Research Article: Developing a community-based nursing and midwifery career pathway – A narrative systematic review

Date Published: March 28, 2019

Publisher: Public Library of Science

Author(s): Clare Harvey, Desley Hegney, Agnieszka Sobolewska, Diane Chamberlain, Elspeth Wood, Lisa Wirihana, Sandy Mclellan, Joyce Hendricks, Troy Wake, Sharon Mary Brownie.


Community nursing and midwifery is changing in response to a shift in care from hospital to home, brought about by increasing costs to care because of an aging population and increasing chronicity. Until now, community nursing positions and scope of practice has been dependent on service focus and location, which has led to the role being unclearly defined. Lack of appeal for a career in community practice and a looming workforce shortage necessitates a review into how community nursing and midwifery transition to practice is supported.

This review sought to identify, assess and summarize available evidence relating to transitioning into community nursing and midwifery practice as a speciality. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A narrative synthesis was then undertaken on papers that examined community nursing and midwifery pathway perspectives which define, and enable or inhibit a contemporary pathway. Thematic analysis used a theoretical framework developed for early career and rapid transition to nursing specialty practice.

There is a paucity of research that identifies community nursing and midwifery as a discreet scope of practice. Twelve papers were eventually included in the review. Verbatim findings were extracted from the papers and clustered into categories based on the chosen theoretical framework. Major themes were ‘the self’ (professional and personal); ‘transition processes’; and, a ‘sense of belonging’. Sub themes included narrative identifying inhibitors and enablers in each theme.

No definition of community practice or pathway was identified in nursing, although midwifery was clearly defined. Community nursing practice was described as generalist in nature although specialist knowledge is required. Being part of the community in the professional sense and personal sense was considered important. The importance of transition was identified where pre-entry exposure to community practice was seen as important. Stages in transition to practice were recognised as pre-entry; incomer; insider; and, a sense of belonging. The process of transition should be planned and individualised acknowledging past experience whilst acknowledging the specialist nature of community-based practice.

Partial Text

The terms primary health care and community care are often used interchangeably, with the concepts encompassing care that is “accessible, acceptable, affordable and equitable and delivered close to where people live, work and play” [1]. The focus of primary health care is principally on early detection of illness, health promotion and early intervention, in line with the Alma Ata Declaration [2]. Primary care is also the first level of contact for people entering the health care system [3]. In Australia, all three concepts are used as care that is provided in the community, through primary health networks, community-based hospital services and non-government organisations, all aim at improving the health of the population [4].

There has been relatively little research conducted specifically in relation to community nursing and midwifery when compared to other areas of nursing/midwifery. Searches of databases and bibliographies yielded 17,965 potentially relevant citations, of which 461 were duplicates and 17, 331 were deemed ineligible on the basis of title and abstract. Full text was retrieved for 173 studies and these papers were assessed against the inclusion and exclusion criteria. A final sample of 12 studies was included in the review. There were ten qualitative papers [20–22, 40–46] and one mixed methods [47] and one quantitative paper [6]. The types of papers and the roles of the participants in the studies are outlined in Fig 3. Also provided in this figure is the verbatim findings extracted from the papers to identify the importance of the narrative, regardless of research design used for data collection and analysis [34].

The aims of this systematic review were to identify, assess and summarize available evidence relating to transitioning into a community nursing practice as a speciality. This systematic review provides a new conceptual framework and model for community career pathway for specialist nurses. A conceptual framework was developed from the findings of this systematic review.

This review could not determine a contemporary definition of community nursing, with only a limited definition of midwifery community practice evident. The whole spectrum of community practice needs to be examined carefully to structure a definition before recruitment or retention can be successful. These are where the deficiencies are evident on our framework and model.

We have conducted a systematic review that provides a new conceptual framework and model for the transition of nurses and midwives to a specialist community practice career. We used the TRANSPEC model as a theoretical framework for specialist practice due to a lack of a contemporary definition of community nursing and midwifery as specialist practice.




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