Exploring the Transition of Registered Nurses from Acute Care to Primary Health Care Settings

TL;DR: The need to improve the professional profile of PHC nursing in order to attract nurses to this sector is highlighted, with a reasonable number of nurses unwilling to commit long term to a career in PHC.

Abstract: Background: Internationally, the health needs of communities are changing as a result of the ageing population and the complexity associated with providing care to people with chronic conditions. This has resulted in the need for a sustainable health workforce skilled in the provision of primary health care (PHC). In Australia, there is evidence that registered nurses (RNs) are being recruited from acute care employment in order to meet nursing workforce shortages in PHC. However, little is known about how and why RNs transition, how efficiently they are able to transfer their skills, their transitioning experiences between settings and their future career intentions. This study provides new knowledge to inform recruitment and retention strategies, workforce policy and nursing education. Aim: To investigate the transition experiences and future career intentions of Australian RNs who move from acute care to PHC employment. Methods: A sequential mixed methods design was selected based on pragmatic underpinnings. Role theory provided the theoretical framework to inform the research design. The study consisted of a national online survey of RNs who had transitioned from acute to PHC employment within the previous five years (n=111), and semi-structured interviews with thirteen purposefully selected survey respondents. Findings: Reasons why nurses chose to transition to PHC were most commonly cited as relating to personal rather than professional issues. Improved work/life balance, better work hours and flexible work arrangements were highly rated, and made up for lower remuneration in the PHC sector. Barriers and enablers to successfully transitioning were also identified, with the nature of orientation and access to other supports such as preceptors and mentors varying greatly across the PHC sector. Availability of funding and/or time to undertake professional learning and knowledge development, and performance review opportunities varied according to the nature of PHC settings and factors such as geographic location and size of the workplace. Despite the positive attitudes of study participants towards the PHC environment and PHC nursing, a reasonable number were unwilling to commit long term to a career in PHC. Reasons cited included concerns about loss of clinical skills and availability of career paths in PHC. Conclusion: This study has highlighted the need to improve the professional profile of PHC nursing in order to attract nurses to this sector. If nurses are to be retained in PHC employment, they must be professionally supported by preceptors and mentors within a positive work environment throughout their transition. Opportunities to retain clinical skills, access to professional development and equitable remuneration are likely to encourage nurses to remain in PHC employment.