A transition to practice programme for community service nurses
BACKGROUND: Professional nurses are expected to be competent and practice independently without supervision after completing their four-year training and a year of community service. However, studies have found that senior nurses in the profession experience community service nurses (CSNs) as lacking critical thinking skills and confidence in delegating tasks, and as incompetent in clinical skills. Evidence regarding the outcomes of supportive programmes such as nursing residency programmes revealed higher rates of new nurse retention, decreased nurse vacancies, cost savings, organizational commitment, improved patient safety, and decreased stress for the nurse. AIM: To develop a transition to practice programme for CSNs in Dr Kenneth Kaunda District. DESIGN: A mixed-method convergent-parallel design was used in this study. METHODS: The study was conducted in two phases. In phase 1, objective 1 explored the competencies of CSNs from the perspective of CSNs and their preceptors using the Competency Inventory for Registered Nurses (CIRN) questionnaire; focus groups and semi-structured interviews were conducted with CSNs, health facility managers and preceptors to explore and describe the learning needs of CSNs (objective 2) during their community service year. In objective 3 a conceptual framework for a transition to practice programme was described using theory development methodology. In phase 2 a transition to practice programme was developed using programme development methodology (objective 4). SETTING AND SAMPLE: This study was conducted in 20 public health facilities of Dr Kenneth Kaunda District in the North West province of South Africa. The public health facilities sample included seven clinics, eight community health centres, three district hospitals, one regional hospital and one specialized hospital. To explore the competencies of CSNs, 60 CSNs completed the CIRN questionnaire with a 100% response rate, while 54 preceptors responded to the questionnaire with a 54% response rate. Nineteen CSNs participated in focus groups at three hospitals, while 20 health facility managers and 12 preceptors were included in semi-structured individual interviews. The researcher used the empirical data obtained in response to objectives 1 and 2 to describe a conceptual framework for a transition to practice programme, and to develop a transition to practice programme which is embedded in the literature. RESULTS: Objective 1 (competencies of CSNs): The CIRN questionnaire item-analysis results indicated that CSNs have underdeveloped clinical skills, knowledge and attitudes. This was evident for competencies that need to be developed in the seven subscales of the CIRN questionnaire, namely clinical care, leadership, interpersonal relations, legal/ethics, professional development, teaching-coaching, and critical thinking-research aptitude. Objective 2 (learning needs): The focus group discussions with CSNs indicated that mentorship during community service plays a pivotal role in their transition period, while factors such as nurse shortages, a theory-practice gap and unsupportive work environments affected their learning opportunities during community service. Semi-structured interviews with Hospital Managers highlighted that there are regulatory challenges with regard to community service that influenced its implementation at the health facilities. Objective 3 (conceptual framework): The conceptual framework for a transition to practice programme showed the importance of a structure being in place before implementation of a transition to practice programme for CSNs. Objective 4 (transition to practice programme): The transition to practice programme for CSNs in Dr Kenneth Kaunda District indicated the level of support that such a programme can provide, by addressing the lack of competencies and learning needs identified in this study, through ensuring that CSNs complete transition modules and are mentored by an experienced registered nurse to ease their transition into their role as a professional nurse. CONCLUSION: This study indicated that once qualified, CSNs still require support to develop in their professional roles as a professional nurse. It identified the competencies they need to develop and learning needs they have during their community service year, in order for them to practice independently. Hence there is a need for a transition to practice programme in Dr Kenneth Kaunda District that will assist these CSNs to transition effectively into their different roles as professional nurses with support from a trained preceptor.
- Health Sciences