Angela M Brown

Transitioning from acute to primary health care nursing: an integrative review of the literature

AIMS AND OBJECTIVES This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. BACKGROUND Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. DESIGN An integrative review, guided by Whittemore and Knafls (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. METHODS Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. RESULTS Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. CONCLUSION There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. RELEVANCE TO CLINICAL PRACTICE There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience.

Clinical leadership development in a pre-registration nursing curriculum: What the profession has to say about it.

BACKGROUND In the last decade literature, inquiries and reports into the short comings in health services have highlighted the vital role of leadership in clinical practice and the impact on patient care and effective workplace culture. Whilst there is an abundance of literature on leadership and the registered nursing workforce, an international literature review revealed there is very little known on leadership development in pre-registration nursing programmes. OBJECTIVE To identify what the professions views are on proposed indicative curriculum content suggested for clinical leadership development in a pre-registration nursing degree in Australia. DESIGN This is a multi-method research study. This paper presents the development and results of one aspect of the study, a national online survey. PARTICIPANTS Nurses: clinicians, managers and academics. METHODS In the absence of a strong evidence base in the literature review, additional pre-requisite curriculum content was augmented from the work of two published frameworks of leadership and management. From this a 67-item survey was designed to ask the profession whether the aggregated content is a reasonable view of what should be included in a pre-registration programme to develop clinical leadership. The survey sought the views of nurses on whether the proposed content was relevant (yes/no) and their opinion on whether it is significant via a 5-point Likert scale. Descriptive and chi-square analyses were performed in SPSS v.19. RESULTS A total of 418 nurses completed the survey; there was consensus amongst the profession on what is considered relevant and important in a pre-registration nursing programme. CONCLUSIONS The content identified could be considered indicative and pre-requisite to include in a pre-registration nursing programme. Members of the nursing profession in Australia have clear views about this. The next step is to design and evaluate a purposeful pedagogical approach and curriculum, leading to the development of clinical leadership knowledge, skills and behaviours in newly graduating nurses.

Clinical leadership in pre-registration nursing programmes – an international literature review

Background: Clinical leadership and the safety, quality and efficiency of patient/client care are inextricably linked in government reports, major inquiries and the professional literature. Objectives: This review explores the literature on clinical leadership development within pre-registration nursing programmes. Method: The literature retrieved from a scoping review was evaluated to identify what is already published on the development of clinical leadership within pre-registration nursing programmes. Twenty-seven publications matched the inclusion criteria and were included in this review, 14 journal articles, one thesis and 11 chapters within one book were analysed and three themes were identified: clinical leadership; curriculum content and pedagogy. Results and main outcomes: This review identified a paucity of literature specifically relating to clinical leadership and pre-registration nursing programmes and what is available is inconclusive and unconvincing. Conclusions: Academics, curriculum development leaders and accreditation bodies have a responsibility to influence how nurses are prepared for the profession as such clinical leadership and the new graduate should be considered an area of greater importance.

Clinical leadership as an integral curriculum thread in pre-registration nursing programmes

BACKGROUND In recent years there has been a growth in leadership development frameworks in health for the existing workforce. There has also been a related abundance of leadership programmes developed specifically for qualified nurses. There is a groundswell of opinion that clinical leadership preparation needs to extend to preparatory programmes leading to registration as a nurse. To this end a doctoral research study has been completed that focused specifically on the identification and verification of the antecedents of clinical leadership (leadership and management) so they can shape the curriculum content and the best way to deliver the curriculum content as a curriculum thread. OBJECTIVES To conceptualise how the curriculum content, identified and verified empirically, can be structured within a curriculum thread and to contribute to the discussion on effective pedagogical approaches and educational strategies for learning and teaching of clinical leadership. DESIGN A multi-method design was utilised in the research in Australia. Drawing on core principles in critical social theory, an integral curriculum thread is proposed for pre-registration nursing programmes that identifies the antecedents of clinical leadership; the core concepts, together with the continuum of enlightenment, empowerment, and emancipation. CONCLUSIONS The curriculum content, the effective pedagogical approaches and the educational strategies are supported theoretically and we believe this offers a design template for action and a way of thinking about this important aspect of preparatory nursing education. Moreover, we hope to have created a process contributing to a heighten sense of awareness in the nursing student (and other key stakeholders) of the what, how and when of clinical leadership for a novice registered nurse. The next stage is to further test through research the proposed integral curriculum thread.

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AIM To present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan. BACKGROUND Globally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership. DESIGN A multi-method research study using theoretical and empirical literature 1974-2015, a focus group, expert opinion and a national on-line survey. DISCUSSION A conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined. CONCLUSION Implementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.

Exploring why nurses transition from acute care to primary health care employment

• The situational relevance of roles, such as improved work life balance and increased autonomy influenced why study participants chose to transition from acute to primary health care (PHC) employment.

The next generation of clinical leaders; future proofing preparation.

We read a lot about leadership per se and more specifically about clinical leadership. In recent years we have seen an abundance of empirical research and literature on leadership in healthcare. The multitude of books, journal articles, TED talks, YouTube clips and so on, provide us with what seems like endless opportunities to think about leadership. In addition, there has been an increasing emphasis on leadership development frameworks specifically for health professionals. Clinical leadership has become a significant issue worldwide in the latter half of the last century and there is every sign this will continue. Why it is important is obvious, given the inquiries and reports into the shortcomings in health services in many countries. The various reports have cited the vital role of leadership in clinical practice. It will be no surprise that in each of these inquiries and reports the role of nurses and midwives and the importance of clinical leadership has been highlighted, yet more reminders or demands are made on leaders and the effectiveness or not of our leadership. In a nutshell, clinical leadership is required for the provision of person-centred and effective care of people providing care and those receiving care. Given it is a topical issue and that it ‘touches’ everyone working in and receiving health care, it is somewhat surprising no agreed yet alone, universal definition of leadership exists. In fact, we continue and seem preoccupied, with producing more and more definitions and more and more models. Clear(er) definitions help us agree on core concepts and what really matters to the profession about leadership. When the definitions of clinical leadership are considered, it is interesting that a key theme is the focus on transformational leadership with management virtually ignored. Surely, clinical leadership requires an overt management component given the demands placed on nursing to contribute to the target driven compliance cultures we see proliferating in healthcare? However, we argue that while nursing itself is required to comply, innovation still needs to be kept alive. Therefore, it is our view that clinical leadership needs to embrace both leadership and management overtly. Millward and Bryan (2005 p.xv) embrace both concepts proposing ‘management is about planning, organization and control, while leadership is about the process of influence. It is goal-oriented and inextricably linked with the group or team process’. Our view is that the process of influence needs to be oriented towards nurturing person-centred cultures (Cardiff 2014). Warren Bennis, considered to be a forerunner in the pursuit of understanding leadership, is frequently quoted as saying ‘Leadership is like beauty, it’s hard to define but you know it when you see it’ (1989 p.1). In the context of nursing and midwifery practice from our combined practice wisdom, we agree with this statement. When nurses and midwives are engaging with patients and clients providing optimum care (moments of person-centredness) clinical leadership is clearly visible, you know it when you see it and it can be described. If we want nurses and midwives to be clinical leaders then we need to do more to highlight what knowledge, skills and interventions can and should be developed. We acknowledge that much is being done about developing the existing nursing and midwifery workforce regarding effective management for service delivery. However, the future nursing and midwifery workforce needs more overt preparation to become clinical leaders – for the sake of the profession and people receiving care. The development of novice clinical leaders is thus a professional responsibility. In the last editorial in this journal, Patricia Thompson (2016) challenged all of us to become part of the solution to ‘problems’. The solution to this particular problem, we believe needs to be extended to and include nursing and midwifery students. As a profession we need to nurture the next generation and be overt in what we can do to help prepare and support them to become clinical leaders and not simply managers. New graduate nurses and midwives need to be prepared to be more ready to become clinical leaders. This begins with both leading and managing themselves in preparation to lead and manage others. There is ample opportunity to achieve this in pre-registration programmes (Brown, Dewing & Crookes 2016a). Recent research has shown how the antecedents of clinical leadership can be included as curriculum content (Brown, Crookes & Dewing 2016b). In most