A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Role transition of newly graduated nurses from nursing students to registered nurses: A qualitative systematic review

BACKGROUND

The transition experience of newly graduated registered nurses is highly stressful and associated with high attrition rates.

OBJECTIVES AND DESIGN

This qualitative systematic review aims to consolidate the available evidence on the experiences of newly graduated registered nurses' role transition from nursing students to registered nurses.

DATA SOURCES

English language research published between 2010 and 2022 was searched using PubMed, CINAHL, Scopus, Embase, PsycInfo and ProQuest Dissertations and Thesis databases.

REVIEW METHODS

Data were extracted using a data extraction form and appraised using the Critical Appraisal Skills Programme (CASP) tool for published studies or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for unpublished studies or grey literature, respectively.

RESULTS

The review included 25 studies and the meta-synthesis identified four themes: (a) Knowledge deficit, (b) Overwhelming clinical practise, (c) Importance of workplace support, and (d) Meaning of "being a nurse".

CONCLUSIONS

Newly graduated registered nurses experienced facing knowledge deficits in the clinical setting and felt overwhelmed with work, especially for newly graduated registered nurses during the Covid-19 pandemic. Support from colleagues was invaluable, and they wished for better support through standardised transition programs. Despite nursing being mentally and physically exhausting, many newly graduated registered nurses regarded their profession satisfying and meaningful, however some eventually resigned. Understanding the transition experiences of newly graduated registered nurses can provide valuable insights on how to facilitate their transition and in turn decrease attrition rates, and ensure safe care for the patients and that public healthcare needs are met.

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce

Aim

The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care.

Methods

A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce.

Results

A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs.

Conclusions

The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.

Implementation of a Registered Nurse Primary Care Clinical Mentoring Academy

Registered nurses (RNs) are pivotal team members for improving the quality of care in communities; however, they are underutilized in primary care. Two schools of nursing in Alabama partnered to develop and implement a project to build a resilient primary care RN workforce. A major component of this project is the Primary Care Clinical Mentoring Academy (PCCMA), which was designed to prepare RN clinical mentors to implement positive student learning experiences in the primary care setting. The PCCMA follows a comprehensive curriculum implementing both didactic instruction and interactive activities related to primary care competencies; interprofessional education and collaborative practice; and primary care RN mentor roles and responsibilities. Participants reported that the PCCMA was effective and useful, and they perceived that it would improve their overall job performance as a clinical mentor. The PCCMA is an effective way to produce confident and capable RN mentors in primary care. [J Contin Educ Nurs. 2022;53(7):312-320.].

Funeral Experience in South Korea: A Phenomenological Study

Few studies of death preparation in South Korea are available. This article describes South Koreans' experiences of death and a funeral in a hospital setting to improve health care providers' ability to care for dying patients and their family. Using Colaizzi's phenomenological method, we conducted semistructured interviews with 40 South Koreans who had lost a family member in a hospital setting. Participants' statements were classified into 12 themes, 5 theme clusters, and 3 categories: (a) vagueness of funeral culture, (b) distortion of meaning in funeral culture, and (c) the need to prepare for death and process grief. Our findings are relevant to hospital-based health care providers who care for dying patients and their family. Targeted educational information could help health care providers better serve patients and family. Policy changes could improve quality of care by allowing health care providers to transition with the family from hospital units to a hospital-based funeral setting.

What is the evidence that can inform the implementation of a preceptorship scheme for general practice nurses, and what is the evidence for the benefits of such a scheme?: A literature review and synthesis

OBJECTIVES

This is a literature review of the published evidence of the benefits and suggested structure of preceptorship programmes for General Practice Nursing, with the aim of informing General Practices and networks who are instituting preceptorship programmes.

DESIGN & DATA SOURCES

A literature search was carried out in the CINAHL Plus database of English language papers from the year 2000-2019 using the search terms; (Precept* OR mentor*) AND ("community practice" OR "primary care" OR "general practice" OR "new GPN" OR "new general practice nurse" OR "nurse new to general practice" OR "induction GPN" or "GPN").

REVIEW METHOD

A literature review and narrative synthesis of the evidence.

RESULTS

Our searches produced twelve papers. Seven papers reported on single preceptorship programmes in General Practice or primary care, with qualitative or quantitative evaluation of their effects. Three qualitative papers reported participant experience of preceptorship, or discussed the learning needs that preceptorship must address. Two literature reviews reported the evidence for preceptorship in General Practice or nurse practitioner programmes.

CONCLUSION

The quality of the evidence on General Practice Nurse preceptorship is low. There is a lack of robust evidence on the effects, and the benefits. These should be evaluated as preceptorship programmes are implemented. The limited available evidence suggests that a structured preceptorship programme, of more than 4 months duration, which allows the development of peer-to-peer support, is a good model for General Practice Nurse preceptorship. The involvement of doctors and the wider practice team is essential for the success of such a programme. Preceptors require training and support in the role. General Practice Nurse preceptorship should support the development of existing professional competencies, including the ability to make real-time autonomous clinical decisions. The financial costs, and cost of time away from clinical care, should be ameliorated as far as possible, when instituting a national General Practice Nurse preceptorship programme.

Barreras y facilitadores en la implementación de la estrategia de atención primaria en salud en Palmira, Colombia

Objetivo Conocer las barreras y facilitadores para la continuidad en la implementación de la estrategia de Atención Primaria en Salud en Palmira.Métodos Se tomó la experiencia de Atención Primaria en Salud (APS) del ente territorial de salud del Municipio de Palmira, Colombia, un territorio de aproximadamente 283 431 habitantes. Se usó el enfoque metodológico cualitativo mediante el análisis de contenido temático. La población objeto fueron los informantes clave, individuos con un papel potencialmente significativo en la formulación y desarrollo de la estrategia de APS, elegidos con un enfoque no probabilístico por conveniencia. La información se obtuvo de fuentes primarias y secundarias y se utilizó el software informático de análisis cualitativo Atlas Ti V7, como herramienta de apoyo para el manejo de datos.Resultados El análisis de barreras y facilitadores para la continuidad de la estrategia de APS identificó las principales características de la estrategia y una serie de temas recurrentes al momento de analizar las posibles barreras y facilitadores en los componentes de proceso, actores, contenido y contexto. Cada uno de estos temas presentó comportamientos diversos según la percepción de los participantes. Algunos temas fueron percibidos como facilitadores, barreras o como ambos.Conclusión Al comparar las barreras y facilitadores, se encontró que, a nivel global, son mayores las barreras que los facilitadores, comportamiento reflejado en la teoría, que indica que la población con algún tipo de vulnerabilidad presenta mayor cantidad de barreras frente a los servicios de salud y que la estrategia de APS hace especial énfasis en este tipo de población.

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.

An overview of the general practice nurse workforce in Australia, 2012–15

Several surveys of the general practice nurse (GPN) workforce have been undertaken in Australia over the last decade, but they have limitations, which mean that the workforce is not well-understood. The aim of this study is to describe the profile of the GPN workforce using the dataset available through the Australia Health Practitioner Registration Agency and to explore how it differs from the non-GPN nursing workforce, and if this workforce is changing over time. Data from labour force surveys conducted from 2012 to 2015 were used. Variables examined were age group, gender, remoteness area, hours worked, nurse type (enrolled (EN) or registered (RN)), years in the workforce and also intended years of work before exiting the workforce. When compared with the broader nursing workforce, a greater proportion of GPNs in 2015 were older (60 v. 51%), worked part-time (65 v. 48%) and worked in regional areas (35 v. 26%). Additionally, the characteristics of GPNs has changed between 2012 and 2015, with an increased proportion of younger nurses, more registered nurses and fewer working in remote areas. To ensure a sustainable workforce, particularly in rural and remote areas, strategies to recruit and retain this workforce will be needed.

Australia's first transition to professional practice in primary care program for graduate registered nurses: a pilot study

Background

Increases in ageing, chronic illness and complex co-morbidities in the Australian population are adding pressure to the primary care nursing workforce. Initiatives to attract and retain nurses are needed to establish a sustainable and skilled future primary care nursing workforce. We implemented a transition to professional practice program in general practice settings for graduate nurses and evaluated graduate nurse competency, the graduate nurse experience and program satisfaction. This study aimed to determine whether a transition to professional practice program implemented in the general practice setting led to competent practice nurses in their first year post-graduation.

Methods

A longitudinal, exploratory mixed-methods design was used to assess the pilot study. Data were collected at three times points (3, 6, 12 months) with complete data sets from graduate nurses (n = 4) and preceptors (n = 7). We assessed perceptions of the graduates’ nursing competency and confidence, satisfaction with the preceptor/graduate relationship, and experiences and satisfaction with the program. Graduate nurse competency was assessed using the National Competency Standards for Nurses in General Practice. Semi-structured interviews with participants at Time 3 sought information about barriers, enablers, and the perceived impact of the program.

Results

Graduate nurses were found to be competent within their first year of clinical practice. Program perceptions from graduate nurses and preceptors were positive and the relationship between the graduate nurse and preceptor was key to this development.

Conclusions

With appropriate support registered nurses can transition directly into primary care and are competent in their first year post-graduation. While wider implementation and research is needed, findings from this study demonstrate the potential value of transition to professional practice programs within primary care as a nursing workforce development strategy.

Practice manager expectations of new graduate registered nurses in Australian general practice: a national survey

Practice managers are often involved in the employment of practice nurses and are likely to have a significant role in future transition programs in general practice. Therefore, the aim of the study was to explore practice managers' expectations of new graduate registered nurses working in general practice. A nation-wide web-based electronic survey distributed by the Australian Association of Practice Management was used to collect demographic data and practice managers' expectations of new graduate nurses directly transitioning into general practice in their first year of practice. The sample was broadly representative of the Australian state and territory population numbers. Respondents were predominantly female with postgraduate qualifications. The findings of this study highlight that practice managers who currently work with practice nurses would be supportive of graduate registered nurses in general practice in their first year with preceptor support. The results of this study have important implications for nursing workforce development and it is recommended that such initiatives are widely introduced with appropriate financial support.