Date Published: May 1, 2019
Publisher: Public Library of Science
Author(s): Desley Hegney, Diane Chamberlain, Clare Harvey, Agnieszka Sobolewska, Bruce Knight, Anne Garrahy, Heather Cuevas.
Shortages in the speciality nursing workforce, both nationally and internationally are driving the need for the development of an evidence-based model to inform recruitment and retention into speciality nursing practice. This study aimed to identify the factors influencing rapid and early career transition into speciality nursing practice.
A comprehensive systematic review of the literature was undertaken using a convergent qualitative synthesis design where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Databases included CINAHL, Medline, Scopus and PsycINFO. Search terms were: nurse, early career, rapid career, transition, specialty, and Medical Subject Heading terms included: professional development and educational, nursing, and continuing. Using validated tools, papers were independently assessed by a minimum of two reviewers.
Twenty-three research articles were included. There were no randomized control trials. Through thematic analysis and matrix mapping of the results, the TRANSPEC model was developed. The model outlines three phases of transition: pre-entry, incomer and insider. There has been little focus on pre-entry with programs being designed at the incomer and insider phases. Impacting on these phases are three concepts: the self (professional and personal), the transition processes (informal and formal) and a sense of belonging. The overarching theme influencing the phases and concepts is the context of practice. Enablers and inhibitors influence successful transition and therefore impact on recruitment and retention. Each nurse’s transition is influenced by time.
For successful transition, the enablers and inhibitors impacting on the three concepts, phases and the context of practice need to be considered when developing any program. It is apparent that while previous studies have focused on the transition processes, such as curricula, the development of the self and a sense of belonging are also essential to successful transition. Further studies should include the pre-entry phase.
The need to re-examine the numbers and the types of nurses, and their role within the health workforce arises due to many factors including population drivers; economic considerations such as increased costs of medical advances and the use of technology to provide services; and problems with health workforce supply and mal-distribution . Population drivers include an increased demand on health services driven by the increased life expectancy of populations, particularly in developed countries, alongside the rising number of people living with chronic conditions who require more complex and long term treatment [2–4]. In Australia, a major driver of the change in health service delivery has been the 50% of the population with at least one chronic condition, as 40% of all preventable hospital admissions are related to chronic conditions . Servicing the need for this population alone has driven up the cost of provision of services. Described as a “growing health crisis” , the increased cost for treatment has resulted in an increased acuity of patients in the acute care system, with a flow on effect of earlier discharge in an attempt to reduce the length of hospitals stays. The flow on effect has meant that patients who are sicker are being cared for in their homes by multidisciplinary teams from numerous specialty areas and service providers . The cost of medical devices, particularly the increase in availability and use of technology for diagnosis and treatment  and Tele-health provision, particularly to populations in rural and remote areas, has also driven the cost of delivery . These changes have resulted in a need to re-examine traditional ways that health professionals provide services within hospitals and the community.
The overall study aimed to provide an evidence-based model for early career and rapid specialisation to nursing specialities. The project contained three studies: a systematic review of the literature, interviews with RNs who had participated in a recent transition to speciality practice program and a Delphi study to confirm findings of stages 1 and 2 and to provide a model on which to base policy and education programs. The aim of study one, the systematic review, was to identify, assess and summarize available evidence relating to early or rapid career transitioning into a specialty area of nursing practice. The specialty areas considered for this review were peri-operative, mental health, neonatal, critical care, rural and remote area and emergency nursing. The primary outcome of the review was to establish a model or framework for successful early and rapid transition into speciality practice. As a secondary outcome, the review was designed to inform the healthcare and education industry of the inhibitors and enablers, influencing an effective transition into specialty areas.
The main concepts identified in the transition process included: the Self (personal and professional), the Transition Processes (formal and informal), and a Sense of Belonging. The data also clearly identified three phases to the transition: Pre-entry, Incomer and Insider. Influencing successful transition at each phase and within each theme were the identified enablers and inhibitors. It was apparent from the data analysis that at each phase, the three major concepts of the Self, Transition Processes and the Sense of Belonging occurred. It was possible therefore to map these conceptually (hence TRANSPEC model emerged). It was also apparent that the over-arching theme of the Context of Practice, particularly the geographical location and the speciality, influenced the transition. Thus it was possible to enclose the phases and concepts within an over-arching theme of the Context of Practice. To inform the development of a transition program, it was possible also to identify enablers, inhibitors or both in each phase and concept. Thus the model developed from the data analysis.
The TRANSPEC model provides a foundation for effective recruitment and retention for both early career and rapid transitions to speciality practice. It shows that transition begins prior to entry to the speciality (pre-entry) and then continues to be developed over time. A successful transition relies on, at each phase, enablers to the professional and personal self, the formal and informal transition processes and a sense of belonging developing. This transition is influenced by the context of practice and the transition time will vary from one nurse to another.