGROUND

Primary care health settings provide access to services for underserved populations, yet baccalaureate (BSN)-prepared nurses are currently underutilized on the primary care health care team.

PROBLEM

BSN curricula often focus on acute care settings for clinical experiences, and students may not be aware of the scope and impact the RN has in a primary care setting. This gap in experiences may lead to overlooking primary care employment opportunities.

PURPOSE

The purpose of this article is to describe the development, implementation, and evaluation of an innovative course that builds the primary care nurse workforce capacity.

APPROACH

An undergraduate elective course focusing on primary care didactic and clinical experiences was created.

OUTCOMES

Qualitative student feedback regarding the course was positive, while quantitative data revealed an above-average course outcome rating.

CONCLUSIONS

An effective intervention to increase workforce capacity in primary care settings is to immerse students in primary care concepts and experiences in a formal, combined didactic and clinical course.

Perceptions and experiences of nurses transitioning to primary care: A qualitative study

BACKGROUND

Transitioning to primary care is a highly stressful process for nurses due to the diverse roles and responsibilities required. Despite the global shift of health services requiring more nurses in primary care, there is a dearth of literature regarding their transition experiences.

AIM

To explore the perceptions and experiences of nurses transitioning to primary care.

METHODS

A qualitative descriptive design was used. Nineteen nurses from five primary care clinics in Singapore participated in the semi-structured interviews. These interviews gathered the experiences of nurses transitioning to primary care. Interviews were analysed using thematic analysis through an inductive and theoretical approach. Rigour was established through an audit trail, peer examination and member checking.

FINDINGS

Three themes of Idealistic assumptions, Role realignment and Seeking enlightenment emerged. These themes described the nurses' initial disorientation to the unfamiliar primary care setting; their attempts to fit in by embracing the new environment and suppressing their true emotions; and the support received coupled with their ownership to learn.

IMPLICATIONS FOR NURSING POLICY

The findings highlight the importance for nurse managers to promote positive transition experiences through the modification of existing support programmes and organizational cultures. To further enhance the nurses' retention within primary care, it is imperative for nurse educators and policy makers to revise the nursing curricula, primary care nursing career framework and recruitment campaigns at the national level. This brings clarity to the misconceptions in the roles and expectations required of nurses in primary care.

Approaches used to enhance transition and retention for newly qualified nurses (NQNS): A rapid evidence assessment

AIM

To undertake a rapid evidence assessment of approaches used to enhance nurse transition and retention for newly qualified nurses and to evaluate the strength of the evidence for specific approaches to nurse transition and retention.

DESIGN

A rapid evidence assessment was undertaken. Electronic databases were searched, and the full texts of relevant papers were retrieved. Studies were appraised using relevant Critical Appraisal Skills Programme and Mixed Methods Assessment Tools and a single descriptor of quality: high; medium; or low was assigned to each output. Given the disparity in methods, the lack of randomised trials, results could not be combined; therefore, a descriptive approach was used to synthesise and present the data.

DATA SOURCES

The search was undertaken using: specific database searching; and secondary searching of relevant websites. Electronic databases (CINAHL complete, Academic search premier, Open Grey, ERIC* (Education), Web of Science-Social Science Citation Index and PubMed) were searched during February 2018.

RESULTS

Orientation and creating supportive environments were frequently reported as being effective in enhancing transition across a range of studies. A range of methods: quasi-experimental, survey and qualitative were used. Generally, the quality of most studies was poor.

CONCLUSIONS

Despite decades of research into the experiences of newly qualified nurses and development of schemes and frameworks to support them during this period, there is little substantive or robust evidence in terms of impact on retention. Further research into the longer-term retention of newly qualified nurses is recommended. Longitudinal studies would be beneficial in assessing the efficacy of approaches to enhancing retention.

Developing and validating the transition status scale for newly graduated nurses in China

AIM

The present study aimed to develop and examine the psychometric properties of the Transition Status Scale for Newly Graduated Nurses.

METHODS

Three phases were conducted: Phase I involved a qualitative research to explore and establish the potential items pool; Phase II reduced the items using the item analysis with a sample of 73 nurses. Phase III evaluated the psychometric properties of the final scale. Data from 814 valid questionnaires were analysed using exploratory factor analysis and confirmatory factor analysis.

RESULTS

Five factors, including 'Interpersonal integration', 'Profession-related positive emotion', 'Competence for nursing work', and 'Active coping strategies', 'Balance between work and life', accounted for 68.87% of total variance. Cronbach's α was 0.891. Confirmatory factor analysis indicated acceptable model fitness.

CONCLUSIONS

The Transition Status Scale for Newly Graduated Nurses has good psychometric properties. It can be used to measure the transition status conveniently and effectively.

IMPLICATIONS FOR NURSING MANAGEMENT

The assessment result with the Transition Status Scale for Newly Graduated Nurses can provide information about the transition status of new nurses, thereby providing reference to guide the specific nursing interventions to smooth the transition process. It can also work as an alternative instrument to compare the effectiveness of different transition programs.

Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015-19

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses

Aims and objectives

To explore newly graduated registered nurses' experiences and how they manage complex patient situations.

Background

Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.

Design

Qualitative study design.

Methods

Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.

Results

The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.”

Conclusion

The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.

Relevance to practice

Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

Newly graduated registered nurses' self-assessed clinical competence and their need for further training

Aim

To explore and describe changes in self-assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings.

Design

Quantitative longitudinal design.

Methods

The 50-item Professional Nurse Self-Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience.

Result

The components "ethical decision-making," "cooperation and consultation" and "clinical leadership" were rated highest in clinical competence and lowest in need for further training. The components "professional development" and "critical thinking" were rated lowest in clinical competence and "direct clinical practice" rated highest in need for further training. The clinical competence increased significant between 9-15 months, with the exception of "critical thinking" and need for further training decreased significantly between 9-15 months, with the exception of "critical thinking."

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals

AIM

To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

BACKGROUND

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care.

DESIGN

A cross-sectional design.

METHODS

Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used.

RESULTS

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

CONCLUSION

The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

RELEVANCE TO CLINICAL PRACTICE

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

Facilitating an early career transition pathway to community nursing: A Delphi Policy Study

Aim

To further develop and validate a new model of the early career transition pathway in the speciality of community nursing.

Design

Delphi policy approach, guided by a previous systematic review and semi-structured interviews.

Methods

Four rounds of an expert panel (N = 19). Rounds one, two and four were questionnaires consisting of a combination of closed (Likert response) and open-ended questions. Round three comprised of a focus group conducted using virtual meeting technology.

Results

The final model demonstrated reliable and valid measures. There were deficiencies in "pre-entry"-where the marketing of community nursing was negligible and the support around orientation informal and minimal, mainly due to tight budgetary concerns. Community practice holds a whole new dimension for nurses transitioning from acute care as the concept of "knowing your community" took time and support-time to be accepted reciprocally and develop a sense of belonging to the community.

The experience of transition from nursing students to newly graduated registered nurses in Singapore

Objectives

To investigate the experience of newly graduated registered nurses (NGRNs) in Singapore following their initial 6–12 months of transition from nursing student to registered nurse.

Methods

This mixed-methods study consisted of two phases. In the first phase, data were collected via the administration of the online survey to 30 NGRNs. The questionnaire contained 42 items of the four-point Likert scale survey. In the second phase, a focus group interview was conducted with 5 NGRNs to gather complementary information regarding the major findings from the first phase.

Results

The survey revealed despite most NGRNs (80%) in this study expressed overall satisfied with their transition, the item score was (2.97±0.61) out of 4, the majority (83.3%) also perceived their transition to professional practice being stressful, the item score was (3.07±0.74) out of 4.Three themes emerged from the interview, ‘personal transition experience’, ‘professional transition experience’, and ‘organizational transition experience’, which are entwined to construct overall NGRNs’ transition experiences.

Conclusions

This study reaffirms the theory-practice gap phenomenon. This signifies the need for closer collaboration between educational, healthcare industry and regulatory stakeholders to examine and address factors that influence their transition experience to better support them for workforce readiness.

Factors associated with final year nursing students' desire to work in the primary health care setting: Findings from a national cross-sectional survey

BACKGROUND

Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs.

OBJECTIVES

This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care.

DESIGN

A cross-sectional survey design comprising a quantitative online survey.

SETTING

14 Australian universities from all states/territories, both rural and urban.

PARTICIPANTS

530 final-year nursing students.

METHODS

Binary logistic regression identifying factors contributing to desire to work in primary health care.

RESULTS

The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support.

CONCLUSIONS

Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care.

Registered nurses transitioning from acute care to primary healthcare employment: A qualitative insight into nurses' experiences

AIMS AND OBJECTIVES

To describe the experiences of acute care registered nurses transitioning to primary healthcare settings.

BACKGROUND

The worldwide increasing demand for primary healthcare services has resulted in skilled acute care nurses transitioning to primary healthcare settings to meet workforce requirements. Little is known about the experiences and challenges associated with the transition. Knowledge of this will enable employers to design appropriate support processes and transitioning nurses can make informed choices.

METHODS

Semistructured interviews were conducted with nurses who had transitioned into primary healthcare employment in the last 5 years. Data analysis was undertaken using Braun and Clarke's (2006) thematic analysis approach.

RESULTS

Thirteen nurses were interviewed, and two themes identified-role learning: the new environment, and role socialisation: transition validation. Role learning was influenced according to the quality of orientation programmes, previous experience, clinical knowledge and professional support. Support and professional respect from mentors and/or employers greatly assisted with role socialisation and the transition experience.

CONCLUSIONS

Transitioning to primary healthcare employment provides unique challenges which must be considered by employers if they are to attract and retain experienced acute care registered nurses.

RELEVANCE TO CLINICAL PRACTICE

Understanding the experiences of nurses who transition from acute to primary healthcare employment can inform the design of orientation programmes and ongoing professional supports to address barriers and challenges. Targeted orientation and support has the potential to enhance recruitment and retention of experienced nurses in primary health care.

Assessment of public health core competencies in prelicensure baccalaureate nursing students

OBJECTIVE

The purpose of this study was to assess the use of the Public Health Foundation's (Public Health Foundation [PHF], ) Competency Assessment for Tier 1 Public Health Professionals to examine prelicensure baccalaureate nursing students' self-reported levels of competence in public health before and after completing community health nursing courses.

DESIGN

Prelicensure baccalaureate nursing students enrolled in community health nursing courses completed a pre and postcourse Competency Assessment for Tier 1 Public Health Professionals survey. The survey results were analyzed using nonparametric tests to determine whether there were significant differences in pre and postsurvey scores for the eight domains of public health core competencies, and for an overall competency score.

RESULTS

Significant differences were found in the pre and postaggregate mean scores for each of the eight domains of public health core competency, and the overall mean public health competency score. Chi-square testing of pre and postcourse competency found significant difference in the proportion of students who met criteria for self-reported competence in each of the eight domains and overall public health competence.

CONCLUSION

The Competency Assessment for Tier 1 Public Health Professionals can assist baccalaureate nursing faculty with assessing precourse learning needs, and postcourse evaluation of self-reported competence in public health.

Experiences of registered nurses transitioning from employment in acute care to primary health care-quantitative findings from a mixed-methods study

AIMS AND OBJECTIVES

To describe the experiences of registered nurses who transition from acute to primary health care (PHC) employment.

BACKGROUND

Internationally the provision of health care in PHC settings is increasing. Nurses are moving from acute care employment to meet the growing demand for a PHC workforce. However, little is known about the transition experiences of these nurses.

DESIGN

A sequential mixed-methods study comprising a survey, and semi-structured interviews. This study reports on survey findings relating to the transition experience.

METHODS

Convenience and snowballing techniques were used to recruit 111 registered nurses who had transitioned from Australian acute settings to PHC employment within the last 5 years. An online survey gathered data relating to personal and professional demographics, type of PHC setting and transition experiences.

RESULTS

Most respondents (n = 90, 81.1%) reported receiving some orientation, although the length and content varied considerably. Those working in metropolitan locations were more likely to report concerns associated with their orientation, with respondents from rural or remote locations more likely to have access to a preceptor than city/metropolitan respondents. Just under half of respondents found prioritising workload (n = 47; 42.7%) or organisational knowledge (n = 45; 40.9%) difficult or very difficult, and 47.7% (n = 53) felt isolated or unsupported. 49.5% (n = 55) reported being overwhelmed with the new role either sometimes or regularly. Barriers to transitioning successfully included limited employer support to attend professional development activities.

CONCLUSIONS

Availability of specific support measures may assist in the transition process. Findings from our study should be considered by employers when recruiting nurses new to PHC, and when designing orientation and ongoing education programmes.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the challenges faced by nurses who transition from acute care into PHC employment. Understanding the barriers and facilitators to successful transitions enhances the process for future recruitment and retention of PHC nurses. This evidence can inform managers, educators and policymakers in developing support programmes for nurses moving into PHC.

Impact of interactive situated and simulated teaching program on novice nursing practitioners' clinical competence, confidence, and stress

BACKGROUND

Novice nursing practitioners (NNPs) often struggle to make the transition to fully competent professionals. We sought to determine the impact of an interactive, situated learning workshop on a participant's clinical competence.

OBJECTIVES

This work aimed to improve the clinical competence, promote the self-confidence, and reduce the number of work-related stressors of NNPs.

METHODS

We randomly allocated 31 newly graduated NNPs into interactive situated and simulated teaching (ISST) and non-ISST groups, which were perceived as the homogeneity of the 2 groups based upon no significant difference at age, education level and work units. The ISST program comprised six follow-up interactive face-to-face support sessions over a three-month period following the standard orientation training course. We assessed the participants' competency, stress, and confidence levels in professional competence before and at the end of the study.

RESULTS

At the end of the three-month study period, the ISST group demonstrated superior nursing competency (p=0.001), as well as reported lower stress levels (p=0.011), and increased confidence in professional competence (p=0.026) as compared with those in the control group. A multiple regression analysis revealed that clinical nursing competence was positively correlated with the use of ISST (p=0.02) and negatively correlated with stress (p=0.03).

CONCLUSIONS

The ISST program for NNPs significantly improved their clinical competence. It may be helpful to ensure that new trainees have access to training programs that can facilitate their acclimation to their new working environments at the beginning of their careers.