Transitioning into new clinical areas of practice: An integrative review of the literature

Why do nurses seek employment in forensic mental health and what are their first impressions of the clinical environment? A mixed methods study

AIM

The aim of the study was to investigate why registered nurses seek forensic mental health employment and explore their initial impressions of this setting.

DESIGN

Explanatory sequential mixed methods.

METHODS

Registered nurses employed in a forensic mental health hospital completed an online survey about their reasons for seeking work in forensic mental health and their transition into the setting. To fully explore findings, semi-structured interviews were conducted with a sub-group of survey respondents. Descriptive statistics were used to analyse survey data, and thematic analysis was used to analyse the interviews.

RESULTS

Sixty-nine respondents completed the survey, and 11 interviews were conducted. Prior interest in forensic mental health and encouragement from hospital staff were considered important influences in seeking forensic mental health employment. New knowledge, changes in clinical responsibility, exposure to patients' background offences and security processes overwhelmed some participants initially. However, participants reported that the initial challenges of their transition revealed opportunities to develop genuine connections with patients.

CONCLUSION

This study provides a new understanding of the reasons why nurses seek employment in forensic mental health and the challenges and opportunities experienced when first working in this setting. Such professional and personal elements need to be considered by organizations to strengthen recruitment strategies and support future nurses' transition into forensic mental health settings.

IMPACT

This study provides new knowledge about recruiting and supporting nurses' transition into forensic mental health employment. As such, it informs policymakers, clinical services and managers about strategies needed to attract and retain this workforce.

PATIENT OR PUBLIC CONTRIBUTION

No public or patient involvement.

The experience of nurses moving into forensic mental health employment: A qualitative study

While forensic mental health has seen considerable growth over the last two decades, little is known about the experience of registered nurses working in these environments. This study used a qualitative descriptive approach and interviewed 11 registered nurses to explore the interpersonal experiences of transition into a forensic mental health hospital. The data revealed three themes. 'Observing what's safe' examined nurses' ability to maintain safety in the context of inconsistent practices among colleagues. 'Navigating cliques and divisions' focused on nurses' sense of belonging and adapting to professional and personal groups. Finally, 'gaining management support' reflected nurses' experiences of engagement with management. This study provides new insight into nurses' experience of adapting to employment in forensic mental health settings and highlights the importance of positive support strategies for workplace transition.

Nurses' Clinical Decision-Making in a Changed COVID-19 Work Environment: A Focus Group Study

This study aims to explore how a changed COVID-19 work environment influences nurses’ clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues’ competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.

Weathering the Storm of Uncertainty: Transitioning Clinical Specialties as an Experienced Nurse

BACKGROUND

Changing jobs is very stressful for new and experienced nurses alike. However, the focus is usually placed on new graduate nurses. Processes that experienced nurses who transition clinical specialties (new-to-setting nurses) undertake are absent from the literature, threatening negative outcomes.

METHOD

Constructivist grounded theory guided discovery of the transition process for new-to-setting nurses, and a trustworthiness protocol was used to augment rigor.

RESULTS

Experienced nurses who transitioned clinical specialties shared their experiences via 11 in-depth interviews, resulting in the middle range theory: weathering the storm of uncertainty. Nurses detached, encountered uncertainty, and established practice and place as they changed specialties. Nurses continuously handle change, but as they weather such storms, they can not only survive but also thrive.

CONCLUSION

This framework provides a structure for nurse leaders (e.g., staff development professionals) as they support experienced nurses at times of change. These leaders can help nurses to successfully navigate changes to improve the safety, quality, and outcomes of health care. [J Contin Educ Nurs. 2021;52(10):471-481.].

From registered nurse to nursing student - Exploring registered nurses' transition to nursing student during a post-registration children's nurse programme: A qualitative descriptive research study

BACKGROUND

Registration as a children's nurse in Ireland occurs via two routes, an undergraduate degree in children's and general nursing and a twelve-month post-registration children's nurse programme. Candidates undertaking the latter are experienced nurses on the register for either general, intellectual disability or mental health nursing yet they are required to become a nursing student for the duration of the programme. Although anecdotal evidence indicates that this presents unique challenges for these students the experiences of transitioning from registered nurse to nursing student has not been explored since inception of the programme in 2006.

OBJECTIVES

The study aimed to explore the experiences of the registered nurse that transitioned to nursing student during the Post-registration Children's Nurse Programme, to identify the previous experience of the registered nurse and to identify what challenged and supported successful transition.

DESIGN

A qualitative descriptive research design was used.

SETTING

The study was carried out in a large teaching children's hospital in Dublin, Ireland.

PARTICIPANTS

A purposeful sample of six registered nurses that completed the programme within the last 12 months was interviewed about their experiences of being a post-registration nursing student.

METHODS

Face-to-face, semi-structured, conversation-style interviews were conducted.

RESULTS

Four main themes were identified from the data: 'Feelings related to returning to student status', 'Supports throughout the transition', 'Differences between disciplines' and 'Knowing your place'. Registered General Nurses (RGN) had different learning needs in comparison to registered nurses in intellectual disability (RNID) and expressed difficulty adapting to the role of nursing student as they felt that their previous knowledge and experience was being overlooked. In contrast, RNIDs were more challenged on clinical placement by unfamiliarity with clinical equipment and terminology. Both RNIDs and RGNs found that the nursing staff on their placements were a source of support despite reporting that they rarely worked with their designated preceptor.

CONCLUSIONS

The challenges experienced by nursing students from different nursing disciplines sharing the same post-registration programme needs to be considered in the planning and implementation of all aspects of the programme. Healthcare staff should become more aware of the challenges experienced by the postgraduate nursing student when educating and supporting their learning within the preceptor-student relationship.

Current trends in global nursing: A scoping review

Aim

This review aimed to elucidate research trends in global nursing in international literature.

Design

A scoping literature review of the PRISMA was used to guide the review.

Methods

PubMed was used to search for English articles published in academic journals between 2016–2018. The search keywords were “global/international/world nursing.” We used thematic synthesis to analyse and interpret the data and generated topics for global nursing literature.

Results

In total, 133 articles were analysed. Six topics emerged: (a) conceptualization of global nursing, (b) environmental health, (c) infectious diseases, (d) security efforts, (e) global shortage of nursing personnel and (f) diversification of study abroad programmes. The results of this review reflect today's serious international health, labour and global environmental issues. Based on these latest global nursing topics, it is necessary to develop new strategies, nursing models and environment‐related theories to create and maintain a healthy environment.

The perception of training and professional development according to nursing students as health workers during COVID-19: A qualitative study

Aim

To explore the perception of education and professional development of final-year nursing students who carried out health relief tasks during the COVID-19 pandemic.

Background

The COVID-19 pandemic has led to a global health emergency. This situation has exacerbated the need for additional healthcare employees, forcing the Spanish government to incorporate volunteer nursing students as auxiliary health staff.

Design

A qualitative study framed in the constructivist paradigm.

Methods

Twenty-two students of nursing were recruited. A purposeful sampling was implemented until reaching saturation. A semi-structured interview as a conversational technique was used to collect information based on three dimensions: academic curriculum, disciplinary professional development, and patient care. Subsequently, a content analysis of the information was carried out. Three phases were followed in the data analysis process: theoretical, descriptive-analytical, and interpretive. The COREQ checklist was used to evaluate the study.

Results

The most important results are linked to the students’ professional and academic preparation, how the nurses handled the pandemic situation and the characteristics of the COVID-19 patients.

Conclusions

Students require training in order to offer holistic care to patients, adapted to the context. Participants highlight the importance of professional values and recognise a high level of competence and autonomy in nurses.

Using technology to support the emotional and social well-being of nurses: A scoping review

AIMS

(a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research.

DESIGN

A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented.

DATA SOURCES

Between 11-12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies.

REVIEW METHODS

Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies.

RESULTS

Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community.

CONCLUSION

The review identified a dearth of research into how technology can support the well-being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed.

IMPACT

Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face-to-face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology-mediated support for the emotional and social well-being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.

From incomer to insider: The development of the TRANSPEC model - A systematic review of the factors influencing the effective rapid and early career TRANsition to a nursing SPECiality in differing contexts of practice

OBJECTIVE

Shortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice.

METHODS

A comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers.

RESULTS

Twenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse's transition is influenced by time.

CONCLUSIONS

For successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase.