An investigation into the provision of support within transition to practice programs for new graduate nurses in rural health settings

Abstract

In Australia, very few new graduate nurses enter the rural nursing workforce, and those who do go to large regional area health services. Little is known about the role transition process experienced by the small number of graduates working in rural health services and even less is known about their support needs during the transition process. The new graduate nurse who enters the rural health workforce enters a professional practice very different from metropolitan nursing practice and also from what they have experienced in their preparation for professional nursing practice. In the rural practice environment many nursing graduates will be expected by employers to have high levels of independence, well-developed problem solving abilities and assume management and leadership responsibilities early in their graduate year. The diversity and complexity of rural nursing practice, coupled with the present staffing ratios and skill mixes within rural health services, often prevents the new graduate from having time to make an effective transition into the nursing workforce and also significantly impacts on the educational and support services that can be offered to new graduate nurses in transition programs in rural health services. This study sought to investigate the nature and timing of support required for the safe transition to the rural nursing workforce. Using a qualitative, exploratory, descriptive longitudinal case study design, this study was conducted in rural health services within one area health service of northern New South Wales, Australia. Data collection for this study occurred in two phases. First, a questionnaire of rural nurses responsible for Transition to Practice Programs within rural health services was conducted in Phase One of the Study. In Phase Two, individual interviews with new graduate nurses occurred at three points in time at intervals consistent with Duchscher’s Stages of Transition Theory (2008,p. 443),which was utilised as the theoretical framework for this study. Also in Phase Two, individual interviews were conducted with experienced rural nurses who, at the time of the study, worked with the new graduate nurses. The data were analysed using content analysis in Phase One and thematic analysis in Phase Two and the findings from Phase Two have been presented as four major themes. This study found that the new graduate nurse making the transition to professional rural nursing practice moves along the transition continuum described by Duchscher (2008) and that there are particular and unique aspects of the rural nurses role and responsibilities for which new graduate nurses require learning support during their transition to rural nursing practice. This study also found that there is minimal understanding at the individual clinical unit level, local health service level, and at the Area health service level, of the support needs of the new graduate nurse who is making the transition to rural nursing practice. This study has implications for practice and policy in relation to the support offered within rural Transition to Practice Programs and for the recruitment and retention of graduate nurses to the rural nursing workforce. Recommendations for addressing the nature and timing of support to provide for a safe, supported transition to the rural nursing workforce are made. A proposed framework that would support a Transition to Practice Program in the rural context is presented and discussed. The framework consists of five principles and each principle provides strategies on which to base structural decisions when designing and developing a rural Transition to Practice Program. Further investigation regarding the provision of support during the transition from student to professional practicing rural nurse is required. As this case study was conducted in only one area health service of northern New South Wales it is recommended that this study be replicated and extended to all rural areas of New South Wales to determine and compare similarities and differences in the level of support offered by other rural Area health services.

Date of Award	2013
Original language	English
Supervisor	Mary Cruickshank (Supervisor) & Laurie Grealish (Supervisor)