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Open Access

Peer-reviewed

Research Article

Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

Affiliation Vanuatu College of Nursing Education, Ministry of Health, Port Vila, Vanuatu

Roles Conceptualization, Formal analysis, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Public Health and Primary Care, Fiji National University, Suva, Fiji

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Roles Conceptualization, Supervision

  • Adel Tutuo Tamata, 
  • Masoud Mohammadnezhad, 
  • Ledua Tamani

PLOS

  • Published: May 20, 2021
  • https://doi.org/10.1371/journal.pone.0251890
  • Reader Comments

Table 1

Registered nurse has a vital role in delivering healthcare services to individual, family and community. One of the main challenges that health system facing globally is the shortage of nursing workforce. Vanuatu as a Pacific county is also facing the shortage issue and the impact on the registered nurses’ performance.

A qualitative study was used to collect data from 25 registered nurses in three randomly selected hospitals in Vanuatu between 4 th to 14 th September, 2020. A semi-structured open-ended questionnaire was used to collect data using face-to-face in-depth interviews. The data were transcribed and analyzed using thematic analysis process.

Four themes were identified including; Difficult working conditions, Reinforcing factors and Perceived risks. Sub themes for difficult working condition were heavy workload, lack of workforce and unusual working hours. Sub themes for reinforcing factors were lack of support, lack of opportunities and advancement in nursing practice. Sub themes for perceived risks were stress, physical and mental risk, and social and family risks.

This study has identify factors affected shortage of current nursing workforce and the impact it has on registered nurses. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to registered nurses and the effects on their performance which includes stress or moral distress from work overload and lengthy hours shift which impact the nurses’ physical, psychological, social, and family relationship, and lack of leadership support. The findings can be helpful to policy makers at the decision-making level to resolve the nursing workforce shortage and its effects in the future by refining and developing relevant policies that will address and strengthen the nursing workforce to meet the demand and improve delivery of quality health services to all individual.

Citation: Tamata AT, Mohammadnezhad M, Tamani L (2021) Registered nurses’ perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study. PLoS ONE 16(5): e0251890. https://doi.org/10.1371/journal.pone.0251890

Editor: Kingston Rajiah, International Medical University, MALAYSIA

Received: February 25, 2021; Accepted: May 4, 2021; Published: May 20, 2021

Copyright: © 2021 Tamata et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data can be found at the Open Science Framework (OSF): Factors affecting nursing shortage in Vanuatu (Mohammadnezhad, 2021) (DOI: 10.17605/OSF.IO/W7G8E ).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Registered Nurses (RNs) are valued professionals and constitute the largest proportion of nursing population. They play a very significant role to ensure that effective quality care is provided in improving the health system [ 1 ]. In order to improve the health coverage and achievements of health targets, adequate nurses are crucial as the effectiveness of the patient care depend on the availability of more nurses [ 2 , 3 ].

While the world has acknowledged nursing profession as vital in delivering healthcare services, one of the main challenges faced today globally is the shortage of nursing workforce which has major impact on nurses and causes severe effects on the nurses’ performance to provide quality of health care services and improving well-being of the global population [ 3 – 5 ]. The nursing shortage caused severe stress or burned out which aggravate the problems on nurses to leave their job [ 1 ].

According to the World Health Organization (WHO), it was estimated that there will be a shortage of 7.2 million health workers to deliver healthcare services worldwide and by 2035 the demand of nursing will reach 12.9 million [ 6 ]. The inadequate supply of nurses has notably created many negative impacts not only on RNs but also on patient health-related outcome as well as challenges to fight diseases and improving health, which causes increase workload on nurses and later results in decreasing the quality of nursing care [ 7 , 8 ].

There are many factors affecting the healthcare system as a result of shortage of nursing workforce. These include decreased number of student nurse’s enrolment in nursing program and increase number of early retirement due to health problem [ 3 , 9 ]. However, one of the main factors reported in many countries is inadequate policies and workforce planning [ 10 , 11 ].

In the Pacific Island Countries (PICs), the shortage in nursing workforce is becoming a common problem [ 9 ]. In Solomon Islands, Papua New Guinea and Vanuatu, the health worker density per 1,000 populations (mainly nurses and midwives) is far below the minimum threshold density (4.45 per 1,000 populations) to sustain basic health services [ 12 ]. In countries such as Tonga, Samoa and Fiji, the main factors that trigger shortage of nursing staff includes very high rate of nurses’ migration to other countries, especially to Australia and New Zealand for better working conditions and for other potential opportunities. This has created challenges and gaps that needed to be identified to better explore the extent of the nursing shortage and to address it promptly and efficiently [ 13 ].

In Vanuatu, nurses constitute only 58% or 12.0 per 10,000 populations, which is below the WHO recommended ratio of 45 nurses per 10,000 populations [ 14 ]. According to the Vanuatu Ministry of Health (MoH) Annual Report (2018), the number of retiree nurses in the next 10 years will continue to rise but will be disproportionate to the qualified nurses graduated from the Vanuatu College of Nursing Education (VCNE) which becoming a major problem for Vanuatu MoH to fill the vacant positions. This will create more workload for nurses which will impact their performance. This study sets out to explore RNs’ perceptions on the impact of nursing shortage of nurses and their performance in providing quality care in Republic of Vanuatu in 2020.

Methodology

Study design and setting.

A qualitative study was used to gather information using face-to-face in-depth interviews from RNs in three hospitals in Vanuatu between 4 th to 14 th September, 2020. The three hospitals were randomly selected among six hospitals that included Vila Central Hospital (VCH) in Shefa Province, Northern Provincial Hospital (NPH) in Sanma Province and Lenakel hospital in Tafea Province. In-depth interviews are very powerful methods to allow participants to express their view freely regarding their detailed personal experiences [ 15 , 16 ].

Study population and sample

All RNs in Vanuatu were considered as the study population and those who were currently working at the three selected hospitals with at least 6 months’ work experience were included in this study. Those who were not willing to participate in the study were non-respondent. A purposive sampling was used to choose study participants. The RNs were interviewed using face-to-face, in-depth interviews until data saturation is reached. A total of 25 RNs were involved in this study.

Data collection tool

In-depth face-to-face interviews was conducted using a semi-structured open-ended questionnaire to probe elicit information from the identified participants from both the target populations. Open-ended questions aimed for participants to express their personal experience freely [ 17 ]. The interview questions developed is based on relevant literatures and research studies that will fulfill the aim and the research question of the study. Seven questions were prepared and asked during in-depth interview to enable the participants to explain or discuss their perceptions about the research topic.

The demographic information form was also used to collect demographic characteristics regarding their gender, age, marital status, education level, work station and years of experience. The interview questions were checked by 3 experts in the relevant filed and also by 3 RNs to make sure they are understandable and are in line with the research questions before conducting the interviews.

Study procedures

Following the ethic approvals, all potential RNs in three selected hospitals were informed about the aim of study and were invited to participate. An information sheet was used to inform the participants about the purpose, procedure and nature of the study; duration of interview; the right to participate; benefits and risks of the study; notification for decline or withdrawal at any time from participating; informed consent and the interview procedure. They were informed that their information will be confidential and they are allowed to leave the study at any time. Those who met the study criteria and were willing to participate were asked to sign a consent form. An arrangement was made about the date, time and venue of the interview. A trained bi-lingual interviewer who signed a consent form was employed to conduct interviews. Participants were asked about their preferred language to do interview before the interview. Those who preferred to speak in local language were interviewed in Bislama language otherwise the English language was chosen for the interviews. All interviews were audio-taped for transcription later.

Data management and analysis

Cross translation was applied for translating the interviews that were in Bislama to English. All the interviews were transcribed by the main researcher and were checked by the research assistant to make sure they are transcribed accurately. The data were manually analyzed using thematic analysis process to identify the final themes. Thematic analysis is a method which involves identifying, analyzing, and reporting patterns of data and is widely used for analyzing qualitative research [ 18 ]. The participants’ answers were read and re-read closely by the main researcher to divide into key words or phrases into their similar meanings and create codes. The transcribed results were later transferred to A4 paper. Then the coded data were sorted into themes and sub-themes based on the similar issues which formed the result of the study.

Ethics approval

Before proceeding to data collection, ethic approvals were obtained from the College Health Research Ethics Committee (CHREC) in Fiji National University (FNU) and from the Research Ethics Committee in Vanuatu MoH. All participate were provided a consent form and the information sheet. The participants were informed about the purpose of the study and ensures that their identities are anonymous and the participants ‘data and any other information would be kept confidential and protected.

Demographic characteristics of participants

Twenty-five participants were involved in the in-depth interview (12 males and 13 females). With respect of age, 14 with age range <40 and 6 of the participant with the age range from 40–49, and 5 age ≥50, and 18 of them were married. Their educational level, 21 of them had their undergraduate qualification and 4 had their highest qualification as post graduate level which includes post graduate diploma ( Table 1 ).

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Themes and sub-themes

The thematic analysis found three major themes emerging; 1) Difficult working condition, 2) Reinforcing Factors, and 3) Perceived risks. Each theme had several sub-themes ( Table 2 ). The participants’ reflection for each theme and sub-theme are further expanded and compared with other published studies. In this section, participants are presented with a “P” and cardinal number like P1, P2.

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https://doi.org/10.1371/journal.pone.0251890.t002

Difficult working conditions

The nurses believe that the conditions where nurses’ work can have a major influence on their performance and the quality of care provided to patients include “heavy workload”, “lack of workforce” and “unusual working hours”.

1. Heavy workload.

All the participants (25) working in the hospitals have confirmed that workload has been a challenge when there are extremely limited nurses to manage the patients on each shift. P3 stated that shortage of nursing and workload is seen throughout the hospital wards which exceed the number of nurses working per shift.

“Shortage of nursing is seen throughout the hospital wards and is a long-term issue where workload exceeds the number of nurses working in one shift” .P3 (a 56-year-old female RN).

All the participants (25) also reported that the workload is increasing because of the high number of patients’ admitted. P16 compared the population in the past with the current and stated that when the population increased, diseases also increased that caused workload on nurses.

“In the past , the population was less but now the population increases due to the high number of disease cases that causes more patients’ admission and more workload to us nurses” .P16 (a 32-year-old male RN)

Some of the participants (15) reported an inadequate number of nurses working in each shift also create challenges due to workload when other nurses on sick calls or annual leave. P6 expressed the workload when only one nurse worked to cover for nurses who were on various leaves.

“Workload is too much as most of the time only two nurses working in each shift is not enough , if one staff on sick leave or annual leave then we must double the shift” . P6 (a 34-year-old male RN)

Four participants stressed the ratio of nurses to patients admitted in the hospital in Vanuatu as a huge difference which affects nurses’ performance compared to the other countries. P14 stated:

“Uh… . when we look at the ratio of nurses to patients in Vanuatu which is 1 : 10 or 1 : 15 compared to other countries of which they have 1 : 4 , there is a huge difference . One ward receives on average of 20 to 30 patients at one time but only 2 to 3 nurses work on one shift which is too much for one nurse to perform his or her duty effectively” .P14 (a 33-year-old male RN)

Twenty participants have the same responses due to the nursing shortage they experienced in their workstation, that they neglected a lot of their duties and responsibilities as a registered nurse. P8 reported that the impact of shortage prevents him to perform his duties and responsibilities such as home visits and other bedside nursing care which also affects the quality of care the patients required.

“Impact of shortage prevents me from performing some of my duties and responsibilities such as home visits and follow-up care to patients with chronic illnesses . Bedside nursing and wound care or wound management are also not done regularly , which can have a great impact on patients’ health” . P8 (a 43-year-old male RN)

2. Lack of workforce.

Increased workload compared to less number of nurses working in the hospitals causes nurses’ physical exhaustion leading to job dissatisfaction as expressed by all 25 participants. P11 expressed the result of lack of workforce to his well-being.

“Workload is too much in the hospital wards and we cannot do all our work at one time……I normally experienced tiredness and exhaustion and not interested to work due to incomplete jobs seen each day” . P11 (a 37-year-old male RN)

Thirteen of the participants responded that the increased workload does not correspond with the number of nursing staff in the health facilities especially with increased number of patients admitted and less number of nurses working. P8 stated that the number of workforce does not match with the number of workload from increased admission.

“Few nurses do not match with the increased workload today . For example , increased number of admissions with only 2 staff working per shift is a great challenge to us” .P8 (a 43-year-old male RN)

Other participant added:

“Shortage in my ward with only 2 nurses in one shift is not enough compared to the number of patients admitted especially when we have the critical patients that need close supervision in the ward” . P22 (a 53-year-old female RN).

Furthermore, eight participants stated that training and enrolment have significant effects to the shortage on the nursing workforce due to a single nursing college in the country with limited number of student nurses’ enrolment. P6 said that lack of workforce is due to inadequate enrolment from the nursing college each year.

“ One nursing college is not enough to train more nurses to have an adequate number of nurses in the workforce . Furthermore , the decreased number of intakes to only 30 per year is not enough” . P6 (a 34-year-old male RN)

Conversely, seven participants stated that lack of nursing workforce is due to irregular nursing enrollment in the nursing college in the past.

“The reason for having a shortage of nurses frequently is due to uhm……no regular nursing intake from the VCNE each year . In the past 15 years , nursing college always have regular intakes each year even if the number of intakes is less , we still have continuous graduation of nurses each year with a good supply of nurses in the hospital to work and provide care . Nowadays , the intake occur every 2 or 3 years . P20 (a 33-year-old female RN)

Few of the participants (4), reported that the other reasons for lack of workforce is nurse turnover. P24 stated that the workforce is affected especially when nurses leave their profession and look for other jobs elsewhere due to too much pressure from work.

“Workforce is affected when nurses leave their profession and look for other jobs elsewhere . They left due to too much work load and not enough time to rest” . P24 (a 42-year-old female RN).

3. Unusual working hours.

Working long shift hours up to 12 to 16 hours or double the shift due to not enough staff to do shift work especially when staff on sick leave or on annual leave causes physical and emotional exhaustion and also affects quality patients’ care. P21 expressed the reasons for long hours shift and its impact to the nurses and to the patient.

“Most of the time we spend long shift hours of work e . g . 12 to 16 hours or we double the shift due to not enough staff in the ward to do shift work when we don’t have enough staff and when staff are on sick leave . It is so tiring and causes a lot of stress to most of us who work long hours which also affect the quality care provided to patient” .P21 (a 42-year-old female RN)

Fifteen of the participants who normally work shift stated that they used to work double shift especially during the night where only few nurses were working. P17, an experienced nurse expressed that double shifts especially at night is common in the hospital wards when nurses on duty unexpectedly on sick leave which significantly affect the nurses’ physical well-being.

“Double shift is a common practice in the wards especially when there are not enough nurses to work or when a working colleague is on sick leave . This causes much stress to us nurses due to tiredness” . P17 (a 64-year-old female RN)

Five senior nurses responded that occasionally they work 24 hours to assist nurses in the ward when more critical patients are admitted or during an epidemic. P3 stated that as a senior in charge nurse, they committed to work 24 hours when lack of nurses to take care of increased patient admission

“It is our duty as senior nurses to assist the nurses in the wards when more critical patients are admitted or during disease outbreak and work for 24 hours . It is quite tiring but we have no choice because it is part of our responsibilities” . P3 (a 56-year-old male RN)

Three participants responded that during natural disasters, where a lot of nurses are unable to attend work and more patients admitted, they have to work extra hours during the day and during the night. P22 expressed her experience during natural disasters where she has to work on unusual hours to care for the casualties and assist nurses in the wards.

I have experienced spending all day and night for one whole week during tropical cyclones to look after patients as more nurses were unable to come to work” . P22 (a 53-year-old female RN).

Reinforcing factors

The nurses quoted during the interviews that “lack of support” and “lack of development opportunities and advancement in nursing practice” were reasons for low motivations in their performance and job retention.

1. Lack of support.

Most respondents (13) reported that lack of support from the leaders causes low working morale and low motivation. P15 stated that the leaders in the hospital management haven’t provide much support to the nurses.

“We always confront our nursing managers or clinical supervisors concerning problems in our work place such as poor working equipment needing replacement and poor working environment but they always give excuses and no action taken seriously which affects our morale of work ….” P15 (a 35-year-old male RN)

Another participant added:

“We hardly see the managers or supervisors doing regular visitation to support nursing staff and to assess nurses work performance , this causes low staff motivation” . P14 (a 33-year-old male RN)

All nurses (25) responded that lack of family support is common due to working overtime and coming home late from work. One participant (P21) reported that they don’t receive any support from the family especially when they came home late from work

“When I came home very late from work my family got angry with me . I don’t receive any support from my family . They even forced me to quit my job due to coming home late from work every day” . P21 (a 42-year-old female RN)
“Even my family don’t want to give me food due to frustration of continuously coming home late from work . ” P16 (a 32-year-old male RN)

Most of the participants (15) have expressed their frustration due to lack of financial support from the MoH especially special allowance for working overtime and others. P1 stressed that she has been working for more than 20 years but she hasn’t received any financial support concerning their overtime package or other allowance or incentives apart from their normal wages which affect their motivation to perform duty effectively.

“I work for many years but I don’t receive any financial support from the health authorities apart from my little salary regarding extra responsibility allowances or overtime allowances or any incentives” . P1 (a 56-year-old female RN)
“Even our working status is on contract bases for so long due to positions not budgeted for which affects our benefits and job insecurity” . P11 (a 37-year-old male RN)

2. Lack of development opportunities and advancement in nursing practice.

All participants (25) stated that lack of development opportunities to advance in nursing practices and career pathways are common problems that cause disappointment within the working environment. P24 expressed her disappointment that she works for quite a long time in the hospital but chances to advance in her knowledge is very slim and don’t have the opportunity to expand her knowledge and skills in nursing practice.

“I am very disappointed because I worked in the hospital for many years doing the same routine job as usual and I still remain the same usual nurse… . I don’t receive any promotion because I don’t have any opportunities to advance in knowledge and skills in nursing practices” . P24 (a 42-year-old female RN)
“I haven’t seen any effective career pathway for nurses developed by managers for further trainings to upgrade nurses’ knowledge and skills for advancement in our clinical practice” . P4 (a 34-year-old male RN)

All the participants stated that most of them don’t have any chances for professional development. P18 responded that most nurses perused their training from the Vanuatu nursing college with a diploma level and haven’t had any chances to upgrade to a higher level of qualification.

“ Most of us nurses graduated from the nursing college with a diploma of nursing but we don’t have changes to upgrade to a higher level of qualification or to up skill our-selves” . P18 (a 30-year-old female RN)
“Our skills in nursing practice need to be upgraded in order for us to advance with our clinical practices . It is very good to have regular in-service training but it never happens on regular bases , in order to keep us updated with our nursing practice skills ”. P2 (a 34-year-old male RN)

Other nurses reported that specialty training is also necessary to up skill nurses and advance in their clinical practice in the speciality area but only few nurses had given the chances in the past to attend those training.

“Vanuatu needs more specialized nurses to provide quality care to different types of patients however , only few nurses had been given the chances to take up those training which is still needed for more nurses to take specialize training to provide effective and quality care needed” . P3 (a 56-year-old female RN)

Perceived risk

The nurses quoted during interviews that “stress” and “physical and medical risks” were reasons that affect nurses and increased the chances to quit their profession.

Majority of the participants (20) have worked in the hospital for more than 5 years and reported that they have experienced the impact of shortage of nursing personally. P5 reported that stress causes a major effect on nurses due to workload and also threatens her job.

“I experienced tiredness , stress and not satisfied with my job each day due to work overload . I normally go home late due to long hours of work and no time for my family which affects my family relationship . Even my family asked me to look for another health facility to work which has less workload” . P5 (a 31-year-old female RN)

Four of the participants stressed the effects of work overload and overtime due to nursing shortage causes stress and frustration and violence at home.

“Work overload and work for long hours causes a lot of stress and frustration where I don’t have enough rest , no time to relax , and not enough quality time for my family which causes frustration and violence in my home” . P23 (a 53-year-old female RN)

O ther participants (12) added:

“Stress is the result of tiredness and not enough rest especially when the ward is full and less nurses working and you have to double the shift” . P12 (a 40-year-old female RN)

2. Physical and mental risks.

Some participants (6) stated that work overload and work for long hours causes more physical and medical risks

“Shortage of nurses affects our physical body very badly . We experienced back pain and back injury for trolleying patients to the theatre and to other diagnostic units……and we felt tired and cannot provide the best quality nursing care to our patients” . P20 (a 33-year-old female RN)

Other physical risks which was reported by all participants (25) is when they don’t have enough time to rest and eat or drink due to too much work load and limited nurses. P24 expressed that they don’t have enough time to rest and eat during busy times which affect her physical body and her health.

“Most of the time our ward is busy and those times I don’t have enough time to rest and eat or even drink which affects my physical health” . P24 (a 42-year-old female RN)

Workload with only few nurses causes a lot of medical risks on nurses’ health and clinical performance which leads to early retirement or were granted early retirement due to medical reasons. One participant stated:

“A lot of nurses in our hospital leave their job and most of them were granted early retirement due to medical health reasons which prevent them to continue with their job” . P11 (a 37-year-old-female)
“I worked almost 20 years now and I have medical issues which affect both my lower extremities and I have requested to take my early retirement because I won’t be able to work with the current health conditions . My health conditions will not only affect my well-being but will also affect my clinical nursing performance” . P7 (40-year-old-female RN)

Most nurses (15) reported that high job demands increase physical and mental health problems. P9 mentioned the impact of stress to physical and mental problem on nurses

“Stress affects our mental health when we are exhausted due to work overload which prevents us to think properly which also increases the chances to make mistakes” . P9 (a 56-year-old female RN)
“When we have too many patients and lack of skills especially for us inexperienced nurses , it affects us psychologically as well which can affect our performance” . P5 (a 31-year-old male RN)

3. Medical risk.

One of the respondents stated that medical errors are one of the common risks that occur due to stress from working long hours or work overload.

“I have experienced the result of stress that causes high chances of errors in our work station which threaten the lives of the patient . Some prevented errors are the result of work overload and long hours of work which prevent nurses from perform their duties effectively and increase the chances to make mistakes” . P2 (a 34-year-old male RN)

Four participants reported that medical errors were seen in their work station due to physical and psychological stress where they gave incorrect medication to the patients.

“Few times I gave incorrect medication to patients because I can’t think properly due to tiredness and exhaustion or sometimes I gave the correct medication but I don’t explain it well to the patient especially the dose , time and route of administration” . P4 (a 34-year-old male)
“Most of the time due to frustration and too much workload I don’t practice infection control rules and regulations which cause more medical risk to my patients” . P11 (a 37-year-old male RN)

4. Social and family risk.

Nurses experienced social and family risks when they have high volume of pressure and when patients are not receiving services immediately, they cause mischief to nurses and their families. P12 expressed his fear when patient and relatives were frustrated due to patients’ not receiving care or service immediately and threaten her family.

“I experienced most times especially when we have less nurses working in one shift in the emergency department when I and even my family were threatened when patients’ relatives got angry with me for not attending to them immediately or not treating them well as expected . Sometimes they threatened me and my family as well” . P12 (a 40-year-old female RN)
“Occasionally I get frustrated from work due to pressure and when I bring frustration to my home , it causes domestic violence in my home . This causes much risk to my family” . P6 (a 34-year-old male RN)

Prompted by the findings from the RNs in Vanuatu on the nursing shortage, it impacted the health service delivery throughout the Vanuatu population [ 14 ]. Although the Vanuatu MoH has been implementing strategies in the past to address the issues, the shortage of nursing is still evident with the current nursing workforce shortage of more than 400 where Vanuatu MoH is still unable to fill the shortage gaps [ 14 ]. The current study findings have reported the impact of nursing shortage on the nurses and their performance in providing quality care.

The working conditions for nurses have major influence on the nurse’s performance and the quality of care provided to patients due to job dissatisfaction. The findings emerged with the condition which includes workload due to high patients’ admission, lack of workforce and unusual working hours. Several studies have shown that job dissatisfaction always emerged along with poor working conditions due to workload and lack of workforce [ 19 , 20 ].

It is obvious that the workload in the health facilities within the MoH health system has been a long-term issue and become a challenge when few or limited number of nurses who care for the large number of patients admitted, and workload exceeds the number of nurses working in each shift. The maximum number of nurses working per shift is 2 to 3 nurses according to the findings, which is not effective to provide a quality care needed for nurses and patient’s safety. Although the managers within the hospital setting are aware of the workload issues, they have no better solutions to address the workforce shortage as it become a major challenge across the country that needs effective planning and policy directions from the policy makers at the government level. Studies stressed that work load is becoming a major factor when there are inadequate number of nurses working compared to the demand [ 21 , 22 ]. Other studies from other developed countries also reported that inadequate policy direction and planning has huge impact on nursing population including nurses’ workload [ 5 , 23 ]. The difference is that our study participants have experienced shortage and its impact while working in the hospital and might have limited knowledge about the policy and planning direction of Vanuatu MoH.

With few number of nursing staff compared to high workload, causes a lot of pressure and physical exhaustion to nurses. There are factors that contributed to lack of workforce identified by participants who include low student nurse enrolment or irregular training provided by the nursing college. Although the nursing college enrolled nurses continuously for the last 30 years, the number of output is so limited and does not match with the increased demand. Other health leaders also supported the fact that low enrolment in the nursing college is becoming obvious when looking at the current increase number of aging population of nurse within the MoH. Studies from other countries stated that low enrolment have significantly contributed to lack of workforce which affect nursing and their profession in the future [ 4 , 24 ]. The shortage were identified by the participants from the low number of nurses distributed and work in each of the hospital.

In this study it was found that most of the nurses working in the hospital had experienced long shift hours up to 12 to 16 hours or double the shift due to not enough staff to do shift work or when other nursing staff on sick calls or annual leave. The nurses stated that long working hours is very stressful which affects their work performance and as well as their social and family relationship. The nursing managers and senior clinical supervisors aware that nurses normally work on unusual hours when not enough staff to do shift work, and have noticed moral distress on nurses which affects nurses’ motivation to perform the job effectively. In other industrialized countries, one third of the nursing workforce has irregular or unusual working hours which significantly affects the nurses’ health and patient outcome [ 25 ]. Furthermore, pressure of working long hours contributed to nurses leaving their profession from job dissatisfaction and poor working environment. Study have shown that nurses leave their job due dissatisfaction with working condition in a stressed environment such as irregular working hours [ 26 , 27 ].

Findings shows that lack of support and lack of development opportunities and advancement in nursing practice were reasons for low motivations which affects nurses’ performance.

Most nurses reported that lack of support from the managers and supervisors causes low working morale and low motivation to perform duties effectively. Although the nursing managers and senior clinical staff are experienced in their position, nurses still haven’t received full support for the leaders. This includes no regular visits and no actions to nursing staff complaints or grievance. It is evident due to areas that yet to be resolved and need urgent actions from the managers. Studies show that nurses needed attention from the managers and supervisors to identify areas that needs urgent or serious attention or early detection of any problems that might occur among nurses and their work performance [ 20 , 28 ].

Most of the nurses stated that lack of development opportunities to advance in nursing practices is one of the common issues that create disappointment on nursing staff within their working environments. Nurses believed that when opportunities to advance is left too long or no attention from their superiors, it causes low motivation that leads to low performance that will certainly allow nurses to leave their job. Although the HR at the national level develop career pathway for nurses, most nurses are not given any chances to advance in their profession or capacity building as part of their professional development, which is also reflected on the level of Education on demographic information where the highest level for most nurses is diploma of nursing. A study in Iran has shown that lack of opportunities to advance in nursing and lack of professional vision towards nursing, cause discrimination among nurses and dissatisfaction which causes nurses intended to leave their profession [ 21 ]. According to the RNs personal characteristics, more than 50% have completed undergraduate studies with diploma of nursing as their highest level of nursing which reflect lack of professional vision to upgrade nurses to higher level which might results to low motivation in the workplace.

The findings perceived that stress and medical risks impact nurses that increase the chances to quit nursing profession.

Stress has major effect on nurses not only with physical exhausted but also has an effect on social and family relationship. Stress affected nurses due to workload and overwork which significantly affect the quality of care provided to patients as well. Majority of the RNs who work in the hospital might experience the impact of shortage of nursing personally because they have worked for more than five years. If stress was managed promptly, it will prevent burnout, job satisfaction and improve patients’ quality care. Although studies have shown that stress affect all nurses due to worldwide nursing shortage, the nursing managers and leaders in Vanuatu, who have in contact with nurses regularly must have better understanding of stress and its relationship and also its symptoms in order to manage stress effectively [ 29 , 30 ]. It is important for Vanuatu MoH to adopt stress management process by other countries in order to identify and management stress among nurses effectively.

Findings have shown that work overload and long hours’ work causes serious threats to nurse’s physical health. Furthermore, finding shows that nurses experienced injuries and other medical conditions while performing service. Furthermore, majority of the RNs have been granted early retirement due to medical reasons that might be due to work overload or poor working conditions. The challenges of having nurses gone on early retirement is when not enough nurses for replacement, however nurses with medical reasons need to leave their profession as they will negatively impact patient’s care and also their well-being. Studies supported that mental and physical health of nurses has significant effects on the quality of care provided to the patient [ 30 , 31 ]. On the other hand, other studies supported that senior nurses leave their profession before their retirement age due to medical reason and is necessary for patients’ safety to decrease mortality [ 32 , 33 ].

Furthermore, stress associated with nursing shortage has a significant impact on patients’ care in the hospital which causes much health risks and increase the risk of medical errors and lack of quality care up to a required standard. Findings show that, Vanuatu nurses were able to work under pressure, but medical errors can still be experienced at the workplace. Studies confirmed that medical errors are associated with nurses’ psychological stress and other health risks due to work overload [ 8 , 31 ].

Study strengths

The study is a high quality study and the first study that was conducted in the Republic of Vanuatu among the registered nurses. The study rigors was followed from conducting the study, data collection and data analysis. The study will benefit the Vanuatu ministry of health by enabling the policy makers to refine and develop relevant policies to address and strengthen the nursing workforce to meet the demand and improve delivery of quality health services to all individuals in both urban and rural settings.

Study limitations

There were some logistic limitations in terms of conducting interviews or reach the study participants easily due to was unable to Covid-19 pandemic. It was not possible to study other hospitals in Vanuatu to extract more information due to time limitation.

This study has identified many key factors that contributed to the shortage current nursing workforce and the impact it has on RNs which needs to be addressed promptly to resolve the shortage of nursing workforce Vanuatu in the coming years. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to RNs and the effects on their performance. The studies showed that stress or moral distress from work overload and lengthy hours shift impact the nurses’ physical, psychological, social, and family relationship.

The recommendation to assist the Vanuatu government through the Ministry of health to address chronic shortage of nurses is, the government should invest on establishing a much bigger nursing college to increase its yearly intake in nursing, to have interim plan to address the current shortage of nurses and review the whole nursing situation and nurses distribution, and to promote nursing in all the secondary levels of education.

Acknowledgments

We would like to thank all the study participants and those who were very supportive for their valuable time and participation in the interview.

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  • Published: 21 March 2023

Understanding registered nurses’ career choices in home care services: a qualitative study

  • Guro Hognestad Haaland 1 , 2 ,
  • Olaug Øygarden 3 ,
  • Marianne Storm 4 , 5 &
  • Aslaug Mikkelsen 1 , 2  

BMC Health Services Research volume  23 , Article number:  273 ( 2023 ) Cite this article

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The anticipated growth in number of older people with long-term health problems is associated with a greater need for registered nurses. Home care services needs enough nurses that can deliver high quality services in patients’ homes. This article improves our understanding of nurses’ career choices in home care services.

A qualitative study using individual semi-structured interviews with 20 registered nurses working in home care services. The interviews were audio-recorded, transcribed and thematically analyzed.

The analysis resulted in three themes emphasizing the importance of multiple stakeholders and contextual factors, fit with nurses’ private life, and meaning of work. The results offer important insights that can be used to improve organizational policy and HR practices to sustain a workforce of registered nurses in home care services.

The results illustrate the importance of having a whole life perspective to understand nurses’ career choices, and how nurses’ career preferences changes over time.

Peer Review reports

The anticipated growth in number of older people and earlier hospital discharge of patients with more complicated medical diagnosis is associated with a greater need for health care services at home [ 1 , 2 , 3 ]. Similarly to other Nordic countries, Norwegian municipalities are responsible for providing primary health care services in patients’ homes [ 4 ] irrespective of gender, age, geographical location or socioeconomic status [ 5 ]. Primary care services include home care services, nursing homes, municipal emergency care units, intermediate care, the provision of GPs and preventive services [ 4 ]. Consistent with previous research [ 6 , 7 , 8 , 9 ], this paper makes use of the term home care nurses referring to registered nurses who work in home care services. Home care services include nursing care and other forms of health care such as physiotherapy, occupational therapy or rehabilitation for either a short or a long period [ 5 ]. Health care delivered at home has become more complex, and registered nurses play a critical role providing care to sicker patients needing advanced care [ 8 , 10 ]. The number of recipients receiving nursing care in their own homes has grown rapidly in the recent years [ 11 ], and the growth is expected to increase significantly also in the years to come [ 12 ]. With the worldwide shortage of nurses [ 13 ], there is an urgent need to understand what influences registered nurses’ career choices in home care services. This may provide information to ensure that registered nurses consider home care nursing as an attractive workplace for a lifelong career.

Traditionally, the choice of an occupation was associated with a linear career path and a secure employment within one organization. Nowadays, careers can be unpredictable and complex, and employees are not bound to their initial occupation [ 14 ]. In Norway, one in five registered nurses leave health care services ten years after graduating [ 15 ]. High turnover among nurses who leave their clinical jobs or profession is costly, because it is expensive to train and replace experienced nurses. The result is understaffing, which is a potential risk to patient safety [ 16 ]. Previous studies have mainly focused on nurse students’ career preferences, and identified that primary health care is not the preferred workplace for nursing students [ 17 , 18 , 19 ]; however, the likelihood of working in the municipal health and care services increases with time [ 20 , 21 , 22 ]. In a quantitative longitudinal study, Abrahamsen [ 23 ] identified how nurse students’ career expectations relate to their career choices. One year after graduation, choosing to work in nursing homes and home care nursing related to nurses’ expectations of achieving a management position. Ten years later, nurses’ choice to work in nursing homes and home care services rather related to nurses’ expectations to work part time, illustrating that the motives behind career choices change with time. Abrahamsen tested three dimensions of career expectations and emphasized the importance of additional knowledge of registered nurses career choices to improve recruitment and retention strategies in the less popular nursing fields such as home care services.

As contemporary careers are increasingly dynamic and complex, employees can make several career choices over time and adjust to external influences [ 24 ]. Nurses can change occupation, work in different organizations, have a permanent or temporary position, and apply for temporary unpaid leave to raise their children. The shortage of registered nurses means that they can choose between many career options. Researchers have investigated the most and least satisfying aspects of work in primary health care [ 25 ], nurses’ job satisfaction and quality of life [ 26 , 27 ], and why home care nurses remain in their jobs [ 28 , 29 ]. Results of these studies identified autonomy, work-life balance, interaction with patients, role diversity, and patient-family interaction as satisfying aspects of work in primary health care and influence nurses’ intention to remain. In contrast, low pay, lack of a career path, time constraints and workload have been identified as the least satisfying aspects of work in primary health care [ 25 , 27 ]. Although these studies increased our knowledge of important aspects of nurses’ career in primary health care, there is still a need for a more detailed understanding of what affects nurses’ career choices in home care services [ 30 , 31 ]. Since 2015, the municipalities have experienced an increase in challenges recruiting registered nurses to nursing homes and home care services [ 32 ], and previous studies have reported a lack of registered nurses with sufficient competence in primary health care services [ 33 , 34 ]. This stresses the importance to increase our understanding of what influences registered nurses career choices in home care services. This paper seeks to address this gap by asking the following research question; how do contextual and individual factors influence registered nurses’ career choices in home care services ? The results can provide home care services and other health care organizations with important information on how to provide human resource management practices and organizational policies in order to recruit, develop and retain registered nurses. Changing needs and motivations, and contextual demands affect person-career fit and people’s career choices over time [ 35 ]. Examples of registered nurses’ career choices are starting in home care services, working part-or full-time, changing hours of work, becoming a resource nurse, taking a specialization, or leaving home care services. We will use the sustainable career framework that provides a whole-life perspective on careers that is useful for understanding nurses’ career choices [ 24 ].

Sustainable careers

Careers are dynamic, made up of choices and events over time that will determine their sustainability [ 24 ]. Unlike other career paradigms, the sustainable career perspective stresses the importance of context and the role of multiple stakeholders on the sustainability of employees’ career over time [ 36 ]. Sustainable careers draws on theories like selection optimization and compensation [ 37 ], conservation of resources [ 38 ] and self-determination theory [ 39 ], and emphasize the importance of resources and fulfillment of the psychological needs for autonomy, competence and relatedness for ensuring sustainable growth and continuity in one’s career [ 36 ]. Findings suggests that basic psychological needs relate to registered nurses’ turnover intention [ 40 ] and career commitment [ 41 ]. Something that is sustainable can last for a long time without being depleted or destroyed [ 24 ]. For nurses to have a long career, the home care services needs to create work conditions that endorse motivation and well-being, and nurses themselves needs to stay employable. Sustainable careers are characterized by happy, healthy and productive workers, and are defined as “sequences of career experiences reflected through a variety of patterns of continuity over time, thereby crossing several social spaces characterized by individual agency, herewith providing meaning to the individual” (24, p.7). In order to attract, motivate, develop and retain registered nurses over time, home care services should foster sustainable careers as unsustainable careers increase the risk for career turnover [ 42 ]. Three dimensions can be used to study sustainable careers, the person, the context and time [ 36 ].

The person dimension relates to agency and meaning [ 24 ]. Agency refers to making career choices that are consistent with individual’s needs and aspirations, or adapting to external changes and events [ 36 ]. To have a sustainable career over time, employees need to craft their career, which refers to “proactive behaviours […] to self-manage their career and that are aimed at attaining optimal person-career fit” [ 43 , p. 175–176]. Meaning refers to people being mindful about what and who is important to them in their career, and this might change over time [ 36 ]. Meaning of work is associated with registered nurses’ intention to leave [ 44 , 45 ] and organizational commitment [ 46 ]. Further, people’s values will guide their careers. De Vos et al. [ 47 ] cite the kaleidoscope career model [ 48 ], which distinguishes three values: authenticity, balance and challenge. Although all three values are always active, one value will have priority. In line with the findings by Abrahamsen [ 23 ], this may explain why registered nurses career preferences change and why primary care work becomes more popular with time. As personal needs, interests and aspirations might change, career competencies and career adaptability are important for individuals to achieve their desired career [ 36 ].

Current career literature places a significant focus on personal agency and control, but to understand a career trajectory that is becoming more complex, it is necessary to include the role of context and external events [ 49 ]. The context dimension refers to how the work-related context and private life affect people’s career sustainability, such as first-line managers, colleagues, patients, family, and friends. For example, numerous studies within health care have highlighted the importance of social support from immediate supervisor for registered nurses’ intention to leave the profession [ 50 ], commitment to the organization [ 51 ] and reduced intention to leave [ 44 , 52 ]. The experience of conflict between work and family correlates with nurses’ choice to leave an organization and the profession [ 53 ]. Nurses will most likely experience several career shocks, defined as disruptive and extraordinary events that are, at least to some degree, caused by factors outside the focal individual’s control and that trigger a deliberate thought process concerning one’s career (49, p. 4). For instance, going through a divorce, having children, being diagnosed with a serious illness, accepting a new job or reorganizations are likely to affect nurses’ career choices. Changes in demands or resources at home or at work can make careers more or less sustainable over time [ 54 , 55 ]. If nurses’ work becomes too demanding without an increase in the necessary resources, it could lead to stress and exhaustion according to the job demand- resource (JD-R) model [ 56 ] and affect nurses’ choice to leave home care services or the profession [ 57 ]. Emotional demands [ 58 ] and burnout [ 53 ] are associated with registered nurses’ intention to leave. Although individuals are the “owners” of their careers, both employees and employers are responsible for creating sustainable careers [ 59 , 60 ]. Home care nurses’ ability to perform advanced procedures that had previously been done in hospitals has raised expectations of their work and competence [ 61 ]. To succeed and remain employable, individuals are required to manage and develop their knowledge, abilities and skills to meet changing demands [ 62 , 63 ]. At the same time, employers must provide opportunities for professional learning and development [ 64 ]. Aligning one’s needs with the organization and private context, will benefit all stakeholders, and impact the sustainability of his or her career [ 24 ].

The time dimension relates to the dynamic evolution of careers [ 36 ]. Employees’ careers might be more or less sustainable over time due to changes in demands or resources at home or at work [ 54 , 55 ]. For example, registered nurses often work part-time while the children are young [ 65 ]. Earlier research shows an age differences between younger and older nurses and their wish to leave home care services and nursing homes [ 66 ]. This is in line with previous findings of a negative relationship between registered nurses’ age and turnover intention [ 50 , 67 ].

Setting, design, participants and ethics

This study is part of a larger research project in Leadership and Technology for Integrated Health Care Services. The project explores how home care nurses, general practitioners (GPs) and multimorbid patients experience and contribute to integrated care. In Norway, the municipalities are responsible for the organization and delivery of primary care services, and national health and regional health authorities are responsible for specialist care services. Local authorities are free to determine how to organize community services; the municipality in this study organized home care services in ten units. The responsibilities of the municipalities have increased over time and challenges have been identified in management, recruitment, competency and in the responsibilities assigned to professional groups within primary health care services [ 68 ]. A qualitative research design using individual interviews was chosen for this project, as this enabled us to have a dialogue with the study participants and explore individual experiences [ 69 ].

This qualitative study uses individual semi-structured interviews with 20 home care nurses from a medium-sized municipality in Norway (Table  1 ). In Norway, registered nurses have a bachelor’s degree and are authorized to practice as a nurse by the Norwegian Authority for Health Personnel [ 70 ]. The project group established contact and made a formal agreement to conduct the study with the administrative leader of the municipal division of health and social care. We used purposive sampling and approached first-line managers in relevant units by phone or e-mail, and they helped recruit registered nurses with a minimum of a bachelor’s degree and who were familiar with the patients included in the project. Potential participants received written information about the study so that they could decide whether to participate. This included information on the purpose of the project, the person in charge, what their participation involved, how data was stored and used, what would happen with the personal data at the end of the research project, rights and that participation was voluntary. The first-line managers scheduled the interviews, which were held during the participants’ working hours in a quiet room located at the nurses’ workplace. The interviews were held face-to-face with only the interviewer and participant present. None of the registered nurses have subsequently withdrawn from the research project.

The research procedures were reported to the Norwegian Centre for Research Data (ref. no. 228,630). The Regional Committee for Medical and Health Research Ethics in Norway (ref. no. 2019/1138) exempted the research project from formal review since the research project was not expected to generate new knowledge about health and disease. Before the interviews, all participants received oral information about the aim of the research project, that the interviewer was a PhD student and had the opportunity to ask questions, before signing a voluntary written consent. The study participants were informed that they could withdraw from the study at any time without consequences and could access the data collected. The participants received written contact details to the project leader, Data Protection Officer and Data Protection Services. A voice recorder was used to record the interviews. In the beginning of the interview, the participants were asked not to use any identifiable names, and the interviewers did not mention or record the name of the participants. Each participant received a study number to secure confidentiality. Anonymous transcripts and recordings were stored on a password-protected computer. A list of names and respective codes is locked in a secure cabinet at the University where the project leader is employed, and can only be accessed by the research group. In accordance with the protocol of the Norwegian Center of Research Data all collected data will be deleted in the beginning of 2025.

Data collection

Data collection took place between October 2019 and March 2020. The semi- structured interviews ranged from 48 min to 1 h and 38 min. All were audio recorded with participants’ permission, transcribed verbatim and de-identified. One interview was incomplete, because the participant had to leave before we had asked all the questions. This interview lasted for 30 min, and we included the answers in the study. The research questions were developed by the research group, and the interview guide addressed participants’ gender, age, family situation and open-ended questions explored nurses’ thoughts, reflections, and experiences on their career in home care services and further career interests. The interviews also focused on nurses’ experience of cooperation with the patient and GP on the project. The interview guide included questions such as “How would you describe your working situation in home care services?”, “How do you envision your career as a nurse?” and “what would be important to you in terms of support/incentives/development in order to make your desired career possible?”. The researchers were not acquainted with any of the registered nurses participating in the study.

The research group consists of four females and one male. Two members of the research group are professors experienced with qualitative studies, whereas the other members are PhDs. The first author conducted 15 interviews and another member of the research group conducted five. Both interviewers were PhD students, with previous experience in conducting qualitative interviews. The first author is a female with human resources experience in specialist health care, and the other male researcher is a GP. Other members of the research group are experienced in leadership and nursing, making the group multidisciplinary. The research group had peer debriefing during the project period to discuss and gain different perspectives on the ongoing interviews. In addition, the two researchers conducting the interviews had an ongoing dialogue checking the correspondence between the findings. A sample size of 6–20 + participants is considered satisfactory in qualitative research, depending on the richness of the data and size of the project [ 71 ]. We determined that saturation had been met after about 15 interviews.

An inductive thematic analysis of the data was undertaken. This is a flexible way to identify themes and patterns in qualitative data analysis [ 72 ]. The analysis was guided by Braun and Clarke’s [ 72 ] six-phase process (Table  2 ). The main themes were generated abductively. Preexisting knowledge guided some of the interview questions, and when analyzing the data the first author read career theory to identify the relevance of information to the research aim. To address the trustworthiness of this study we applied strategies from the standardized criteria by Lincoln and Guba [ 73 ], namely credibility, transferability, dependability and confirmability. In line with Nowell et al. [ 74 ] we used these criteria as guidelines to support a rigorous thematic analysis. To ensure the trustworthiness in the first phase, all co-authors familiarized themselves with the data and individually searched for meaning and patterns enhancing the credibility of the study. The raw data and transcripts were organized in folders representing each nurse. In the second phase when generating initial codes, research triangulation enhanced confirmability. In phase three, the first author used Microsoft Excel and drew visual mind maps in the search for themes and connections. This process was documented and discussed with co-authors. In phase four and five of the thematic analysis themes were examined by co-authors and themes was reviewed in relation to the raw data before everyone agreed on the final naming. In phase six, we used the consolidated criteria for reporting qualitative studies (COREQ) as a guideline to ensure the transferability and confirmability of the research process [ 75 ].

The data analysis produced three distinctive themes for nurses’ career choices in home care services: (1) as a result of influence from multiple stakeholders and contextual factors; (2) as a result of fit with nurses’ private life; and (3) as a result of enhancing meaning of work.

Career choices as a result of influence from multiple stakeholders and contextual factors

The nurses described their choice to start working in home care services as resulting from coincidences, stakeholder influence, organizational policies and educational factors. Some participants started working in a part-time position in home care services while they were in their late teens. One nurse said:

I started working here as a student during my second year. Then a family member of a friend asked if I would like to work here as an extra and I thought yes, I could try that. And I’ve been here ever since. So yeah, it was really just coincidental that I ended up working in home care services. (Informant 18)

Clinical practice placements, part of the bachelor program in nursing, take place in hospitals, nursing homes, and home care services. The hospitals and municipalities are responsible for organizing the clinical practice, where a student gains experience with departments under clinical supervision. One nurse said:

We have many practicums at school and for my last one I also chose home care services. It was really just because I thought it had been the most fun practicum, and I ended up here. (Informant 16)

Clinical practice placements or part-time jobs familiarize nursing students with home care services as a potential employer. A good work environment, supportive colleagues and first-line managers, interesting work tasks and autonomy were among the factors influencing some nurses’ view of home care services as a potential workplace. Other nurses applied for a position in home care services as a result of changes in their personal life, like moving to a new city. We also found that different stakeholders and organizational factors influenced nurses’ choice to apply for postgraduate education or become a resource nurse. Nurses emphasized the importance of financial support from the employer in entering a specialization. The municipality provides financial support for unpaid leave and school expenses for relevant specializations. People or experiences in nurses’ surroundings often influenced their choice of specialization. One nurse explained how she had been inspired by the skilled geriatric nurses she met during clinical practice. Another nurse described why she became a resource nurse in palliative care:

It was basically because they asked me. They probably thought it was a good fit for me, even though I didn’t think so myself at that time because I thought it was a bit scary to speak to people who were in their last stage of life. “I don’t think I would be good at that” I said, but then I thought well, I just have to give it a go. So that’s what happened. I don’t really know another reason. (Informant 8)

Especially first-line managers appears to have both a positive and a negative effect on nurses’ career choices in home care services. The nurses had different experiences of management. Some unit leaders were inspiring, encouraging and supportive, while other units experienced instability and absence of a first-line manager. One nurse had applied for unpaid leave, to start working in a nursing home. Her unit had been chronically understaffed. She thought that her managers were not advertising vacancies, and were inattentive to employees’ needs. When she read a newspaper article reporting that politicians would not provide more resources to home care services, she doubted that she would return. She said:

That’s the reason I feel that I can’t do this anymore. I feel that I give, give, give all the time, while my superior is away a lot, and that really affects my motivation. (Informant 17).

Career choices as a result of fit with nurses’ private life

An overarching theme that explains nurses’ career choices in home care services can be seen as a result of fit with their private life. It captures the ways in which nurses make career choices that improve their work-life balance and how their needs change. Some of the nurses had previously worked, or considered working, at a hospital in a nearby municipality. However, the geographical location of work, shift arrangements and family situation affected nurses’ choice to work in home care services. As one nurse said:

From 2013, I think it was, when I started working a bit at the hospital and I thought I should give it a go again. So I was there a couple of years, I think, but then it became quite hard to combine with family life, especially because my husband travels a lot. That just made it too hard to work there. (informant 6).

Some nurses applied for a position in home care services, as the workplace is closer to home, and they would have a shorter commute and spend less time in traffic. Even though work in a hospital is considered professionally attractive, some nurses found it difficult to combine with their family life. As the example illustrates, when both parents have irregular work schedules, organizing family life is not easy. This was especially true for nurses with children, who struggled to balance their responsibilities to work and family. One nurse said:

After I had children it’s been quite practical. I didn’t have to work a three split schedule for example. My evening shifts start 3.30 pm or 4.30 pm. It’s a flexible job, and because you start at 7.30 am you are able to bring your children to nursery first. (Informant 18)

Nurses identified working hours to be better in home care services than at a hospital or nursing home. Shift arrangements in home care services involves more flexible working hours and does not include work at night. However, nurses still experience shift work as demanding, as it includes evening, weekend, and holiday work. To accommodate this kind of schedule, nurses had to depend on a partner who worked standard business hours and who could pick up the slack with family responsibilities. Nurses described how they and their partner shared household and childcare responsibilities. Several nurses who had small children worked fewer hours to spend more time at home. However, none of the nurses mentioned having a male partner taking unpaid leave to be at home with their children, illustrating a traditional gendered division of childcare. A nurse said:

When the children were little we really had enough just trying to keep our heads above water so I worked part time and as the children have had less need of me I’ve increased my work hours. I’ve felt that my work at home has been the most important one, and that I’ve worked as a nurse in addition to that one. But as time has gone by, and I’ve gotten more energetic, and my children get by more on their own, I’ve been working full time. (Informant 20).

In Norway, parents are entitled to 12 months of paid leave. In addition, each parent is then entitled to one year of unpaid leave. Most children between the ages of one and five attend kindergarten. There is one admission every year facilitated by the municipality. This means that some parents need to apply for unpaid leave so that they can stay home with their children who are waiting to start kindergarten. Several nurses chose to work part-time evening shifts while waiting for a place in kindergarten, so they were able to combine work and family. Other nurses whose children were eligible for kindergarten preferred to apply for unpaid leave in order to stay at home with them. Their colleagues and first-line manager supported their decision to work part time and adjust their working situation. However, as their children became less dependent on them, some nurses opted to return to work full time, in the evenings, and apply for a specialization. Nurses felt a tension between personal and professional wishes. One nurse described how she wanted to take a specialization, but adjusted the time and place to accommodate her children. However, younger informants did not want to delay pursing a specialization or master’s degree for too long. Nurses in the later stages of the careers and without a specialization, supported this view, as they believed that they were too old for further education. However, they expressed an interest in developing their skills and knowledge at work.

Career choices as a result of enhancing meaning of work

Nurses can work in different clinical fields and types of organizations. Work content and organization of work influenced participants’ application for a position in home care services. One nurse explained why she started in home care services:

It’s very special to go into people’s houses, it’s a very pleasant atmosphere. You get to see the whole person in a way, not just their illnesses. And you get to see how they live, which gives you an idea of who they are as people. It’s also very exciting to hear their stories and not just see them when they are at their lowest. (Informant 5).

In home care services, many patients receive treatment for years, so their nurses know their complete history, needs, routines, and interests, all of which affect quality of care. Nurses can take a holistic approach to patients. An important part of nurse’s job is to monitor changes in a patient’s condition. Spending time in the patient’s home and getting to know them and their family help nurses to understand that patient’s needs. A nurse described why knowing the patients is important:

I think it’s important. Because you care about their well-being, and….The fact that you can get a bit close to them so that you’re able to help in the best possible way. And to not just see their illnesses, but also everything around them. Their next of kin, contact with their doctor….to be able follow up properly. (Informant 13).

Knowing patients well is an antecedent for providing quality of care, something the organization of work in home care services facilitate. Nurses enjoyed the coordination of care among stakeholders, like the patient’s family, GP, physiotherapy services and allocation office. However, nurses were frustrated with the lack of collaboration with GPs or hospitals, because it led to uncertainty and extra work for nurses who often work alone in patient’s homes. Although it can be difficult to work independently, it can also be motivating. One nurse said:

Yes, I did consider the hospital. I thought it might be more challenging, as there are a lot of procedures. But the thing with home care services is that you work quite independently because you’re out there driving. So I figured I’m learning just as much here, and maybe even more. You become independent, and you have to make your own choices and I feel more in charge of my own work situation here. (Informant 14).

The nurse mentions the importance of having an interesting job and recognizes autonomy as a factor in her choice to work in home care services. When driving from patient to patient, nurses have time to reflect. In addition, informants expressed happiness at not being tied to an institution. At the same time, they noted the importance of professional support, and described daily arenas where they were able to discuss challenges and patients’ conditions with colleagues and first-line manager. They also discussed patient’s conditions with the patients themselves, their families, GP, and contacted acute care if necessary. The motivation for enhancing the welfare of others influenced nurses’ career choices, like specialization, becoming a resource nurse and leaving home care services. Several of the informants had taken a specialization. According to one nurse:

And that’s why I wanted to do further postgraduate studies too. I felt I needed it. And I feel that it’s good that we are three, rotating it, because there are so many wounds it’s needed. (Informant 5).

Nurses described how work in home care services has become more specialized in the past decade, and diagnoses have become more complicated. Hospitals discharge patients sooner and nurses are expected to perform unfamiliar procedures. To provide quality of care, nurses stressed the importance of professional knowledge. However, some considered postgraduate education as a possible alternative to home care services and shift work. Some nurses who study for a master’s degree were unsure about their future in home care services, and how the municipality would make use of their competence after graduation. One nurse with a specialization had resigned from her job in home care services to accept a position in the specialist health care services. Work in home care services is diverse, as nurses usually serve a variety of patients with different diagnoses. She had thrived in home care services, but wanted to use her skills to help patients with more serious diagnoses.

The aim of this study was to increase our knowledge of home care nurses’ career choices. Three themes emerged: (1) career choices as a result of influence from multiple stakeholders and contextual factors; (2) career choices as a result of fit with nurses private life; and (3) career choices as a result of enhancing the meaning of work. Based on the sustainable career perspective [ 24 ], we expected that the dimensions of person, context and time would relate to the career choices of home care nurses. Previous career literature has been criticized for putting too much attention on people’s agency [ 14 , 49 , 76 ]. This study advances knowledge by highlighting the importance of context and time on registered nurses’ career choices, and provide support for the use of the sustainable career perspective as a broad theoretical framework in understanding registered nurses career choices. It contributes to a field where previous research is largely based on quantitative data [ 17 , 23 , 31 ] and illustrates how nurses themselves, their private context and work context influence their career choices over time.

The results identified how stakeholders and factors within multiple contexts influenced nurses’ career agency over time. Clinical practice and the offer of a part-time job, considered a positive career shock, provided job resources and experience. This appeared to affect nurses’ perception of home care services as a potential employer, the person-job fit, and their choice to apply for a permanent position after graduation. This supports previous research [ 18 , 77 , 78 ], in which clinical experience and curriculum content are identified as the main tools for changing nurse students’ negative perceptions about work in primary health care [ 79 ]. The implication of this is that managers and employees in home care services are proactive and encourage people to work in home care services and create opportunities for learning and development in line with registered nurses and home care services needs for competence. This will benefit both employer and employees need for development [ 80 ]. Home care services could offer mentors, role models, interesting work tasks, encourage voice, feedback and support in order to provide high-quality work experiences, as lack of support, uninspiring work tasks, and time constraints could lead to stress and frustration and preclude employment in home care services [ 25 , 27 , 81 ].

Two nurses had applied for a position outside home care services; however, the motives and types of agency behind their choices differed. One nurse wanted to quit because of increased workload, time pressure, and lack of support from managers and politicians (push factors), resulting in an unsustainable career. The other nurse was drawn to another job where her competence would be put to better use (pull factors). Previous research has identified burnout as a threat to career sustainability by causing career turnover [ 42 ]. Time pressure and heavy workload may hinder nurses from performing work that meets their professional standards, leading to stress and frustration. In line with the JD-R theory [ 56 ], high demands and low resources over time can decrease person-job fit, which causes nurses to leave home care services for a more sustainable career. However, research has indicated that employers can mitigate the negative effects of increased work demands by offering job resources [ 54 ]. In line with previous research [ 29 , 44 , 50 ], this study highlights the important role of first-line managers for nurses’ career choices. To develop first-line managers skills by offering training programs which focus on understanding employee needs, how to provide support and encourage nurses career development will be important. This can prevent nurses from seeking other job opportunities, something that will serve the interests of home care services by ensuring a stable workforce.

Nurses started to work and continue to work in home care services as it fits their private life, supporting previous research identifying work-life balance as one of the most satisfying aspects of work in primary health care [ 3 , 25 , 82 ]. When nurses become mothers, they seem to give the top priority to balancing work and home. Our results show that organizational factors such as the location of work, shift arrangements, and the possibility to adjust work based on the demands of family life becomes important for nurses’ choices. Previous research has showed that working night shifts is associated with negative family outcomes such at work-family conflict, especially when children are small [ 83 ]. Nurses adapt to family demands by working part-time, changing their hours of work and postponing their plans for higher education. However, none of the nurses stated that their choices depended on the limits set by a full-time working partner. This study supports the importance of including non-work domains in research on sustainable careers [ 82 , 84 ]. Kossek and Ollier-Malaterre [ 59 ] and Straub et al., [ 60 ] have emphasized the importance of both employees and employer to foster sustainable careers. This implies that to retain registered nurses, home care services should adjust HR politics and practices with employees’ expectations, norms and values through different phases of life, as this can facilitate nurses’ experience of fit between their personal life and their work in home care services. For several nurses the desire to work part-time appears to be temporary for parts of their lives when they experience increased family obligations, supporting earlier findings [ 20 ]. Registered nurses in the last phase of their career seem to have other career aspirations than nurses in their first phase. As the proportion of adults is increasing, health care organizations should motivate registered nurses to continue until a later age. In line with suggestions by Kooij et al. [ 85 ], municipalities can offer HRM practices such as training, career planning or lateral job moves.

The results show that nurses experience meaning of work by helping their patients. Autonomy, helping people and having a close relationship with patients have been identified as some of the most satisfying aspects of work in primary health care [ 3 , 25 ]. The ability to derive meaning from work is important for people’s psychological well-being [ 86 ], and this highlights the importance of considering meaning of work as an important resource. Some nurses proactively shaped their careers by undergoing or completing postgraduate education. In line with self- determination theory [ 39 ], nurses expressed a need for knowledge, to improve patient care for a growing number of patients with complicated diagnoses. Studies indicate that home care nurses must perform increasingly advanced procedures and assessments, and call for more information and training about specific procedures [ 8 ]. To encourage, facilitate, and support registered nurses’ development of competence will be important. In line with previous research [ 6 , 87 ], our findings demonstrate the importance of home care services continuously working to ensure improved collaboration with other health care providers in order to reduce uncertainty and extra work for registered nurses. A sense of accomplishment has been identified as important for nurses’ intention to remain in home care services [ 28 ], and our results indicate that this guides additional career choices. In line with the principle of conservation of resources [ 38 ], acquiring resources makes nurses more employable and provides them with career opportunities inside and outside primary health care. Some nurses who studied for a specialization were unsure about their future in home care services, and did not see their employer as taking the initiative in discussing possible career paths. Providing career planning support, with a perspective of possible career alternatives within home care services that are valuable to the organization and provides meaning to registered nurses will be important to develop and retain registered nurses. At the same time, nurses need to be aware of what matters to them and act in the interests of their own needs and values. This will improve the chance of person-career fit and of a sustainable career [ 36 ]. Home care services should align work with nurses’ interests, strengths, and values, as this would benefit both the municipality and nurses in terms of improved job performance, meaningfulness, and organizational commitment [ 64 ].

Limitations

This study has several limitations. First, the sample consisted only of women from a single municipality in Norway. Further research should be conducted in different health care settings and cultures. A second limitation is that the results may be biased as it can be hard to recall what happened many years ago. Additional research should use a longitudinal design to increase our understanding of nurses’ career choices. Finally, future research should examine the role of age and the perspective of the organization.

The aim of this study was to increase our understanding of nurses’ career choices to offer insights that can be used to attract, motivate, develop and retain registered nurses in home care services. The results illustrate the importance of having a whole life perspective to understand nurses’ career choices, and how nurses’ career preferences change over time. To meet the population’s increased need for health and care services it is important for the municipality to facilitate sustainable careers across the life span through HR policies, motivating and stable managers, which support nurses changing needs, interests and values. Nurses need to be mindful and act according to what is most important to them.

Data Availability

The datasets generated from the study are not publicly available due to reasons of confidentiality. Additional knowledge of the de-identified data can be available from the corresponding author on reasonable request.

Abbreviations

General practitioners

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Acknowledgements

The authors thank the participants and the local municipality for participation in the study, and members of the research group who are not co-authors of this article. We thank the University of Stavanger and Stavanger University Hospital for supporting this study.

This study has been supported by the University of Stavanger and Stavanger University Hospital.

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GHH contributed to the study by recruiting study participants, developing the interview guide, collecting and analysing data, and writing the first draft of the manuscript. AM, OØ and MS contributed to the development of the interview guide, interpretation the data and critically revising all drafts of the manuscript. All authors read and approved the final manuscript.

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The research procedures was reported to the Norwegian Centre for Research Data (ref. no. 228630). The Regional Committee for Medical and Health Research Ethics in Norway (ref. no. 2019/1138) exempt the research project from formal review since the research project did not intend to generate new knowledge about health and disease. The study was carried out in accordance with relevant guidelines and the declaration of Helsinki. A formal approval to conduct the study was obtained from the Divisions of health and social care services in the municipality. All participants signed a voluntary written consent before the interviews and were informed that they could withdraw from the study at any time without consequences.

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GHH, MSc, HR Adviser at Stavanger University Hospital and currently a PhD candidate at Stavanger University Hospital and University of Stavanger Business School. OØ, PhD, Research associate professor at NORCE Norwegian Research Centre. MS, PhD, Professor at the Faculty of Health Sciences, University of Stavanger, AM, PhD, Professor at the University of Stavanger Business School.

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Haaland, G.H., Øygarden, O., Storm, M. et al. Understanding registered nurses’ career choices in home care services: a qualitative study. BMC Health Serv Res 23 , 273 (2023). https://doi.org/10.1186/s12913-023-09259-0

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  • Documenting that their research protects any human or animal subjects involved
  • Publishing findings in peer-reviewed journals or books
  • Presenting at conferences
  • Keeping up with professional literature

Career Traits

  • Strengths in analysis, observation, and written communication
  • Ethical in publishing studies and the treatment of human or animal subjects

A mid-adult Hispanic female nurse researcher is writing on a whiteboard in her office.

Credit: JGI/Tom Grill / Getty Images

Where Do Nurse Researchers Work?

Nurse researchers work in academic medical centers, government agencies, and other healthcare providers.

Academic Medical Centers

Nurse researchers in academic medical centers conduct research, publish results, and teach undergraduate or graduate students.

Government Agencies

In government agencies, these professionals perform research, share findings, and publish results internally or externally.

Nurse researchers working in publishing select articles for publication, review methodology and validity, and edit articles in collaboration with authors.

Featured Online Programs

Why should i become a nurse researcher.

Research nurse jobs add to professional knowledge and help nurses to do their jobs with evidence-based research, improving healthcare outcomes. Nursing research doesn't include the same physical demands as clinical nursing and offers more predictable schedules. However, nurse research jobs typically do not pay as much as clinical nursing roles.

Advantages To Becoming a Nurse Researcher

  • Contribute to professional knowledge
  • Important findings can change how nurses work and improve healthcare
  • Less physically demanding and more predictable schedules than clinical care

Disadvantages To Becoming a Nurse Researcher

  • "Publish-or-perish" culture in academia
  • Some may find work less fulfilling by not directly interacting with patients
  • Requires time and financial investment in a master's or doctorate
  • Salaries are typically lower than clinical nurse practitioner salaries

How To Become a Nurse Researcher

Becoming a nurse researcher requires developing skills in research methodology, informatics, statistics, and nursing itself.

Graduate with a bachelor of science in nursing (BSN) or an associate degree in nursing (ADN).

Pass the nclex-rn exam to receive registered nurse (rn) licensure., begin research., apply to an accredited msn, doctor of nursing practice (dnp), or doctor of philosophy in nursing (ph.d.) program., earn an msn, dnp, or ph.d., apply for certification., how much do nurse researchers make.

The annual median research nurse salary is $81,500 . Generally, nurse researchers with doctoral degrees earn more than those with master's-level education. Some research nurse professionals in academia qualify for tenure. In general, clinical research associates earn a median salary of $66,930 , while certified clinical research professionals earn an average salary of $72,430 . However, because of the RN credential, nurse researchers with these certifications generally earn above the average or median for those positions.

Frequently Asked Questions

How long does it take to become a nurse researcher.

Nurse researcher careers require a significant time investment. It takes at least six years of education to earn an MSN and seven years for a doctorate. In addition, most MSN and doctoral programs require at least two years of experience as an RN.

Why is nursing research important?

Nursing research finds the most effective approaches to nursing and improves the outcomes for nurses, patients, and healthcare organizations. It builds the body of knowledge for nurse education.

What are some examples of responsibilities nurse researchers may have?

Professional responsibilities include protecting human or animal subjects in their research, designing studies that produce valid results, accurately reporting results, and sharing findings through publishing.

What opportunities for advancement are available to nurse researchers?

Research nurse jobs offer opportunities for advancement in the academic or research field, such as becoming primary investigator on studies of increasing scope and importance, advancement in administration, or receiving tenure as a professor or college instructor.

Resources for Nurse Researchers

International association of clinical research nurses, national institute of nursing research, the association of clinical research professionals, society of clinical research associates, related pages, reviewed by:.

Portrait of Nicole Galan, RN, MSN

Nicole Galan, RN, MSN

Nicole Galan is a registered nurse who earned a master's degree in nursing education from Capella University and currently works as a full-time freelance writer. Throughout her nursing career, Galan worked in a general medical/surgical care unit and then in infertility care. She has also worked for over 13 years as a freelance writer specializing in consumer health sites and educational materials for nursing students.

Galan is a paid member of our Healthcare Review Partner Network. Learn more about our review partners .

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  • Open access
  • Published: 12 May 2022

Registered Nurses' experiences of reading and using research for work and education: a qualitative research study

  • Sonia Hines 1 , 2 ,
  • Joanne Ramsbotham 2 &
  • Fiona Coyer 2 , 3  

BMC Nursing volume  21 , Article number:  114 ( 2022 ) Cite this article

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Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature to enable their engagement with evidence-based practice. Despite these efforts, a considerable number of nurses experience difficulty with research literature and are reluctant to use it in practice.

This study aimed to explore the experiences and perceptions of Registered Nurses when they have been required to read and understand research literature for work or education.

A qualitative descriptive study using online and in-person focus groups.

Focus groups (online and in-person) were conducted between June and November 2020. Forty participants were included. We used focus group recordings and field notes to collect data. Transcribed records of these focus groups were coded on the basis of similarity of meaning and then subjected to thematic analysis.

Three distinct themes were identified from the data: 'coming into learning about research', fitting research into the reality of nursing life', and 'working towards using research.' Participants described their early experiences in learning about research, experiences both positive and negative in integrating research into practice, and their personal strategies for reading and using research, particularly in the context of significant anxiety about understanding the content of methods and results sections of quantitative research articles.

This study goes beyond the barriers and facilitators dichotomy that has been the majority of the conversation about nurses' evidence-based practice engagement previously, and explores the issues underlying aversion to research literature. Many nurses struggle with the language, numbers, and/or statistics used in research and this requires educational interventions suited to the problem and the population.

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Introduction

Reading and using research is integral to evidence-based practice and therefore to nursing [ 1 ]. It is known, however, that many nurses avoid engagement with research literature and evidence-based practice (EBP) for a variety of reasons [ 2 ]. Positive attitudes to EBP, involvement in research education and activities, regular journal reading, and higher levels of education have been found to be associated with higher levels of EBP engagement [ 3 ]. These positive EBP attitudes may indicate that past experiences and associated feelings about research are a more important factor than perhaps the literature would indicate.

Considerable resources have been expended, both in universities and health workplaces to improve nurses' abilities to interact with research and research literature. Most university nursing degree courses around the world include research education in some form as part of their undergraduate curriculum, however in practice there continue to be nurses who are reluctant to engage with evidence-based practice and research utilization [ 4 ]. Globally, the World Health Organization (WHO) identifies nurse graduate attributes that includes the ability to demonstrate the use of evidence in practice [ 5 ]. This research, which is part of a larger body of work on nurses' research literacy, intends to describe RNs' perspectives on reading and using research in practice and education, to understand their feelings about this activity and to generate new knowledge about their behavior in this area of practice.

A qualitative systematic review of 11 studies has identified a broad range of emotional responses nurses may experience when interacting with research literature including negative feelings such as discomfort, irritation, frustration and vulnerability [ 6 ]. While this small body of qualitative research describes the barriers to nurses' research utilization in practice, a notable gap in understanding the experiences that have led to forming those emotional reactions has been identified.

The requirements for Registered Nurses are clear – they are expected to be able to participate in evidence-based practice and this requires them to be research literate – able to read and understand publications that use research language – but what is equally clear is that nurses find evidence-based practice difficult, challenging or even impossible [ 7 , 8 , 9 ].

In addition to factors such as organizational characteristics and pressures [ 10 ] it has been hypothesized that nurses experience difficulty understanding the language used in research literature [ 9 ]. Difficulties with language, however, may not be the only issue at the root of this problem. Nurses learn a great many specialist terms in their careers, quickly becoming familiar with the particular language used in different clinical, community and other specialist areas, so it seems unlikely that research language alone is the problem. It may be that there are particular feelings and experiences specifically attached to research literature that deter nurses from engaging with it, or other factors affecting their engagement. Much is known about barriers to EBP, but less is known about nurses' experiences and feelings about research in the context of their lives and careers.

The aim of this study was to explore the experiences and perceptions of registered nurses when they have been required to read and understand research literature as part of work or educational activities chiefly, to describe their feelings about this activity, to understand the relationship between these experiences and participants' willingness to engage in activities that require interaction with research literature and their experiences with those activities.

Research question

This study was designed to answer the question, "How do registered nurses experience and perceive reading and using research for work and education?".

This study employed a qualitative descriptive design, as described by Sandelowski [ 11 ], Milne [ 12 ], Lambert [ 13 ], and Kim [ 14 ]. The aim of the qualitative descriptive design, according to Lambert, is to comprehensively summarize particular events experienced by individuals [ 13 ]. Used widely in nursing due to its pragmatic, simple approach, qualitative descriptive research seeks to understand experiences and perceptions without transforming them beyond recognition [ 15 ]. The qualitative descriptive design was derived from the interpretivist research paradigm which holds that reality and truth are socially constructed and that complex phenomena can have many interpretations [ 16 ].

Qualitative descriptive studies, considered a form of naturalistic inquiry [ 17 ], use straightforward methods of data collection, such as focus groups, to elicit information about participant experiences and so this methodology is most suitable for research questions such as those being posed in this study. This design is categorized by minimal transformation of the data, and to this end we attempted to utilize the participants' own voices as much as possible to convey their experiences as they described them [ 14 ].

In this study, we conducted a series of online and in-person focus groups utilizing semi-structured interviews to collect participants' responses to open-ended questions and prompts from the researcher about their experiences and perceptions. Focus groups, due to their inherently social nature, are ideal for revealing attitudes, beliefs and experiences.

Sample/participants

The study protocol planned for a sample size of 75 registered nurses, however data saturation was reached at 40 participants and so recruitment was ceased. Sampling was not purposive, and any interested registered nurse was eligible to volunteer to participate.

The study population was planned to be drawn from registered nurses attending educational short courses or sessions at the study location (a center for education and research in a remote Australian town), however this was disrupted by the COVID-19 pandemic and travel and contact restrictions meant that in-person short courses and other education were moved to online delivery, preventing recruitment for in-person data collection, except for five participants for one focus group. Additional participants were then recruited to participate in online focus groups using nursing forum posts, social media, email, and personal contacts. Eligible participants were any adult person holding a current nursing registration with AHPRA (Australian Health Professional Regulation Agency), currently practicing in any health setting and with any educational background.

Data collection

Data were collected between June and October of 2020. Online focus groups were conducted using Zoom video-conferencing software, which enabled video as well as audio capture of participants' interactions. Video-conferencing supported participant to participant interactions, as well as participant to researcher, and moderately replicated the strength of the social elements of an in-person focus group. The single in-person focus group was audio-recorded only, but field notes were recorded. Post-interview field notes were also recorded for the online focus groups. Fourteen focus groups were scheduled, with 45 min allocated to each. Following their completion of the consent form, participants were contacted with a range of focus group times to choose from and once three to six participants had chosen the same time slot, the group time was confirmed and took place. In three cases, scheduled participants did not attend or advise their inability to attend, and so the data collection proceeded with only one participant.

Expectations for the group in terms of turn-taking, disagreements and politeness were discussed at the start of each group's session. Focus groups each generally took 30–45 min to discuss the questions in the interview guide, although occasionally more time was taken due to lively conversation.

The interview guide (Fig.  1 ) was developed by the researchers at the beginning of the study and changed iteratively over the course of the interviews in response to the discussions and two more questions were added. Questions in the interview guide were designed to answer the research question, and influenced by Melnyk's work on EBP in organizations, and EBP education [ 18 , 19 , 20 ] as well as the researchers' previous work in this field. The primary researcher was the only interviewer.

figure 1

Interview guide. Items with asterisks* were added iteratively

Data analysis

This study used the six stage thematic analysis process recommended by Braun and Clark [ 21 ]:

After verbatim transcription of the audio recordings by a professional transcription service, the first author spent considerable time reading the transcripts and becoming familiar with the data.

Transcripts were entered into NVivo 12 (QSR International) which was used to aid thematic analysis. Initial codes were developed from both meaning and context by the PI at a semantic level of meaning. The codes were checked by the associate investigators to improve dependability.

Codes were then categorized into groups on the basis of patterns of similar meanings.

Categorization into themes and subthemes was achieved through repeated readings of the transcripts and considering the meaning of participants' statements. The associate investigators checked and gave input on the themes and subthemes at this stage.

The themes and subthemes were named in an iterative process that involved repeated readings and returns to the participant data to select the appropriate illustrative quotes which were then used verbatim to convey participants experiences and perceptions.

The sixth and final stage involved writing up the data, deciding on the order the themes and subthemes would be presented and making final decisions about how the story of the research might best be told. At this stage, participant names were replaced with pseudonyms to preserve confidentiality.

Reflexivity

The primary researcher SH is a registered nurse coming from a professional background in nursing research and education, particularly focusing on evidence-based practice and research capability. Reflecting on her experiences teaching and learning about research and EBP, she needed to recognize her biases and prior assumptions regarding the root causes of disengagement with research and EBP literature, acknowledging these in discussions and making space for participants to relate their own experiences.

Trustworthiness

The trustworthiness of this research was enhanced through careful attention to credibility, transferability, dependability, confirmability, auditability, and reflexivity [ 22 , 23 ]. The credibility and auditability of this study was enhanced by the use of extensive record keeping for the field notes, recordings, transcripts, and coding. Decisions about coding and data management were clearly documented. After each focus group field notes were recorded and checked against the recording.

Transferability and authenticity [ 24 ] have been addressed by recording and reporting detailed 'thick' descriptions of the interactions and discussions in each focus group. While qualitative research is not precisely transferable, there are similarities between many kinds of human experiences and readers of the research may recognize the findings as transferable to their own context, particularly as we have included the participants' own words as much as practicable [ 22 ].

Dependability in qualitative research is similar to the concept of reliability in quantitative research [ 25 ]. In this study we have ensured the research has been accurately reported, that decisions were documented and so are able to be clearly auditable. The use of an interview guide to ensure the same questions are asked of each focus group was also designed to increase the dependability of the study. The confirmability of the study will be established when the above methods for achieving credibility, transferability and dependability have been enacted [ 22 ]. All data related to the study has been retained: focus group recordings, transcripts, field notes, coding decisions, the codebook, and NVivo files. Completeness of reporting was ensured by following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline [ 26 ].

Participant descriptions

Initially 53 registered nurses (RN) volunteered and signed a consent to participate, however not all responded to the contact emails to arrange a focus group time or were able to find a suitable time to participate, and so 40 registered nurses completed the study in 14 focus groups of 1–6 participants. All focus groups were planned to be at least three participants in addition to the investigator, however last-minute cancellations meant that was not always possible and three focus groups proceeded with only one participant and the researcher conversing.

All participants were registered nurses licensed to practice in Australia, located in every state and territory of Australia in a variety of urban ( n  = 23), rural and remote areas ( n  = 17). Most participants were female, and their ages ranged from 24 – 65 years. Participants were working in a wide range of clinical settings including emergency department ( n  = 7), medical-surgical ( n  = 7), intensive and critical care ( n  = 5), mental health ( n  = 5), perioperative services ( n  = 3), oncology ( n  = 3), remote area nursing ( n  = 3), family nursing ( n  = 2), pediatrics ( n  = 1), occupational health ( n  = 1), community nursing ( n  = 1), rehabilitation ( n  = 1), and Aboriginal health ( n  = 1). All spoke fluent English, as required for nursing registration in Australia [ 27 ], however several spoke English as an additional language. Most were very experienced in their nursing career, with an average length of nursing experience of over 20 years and the majority of participants had a postgraduate level of education (Table 1 ).

The 14 focus groups with 40 participants yielded three themes: 'Coming into learning about research', 'Fitting research into the reality of nursing life', and 'Working towards using research' and ten subthemes (Table 2 ). All participant names used here have been pseudonymized. Pseudonyms, ages and length of RN career are provided in parentheses with each participant quote to give further context to participants' responses.

Theme 1: Coming into learning about research

Given our interest in nurses' early learning experiences regarding research, a significant part of each group discussion focused on participants' first encounters with research. Participants had come to nursing from a variety of paths; as school-leavers, mature-age students changing careers or entering the workforce at a later age, so they had a range of educational and life-skills preparation as they entered nursing. Some participants had begun nursing prior to tertiary nursing education implementation, having been trained in hospitals, and this also impacted on their experiences of learning about research even if they had completed tertiary studies at a later time.

Early experiences

Most of our participants had begun their careers when nurse education was very different from today, some in the early days of university education and some through the hospital training system. This time gap had an impact on the recall of these early events for some participants but for others the memories of their experiences were very clear. Participants described, some with laughter, their initial feelings when first faced with learning about research, either in their undergraduate nursing degree or subsequent graduate level studies, conveying a range of reactions:

When I was first exposed to research as an undergrad, I was horrified (Jack, 55, RN 26 years), I mean it was really good. I loved it, but it was a very steep learning curve (Anna, 59, RN 13 years), and, I didn't really take any interest in articles until I started my first Masters (Joy, 52, RN 33 years).

Difficulty understanding the concepts and feeling lost were common experiences for these nurses as they began to learn about research. Using self-deprecating humor, participants spoke of trying to find simple articles they could understand:

What I would try to do is I would try to find this… Try, try to find the sort of research that spoke in the most simplest of terms.., once I got halfway through it and I recognized that it was well beyond, above me…(Walter, 49, RN 29 years)

The volume of research available was confusing to them as students and they found it hard to identify which was relevant:

It's so broad trying to get so much, I think I actually did, you know, like I went to areas that wasn't meant to be trying to gather information because of time limit I found it was overwhelming (Fatima, 47, RN 9 years) and evidence for practice was not necessarily connected to research being used for an assignment: I think as an undergraduate, you can't… The research underpins your theory so that you have some kind of extended understandings to what you're doing and why, but once you actually get into a prac experience and you're actually on the floor with your mentors or etcetera, then you kind of don't link the two together (Kathy, 46, RN 11 years).

Early learning also brought with it problems of how to interact with the research literature. How and if to critique the literature was recalled as a significant problem:

I vividly remember thinking, who am I to put up an argument against this? These people have published this, for goodness sake. You know who am I to say that they're wrong? So that was my first thing was it was really difficult (Sophie, 51 RN 30 years)

Developing a critical mindset was not something they found easy to develop:

I just took them all as gospel. You know, what was in these articles was gospel, and I used what I could (Joy, 52, RN 33 years)

Others, however, felt they had personal characteristics that helped them in their early learning years:

I was always a bit of a bookworm, so yeah, I didn't struggle too much with that (Jenny, 52, RN 27 years)

Help with learning

A great deal of the focus groups' conversations about their formative years dealt with the help participants had received with their research learning, including help from mentors and role-models. One participant remembered:

When I was doing my nursing degree, one of the best and most memorable tutorials I ever had was in a research topic, which are traditionally the ones everyone hates, find really difficult to do. I had a very inspiring tutor in that topic, and the most memorable tutorial I think I ever had was when we discussed ethics in research (Tess, 42, RN 13 years)

Other participants recalled helpful programs such as peer mentoring, learning success programs, and academic writing courses, as well as library services and librarians that were another source of valuable help. Mentors, lecturers, educators and peers were described as helpful, inspirational, or supportive, and they were described as key to surviving these early learning experiences, according to participants' recollections:

Having good role models, and as I said… Or as I said, mentors, but having mentors, good role models, good people around you that value it helps you to value research 'cause you see what they can make of it (Jack, 55, RN 26 years) and: Study-wise, like I said, I had a fantastic mentor that just encouraged me and pushed me and pushed me, and it was wonderful (Sarah, 59, RN 40 years)

Similarly, the absence of role models was felt to be an additional source of difficulty:

…they tell you to find a mentor or… There just wasn't anyone. You know, it's yeah, a small country town. You don't find anyone, there's, there's nobody that understands it, there's nobody that… that can do that interpretation for you…that…can help you with how to do that (Jenny, 52, RN 27 years)

Theme 2. Fitting research into the reality of nursing life

This theme and its three subthemes (organizational issues, interpersonal issues, and confidence) emerged from discussions of how reading and using research connected with the rest of their nursing lives. Participants were asked about how any difficulties they had with learning to understand research impacted on how they perceived their chances for success as a nurse, how pressures from their working life impacted on interacting with research literature, and how their degree of comfort with reading and using research influenced their involvement in work activities. The need or desire to read and use research sometimes did not fit well with a nursing career, especially in the early years when it was perceived that consolidating the tasks of nursing was paramount. Supportive structures, senior staff and peers were spoken of admiringly, with a sense that they were 'lucky' to be in a research-friendly environment. Achieving confidence with reading and using research was seen as a function of personal characteristics rather than the actions of educators and workplaces.

Organizational issues

A prevalent view across multiple focus group discussions was that organizations were perceived to view nurses' involvement in evidence-based practice (other than simply complying with policy) as an optional extra in the context of getting the job done:

There's really no time for anything else, and from a higher level, research is considered something of a luxury. If there's resource cuts, then education and research are always hit first (Samantha, 55, RN 22 years).

Some participants perceived that preserving the status quo was a higher priority than promoting practice change:

...if people understood how to use the databases, how to research evidence to back up practice or to, or even just to augment their practice great, but it's so hierarchical in nursing and people guard their policies and procedures with their life. I don't think they want change sometimes (Kerry, 53, RN 18 years)

The hierarchical nature of many nursing structures also worked against participants' desires to become involved in EBP activities:

I have never been involved in projects, before because of the hierarchy, I'm at the bottom level (Fatima, 47 RN 9 years)

Many participants worked in organizations with expectations that staff participate in EBP activities, but that did not necessarily mean that resources or support was available to facilitate these activities:

The fact that I was in a, a large metropolitan health service still didn't mean that I could reach out and grab somebody to help me, So but in more recent times, they've put some structures in place to improve that, and it has improved. However, would I call it supportive? I don't know that I'd call it that (Walter, 49, RN 29 years)

There was a consciousness of different organizations being at different levels of engagement with EBP:

…other organizations I've worked for in the past, they're at the forefront, they're engaged with universities and tertiary providers which work alongside the clinical service, and I think that people have a greater understanding about the importance of research and generating research outputs and also using that to inform practice. Whereas, I think that not all organizations are at that stage, which is just how it is really (Ron, 40, RN 16 years)

Interpersonal issues

Many participants recognized that EBP was not something they could really achieve alone, and that without the cooperation of their team it was unlikely they could influence practice change. There was also considerable discussion of the overt hostility some had faced when trying to change practice or undertake further studies. The nature of interpersonal interactions was of considerable importance to these nurses, reflecting the strong focus on teamwork in nursing. Being 'different' or acting outside the team's norm put individuals at risk of feeling out of place in their workplace or in their job. Other participants related stories of assistance and support and spoke of their pride in their workplace and team for providing high quality care.

The perception that research and EBP are not really core to nursing was clear from several participants, as one said:

I don't think I actually put the two together as either being the researcher or the clinician nurse, in that I often probably was looking for something because I couldn't find the answer to it. So, I would… Nobody else was looking up anything and so I guess I felt odd, actually (Ella, 34, RN 14 years)

The demarcation between EBP and practice as it happens 'in real life' was made quite clear:

And when you have eight hours to finish everything that you have to get done, the urgent priorities take over the important or even, really don't know if you call it important, I'd call it a side gig(Mei, 35, RN 14 years)

Caring was seen to be at odds with intellectual activity:

…whereas nurses, well, you're supposed to care, like where's where does research fit into that? (Jenny, 52, RN 27 years)

People inside and outside of nursing did not seem to perceive research as something that nurses should be concerned with:

a fairly new RN, who's got a position as a researcher and yeah, she's had a lot of flak from people, including in our family, about, "Why are you doing this? Is that what you did nursing for?" So yeah, it just speaks to the stereotypes about how research is not an essential part of our profession, which of course it is (Jack, 55, RN 26 years)

Supportive teams and colleagues were seen to enable practice improvement through research use:

I don't have much experience outside emergency departments, but I do think emergency and critical care, there is generally a good culture around that sort of thing. When I was quite a junior nurse, for my graduate certificate, I had to do a literature review on pressure area injuries in emergency care. And through that I was able to alter our nursing assessment charts to include a Braden score because of the evidence that I showed the organization about the risks of pressure injuries and things like that. And they were very receptive to that I found (Tess, 42, RN 13 years)

Participants appreciated a supportive culture in the workplace:

So, I've just become interested in research recently, and just talking to people who are in that field in the hospital has been really easy and very helpful and supportive. And yeah, and helping me try to do that in helping you try to learn that as well. So, it's yes. Really, really good. Really supportive (Maya, 30, RN 3 years).

Participants identified their own personal characteristics as being key to their confidence with research:

I was always very ambitious and thirsty for knowledge. So I read every you know, there are professional magazines that come out like my first place as a registered nurse was the operating theatre. So I read all the operating theatre magazines that came out (Mona, 52, RN 32 years)

Participants related early experiences with reading research that increased their confidence:

I went to search in the library at the [hospital] and got out some articles and read them, and then told my educator that this is what I'm gonna do, and she was of course very impressed. But that was sort of like an automatic. But not all students did that though. You know what I mean? It's probably because I'm just a type A personality and it worked for me… (Diya, 48, RN 20 years)

Confidence with one aspect of using research was perceived as leading to other things:

Yes, I've been taking on, like, you know, the mentoring and the facilitation of the students. And I wasn't really looking into that side of stuff until I started to get a little bit more into the research stuff (Eve, 30, RN 10 years)

Confidence with research literature was something they perceived in other nurses as well:

The nurses who do read articles do stand out, and they're usually of that caliber, and so they're usually in the middle of their Masters or in the middle of pursuing some form of formal education, and even if they weren't, the thing is they're few and far between, that's what I mean by "they stand out," as nurses, the team is receptive to their passion, but they wouldn't be going looking for articles the way this person would (Mei, 35, RN 14 years)

Theme 3. Working towards using research

This final key theme emerged from the discussions about the participants' experiences with research literature, the feelings they had about using it, and strategies they used for dealing with texts they might find difficult. Four subthemes were identified through repeated readings of the transcripts: approaches to reading and understanding research; using research; mathematics difficulties; and research language. In addition, as a final question to all the focus groups, participants were asked how they would feel if they were asked to read a research paper "right now" and their reactions to that prompt, including their non-verbal observed reactions are discussed.

Approaches to reading and understanding research

This was a somewhat unexpected subtheme developed over the course of the focus groups and so was discussed in more detail with the later groups. Participants spoke of how difficult and time-consuming reading research literature was and related their strategies for extracting the meaning, as they understood it, from the papers they read. Very few participants who spoke about their reading strategies stated that they always read the whole article, instead using a range of different approaches.

The methods section of a research paper was a particular source of discomfort, as this participant described in her approach prior to commencing her research degree:

I'd read the abstract and the introduction, skip through all the middle bits, and read the conclusion. None of the actual research methodologies or any of that made any sense whatsoever (Ella, 34, RN 14 years)

Participants developed strategies to allow them to extract some meaning from research articles, even if they had to take the paper's reliability on trust:

...discussion sections were fine as a uni student but trying to interpret what they was talking about in their methods…. And like their results section I kind of skipped past that to the discussion because it was just easier. They even if they were doing something really simple the terminology they used made no sense (Lyn, 24, RN 3 years)

Details of the methods and results were not considered by some participants to be "relevant" to their needs:

I just want to go straight to the facts, I don't care about all that stuff that's probably relevant to a researcher but it's not to me. I tend to go straight to the end to see what the outcomes were and skip everything in the middle, where it's leading to because that stuff just isn't relevant to me on a day to day basis, I just want the information that is relevant (Maryanne, 46, RN 10 years)

Participants also spoke of making pragmatic decisions about reading papers in the context of their limited time:

If I've got the time, I'll read the whole thing. If not, I won't. Definitely being wary of the methodology and the size of the study, and I guess the particular context and any notes on that (Andy, 25, RN 2 years)

They were aware their strategies were not always 'correct' but they were perceived as effective:

Read the abstract content and results. Read the conclusion. That was enough to get through my 3rd year evidence-based practice subject (Eve, 30, RN 10 years)

Using research

Many of the participants were undertaking or had completed postgraduate studies and spoke about using research in writing assignments, but they were also using research to underpin practice and to justify their practice choices. They seemed acutely aware of the expectations on them to use research in education and practice, and sometimes these expectations were felt to be burdensome. Despite the difficulties many experienced with understanding research literature, they were still generally willing to try to use it whenever it was needed.

Using evidence to drive practice change in the interests of patient safety was discussed by several participants:

I don't do research. I use research. So, my emphasis is on finding solid stuff to back up things or, you know, what is evidence based on? That's where I'm still quite active in this field of health and safety (Danni, 54, RN 36 years)

There was a sense that proposed change based on strong evidence was less likely to be argued with:

If I put in an improvement form, I'll often staple a couple of research articles to back it up when I hand it in, and highlight what's relevant, and they don't argue anymore (Noni, 54, RN 38 years).

Participants' own personal safety was also seen to be preserved by the use of the right evidence in practice: Like I work for agency as well. If I don't believe it—if their practices are not based on evidence based practice—I just stick to those places that I know that are evidence based practice because I work in medical oncology/ hematology and I'm very cautious about the fact of how much it will affect me, because I'm still of child-bearing age. So… So, if I work in an area that is not using best practice, I'm not gonna go back there (Bella, 36, RN 14 years).

For some participants working in education, using and normalizing using research was challenging but necessary:

And so, my challenge has been to try and make it relevant to day to day practice. And it's slow, but it's achievable if you can find projects or links where you can sort of embed a little bit of research in there. And then they say that it's not a mystical kind of weird thing that only a bunch of weirdos do somewhere else (Samantha, 55, RN 22 years)

Mathematics difficulties

Difficulties with understanding use of numbers, mathematics, and statistics emerged as a strong theme from these discussions. Participants expressed dismay at the problems they experienced in understanding quantitative results and statistical terminology. Qualitative research, on the other hand, was not considered to be difficult to understand, and the focus of participants' discomfort was centered strongly on numbers and statistics.

Participants found the way that numerical results were written to be confusing:

For me it's the way it's written with all the 0.5 s and all that sort of thing, it doesn't make sense. If it was simple percentages, then that makes sense (Joan, 60, RN 30 years)

There was a sense that statistical terms were a language they did not speak:

...just enough on stats. I think there's something a bit harsher about them being a bit more numbers, but thing I hate about them is almost that foreign language involved, you know, squared chi Wilcoxon and whatever the hell of the names of the and so they frighten me a bit (Sally, 50, RN 8 years)

One participant queried whether discomfort with numbers was related to gender:

It's feeling comfortable with using numbers and whether that's a male or female thing, talk about it as gender, but just feeling really more comfortable, with say, phenomenological studies and things like that just seem to make more sense, and whether that's why I'm a nurse or it's..[trailed off] (Gen, 65, RN 48 years)

However, male participants expressed discomfort also:

The second I saw like, you know, the analysis and all that kind of stuff, I'm like I'm not gonna read over this, you know, You see that I'm not a very numbers person (Bob, 48, RN 1 year)

There was a sense that numbers and feelings were diametrically opposed:

I much prefer to read a qualitative paper… Yeah, rather than… I'd rather read about people's feelings, than the numbers (Joan, 60, RN 30 years)

Numbers were seen as excluding the human element that nurses value:

I also think it's about whether you like the human element and people mattered more to me than numbers. I think it's maybe that and probably I think, you know, when I went to midwifery and child health, that's all about more about humans (Lisa, 54, RN 33 years)

Research language

The specific language used in research was a problem for many participants. They seemed alienated by the language; despite the often-complex terms used by their various clinical specialties the terms used in research seemed untethered from logical meaning. That lack of connection to an action or object that could be clearly conceptualized meant that participants often felt that research was not written with them as readers in mind. When they could see a clear connection to their work or studies, research language became more relatable and easier to understand.

Research language was viewed as alien or foreign:

I think there's an aspect of unfamiliarity with the language too, because it's like reading anything in a foreign language, it's really hard work. And to a lot of nurses, research is a foreign language. They're not being exposed to it (Jack, 55, RN 26 years)

There was a strong sense that research was genuinely regarded as language not everyone could speak:

I haven't done research, so I can talk about research I've read with people at work, but it's like talking another language (Noni, 54, RN 38 years)

Trying to understand the language was full of pitfalls:

So, I started in that levels of hierarchy and evidence. I started then really starting to get picky about what I was really and looking at the language then got confused with intervals and confidence of a lot of talk about 0.95 (Eve, 30, RN 10 years)

Particularly in their early years, it was difficult to engage with research literature due to the language:

I lost interest straight away… I'm better now than I was then, obviously, but in those days, yeah, I was absolutely intimidated by the, the way it was written (Walter, 49, RN 29 years)

The language used in the paper was tied to how much effort participants would put into trying to understand it:

…it was so full of so much jargonized rubbish, that you almost needed to research that research paper, whereas then you find another person who's writing it in a tone or a language that you can understand and you immediately resonate (Kathy, 46, RN 11 years)

Difficulties understanding the language also influenced their reading strategies:

It's a discussion section that I go to. First, the abstract, but then after that the discussion, and only if it's got anything useful, then I will go further if I have to, but that's because the plain English is in the discussion section, that's where they don't dribble on about X equals Y, and we found that, blah, blah, and the average of this was that and… Yeah, 'cause I understand they have to spell out their tables and Excel tables and findings and everything. But the discussion is where the English is, that's where normal human speak is (Mei, 35, RN 14 years)

Despite these issues, most participants, when asked how they would feel if asked to read a research article "right now", responded at least somewhat positively. Some conveyed considerable wariness or concern in the tone of their responses:

I would want to know what the topic was and I would want to know. I would want to know why you wanted me to read it (Nina, 57, RN 9 years)

Some responded with defensiveness:

Again, why? I've got plenty to read. I don't need what you want to give to me to read. Is there any benefits in this particular paper? What is it trying to achieve? So is it a valid study or is it just some ivory tower, need to know something for the sake of it? (Anna, 59, RN 19 years)

Even with a hypothetical request, participants were cautious about committing their time:

I'd be more likely to actually be able to get through it if it was a shorter one rather than a 20 page (Karen, 35, RN 13 years)

Most, however, responded with confidence they would give it a try:

I'm gonna say yes. Tell me what it's about, and I'll say yes, let's read it and see what we can do (Diya, 48, RN 20 years)

Participants in this study responded with a rich variety of stories about their experiences and how they felt about reading and using research literature. Some participants were, as described in the literature, 'research reluctant' [ 28 ] but many held positive views. Having positive attitudes towards research and EBP did not mean participants experienced no challenges with reading and using research, however. Positive attitudes to EBP, combined with involvement in research education and activities, regular journal reading, and higher levels of education have been found to be associated with higher levels of EBP engagement [ 2 , 3 ], but engaging nurses in those educational activities and promoting higher education can be a difficult task.

We deliberately avoided framing the focus group discussions in terms of barriers and facilitators, largely because for more than 30 years a segment of the nursing literature has framed the question of nurses' engagement with EBP and research in terms of this binary [ 29 , 30 , 31 ] with little progression in resolving this issue. Barriers and facilitators, while conceptually helpful in considering issues of implementation, are less so in the presence of an unclear and complex situation such as this. It was also important to gain a deeper understanding of the issues rather than simply statements of barriers or facilitators.

Research methods education at the tertiary level is often designed to train students to conduct research, whereas in most clinical fields such as nursing, the majority of students will be research users [ 32 ]. A systematic review of non-discipline-specific research methods education studies presents some findings similar to the perceptions and experience related by participants in this study [ 32 ]. Earley’s review synthesizes a number of student characteristics observed in the 51 included studies, such as “They are typically anxious or nervous about the course,” “They fail to see the relevance,” and “They come to the course with poor attitudes about research,” [ 32 ](p. 245).

This study adds several nuances to the current conversation about nurses' EBP and research engagement. In exploring the research reading strategies used by the participants this data connects with other work conducted on research reading strategies [ 33 ]. Similar to the findings by Hubbard and Dunbar [ 33 ], their sample of undergraduates and early career researchers in biological sciences placed less value on understanding the methods and results sections of a paper, as did many of the nurses in our study. Some participants in this study believed the methods and results sections held little useful information for them. It has been suggested that addressing research language difficulties can help increase engagement and improve reading strategies [ 33 ].

Research language has been identified as an issue for learners across the professions, including nursing. Nurses in a Swedish quantitative study were asked several questions about their experiences reading research literature, with the vast majority indicating they only "sometimes" understood the research articles they read, and that if research articles used "simple/normal language" they would read them more often and apply the findings in practice [ 4 ]. Participants in our study also commented on their difficulties with the language in research papers and expressed a wish for simpler language to be used. As research writing conventions are unlikely to change, it may be that a different pedagogical approach would be beneficial for bringing learners into an understanding of research literature. Learning the language of research has been compared to second language acquisition and the use of similar teaching and learning approaches has been suggested [ 34 ]. A language-based approach, genre analysis, has been piloted with registered nurses for research methods education with some success, however more work is needed [ 35 ].

Related to participants' difficulties with the methods and results sections of research papers, may be connected to a well-known phenomenon known as mathematics anxiety – a fear of or aversion to mathematics, which often leads to avoidance of mathematics-related activities [ 36 ]. Participants in our study made many mentions of "the numbers"; they felt numbers were hard to understand, incompatible with caring, and confusing. Given the importance of mathematics to nursing, any changes to research methods pedagogy will need to include strategies to improve attitudes to and abilities with understanding and interpreting numerical reporting in research literature [ 37 ].

In our exploration, we focused on nurses' experiences and the feelings they attached to those experiences, rather than research attitudes or knowledge, although both these are important, they are not the whole story. Whatever the sources of the challenges in addressing nurses' engagement with research and EBP, it seems clear that a multifaceted approach is needed. Effective pedagogies along with strategies to address work culture and organizational challenges are all needed to provide the environment for evidence-based healthcare to flourish.

Implications for practice

Some of the factors influencing nurses' perceptions of research, such as mathematics anxiety, may not be modifiable by nursing educators at a tertiary or workplace level, however confidence and self-efficacy in terms of reading and understanding research can be increased by creating success experiences using effective pedagogies [ 38 ]. Creating scaffolded research methods education that gradually introduces nurses into an understanding of research literature focusing on both understanding the language and understanding the statistics and numerical reporting may be the most appropriate approach to creating familiarity, and increasing self-efficacy, therefore leading to better experiences and greater engagement. Increasing the research friendliness of workplaces and availability of mentoring options would encourage all nurses to engage with research.

Implications for research

There is likely to be considerable value in investigating new pedagogical strategies for teaching research, both to undergraduates and registered nurses. Future research could further investigate in detail the theorized link between research aversion and mathematics anxiety.

Limitations

Registered nurses who self-selected to participate in this study may have been systematically different in important ways from nurses who declined to volunteer, particularly in their level of education and interest in research. Many of the participants were in senior roles in their organizations, and some were studying for research degrees. Participants in this study were slightly older than the average Australian RN (44.3 years vs 47.5 for this study) and slightly more likely to be male – 89.1% of Australian RNs are female, while 87.5% of these participants were [ 39 ]. These small differences may affect the transferability of these findings to the wider population, however the findings do align with other work, such as that by Hendricks and Cope [ 4 ], the findings of which are discussed above.

Nurses have a wide range of experiences interacting with research literature, but many report struggling with the language, the numbers, or the statistics. Many nurses value research and EBP and capably use it in practice, however the current reading strategies used by nurses in this study do pose a risk to EBP if research is used without being properly appraised. Nursing workplace cultures are a significant influence on how nurses perceive research reading and use, and workplaces with hostile or apathetic culture toward research risk poor practice and alienating staff interested in improving practice.

Availability of data and materials

The data used in this study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to acknowledge the valuable contribution of Flinders Rural and Remote Health, NT to enabling the completion of this project.

This study was funded in part by a scholarship awarded to the primary author by the Australian College of Nursing. The funding body had no role in designing, conducting or analyzing the data for this study.

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Contributions

SH conceived and wrote the study protocol with contributions from JR and FC. SH completed and submitted the ethics application in collaboration with JR and FC. JR and FC provided feedback on the interview guide. SH recruited participants and conducted the focus groups. JR and FC provided advice and guidance during data collection. SH arranged for transcription, checked the transcripts against the recordings and conducted the initial coding. Coding decisions were approved by all three authors. Themes and subthemes were initially conceived by SH and then agreed by all three authors. SH wrote the initial draft of the manuscript and revised it in response to feedback from JR and FC. All authors have approved the final manuscript.

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Correspondence to Sonia Hines .

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The study was approved by the Central Australian Human Research Ethics Committee in 2020, as well the Queensland University of Technology Office of Research Ethics (approval numbers: CA-20–3639, and 2000000237 respectively). All methods were carried out in accordance with the conditions of the approval and any relevant guidelines and regulations.

Individuals volunteering for the study all provided written informed consent after reading the study's participant information sheet online and signing electronically. Participants were only contacted to arrange an interview time once this had been completed, meaning that individuals had sufficient time to consider whether to participate. All participants consented to being recorded, although some participants chose not to enable video during all or part of the interview due to internet service difficulties or for personal reasons. As a token of gratitude for their time and effort, a $20AUD grocery store gift card was sent to all participants after their interview.

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Hines, S., Ramsbotham, J. & Coyer, F. Registered Nurses' experiences of reading and using research for work and education: a qualitative research study. BMC Nurs 21 , 114 (2022). https://doi.org/10.1186/s12912-022-00877-3

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  • Research literacy
  • Focus groups
  • Qualitative research
  • Mathematics anxiety

BMC Nursing

ISSN: 1472-6955

registered nurse career research paper

Clinician researcher career pathway for registered nurses and midwives: A proposal

Affiliations.

  • 1 Lung, Sleep and Heart Health Research Network, School of Nursing and Midwifery, Western Sydney University, Penrith, NSW Australia.
  • 2 Respiratory, Sleep and Environmental Health Research Academic Unit @ Ingham Institute, South Western Sydney Local Health District, Liverpool, Australia.
  • 3 Sydney Nursing School, University of Sydney, Camperdown, Australia.
  • 4 Nursing & Midwifery Directorate, Far West Local Health District, Broken Hill, Australia.
  • 5 Faculty of Health, University of Technology Sydney, Australia.
  • PMID: 29575330
  • DOI: 10.1111/ijn.12640

Aim: To consider clinician researcher career frameworks and propose a new pathway, integrating university and health service components to support research career progression within nursing and midwifery practice.

Background: Hospitals with research-active clinicians report fewer adverse events and better patient outcomes. Nursing clinician researcher career development is therefore an international priority, yet positions and expectations associated with this are not always well articulated, with nurses and midwives challenged to accommodate research and clinical careers.

Design: This discussion paper describes nurse/midwife clinician researcher career frameworks and a new pathway that aligns academic and nursing role descriptions.

Data sources: The new framework was informed by a brief literature search for international framework documents, three Australian state-based Nurses and Midwives Awards: the Australian Qualifications Framework, publically available University Academic (Research) Award schedules and academic staff descriptions, and state health department and health services publications.

Implications for nursing: The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement.

Conclusion: This paper provides a blueprint for clinician researcher career development. It elevates the research domain as an equal alongside clinical, managerial and educational clinical career development.

Keywords: career; clinician; framework; midwifery; nursing; pathway; research.

© 2018 John Wiley & Sons Australia, Ltd.

  • Career Mobility*
  • Midwifery / organization & administration*
  • Nurse Clinicians*
  • Nurse Midwives*
  • Nurse's Role*

Reimagining the nursing workload: Finding time to close the workforce gap

US healthcare organizations continue to grapple with the impacts of the nursing shortage—scaling back of health services, increasing staff burnout and mental-health challenges, and rising labor costs. While several health systems have had some success in rebuilding their nursing workforces   in recent months, estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected. 1 Gretchen Berlin, Meredith Lapointe, Mhoire Murphy, and Joanna Wexler, “ Assessing the lingering impact of COVID-19 on the nursing workforce ,” McKinsey, May 11, 2022. Identifying opportunities to close this gap remains a priority in the healthcare industry. This article highlights research conducted by McKinsey in collaboration with the ANA Enterprise on how nurses are actually spending their time during their shifts and how they would ideally distribute their time if given the chance. The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses.

Over the past three years, McKinsey has been reporting on trends within the nursing workforce , collecting longitudinal data on nurses’ self-reported likelihood to leave their jobs and factors driving nurses’ intent to leave. 2 “ Nursing in 2023: How hospitals are confronting shortages ,” McKinsey, May 5, 2023. As of March 2023, 45 percent of inpatient nurses (who make up about 2.0 million of the 4.2 million nurses in the United States 3 Nursing fact sheet, American Association of Colleges of Nursing, updated September 2022. ) reported they are likely to leave their role in the next six months. Among those who reported an intent to leave, the top two reasons cited were not feeling valued by their organization and not having a manageable workload. In fact, nurses have consistently reported increasing workload burden as a main factor behind their intent to leave.

About the research

We conducted a survey of 310 registered nurses across the United States from February 8 to March 22, 2023. Our goal was to understand nurses’ perception of time spent throughout the course of a shift and to identify existing and desired resources to help nurses provide high-quality care. Our sample focused on nurses in roles that predominantly provide direct patient care in the intensive-care unit, step-down, general medical surgical, or emergency department settings. Insights were weighted by length of shift (the minimum shift time included was six hours).

For questions related to intent to leave nursing, all nurses from any care setting (including home care and long-term care facilities) were included. Our survey questions on intent to leave have been kept consistent to collect longitudinal data on nurses’ intent. Our last survey, of 368 frontline direct-care nurses, was conducted in September 2022.

In our new survey, nurses provided a breakdown of the average time spent during a typical shift across 69 activities (see sidebar “About the research”). They also reported their views on the ideal amount of time they would like to spend on these same activities. In looking at ways to redesign care activities, we found the potential to free up to 15 percent of nurses’ time through tech enablement, or automation, and improved delegation of tasks (Exhibit 1). Leveraging delegation and tech enablement could reduce and redistribute activities that nurses report being predominantly responsible for. The subsequent reduction in time savings could improve nursing workload and their ability to manage more complex patients. When we translate the net amount of time freed up to the projected amount of nursing time needed, we estimate the potential to close the workforce gap by up to 300,000 nurses.

Nurses report a desire to spend more time with their patients, coach fellow nurses, and participate in professional-growth activities

In our survey, we explored where nurses wanted to spend more of their time (Exhibit 2). The responses fall into the following three categories.

Direct patient care

Nurses report spending the majority of their shift—54 percent, or about seven hours of a 12-hour shift—providing direct patient care and creating personal connections with patients (direct patient care includes patient education, medication administration, and support of daily-living activities). The survey reveals that nurses wish to spend even more time in these activities.

Spending sufficient time on patient-care activities promotes both nursing satisfaction and quality of patient care. 4 Terry L. Jones, Patti Hamilton, and Nicole Murry, “Unfinished nursing care, missed care, and implicitly rationed care: State of the science review,” International Journal of Nursing Studies , June 2015, Volume 52, Issue 6. Furthermore, rushing care and not having sufficient time to meet patients’ needs can contribute to moral distress and burnout.

Teaching and training for new nurses and peers

Nurses report spending on average about 2 percent of their shift teaching peers and students (excluding shifts when nurses are in a dedicated teaching or “precepting” role), an activity they say they want to spend double the amount of time on. Peer-to-peer teaching is an important component of building workplace cohesiveness, improving patient outcomes, and preparing new generations of nurses. In our survey, nurses report that they often lack the time to engage in coaching new nurses. As a result, important informal teaching, which is critical to build confidence and to support skill development for newer nurses, is often missed.

Involvement in professional-growth activities

Similar to educating other nurses, nurses report wanting to spend more than double the amount of time on growth and development activities (about 7 percent of an ideal shift). These activities include participating in shared governance, reviewing and reading work emails, and completing annual requirements and continuing education hours.

Freeing up nursing time to support organizational initiatives and further professional development may contribute to a nursing staff that is more engaged, feels valued, and has a strong connection to their departments.

Nurses desire to spend less time on documentation, hunting and gathering, and administrative and support tasks

Charting and documentation.

Documentation continues to greatly contribute to nurses’ workloads, making up 15 percent of a nurse’s shift. The most time-consuming documentation tasks are head-to-toe assessments, admissions intakes, and vitals charting, which account for the majority of documenting time (70 percent). Nurses say that ideally, documenting should make up only about 13 percent of their shift. But without realistic and effective alternatives (for example, nursing scribes, device integration, reduction in documentation requirements, and AI to aid with documentation), it is unlikely that nurses’ documentation burden can be fully alleviated.

Hunting and gathering

For nurses, hunting and gathering means searching for individuals, equipment, supplies, medications, or information. Nurses report that they spend about 6 percent of a 12-hour shift on hunting and gathering—tasks they would spend approximately 3 percent of their shift on in an ideal shift.

Activities best delegated to support staff

Nurses report spending nearly 5 percent of their shift on tasks that do not use the fullest extent of their license and training. For example, they say they spend nearly an hour on nutrition and daily-living activities, such as toileting, bathing, and providing meals and water. In an ideal shift, nurses say they would spend about 3 percent of their time on these activities.

Redesigning care models: Adjusting how nurses spend their time

As we consider how to alleviate nursing workforce challenges, one area of intervention could be evaluating how current care models can be redesigned to better align nursing time to what has the most impact on patient care. Performing below-top-of-license or non-value-adding activities can create inefficiencies that lead to higher healthcare costs and nurse dissatisfaction. Rigorously evaluating whether tasks can be improved with technology or delegated to allow nurses to spend time on activities they find more valuable could help to reduce the time pressures felt by nurses. 5 “National guidelines for nursing delegation,” a joint statement by the NCSBN and American Nurses Association, April 1, 2019. In our analysis, we reviewed the activities nurses say they would ideally spend less time on and considered whether delegation and tech enablement of such tasks could free up nurses’ time.

Based on our analysis, we estimate that full or partial delegation of activities to roles including technicians, nursing assistants, patient-care technicians, food services, ancillary services, and other support staff, could reduce net nursing time by 5 to 10 percent during a 12-hour shift (Exhibit 3).

While nurses report wanting to spend more time overall on direct patient care, there are specific tasks that could be delegated both vertically and horizontally to ensure that the work nurses perform is at the top of their license and promotes professional satisfaction. Appropriate delegation requires training support staff and upskilling where appropriate, as well as evaluating systemwide resources that can be used where needed. For example, within direct patient care, nearly an hour could potentially be freed up by delegating tasks such as patient ambulation, drawing labs and starting IVs, transferring patients, and supporting patient procedures.

Full or partial delegation of activities to roles such as technicians and other support staff could reduce net nursing time by 5 to 10 percent during a 12-hour shift.

Tasks that are evaluated for redistribution to other clinical and non-clinical staff can also be considered as part of broader care-model redesign. Upskilling support staff across clinical and nonclinical roles can often result in overall better use of resources already in place across a health system.

Tech enablement

Based on our assessment, we estimate that a net 10 to 20 percent of time spent during a 12-hour shift is spent on activities that could be optimized through tech enablement. Investing in digital approaches that automate tasks (either completely or partially), rather than simply redistributing workload, could potentially free up valuable time for nurses (Exhibit 4).

Examples of tech enablement and delegation in practice

To determine the amount of time that could potentially be freed up over the course of a nurse’s shift, we used estimations based on best-in-class care delivery models from practice, innovative emerging technology from industry, and how easy it would be for health systems to implement the intervention (for example, cost and technological requirements).

Tech-enablement

  • Robotic automatic-guided vehicles (AGVs) deliver equipment, food, and supplies throughout a hospital. 1 “Robots help nurses get the job done–with smiles and beeps,” Cedars Sinai, November 29, 2021.
  • Robotic pill-picker machines select and deliver medicines throughout a hospital. 2 Jay Kiew, “The digital surgery: Humber River Hospital reinvents itself with AI & robotics,” Change Leadership, June 16, 2018.
  • Virtual nurses monitor patients remotely, working alongside a bedside-care team comprising a bedside RN, bedside licensed vocational nurse, and virtual RN. 3 Giles Bruce, “Trinity Health plans to institute virtual nurses across its 88 hospitals in 26 states,” Becker’s Health IT, January 13, 2023.
  • Ambient intelligence (that is, passive, contactless sensors embedded in a clinical setting to recognize movement or speech) reduces documentation workload and can continuously monitor patients. 4 Albert Haque, Arnold Milstein, and Li Fei-Fei, “Illuminating the dark spaces of healthcare with ambient intelligence,” Nature , September 9, 2020.
  • Centralized training for roles such as transporters that can then be utilized in all areas of the hospital.
  • Upskilling employees and modifying staffing models allow nurses to work in units where they are needed most (for example, non-critical-care nurses in critical-care departments).

For example, nurses spend 3 percent of their shifts on patient turning and repositioning. This task could be optimized through innovative “smart” hospital-bed technology, including bed-exit alarms, advanced therapy for redistributing pressure, integrated scales and measurements, and remote information on patient conditions. Voice-automated devices and smart beds can also equip patients with control and autonomy over their rooms and preferences (for example, shades, television, and lighting) without nurse intervention (see sidebar “Examples of tech enablement and delegation in practice”).

These interventions, however, can be costly and may not be appropriate solutions in every system. Healthcare organizations will need to assess the specific needs of nurses and patients to determine which interventions will have the most impact.

Healthcare organizations could also consider continuously evaluating the digital approaches they have implemented to ensure that the technology itself does not create redundancies or rework, introduce delays, or adversely increase workload. For example, 37 percent of nurses report that they do not have access to vital signs or telemetry machines that are integrated with electronic medical records for automatic documentation. This could explain why nurses say they could spend less time—about 30 percent less—documenting vital signs. Technology like scanners and automated vitals machines have been an effective way to streamline documentation. But nurses still report spending nearly 10 percent of their shift scanning medications into the patient record, documenting vitals and completed patient education, and drafting progress notes.

Nurse time saved through care-model changes and innovations can benefit patients and nurses—and contribute to building sustainable careers in healthcare

The impact of care-model redesign could range from improving workload sustainability to addressing a substantial portion of the projected 200,000 to 450,000 nursing gap. Our analysis finds a potential net time savings of 15 to 30 percent of a 12-hour shift, based on estimating the possible range of time reduced through delegation 6 “ANAs principles for delegation,” American Nurses Association, 2012. or tech enablement. 7 Mari Kangasniemi, Suyen Karki, Noriyo Colley, and Ari Voutilainen, “The use of robots and other automated devices in nurses' work: An integrative review,” International Journal of Nursing Practice , August 2019, Volume 25, Issue 4.

In our conservative estimate, there would be no additional opportunity to alleviate the potential nursing shortage, as health systems would reallocate the saved time to their current nursing staff for activities they say they would spend more time on, including time with patients, teaching peers, and investing in their growth and development (Exhibit 5). However, this reallocation of time could improve the sustainability of nursing careers in acute-care practice.

In our optimistic estimate, after reallocating time back to nurses, health systems could free up a 15 percent net time savings, which could translate to closing the nursing workforce gap by up to 300,000 inpatient nurses. Achieving this may require health systems to invest heavily in technology, change management, and workflow redesign.

Realizing these changes will require bold departures from healthcare organizations’ current state of processes. It will be critical for hospitals to bring both discipline and creativity to redesigning care delivery in order to effectively scale change and see meaningful time savings. Close collaboration beyond nursing is also paramount to ensure alignment across the care team and hospital functions including administration, IT, informatics, facilities, and operations. A comprehensive evaluation of redesign requirements can enable health systems to understand what is limiting care-model change (for example, policies, skill development, education). Investment in education and additional onboarding may be needed to upskill and train staff on expectations as work is shifted across roles. Partnering with tech companies and industry vendors in areas such as electronic-health-record platforms can accelerate innovation and implementation to build off existing tools and reduce implementation risks. Although the idea of change may be daunting, incorporating innovations in healthcare delivery could be a strategy for building a sustainable workload that could attract and retain nursing talent by allowing them to do more of what matters to them most: taking care of patients and one another.

Gretchen Berlin, RN , is a senior partner in McKinsey’s Washington, DC, office; Ani Bilazarian, RN , is a consultant in the New York office; Joyce Chang, RN , is an associate partner in the Bay Area office; and Stephanie Hammer, RN , is a consultant in the Denver office.

The authors wish to thank Katie Boston-Leary, RN, and the ANA Enterprise for their contributions to this article. The authors also wish to acknowledge and thank the entire healthcare workforce, including all of those on the front line.

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  • v.7(4); 2020 Jul

The role of registered nurses in primary care and public health collaboration: A scoping review

Monica swanson.

1 School of Nursing, University of British Columbia, Vancouver BC, Canada

4 Present address: North Island College, Courtenay BC, Canada

Sabrina T. Wong

2 School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver BC, Canada

Ruth Martin‐Misener

3 School of Nursing, Dalhousie University, Halifax NS, Canada

Annette J. Browne

Associated data.

The purpose of this work was to examine the roles of Registered Nurses (RNs) in primary care (PC) and public health (PH) collaboration. Additionally, we aimed to explore whether the current scope of practice for RNs is adequate to support their roles in PC/PH collaboration.

A scoping review of current literature relating to the RN’s role in PC/PH collaboration was conducted using the PRISMA 2009 checklist.

The review used key terms: primary care, public health, collaboration, nursing and nurse role across six electronic databases; 23 articles that were included in the final review were published over a 7‐year span.

Four key RN roles relating to PC/PH collaboration were identified: relationship builder, outreach professional, programme facilitator and care coordinator. RNs supported transitions in chronic disease, communicable disease care and maternity care at various healthcare system levels including systemic, organizational, intrapersonal and interpersonal levels.

1. INTRODUCTION

Worldwide, attention is being given to the transformation of healthcare systems from an illness focus to one that is person‐centred and health‐promotive (World Health Organization (WHO), 2016 ), with calls for improving access to high‐quality collaborative care (Farmanova et al., 2016 ), especially in community‐based primary health care (Organization for Economic Co‐operation and Development (OECD), 2017 ; WHO, 2016 ). Healthcare systems with poor collaboration are inefficient, expensive and not well equipped to handle the potential “tsunami wave effect” of chronic diseases such as heart disease, diabetes, cancer and mental illness (Millar, Bruce, Cheng, Masse, & McKeown, 2013 ) in addition to episodic crises such as avian flu or fentanyl overdose epidemics.

2. BACKGROUND

There are increasing calls for the improvement of collaborative care, which would promote optimal patient care. One way to improve the effectiveness of the healthcare system is collaboration between primary care (PC) and public health (PH) (Institute of Medicine, 2012 ; Strumpf et al., 2012 ; Valaitis et al., 2013 ). The public health system, generally, is legally driven to administer communicable disease management, environmental monitoring and health promotion. Primary care is responsible for being the “first door” to the healthcare system, providing generalized health care throughout the lifespan from infancy to older adulthood. Evidence suggests that collaboration between PC and PH systems can be especially beneficial in circumstances where care delivery and management is complex (Valaitis et al., 2013 ). Communicable disease management such as influenza, chronic disease care such as diabetes and asthma, complex maternal/child health care and care delivery to vulnerable populations experiencing health and social inequities are examples of areas of care that would benefit from collaboration between PC and PH. However, health care can be fragmented and discontinuous, making PH/PC collaboration difficult (Hutchison, Levesque, Strumpf, & Coyle, 2011 ). Collaboration for the purposes of this paper means healthcare professionals assuming complementary roles and working together towards a common goal enhanced patient care (O’Daniel & Rosentein, 2008 ). Workforce analysis of who would do this collaborative work falls on physicians and nurses as the largest health professionals in the two systems. Based on their size in numbers, Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Nurse Practitioners (NPs) could play an important role in strengthening collaboration between PC and PH (Valaitis et al., 2013 ).

Nurses constitute the largest workforce in PH and increasingly in PC (Ammi, Ambrose, Hogg, & Wong, 2017 ; Wong et al., 2015 ). Based on their scope of practice, which includes health promotion, collaboration and chronic disease care (Australian Primary Health Care Nurses Association, 2017 ; British Columbia College of Nursing Professionals, 2018 ), nurses should be considered in primary healthcare system renewal (Fraher, Spetz, & Naylor, 2015 ; Smolowitz et al., 2015 ).

There is a clear need to clarify and optimize the RN’s role in PC/PH collaboration (Bauer & Bodenheimer, 2017 ; Fraher et al., 2015 ; Halcomb, Stephens, Bryce, Foley, & Ashley, 2016 ; Martin‐Misener & Bryant‐Lukosius, 2014 ), using their skills in health promotion and disease prevention and collaboration. Yet, the lack of RN role clarification and competency standards in this area (Halcomb et al., 2016 ; Registered Nurses Association of Ontario, 2012 ) and structural challenges such as restrictive funding models that inhibit team‐based care (Bauer & Bodenheimer, 2017 ; Hutchinson et al., 2011 ) impedes the uptake of the RN role in these areas (Martin‐Misener & Bryant‐Lukosius, 2014 ).

The purpose of this work was to examine the roles of RN in PC/PH collaboration in relation to their scope of practice. Specifically, we answer the following questions: (a) What are the roles of RNs in PC/PH collaboration; and (b) is the current scope of practice for RNs adequate to support their roles and activities in PC/PH collaboration? This research focused specifically on RN degree‐prepared nurses; other nursing designations such as NPs and LPNs were not included in this review due to RNs’ size in numbers and potential impact on the healthcare system and the differing scopes of practice of NPs and LPNs.

A scoping review of the RN’s role in PC/PH collaboration was conducted. One of the goals of using a scoping review is to further enhance understanding, applicability and refinement of research questions that are broad and complex or have not been studied, for example RNs’ role in collaboration between PC and PH in this research (Arksey & O’Malley, 2005 ; Colquhoun et al., 2014 ). Using this methodology illuminates the RN’s role in PC/PH collaboration and may assist in the development of future research questions. The PRISMA checklist (see File S1 ) provided support for reporting findings.

Drawing on the work of Arksey and O’Malley ( 2005 ), Levac, Colquhoun, and O’Brien ( 2010 ) and Valaitis et al. ( 2012 ), we followed six steps in conducting our research: identifying the research questions; searching for relevant studies; selecting studies; charting the data and collating; summarizing; and reporting the results.

4.1. Search strategy and study selection

Our database search consisted of: PubMed, CINAHL; Cochrane; PsycInfo; Sociological Abstracts; Web of Science; and Dissertation International. We also scanned reference lists of included articles and conducted Web searches of government, healthcare associations and research networks for key documents and information. Finally, a general Internet search using key terms was used to capture grey literature and/or other information not gained from formal databases. Key terms used in the search included the following: primary care, public health, collaboration, public health nurse, community health nurse, nurse, patient care teams and nurse's roles. A health science librarian at the University of British Columbia supported this scoping review (Appendix S1 ).

Papers addressed at least one of the following: structures and processes supporting RN’s role in PC/PH collaboration or patient population indicators and outcomes of RN collaboration between PC and PH. Papers were excluded if they addressed PH or PC alone; contained no evidence of collaboration; did not describe the RN’s role in collaboration; or were not published in English (Figure  1 ). Articles published between January 2009– January 2016 were screened for applicability. These dates were chosen to build on the Canadian scoping review completed by Martin‐Misener et al. ( 2012 ) and to capture additional international literature around PC/PH RN implementation. Literature published from 2016–present (Pratt et al., 2018 ; Valaitis, Meagher‐Stewart, Martin‐Misener, Wong, & MacDonald, 2018 ; Wong et al., 2017 ) provides more information on systemic and organizational considerations in PC/PH collaboration; however, they do not specifically address the nurse role.

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PRISMA Diagram

Papers were from the USA, Canada, Western Europe, Australia, the UK and New Zealand. Commentaries were included if they brought context to the research question. In this scoping review, limited grey literature was retrieved and did not inform this study.

4.2. Analysis

Data were extracted using the concept of “charting the data” as suggested in Arksey and O’Malley ( 2005 ). This process is similar to data extraction in a systematic review but involves taking a comprehensive approach to the material and compiling it in a manner that contextualizes the outcomes; this makes it more suitable to readers who will use the findings to inform practice and policy decisions. Data were coded into the following categories: type and/or purpose of collaboration; participants involved in the collaboration; RN’s role in the collaboration; geographic context/situation (urban/rural); health focus such as mental health, maternal or communicable disease; motivators for collaboration; characteristics and attributes of collaboration; and results and indicators of success. We used an interpretive description approach (Thorne, 2016 ) to analyse the coded data and formulate themes.

Data pertaining to the RN’s role in PC/PH collaboration were also analysed using intrapersonal, interpersonal, organizational and systemic levels identified in the Ecological Framework for Building Successful Collaboration between Primary Care and Public Health (Appendix S2 ; Valaitis et al., 2013 ). This framework identifies supporting factors at each level that enhance collaboration between PH and PC sectors. It also provided guidance in the data analysis phase of by allowing us to understand the RN’s role in the context of collaboration and from a lens that identifies collaboration beyond the interpersonal and intrapersonal levels. To ensure credibility and study rigour, data coding and analysis were reviewed by the study team throughout. To examine whether reported RN roles in PC/PH collaboration were in their general scope of practice, we examined these roles against the example of British Columbia's RN scope of practice.

In conducting this scoping review, no research ethics committee approval or patient consent was needed and therefore not obtained. No funding was obtained through this research by the authors or any conflict of interest identified.

The combined search strategy yielded a total of 56 papers, and of these, 23 papers met the inclusion criteria (Figure  1 ). Twelve papers were removed as there was no clear collaboration between PC and PH. The remaining 44 papers were read in detail, and 21 papers were excluded for no identification of nurse role. Most papers were published from 2012–2014 (see Table  1 ).

Papers included in the scoping review

The number of papers from each country, Canada ( N  = 5), the USA ( N  = 9), Europe (UK, Ireland, Norway, Sweden, the Netherlands) ( N  = 6) and Australia ( N  = 3), was included.

PC/PH collaboration was evident at various stages from full collaboration to no collaboration. Studies from the USA (Bodenheimer, Chen, & Bennett, 2009 ; Elliott et al., 2014 ; Ferrer et al., 2013 ; Lebrun et al., 2012 ; Levy et al., 2011 ; Monsen et al., 2015 ; Serpas et al., 2013 ; Weinstein et al., 2013 ) and Canada (Davies, 2012 ; Green et al., 2013 ; Kates et al., 2012 ; Levesque et al., 2013 ; Wynn & Moore, 2012 ) report the youngest collaborative PC/PH systems versus studies from the European countries (van Avendonk, Mensink, Ton Drenthen, & van binsbergen, 2012 ; Clancy, Gressnes, & Svensson, 2013 ; Kardakis, Weinehall, Jerdén, Nyström, & Johansson, 2014 ; Kelly, Glitenane, & Dowling, 2015 ; Korhonen, Järvenpää, & Kautiainen, 2014 ; Peckham, Econ, Hann, & Hons, 2011 ), which discussed PC and PH systems that merged in the early 2000s.

The most common health areas of PC/PH collaboration that involved the RN’s role were maternal/child health and primary and secondary chronic disease prevention (Table  2 ). Many of the collaborations involved a targeted approach to vulnerable populations for health issues such as childhood obesity (Ferrer et al., 2013 ), access to maternity care for Indigenous women and other vulnerable populations (Davies, 2012 ; Psaila, Kruske, Kruske, Fowler, Homer, & Schmied, 2014 ), and chronic and communicable disease screening and prevention (Ferrer et al., 2013 ; Weinstein et al., 2013 ).

Areas of focus for RN collaboration in primary care and public health

No articles focused entirely on the role of the RN in PC/PH collaborations, and when this role was discussed, it was mentioned briefly. Four main RN roles were identified from the data: (a) relationship builder, (b) care coordinator, (c) outreach professional and (d) programme facilitator. These roles were identified at a variety of levels (systemic, organizational and interpersonal/intrapersonal), using the Ecological Framework (Appendix S2 ). For clarity, most of the RN roles discussed in the studies were community‐based public health nurses (PH RNs). The European studies’ primary care systems employed both primary care and public health nurses.

6.1. Relationship builder

At the intrapersonal/interpersonal level, PH RNs played an integral role in team‐based primary care and collaboration between PC and PH. Their role as frontline nurses, working with other providers, placed them in key roles to enhance communication through face‐to‐face interactions (Green et al., 2013 ; Kelly et al., 2015 ; Kempe et al., 2014 ; Monsen et al., 2015 ; Psaila, Kruske, et al., 2014 ; Wynn & Moore, 2012 ). Statements from PC providers about the PH RNs included words such as supportive, sharing, checking in, reminding, visiting and talking (Monsen et al., 2015 ). For example, a PC provider stated, “it gives us a face and a name so we can call (the public health department) if we have other problems” (Kempe et al., 2014 , p. 115). From the PH perspective, it was stated “I think the better they (PC providers) know us and the more they see us as an actual resource, the more comfortable they are when there's really a public health issue that has to be dealt with” (Kempe et al., 2014 , p. 115).

At the organizational level, PH RNs built relationships with organizations in and outside the healthcare sector to improve access to care by providing PC in locations where people work, live and play (Kempe et al., 2014 ) rather than at stationary PC sites. As PH RNs spent time and resources to support PC staff in their practice setting, face‐to‐face communication between PH and PC was enhanced and described as a “network of communication” by Wynn and Moore ( 2012 ), where future initiatives between PC and PH such as chronic disease management and disease surveillance could be supported.

6.2. Care coordinator

At the intra/interpersonal level, the care coordinator role was seen in collaborative clinics and hospital community transition programmes. It was often motivated by the need to increase access to care for vulnerable individuals and families, particularly in maternal/child and chronic disease management health services (Davies, 2012 ; Ferrer et al., 2013 ; Psaila, Fowler, Kruske, & Schmied, 2014 ). Evidence from these studies suggests that PH and PC RN care coordinators improved access to care, streamlined services and increased referrals to community services. RNs integrated care between hospital and community, ran group visits to support chronic disease management and maternal care and addressed the social determinants of health (Ferrer et al., 2013 ).

At the organizational level, care coordination occurred with PH RNs collaborating with community agencies (Elliott et al., 2014 ) and working with PC to improve vertical and horizontal continuity of care, specifically in addressing the social determinants of health for complex maternity patients (Davies, 2012 ; Psaila, Fowler, et al., 2014 ) and chronic disease management (Ferrer et al., 2013 ; Weinstein et al., 2013 ).

6.3. Outreach professional

At the intra/interpersonal level, the literature showed that the PH RN’s role as an “outreach professional” improved patient access to PC, improved prevention and supported a variety of community service and care models. This role is particularly relevant to vulnerable populations. For example, outreach to home settings (only seen in European studies) targeted primary and secondary prevention of chronic disease and obesity. RN activities included assessment and education (Korhonen et al., 2014 ), monitoring of food intake and body weight and implementation of advice from a dietician (van Avendonk et al.., 2012 ). RN‐led screening achieved meaningful weight loss with brief lifestyle counselling (Korhonen et al., 2014 ).

At the organizational level, this outreach care was often associated with team‐based care models such as the Primary Care Medical Home. This care delivery model provides comprehensive and coordinated patient care by providers such as physicians, nurses, pharmacists and social workers ( www.pcmh.ahrq.gov ). Public health RNs worked either as consultants or as members of Primary Care Medical Home models and often in association with academic collaborative PC settings (Weinstein et al., 2013 ). An example of this approach occurred during the H1N1 pandemic in 2010 where family health teams (PC) and PH RNs collaborated in the management of a flu pandemic by creating assessment centres in the community to ensure universal and easy access to care. At these sites, PH RNs liaised with PC sites to provide supplemental staffing for flu immunization clinics and infection control measures such as cough etiquette, education and quarantine, and coordination of clinical care guidelines (Wynn & Moore, 2012 ).

Beyond traditional healthcare sites, PH RN‐led outreach immunization clinics improved access to care and increased vaccination rates by providing immunizations at community‐based venues allowing care to be provided in unique locations and unusual times (Kempe et al., 2014 ; Lebrun et al., 2012 ). Notably, the largest immunization rate increase was seen among healthy children who do not regularly interface with the PC system. This highlights a unique feature of the RN’s role in communicable disease reduction by immunization outreach to people who face barriers in access or do not regularly access PC (Kempe et al., 2014 ).

6.4. Programme facilitator

At the organizational level, the PH RN programme facilitator role supported the transfer of PH knowledge to PC in areas such as communicable disease (immunization and pandemic management) (Green et al., 2013 ; Kempe et al., 2014 ; Wynn & Moore, 2012 ) and chronic disease prevention, for example healthy eating strategies (van Avendonk et al., 2012 ; Levy et al., 2011 ; Monsen et al., 2015 ). The RN’s role at this level not only supported interorganizational collaboration, but also enabled future collaboration and increased awareness of population‐level needs in PC (Kempe et al., 2014 ; Levy et al., 2011 ; Monsen et al., 2015 ; Wynn & Moore, 2012 ).

At the system level, the RN’s role supported the use of tools, guides and programmes in PC/PH collaboration. Examples of RNs working at the system level include the following: (a) supporting the use of the Institute for Systems Improvement—Adult Obesity Guideline into the PC setting in Minnesota (Monsen et al., 2015 ); (b) implementing the Primary Care Nutrition Training Program to targeted underserved PC sites in New York (Levy et al., 2011 ); (c) liaising with schools and community organizations and PC to implement weight screening and healthy eating with The San Diego Healthy Weight Collaborative (Serpas et al., 2013 ); and (d) assisting PC obesity guideline translation, including goal setting with PC sites in the use of guidelines and tools, educating PC site staff on motivational interviewing techniques, supplying resources (food models and portion control plates) and facilitating shared best practices in obesity management (Monsen et al., 2015 ).

6.5. RN scope of practice supported RN’s role identified in the scoping review

The roles identified in this scoping review are in legal regulations in the RN scope of practice (British Columbia College of Nursing Professionals (BCCNP) 2018 ). However, as new roles emerge in the face of changing healthcare demands, challenges with scope of practice documents maintaining their currency have been noted internationally (Birks, Davis, Smithson, & Cant, 2016 ; Fealy et al., 2015 ).

Conclusion . In supporting new roles, regulatory bodies can work with nurse associations and health authorities to advance the concept of individual‐level accountability and self‐reliance in determining best practice decisions.

These results suggest a growing body of evidence of RNs working to strengthen collaboration across PC and PH sectors. We provide evidence to extend our understanding around the various roles RNs can undertake and the kinds of activities they can perform in their scope of practice. Most of what RNs are undertaking in strengthening collaboration across PC and PH sectors occurs at the inter/intrapersonal and organizational levels. Worldwide, RNs play an ever important role in delivering primary healthcare services (Bauer & Bodenheimer, 2017 ; Smolowitz et al., 2015 ), and given the rise of health and social inequities globally (OECD, 2017 ; WHO, 2008 ), these roles and activities strengthen the primary healthcare system by increasing health promotion and prevention and access to care (OECD, 2017 ).

RNs contributed to improved organizational‐level collaboration through increased personal connections and information communication pathways (Levy et al., 2011 ; Psaila, Kruske, et al., 2014 ; Wynn & Moore, 2012 ). Past work suggests that building and sustaining relationships can be more important than structural considerations such as colocation (Clancy et al., 2013 ; Kempe et al., 2014 ). Termed “boundary spanners” by Fraher et al. ( 2015 ), RNs can perform new roles for a new healthcare system with a population health focus. Improved care coordination and transition between the sectors can be supported by these RN roles, highlighting their importance in change management process that occurs with any healthcare reform efforts. As outreach professionals and care coordinators, RNs increased access to PC and PH especially with populations made vulnerable by multiple intersecting determinants of health such as those living on or close to the street and facing homelessness. This role is key to future in the management of disease outbreaks. Programme facilitator roles were particularly important at the organizational and systemic levels. This scoping review reveals the importance of the primary healthcare RN to be used beyond the walls of the office setting to provide care in the community from interpersonal to interorganizational and system levels.

We found less evidence of RN roles in PC and PH at the system level. There are many political, policy, structural and workforce barriers that prevent the expansion of the RN role to collaborative work at the interorganizational and system levels. Societal attitudes, government policy and structural barriers that include the current GP private practice and lack of funding models to support PC nursing (APNA, 2017 ) and perceived fiscal constraints all constrain RN roles. In PC transformation, RN role development will be under pressure from these complex factors. Without due consideration in role development, as has occurred in Australia and Ireland (Brookes, Daly, Davidson, & Halcomb, 2007 ; Kelly et al., 2015 ), RN roles may devolve into roles and activities that focus on “acute care” delivered in the community missing out on important health prevention and promotion activities.

In performing collaborative roles, RNs were more commonly employed by public health than RNs working in PC practice. This could be due to their specific PH RN expertise such as collaboration, community interface/outreach and relationship building and the small number of generalist PC RNs in North American PC settings (Martin‐Misener & Bryant‐Lukosius, 2014 ; Valaitis et al., 2013 ). Structural issues such as the fee‐for‐service remuneration model and the fact that the PC system is separate from the hospital/PH system also act as barriers to employing more RNs in primary care (Bauer & Bodenheimer, 2017 ). Further research to support the RN roles includes evaluation of the RN’s basic education preparation specific to these roles.

To ensure that nurses are able to work in these roles, awareness of the RN scope of practice by government and health authorities and PC providers is essential, and as Bauer and Bodenheimer ( 2017 ) suggest, reversing overly cautious interpretations of scope of practice regulations. Inclusion of primary healthcare content and clinical practice into pre‐licensure training will ensure RNs are well prepared for skills in cross‐sector collaboration and primary care (Bodenheimer & Mason, 2017 ). Ensuring that nursing educators have PC experience could support the establishment of theory and practice into these unique roles and skills into nursing education (Fraher et al., 2015 ). Opening opportunities for RNs in new models of primary care (Hutchison et al., 2011 ) and improving RNs in supporting their own role development will also support appropriate nurse's roles in PC (Ashley, Halcomb, Brown, & Peters, 2018 ).

7. CONCLUSION

There are limitations to this scoping review that require consideration. There was an opportunity of some literature being missed due to database selection, search limitations in language and country and possibly missing some grey literature. There was also a lack of depth in the broadscale nature of the scoping review, and no articles specifically about nurse's roles were obtained, which may have affected the results of the study. The focus of scoping reviews is to provide breadth rather than depth of information; thus, a meta‐analysis is generally not conducted (Tricco et al., 2016 ). However, this method was appropriate for our research given our objectives and the current broad understanding of this topic. Finally, it is possible that there are additional roles for RNs in PC/PH collaboration, as our review included work up to 2016. However, the RN roles described here form a foundation for any new and emerging roles.

Strengthening PC/PH collaboration supports a population health approach and targeted prevention strategies called for by multiple agencies throughout the world (OECD, 2017 ; WHO, 2017). RN roles in PC/PH collaboration, in terms of both the activities performed and populations served, could strengthen cross‐sector work and therefore increase the effectiveness of the primary healthcare system in addressing the healthcare needs of the population. This collaborative role is particularly relevant to vulnerable populations whose health and social needs are optimally met through a team‐based, patient‐centred approach (Browne et al., 2012 ). RN’s roles and activities in PC/PH can support greater continuity of care and health promotion through individual‐, organizational‐ and systemic‐level interventions.

RNs act as the “glue” between PC and PH for patients, providers, organizations and health systems. This role is important in reducing gaps in care and improving health outcomes, especially for vulnerable populations. To optimize the RN role in PC and PH collaboration, government and health authorities should enhance their understanding of the competencies and scope of practice of RNs (APNA, 2017 ; Canadian Nurses Association, 2015 ; Fraher et al., 2015 ; Halcomb et al., 2016 ) and resources should be provided to support professional development for RNs in new and emerging roles. When designing effective primary care teams, policymakers should consider these diverse and varied RN roles and activities and ensure that they are allowed to flourish in a flexible and responsive primary healthcare system with improved health outcomes.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

Supporting information

Appendix S1‐S2

ACKNOWLEDGEMENTS

This research did not receive any specific grant from funding agencies in the public, commercial or not‐for‐profit sectors.

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The 2024 Chemistry Olympiad round one results

Deborah van Wyk

The Royal Society of Chemistry reveals the grade boundaries for the first round of the 56th Chemistry Olympiad

A bar chart showing UK Chemistry Olympiad scores. 29.9% of candidates got no award, 36.8% got bronze, 25% got silver and 8.3% got gold with a mark of 30 or more.

Students had to score 10–17 marks for the Bronze award, 18–29 marks for the Silver award and 30 or more for the Gold award

The Royal Society of Chemistry (RSC) has released the 2024 grade boundaries for the first round of the  UK Chemistry Olympiad . On 25 January, 14,915 students from 1,025 schools took part – a fantastic new participation record. More than 70% of the students who took part achieved Bronze, Silver and Gold awards. To receive a Bronze award, participants had to score 10–17 marks, they needed 18–29 marks for the Silver award and 30 or more marks for the prestigious Gold award. Students can request their scores from their teachers, and pdf certificates will be distributed in March.

The 2024 paper covered topics such as the composition of the FIFA 2023 Women’s World Cup trophy, iodate salts, fuel-producing bacteria, the MRI contrast agent gadopiclenol and sulfur-containing molecules in the atmosphere. This year’s paper was more challenging than last year’s, which is reflected in the grade boundaries, with a decrease in the marks required to obtain each award.

RSC Education executive and competition organiser, Sophie Redman, congratulates and thanks the teachers and students involved: ‘I would like to congratulate all the students who took part in the first round of the UK Chemistry Olympiad. We are delighted to see a big increase in the number of students participating, year on year, and we extend our thanks to all the teachers who gave their time to facilitate this stage of the competition.’

A total of 34 students have been selected for the second round of the competition (one more than last year), which will take take place at the University of Nottingham from 4–7 April. Four standout participants will then go on to represent the UK in the highly prestigious international final , which will take place in take place in Saudi Arabia from 21–30 July.

Past papers

Students who would like to practise answering questions can access past papers with mark schemes with answers . The 2023 question paper, student answer booklet, mark scheme and examiners’ report are now available.

Deborah van Wyk

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    Research describing registered nurses' perceptions of their careers is scarce. We aimed to provide such knowledge. This knowledge will be beneficial for nurse managers to support nurses in their career planning and is needed from the perspective of competence management and future competence needs. Go to: 2. METHODS.

  2. Career Preferences among Nursing Students: A Cross-Sessional Study

    In total, 217 nursing students completed surveys. The most favorite career preferences among nursing students were community health nursing, paediatric nursing, medical surgical nursing, and obstetric & gynecological nursing; while the least career preferences among nursing students were oncology and hospice nursing, mental health nursing, and ...

  3. Nursing [Career Paper]

    UCC 175C-003. Dr. Anne Heintzman. October 4, 2017 My Career Paper. The career I have chosen to pursue is BSN, RN with the specialty in Pediatrics and. Obstetrics Gynecology. Nursing to me is being a helping hand to someone else, you're. considered the life saver in the situation, the shoulder to cry on, and the educational advisor.

  4. The Vital Role of Career Pathways in Nursing: A Key to Growth and

    Editorial. The nursing profession has long been a cornerstone of our healthcare system, providing the essential care and expertise that patients need during critical moments in their lives [].As the demand for highly skilled nurses continues to grow, it is crucial that we consider the importance of career pathways for nurses and the impact they have on professional development and staff retention.

  5. Nursing [Career Paper]

    pediatric nurse practitioner. "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through. the diagnosis and treatment of human response, and advocacy in the care of. individuals, families, groups, communities, and populations ...

  6. What are nurses' roles in modern healthcare? A qualitative interview

    Attempts to shape nursing work have lacked understanding of how nurses contribute to healthcare, with negative consequences. For example, the recent introduction of Nursing Associate roles (Department of Health and Social Care, 2017) in the UK, ostensibly to be a compassionate, patient-facing role and reduce costs, overlooks evidence that replacing registered nurses with other providers leads ...

  7. Insights from defining nurses' career success: An integrative review

    Our review revealed three themes that influenced nurses' career success: personal resources, positive behavior for nursing work and research, and job resources and environments. The mechanisms that enhance nurses' career success can be explained by the concept of resource caravans, which was developed from the COR theory.

  8. Registered nurses' perceptions of their career-An interview study

    Aim: We aim to explore registered nurses' perceptions of their career. Background: Career development options have been found to increase attraction to nursing and support nurses' engagement with their organization and profession. Methods: We collected qualitative individual interviews with 23 registered nurses; data were analysed with thematic analysis and reported according to the ...

  9. New Nurses' Perceptions on Transition to Practice: A Thematic Analysis

    A significantly higher portion of the 1375 Registered Nurses (RNs) who had participated in the NGG reported full-time employment status (63%) compared to their counterparts (56%) (Baumann et al., 2018). For those graduated between 2009 and 2012, a higher proportion of RNs who participated in the NGG remained with the same employer as their ...

  10. Always a Nurse: A Profession for a Lifetime : Nursing Administration

    ALSN has a focus on nursing administration and leadership as well as research at both the graduate and undergraduate levels. 4. Nurse CEOs are even more likely to be seen as no longer belonging to the nursing profession. Some have allowed their licenses to lapse; some do not use "RN" after their names.

  11. Registered nurses' perceptions on the factors affecting nursing

    Background Registered nurse has a vital role in delivering healthcare services to individual, family and community. One of the main challenges that health system facing globally is the shortage of nursing workforce. Vanuatu as a Pacific county is also facing the shortage issue and the impact on the registered nurses' performance. Methods A qualitative study was used to collect data from 25 ...

  12. Understanding registered nurses' career choices in home care services

    Consistent with previous research [6,7,8,9], this paper makes use of the term home care nurses referring to registered nurses who work in home care services. Home care services include nursing care and other forms of health care such as physiotherapy, occupational therapy or rehabilitation for either a short or a long period [ 5 ].

  13. Job satisfaction and career intentions of registered nurses in primary

    Job satisfaction and career intentions of registered nurses in primary health care: an integrative review. Elizabeth Halcomb, Elizabeth Smyth, and Susan McInnes ... described qualitative projects, and the remaining paper (5%) employed a mixed-method approach. Most of the included papers reported research undertaken in Canada (n = 8, 40 ...

  14. Roles and functions in clinical care for registered nurses ...

    Conclusions: In order for nursing practice to reach full potential, clinical positions with clearly defined job descriptions for RN/PhDs are needed. To fully leverage their expertise, it is important to allocate sufficient time to conduct relevant research, as well as to support colleagues and students in the improvement of clinical practice.

  15. Nursing Research Career Guide

    In general, clinical research associates earn a median salary of $66,930, while certified clinical research professionals earn an average salary of $72,430. However, because of the RN credential, nurse researchers with these certifications generally earn above the average or median for those positions.

  16. Registered Nurses' experiences of reading and using research for work

    Reading and using research is integral to evidence-based practice and therefore to nursing [].It is known, however, that many nurses avoid engagement with research literature and evidence-based practice (EBP) for a variety of reasons [].Positive attitudes to EBP, involvement in research education and activities, regular journal reading, and higher levels of education have been found to be ...

  17. Registered Nurse Career Research Paper Nursing

    Download. Essay, Pages 5 (1082 words) Views. 3430. Ever since I was a little girl I always wanted to be a nurse and help people who were ill. As I got older, I got more information and decided that I wanted to become a Registered Nurse (RN). Registered nurses care for patients and educate them on health issues to prevent future illnesses.

  18. Clinician researcher career pathway for registered nurses and ...

    Clinician researcher career pathway for registered nurses and midwives: A proposal. 10.1111/ijn.12640. The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement.

  19. PDF NURSING AS A CAREER: First year Students' perception of and

    them. Therefore, a nurse is an important person and nursing an equally important career to the health care system. (Booth 2002, 392- 340.) In this paper we will look at the global view of nursing, nursing education and the perceptions of nursing career which will help us to relate with the target group of study.

  20. Projecting the Future Registered Nurse Workforce After the COVID-19

    After seeing a drop in the Registered Nurse (RN) workforce in 2020-2021 due to the COVID-19 Pandemic, a recent study by JAMA Health Forum shows a rebound of RNs joining or returning to the workforce. Growth of the RN population younger than 35 years of age (8.2%) more than doubled the growth of the RN population older than 50 years of age (3.5%).

  21. Factors influencing the recruitment and retention of registered nurses

    Introduction and background. The demand for primary care, community care and community nursing services is on the increase due to world demographic changes (World Health Organization, 2008; Maybin, Charles and Honeyman, 2016; Kroezen et al., 2015).The needs of community nursing patients are changing, requiring a new skill mix responsive to local patient and population needs (Drennan and Ross ...

  22. Solutions to close the nursing shortage gap

    The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses. ... We conducted a survey of 310 registered nurses across the United States from February 8 to March 22, 2023. ...

  23. A Career as a Registered Nurse Essay

    As a Registered Nurse they need to be able to deal with blood, snot, vomit etc. The main thing a Registered Nurse has to be good at is being able, and wanting to help people in need. A Registered Nurse typically tends to work in a clean and healthy work environment ("Registered …show more content… para. 1).

  24. The role of registered nurses in primary care and public health

    3. DESIGN. A scoping review of the RN's role in PC/PH collaboration was conducted. One of the goals of using a scoping review is to further enhance understanding, applicability and refinement of research questions that are broad and complex or have not been studied, for example RNs' role in collaboration between PC and PH in this research (Arksey & O'Malley, 2005; Colquhoun et al., 2014).

  25. Registered Nurse Research Paper

    Registered Nurse Research Paper. 1042 Words 5 Pages. Registered Nurse (RN) The Salary of an RN is about $36.94 per hour, but the work schedule of a nurse is crazy. Nurses never really get a break especially floor nurses. I have talked to quite a few nurses and they have said that since you don't truly get a break you tend to gain weight do to ...

  26. 2024 Chemistry Olympiad round one results

    The 2024 paper covered topics such as the composition of the FIFA 2023 Women's World Cup trophy, iodate salts, fuel-producing bacteria, the MRI contrast agent gadopiclenol and sulfur-containing molecules in the atmosphere.