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

BACKGROUND

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

OBJECTIVES

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

DESIGN

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BACKGROUND

Nursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff's clinical competence and adequate and continuous education.

AIM

This study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses' clinical competence and fundamental background factors.

METHODS

We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.

RESULTS

This study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.

CONCLUSION

The clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Costs and Effects of School-Based Licensed Practical Nurses on Elementary Student Attendance and Chronic Absenteeism

Despite increasing reliance on licensed practical nurses (LPNs) to provide health services in schools, we do not know whether this is a cost-effective prevention strategy against student absenteeism. Therefore, we evaluated the costs and effectiveness of an LPN-based school nursing program for improving attendance and chronic absenteeism at a large, urban school district in the southeastern USA. We first identified a matched set of 46 elementary schools (23 nurse, 23 no-nurse) by using an optimal multilevel matching algorithm based on student- and school-level characteristics. We then conducted a cost-effectiveness analysis on the matched set, using the ingredients method to estimate societal costs and multilevel regression to estimate effects. The results indicated that despite substantial incremental costs of $68,228 per school, the presence of a full-time LPN was associated with at best negligible improvements, and at worst slight disimprovements, in attendance and chronic absenteeism. We recommend a careful review of the theory of change for LPN-based school nursing programs to clarify the specific inputs and activities that are expected to lead to improved student outcomes. Education agencies should develop explicit assignment, training, monitoring, and auditing plans to ensure LPNs are equitably distributed and that their activities are aligned with the theory of change. Education agencies should also explore whether expanded Medicaid billing can reduce their share of the nursing cost burden.

Team Triage Intervention, Including Licensed Practical Nurse, to Increase HIV Testing Rates in the Emergency Department: A Quality Improvement Project

INTRODUCTION

Emergency departments have an important role in screening for human immunodeficiency virus infection and reducing the morbidity, mortality, and transmission of the human immunodeficiency virus. There are debates about human immunodeficiency virus screening, including opt-in, opt-out, and active choice models. Previous studies have shown that multiple factors affect the patient rate of acceptance, including where, when, and by whom the screening is offered. The purpose of this quality improvement project was to test a team-based triage intervention to improve the amount of HIV testing done in our emergency department.

METHODS

The design was a single site quality improvement intervention with post-intervention monthly rates compared to historic monthly rate controls. The intervention focused on the introduction of a Licensed Practical Nurse in addition to the current triage process and personnel. The percentage of patients receiving human immunodeficiency virus testing and the number of tests sent per month before and after the implementation of the intervention were measured.

RESULTS

Our results show that 0.6% (SD < 0.01) and 2.5% (SD 2.2) of patients received human immunodeficiency virus testing before and after implementation of the intervention, respectively (χ² = 501.76, P < 0.05). A mean of 37.4 (SD = 12.91) and 151.3 (SD = 33.34) human immunodeficiency virus tests were sent per month before and after implementation of the intervention, respectively (t = 8.53, P < 0.001).

DISCUSSION

This process intervention, in which licensed practical nurses offered human immunodeficiency virus screening tests during team triage, resulted in a 3-fold increase in the percentage of patients being tested for human immunodeficiency virus.

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.