Christine Ashley

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.

Developing an Australian framework for scope of practice decisions by nurses and midwives – lessons for cross-border standards development

AIMS AND OBJECTIVES Lessons for cross-border standard development learned in the consultation to create the Australian National Framework for the Development of Decision-Making Tools for Nursing and Midwifery (National DMF). BACKGROUND Although existing tools are broadly consistent, no cross-border or internationally accepted version exists of scope of practice decision-making guides. Development of a national framework in Australias federated political system required commitment to wide consultation and consensus. Concurrent moves towards national registration stimulated timely completion of the work. Contextual factors such as differentiation of the profession of midwifery from nursing and varying understanding of scope of practice concepts in eight Australian jurisdictions were challenges. DESIGN A consultative policy development framework was used. METHODS Thematic analysis of written responses to a draft document and of focus group feedback informed the production of the National DMF. RESULTS A widely accepted National DMF allowing nurses and midwives in Australia to engage in planned changes to professional practice, grounded in the professional judgement of the individual nurse or midwife, and collaboration with the consumer. CONCLUSIONS The projects grounding in consensus influenced the process and outcomes of consultation. A nationally consistent framework, incorporating useful decision-making tools for two professions and principles to guide implementation and evaluation, was a distinct achievement. The article adds to accumulated knowledge by: * identifying the professional and political factors influencing consultation and outcomes in cross-border standard development and * exploring key considerations for future projects to produce national or international professional standards that are relevant across borders and across professions. RELEVANCE TO CLINICAL PRACTICE Decision-making tools that assist nurses and midwives in determining their scopes of practice and guide them in delegating aspects of consumer care to other health care workers are an essential component of any suite of professional practice standards.

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.