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Nurse graduates’ experiences and support needs: A qualitative systematic review of South Africa’s community service programme

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Background: The student-to-nurse graduate transition is a pivotal phase in the professional development of nurses. In South Africa, this transition is part of a compulsory community service programme, which requires newly graduated nurses to work in rural and/or underserved areas for a period of 1 year. Objectives: The aim of this study was to review nurse graduates’ experiences and support needs during their transition in the compulsory community service programme. Methods: A qualitative systematic review of experiences was conducted. Qualitative research studies that addressed nurses’ experience in South Africa (2008–2017) were identified in Cochrane, Joanna Briggs Institute (JBI), Academic Search Complete, CINAHL, PubMed, SABINET, Science Direct, SCOPUS and Google Scholar databases. The systematic review methods included searching, sifting, abstracting and quality assessment of relevant qualitative studies by two reviewers and cross-checking by a third reviewer. Two reviewers independently performed blinded data extraction and quality assessment using the confidence in qualitative synthesis findings (ConQual) approach. Results: A total of 1257 studies were identified of which 12 met the inclusion criteria. Seven of the 12 studies were published articles and six were theses. The quality of the studies was found to be of high standard based on the ConQual rating. Four main themes emerged from the analysis: (1) rich developmental experiences through practice exposure, (2) difficulties in reconciling theory and practice, (3) contextual challenges in the workplace and (4) need for professional support structures, educational measures and public guidelines. Conclusion: Although positive experiences were reported, various challenges emerged, indicating the need for more systematic support mechanisms during transition.
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Curaonis
ISSN: (Online) 2223-6279, (Print) 0379-8577
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Authors:
Rita O. Abiodun1
Felicity Daniels1
Christoph Pimmer2
Jennifer Chipps1
Aliaons:
1School of Nursing, University
of the Western Cape,
Cape Town, South Africa
2Department of Business
Administraon, University of
Applied Sciences and Arts
Northwestern Switzerland,
Basel, Switzerland
Corresponding author:
Jennifer Chipps,
jchipps@uwc.ac.za
Dates:
Received: 25 Jan. 2018
Accepted: 18 Mar. 2019
Published: 21 Aug. 2019
How to cite this arcle:
Abiodun, R.O., Daniels, F.,
Pimmer, D. & Chipps, J., 2019,
‘Nurse graduates’ experiences
and support needs:
A qualitave systemac
review of South Africa’s
community service
programme’, Curaonis 42(1),
a1906. hps://doi.org/
10.4102/curaonis.v42i1.1906
Copyright:
© 2019. The Authors.
Licensee: AOSIS. This work
is licensed under the
Creave Commons
Aribuon License.
Introducon and background
In 1998, South Africa introduced a community service programme (CSP) for selected groups of
health professionals after the completion of their training. This initiative aimed at promoting
equity in the delivery of health services through the provision of human resources in rural and/or
underserved areas with the long-term goal of retaining these health professionals to work in rural
areas (SANC 2010). In 2008, community service was extended to include newly qualified nurses
following the proclamation of the Nursing Act No. 33 of 2005 (SANC 2010). This meant that newly
qualified professional nurses were required to serve in rural and/or underserved areas for a
period of 12 months after completing their undergraduate degree or diploma in nursing. During
the 12 months of community service, newly qualified nurses are registered as Community Service
Nurse Practitioner (CSNP), after which they are registered as professional nurses with the South
African Nursing Council (SANC 2010).
From a professional development perspective, this transition is central because it strongly impacts
the development of skills and even future career success of nurses (Koen, Klehe & Van Vianen
2012). It can offer numerous opportunities for nurses to further develop their clinical skills, ethical
and professional behaviour and their critical thinking abilities upon graduation (Hatcher et al.
2014). Community service provides a bridge to help students to make the transition from a
Background: The student-to-nurse graduate transition is a pivotal phase in the professional
development of nurses. In South Africa, this transition is part of a compulsory community
service programme, which requires newly graduated nurses to work in rural and/or
underserved areas for a period of 1 year.
Objectives: The aim of this study was to review nurse graduates’ experiences and support
needs during their transition in the compulsory community service programme.
Methods: A qualitative systematic review of experiences was conducted. Qualitative research
studies that addressed nurses’ experience in South Africa (2008–2017) were identified in
Cochrane, Joanna Briggs Institute (JBI), Academic Search Complete, CINAHL, PubMed,
SABINET, Science Direct, SCOPUS and Google Scholar databases. The systematic review
methods included searching, sifting, abstracting and quality assessment of relevant qualitative
studies by two reviewers and cross-checking by a third reviewer. Two reviewers independently
performed blinded data extraction and quality assessment using the confidence in qualitative
synthesis findings (ConQual) approach.
Results: A total of 1257 studies were identified of which 12 met the inclusion criteria. Seven of
the 12 studies were published articles and six were theses. The quality of the studies was found
to be of high standard based on the ConQual rating. Four main themes emerged from the
analysis: (1) rich developmental experiences through practice exposure, (2) difficulties in
reconciling theory and practice, (3) contextual challenges in the workplace and (4) need for
professional support structures, educational measures and public guidelines.
Conclusion: Although positive experiences were reported, various challenges emerged,
indicating the need for more systematic support mechanisms during transition.
Keywords: transition; nurse graduates; qualitative systematic review; community nursing
service; South Africa.
Nurse graduates’ experiences and support needs:
A qualitave systemac review of South Africa’s
community service programme
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well-structured education environment to more flexible self-
guided workplace learning, where they assume greater
responsibilities for their own learning and decision-making.
However, studies that explore this programme indicate that
working in rural and marginalised settings is challenging.
Having limited practice experience, newly qualified nurses
are often placed in clinics in remote areas in which they are
sometimes the most senior nurses (Thopola, Kgole &
Mamogobo 2013). They experience high levels of stress,
anxiety and feelings of isolation (D’ambra & Andrews 2014;
Hlosana-Lunyawo & Yako 2013). According to Meleis (2015)
and Zaayman (2016), the transition from students to nurse
graduate and the responsibilities attached to it may lead to a
state of disequilibrium.
Although a number of research studies have been conducted
in South Africa on the transition experiences of student
nurses into new graduates through the CSP, a systematic
analysis of their experiences and support needs is still
lacking. From a practical standpoint, the CSP does not yet
have harmonised support mechanisms in place. This means
that structures and practices vary considerably, depending
on the local and institutional settings in which the CSNPs are
placed. Accordingly, the experiences of CSNPs can manifest
differently across different settings. This review seeks to
address this gap by providing a synthesis of experiences to
understand the needs of CSNPs and inform policies and
strategies for support mechanisms during the transition
period. This will be achieved by contrasting and synthesising
the different experiences and discussing them in light of
international literature.
The review methods
Aim
The aim of the study was to review nurse graduates’
experiences and support needs during transition in the
compulsory CSP in South Africa.
Research queson
What are the experiences and support needs of graduate
nurses in their transition to CSNPs in South Africa’s CSP?
Design
A systematic review was conducted using the Joanna Briggs
Institute (JBI) standard search procedures (Joanna Briggs
Institute 2011). The approach summarises individual studies,
critiques their design and makes recommendations for future
research and practice.
Search strategy
The search included published articles, following the
guidelines of the JBI (2011), and also grey or unpublished
literature on the compulsory community service in South
Africa (2008–2017). A three-step search strategy was employed
in the study. The search terms included ‘newly graduated
nurse’, ‘community service nurse’, ‘South Africa’, ‘experience’,
‘needs’ and ‘perception’. The search was restricted to English
language studies and was completed in December 2017. An
initial search of Cochrane and JBI databases for published
systematic reviews in this context was conducted by reviewing
titles and abstracts, index and MeSH terms to ensure that all
relevant materials were captured. A second search with the
identified keywords and index terms was undertaken using
the following electronic databases: Cochrane, JBI, Academic
Search Complete, CINAHL, PubMed, SABINET, Science
Direct, SCOPUS and Google Scholar. Thirdly, the reference
lists of identified articles were back-searched. The identified
studies were assessed for relevance based on the title and,
where available, the abstract. The full article was retrieved and
further assessed by two reviewers based on the inclusion
criteria. All full texts were analysed against three inclusion
criteria (see Table 1). The search strategy was summarised
using the PRISMA statement flow chart (Moher, Liberati,
Tetzlaff & Altman 2009).
Crical appraisal (assessment of
methodological quality)
The confidence in qualitative (ConQual) approach was used
to assess the methodological quality of the study. This
approach includes two major elements that influence the
confidence of qualitative synthesised findings: (1)
dependability (a measure of trustworthiness that helps to
establish whether a study’s findings are consistent and
repeatable) and (2) credibility (a measure of trustworthiness
that helps researchers to link a study’s findings to reality)
(Munn et al. 2014).
All qualitative studies selected for retrieval were assessed
independently by two reviewers for methodological quality
and cross-checked by a third reviewer before inclusion in the
review. Any disagreements between the reviewers were
resolved through discussion (Munn et al. 2014). Dependability
was determined to be high, moderate, low or very low based
on the following criteria: (1) congruence between the research
methodology and the research question or objectives,
(2) congruence between the research methodology and the
methods used to collect data, (3) congruence between the
research methodology and the representation and analysis of
data, (4) statements that located the researcher culturally or
theoretically and (5) description of the influence of the
TABLE 1: Inclusion and exclusion criteria.
Variable Descripon
Populaon Inclusion: Newly qualied nurses (community service nurses) during their year of compulsory community service in South Africa.
Exclusion: Registered nurses in their rst year of pracce aer the compulsory community service.
Phenomenon of interest or outcome Experiences (posive and negave), support needs and aendant strategies during their year of compulsory community service in
South Africa were the phenomena of interest.
Type of study Qualitave studies, not limited to design or publicaon type.
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researcher on the research (and vice versa). Credibility was
appraised as either unequivocal (findings accompanied by
an illustration that is beyond reasonable doubt and therefore
not open to challenge), equivocal (findings accompanied by
an illustration lacking clear association with it and therefore
open to challenge) or unsupported or mixed (findings are
not supported by the data). In addition, the reviewers’
judgements on the relevance and appropriateness of each
study and its methodology were considered.
Data extracon
Qualitative data were extracted using a standardised data
extraction tool: the JBI qualitative assessment and review
instrument (JBI-QARI). Two reviewers independently
extracted the data and any disagreements were resolved by
discussion. The data extracted included the demographic
information of the population, the phenomena of interest,
study methods and findings that were relevant to the research
question.
TABLE 2: Themes, sub-themes and categories of experiences of new community service nurses.
Variable Descripons
Theme 1 Rich developmental experiences and condence development (through pracce exposure)
Sub-theme 1.1 Developmental experience
Categories • Time to grow and develop professionally and role development (Andrén & Hammami 2011; Plessis & Seekoe 2013; Thopola et al. 2013).
• Gained from being exposed to dierent instuonal sengs (Govender et al. 2017).
• Working with paent and family as a sasfying experience (Govender et al. 2017).
Sub-theme 1.2 Development of condence through pracce exposure
Categories • Sense of achievement and condence (Roziers et al. 2014).
• Development of communicaon skills and relaonships (Ndaba & Nkosi 2015; Zaayman 2016).
Theme 2 Dicules in theory and pracce
Sub-theme 2.1 Theory to pracce praxis
Categories • Challenges in the integraon of theory and pracce (Tsotetsi 2013; Zaayman 2016).
• Realies of pracce: reality shock (Ndaba & Nkosi 2015; Roziers et al. 2014).
• Ambiguous situaons challenging (Govender et al. 2017; Plessis & Seekoe 2013).
Sub-theme 2.2 Poor pracce readiness, anxiety and stress
Categories • Feeling unprepared from school (Beyers 2013; Nkoane 2015).
• Poor pracce readiness (Nkoane 2015).
• Anxiety and stress (Ndaba & Nkosi 2015; Plessis & Seekoe 2013; Roziers et al. 2014; Shezi 2014).
Theme 3 Contextual challenges in the work place
Sub-theme 3.1 Lack of organisaonal or supervision support
Categories • Lack of orientaon (Govender et al. 2017; Ndaba & Nkosi 2015; Thopola et al. 2013).
• Lack of team work (Andrén & Hammami 2011; Thopola et al. 2013).
• Limited support (Beyers 2013; Ndaba & Nkosi 2015; Tsotetsi 2013).
• Lack of supervision and mentorship (Nkoane 2015; Thopola et al. 2013).
• Uncertainty with unclear objecves of the community service policy (Govender et al. 2017; Thopola et al. 2013).
Sub-theme 3.2 Restricted human and material resources and high workload
Categories • Lack of human and material resources in pracce sengs (Ndaba & Nkosi 2015; Nkoane 2015; Thopola et al. 2013).
• High workloads (Andrén & Hammami 2011; Plessis & Seekoe 2013; Shezi 2014; Tsotetsi 2013).
• Low remuneraon (Andrén & Hammami 2011; Govender et al. 2017; Thopola et al. 2013; Tsotetsi 2013; Nkoane 2015).
Sub-theme 3.3 Interpersonal challenges (dicult relaonships)
Categories • Bullying and strife among sta (Beyers 2013; Ndaba & Nkosi 2015; Tsotetsi 2013).
• Poor communicaon between sta (Tsotetsi 2013).
• Poor acceptance of new nurses (Govender et al. 2017).
• Loneliness (Beyers 2013).
Theme 4 Need for professional support structures, measures and public guidelines
Sub-theme 4.1 Need for professional structures and measures
Categories •  Well-structured orientation programme (Beyers 2013; Govender et al. 2017; Nkoane 2015; Roziers et al. 2014; Shezi 2014; Tsotetsi 2013;
Zaayman 2016).
•  Coaching and mentorship (Beyers 2013; Govender et al. 2017; Hlosana-Lunyawo & Yako 2013; Plessis & Seekoe 2013; Shezi 2014; Tsotetsi 2013;
Zaayman 2016).
• Creang call centres for support (Nkoane 2015; Tsotetsi 2013).
• Communicaon of evidence-based informaon to inform pracce (Roziers et al. 2014; Plessis & Seekoe 2013).
• Connuous professional development (CPD) (Nkoane 2015; Thopola et al. 2013; Tsotetsi 2013; Zaayman 2016).
Sub-theme 4.2 Educaonal or training issues
Categories • Well-structured curriculum for proper preparaon of nurses (Andrén & Hammami 2011; Tsotetsi 2013; Zaayman 2016).
• Inappropriate inducon programmes (Hlosana-Lunyawo & Yako 2013).
• Inadequate training programmes during preparaon (Hlosana-Lunyawo & Yako 2013; Zaayman 2016).
Sub-theme 4.3 Need for guidelines for Community Service Pracce
Categories • Guidelines for community service policy stakeholders (Nkoane 2015; Tsotetsi 2013; Zaayman 2016).
• Guidelines for supervision (Hlosana-Lunyawo & Yako 2013; Nkoane 2015; Tsotetsi 2013).
• Guidelines for support (Andrén & Hammami 2011; Hlosana-Lunyawo & Yako 2013; Nkoane 2015; Shezi 2014; Tsotetsi 2013).
• Guidelines for role claricaon (Andrén & Hammami 2011; Shezi 2014; Tsotetsi 2013).
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Data analysis
Thematic analysis was employed in this study because it
offers a systematic approach to organise, analyse and present
qualitative data collected from different sources of literature
(Thomas & Harden 2008).
Thematic analysis was used to categorise the experiences and
support needs of newly qualified nurses, which were
grouped together into meaningful themes.
The analytical process involved the reading and re-reading of
the studies before extracting relevant statements (Thomas &
Harden 2008). The extracted content was reviewed iteratively
against the emerging themes, which were inferred with
constant recourse to the research question on experiences
and support needs of newly graduated nurses. The analysis
yielded 35 categories which were then grouped into 4 main
themes (see Table 2).
Ethical consideraons
Ethical approval was obtained from the University of the
Western Cape Research Ethics Committee (HS16/6/41).
Results and discussions
Search results
The systematic search identified a total of 1263 studies of
which 1257 were extracted from the initial search and 6 from
grey literature (Figure 1). Duplicates and irrelevant studies
were removed by the review of titles. As a result, 86 studies
that potentially met the inclusion criteria remained.
Thereafter, a detailed review of the title and abstract of
each study was performed, resulting in the final number of
12 studies. The 12 studies included seven full text articles
and six unpublished theses that met the inclusion criteria.
No additional studies were identified from the reference lists
of these articles.
Quality of studies
The 12 studies that met the inclusion criteria (see Table 1)
were reviewed and critically appraised. Seven studies were
determined to have high quality (Beyers 2013; Govender,
Brysiewicz & Bhengu 2017; Hlosana-Lunyawo & Yako 2013;
Nkoane 2015; Plessis & Seekoe 2013; Roziers, Kyriacos &
Ramugondo 2014; Zaayman 2016), five studies were of
moderate quality (Andrén & Hammami 2011; Ndaba &
Nkosi 2015; Shezi 2014; Thopola et al. 2013; Tsotetsi 2013) and
one study was evaluated to be of low quality and was
subsequently removed.
Descripon of selected studies
Of the 12 qualitative research studies selected for inclusion, six
were published in peer-reviewed journals (Govender et al.
2017; Hlosana-Lunyawo & Yako 2013; Ndaba and Nkosi 2015;
Plessis and Seekoe 2013; Roziers et al. 2014; Thopola et al.
2013) and six were unpublished theses (Andrén & Hammami
2011; Beyers 2013; Nkoane 2015; Shezi 2014; Tsotetsi 2013;
Zaayman 2016). Eleven of the studies focused on experiences
and one study centred explicitly on the needs of community
service nurses (Shezi 2014). The studies were conducted in
five provinces of South Africa (Eastern Cape, Gauteng,
KwaZulu-Natal, Limpopo and Western Cape). The 12
qualitative studies included various designs. Six studies used
a phenomenological approach (Hlosana-Lunyawo & Yako
2013; Ndaba & Nkosi 2015; Roziers et al. 2014; Plessis & Seekoe
2013; Shezi 2014; Thopola et al. 2013), whereas the remaining
studies used descriptive-exploratory designs (see Table 3)
(Andrén & Hammami 2011; Beyers 2013; Govender et al. 2017;
Shezi 2014; Tsotetsi 2013; Zaayman 2016). The participants in
the studies were all CSNPs, with the total number of
participants in each study varying between 7 and 27. The
predominant data collection tool was the individual interview.
Synthesis
Thirty-five categories emerged from the analysis, which were
grouped into four main themes (see Table 2). The four main
themes are (1) rich developmental experiences and confidence
development through practice exposure; (2) difficulties in
reconciling theory and practice; (3) contextual challenges in
the workplace and (4) need for professional support
structures, measures and public guidelines.
Discussion
Theme 1: Rich developmental experiences and
condence gains through pracce exposure
Developmental experiences
Five categories describe the rich developmental experiences
of CSNPs through practice exposure and the training
experienced during community service (see Table 2).
A number of studies indicate that CSNPs consider the
Studies included in
qualitave synthesis
(n = 12)
Records idenfied through
database searching
(n = 1257)
Addional records
idenfied through
other sources (n = 6)
Records aer duplicates removed
(n = 1174)
Records screened
(n = 86)
IncludedEligibilityScreening Idenficaon
Irrelevant records
excluded (n = 1088)
Full-text arcles
assessed for
eligibility (n = 12)
Full-text arcles
excluded, with
reasons (n = 74)
Source: Based on Moher, D., Libera, A., Tetzla, J. & Altman, D.G., 2009, ‘Preferred reporng
items for systemac reviews and meta-analyses: The PRISMA statement’, Annals of Internal
Medicine 151(4), 264–269
FIGURE 1: Prisma ow diagram.
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TABLE 3: Data extracon and quality assessment.
Author (year) Populaon and number
(n) of parcipants
Phenomenon of interest Design, methods and analysis Findings Overall ConQual score
Andrén and
Hammami
2011
Newly qualied nurses
7 parcipants
Experiences of newly
qualied nurses of
University of Limpopo,
execung mandatory
community service in
Limpopo province, South
Africa.
A qualitave, exploratory,
descripve and contextual
design.
Qualitave content analysis.
Experiences
• Low salary.
• Lack of material resources.
• Shortage of sta.
• Lack of organisaon of management.
• Missing parts in the structure of curriculum.
• Opportunies to develop within the profession.
Needs or strategies
• Guideline for support.
Moderate
Dependability – Downgrade 1 level
Credibility
No downgrade
Tsotetsi 2013 Newly qualied 4-year
trained professional nurses
6–10 parcipants each
Experiences and support
of the newly qualied
4-year
trained professional
nurses placed for
remunerated
community service in
Gauteng province.
A qualitave, exploratory,
descripve and contextual
study design.
Five focus groups.
Tesch’s method of data
analysis
Experiences
• Mixed experiences.
• Adequate, inadequate, incidental and lack of support.
• Diculty in the integraon of theory into pracce.
• Bad sta atudes.
• Severe sta shortage.
• Poor interpersonal relaonship and low salary.
• Role conicts.
Needs or strategies
Standardised orientaon programme.
• Coaching and mentorship.
•  Role claricaon or structured programme or scope of pracce for community
service.
• Incenves and resources.
• Review of curriculum in line with policies developed by DoH.
• Call centre for CSNs.
• Availability of policy guidelines.
• Pocket procedure manual with simple policies and protocols.
Moderate
Dependability – Downgrade 1 level
Credibility
No downgrade
Plessis and
Seekoe 2013
Newly qualied midwives Experiences and
challenges of newly
qualied midwives in
community services.
A qualitave explorave
phenomenological design.
Themac analysis using
Tesch’s method.
Experiences
Posive experiences-training added value to clinical and professional experience.
• Sense of disillusionment.
• Stress (interpersonal relaonships) in the clinical eld.
Needs or strategies
Guidelines and policies for orientaon and mentorship.
• Conduct in-service training session and connued professional development.
• Strategies to improve eecve communicaon among stas should be employed.
• Communicaon of evidence-based informaon to inform pracce.
High
Dependability – No downgrade
Credibility
No downgrade
Thopola et al.
2013
Newly qualied nurses
8 parcipants
Experiences of newly
qualied nurses at
University of Limpopo,
Turoop campus
execung community
services in Limpopo
province, South Africa.
A qualitave, explorave,
descripve and contextual
research design with a
phenomenological approach
was adopted.
Tesch’s content analysis.
Experiences
Poor orientaon.
• Lack of supervision.
• Lack of team work.
• Low remuneraon.
• Shortage of human resources.
• Training added value to their competence.
Needs or strategies
Orientaon programme.
• In-service educaon.
• Remuneraon policy should be revisited.
Moderate
Dependability – Downgrade 1 level
Credibility
No downgrade
Hlosana-
Lunyawo and
Yako 2013
Newly qualied
professional nurses
20 parcipants
Experiences of newly
qualied professional
nurses in primary health
care facilies in the
Amathole District, Eastern
Cape Province, South
Africa.
A qualitave and exploratory
approach. Using
phenomenological design.
Coliazzi’s six steps of data
analysis.
Experiences
Inappropriate inducon programmes.
• Lack of support and supervision.
• Inadequate training and development programmes.
Needs or strategies
Guidelines for inducon programmes, with role claricaon.
• Guidelines on supervision.
• Coaching and mentoring programme.
High
Dependability – No downgrade
Credibility
No downgrade
Table 3 connues on the next page →
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TABLE 3 (Connues...): Data extracon and quality assessment.
Author (year) Populaon and number
(n) of parcipants
Phenomenon of interest Design, methods and analysis Findings Overall ConQual score
Beyers 2013 Community service
praconers
10 parcipants
Experiences of community
service praconers who
are deployed at a rural
health facility in the
Western Cape.
A qualitave, exploratory and
descripve design.
The process of inducve
coding of Thomas (2003) was
used to analyse the data.
Experiences
Challenges related to adaptaon to a new environment (under preparedness,
interpersonal relaonships, professional accountability, lack of support from
management).
•  Posive experiences (boosted condence and creavity and interpersonal
support).
Needs or strategies
Timely orientaon.
• Structured policy for community service.
• Mentor and preceptorship workshop.
High
Dependability – No downgrade
Credibility
No downgrade
Shezi 2014 Community service nurses
12 parcipants
The needs of community
service nurses with regard
to supervision and clinical
accompaniment.
A qualitave design using
exploratory, descripve and
contextual strategies.
Qualitave content analysis.
Experiences
Negave emoonal experiences such as stress, fear, frustraon, grievances and
disorientaon.
• Shortage of sta.
• Construcve support from experienced professional nurses.
Needs or strategies
• A strategic plan for community service nurses:
• Inducon and orientaon, policies and procedures to be in place.
• Clinical supervision should be provided.
• Construcve support and emoonal support should be provided.
• Sensive feedback should be provided.
• Experienced professional nurses with posive atude within the units.
• Job descripon of the community service nurse.
Moderate
Dependability – No downgrade
Credibility
Downgrade 1 level
Roziers et al.
2014
Newly qualied
South African nurses
8 parcipants
Newly qualied South
African nurses’ lived
experience of transion
from student-to-
community Service nurse.
Descripve phenomenology
(Husserl’s): Two semi-
structured individual
interviews conducted 6 weeks
apart, before and aer
placement.
Themac data analysis.
Experiences
Sense of achievement.
• Uncertainty and fear in ancipaon of reality.
• Reality shock.
Needs or strategies
Structured programme.
• Guided realisc clinical scenarios during training.
High
Dependability – No downgrade
Credibility
No downgrade
Nkoane 2015 Community service nurses
11 parcipants
Community service nurses’
experiences regarding
health care services at
Tshwane district public
hospital.
A qualitave interpretave
phenomenological analysis
(IPA) approach.
11 semi-structured interviews.
Interpretave
Phenomenological analysis
framework for data analysis.
Experiences
• Shortage of material resources and human resources.
• Non-payment of allowances.
• Poor atude.
• Lack of professional support.
• Poor pracce readiness.
• Lack of movaon and condence.
• Frustraon.
Needs or strategies
In-service training and workshops.
• Psychological support.
• Guidelines for supervision and support.
• Availability of community service policy to all stakeholders.
High
Dependability – No downgrade
Credibility
No downgrade
Ndaba and
Nkosi 2015
Qualied professional
nurses
10 parcipants
Lived experiences of newly
qualied professional
nurses on community
service in midwifery.
A qualitave descripve,
interpreve
phenomenological research
with interviews.
Themac analysis (Husserl’s
philosophy of descripve
phenomenology).
Experiences
• Lack of orientaon.
•  Transion created a period of stress, uncertainty and fear which create emoonal
reacons.
•  Posive (good communicaon) and negave (bullying and conict) atude from
colleagues.
Needs or strategies
Proper orientaon.
Moderate
Dependability – No downgrade
Credibility
Downgrade 1 level
Table 3 connues on the next page →
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TABLE 3 (Connues...): Data extracon and quality assessment.
Author (year) Populaon and number
(n) of parcipants
Phenomenon of interest Design, methods and analysis Findings Overall ConQual score
Zaayman 2016 Professional nurses
10 parcipants
Professional nurses’
experiences of their
community
service placement year at
a secondary academic
hospital in
the Western Cape.
A qualitave research
approach and an exploratory
and descripve research
design.
The process of inducve
coding of Thomas (2003) was
used to analyse the data.
Experiences
Diculty in applying new knowledge.
• Posive relaonships with sta and some negave atudes from sta.
• Experienced professional development.
• Inadequate undergraduate programme preparaon.
• Experienced support and challenges (working alone, feeling of inexperience).
Needs or strategies
Nursing programme curriculum should be revisited.
• Jointly prepared guidelines by stakeholders.
•  Long- and short-term support (revised orientaon programme, debrieng
opportunies, workshop and in-service training).
• Mentorship programme.
High
Dependability – No downgrade
Credibility
No downgrade
Govender et
al. 2017
Nurses performing
compulsory community
service
27 parcipants
Pre-licensure experiences
of nurses performing
compulsory community
service in KwaZulu-Natal,
South Africa: A qualitave
study.
A descripve qualitave
approach.
Tesch’s content analysis.
27 semi-structured interviews.
Experiences
Sased with allocaon of sites.
• Gained from exposures.
• Feeling overwhelmed.
• Role confusion.
• Experiencing some frustraon.
Needs or strategies
Proper orientaon to CS.
• Scope of pracce for CNPs should be developed.
• Proper remuneraon should be reconsidered.
High
Dependability – No downgrade
Credibility
No downgrade
DoH, Department of Health; CSN, Community Service Nurse; CS, Community Service; CNP, Community service Nurse Praconer.
, Downgrading for dependability may occur when the ve criteria for dependability are not met across the included studies.
community service as a time to grow and to develop significant
professional skills (Andrén & Hammami 2011; Plessis &
Seekoe 2013; Thopola et al. 2013). A qualitative study by
Thopola et al. (2013) reported that CSNPs emphasised
personal and professional growth and development during
the transition period. Newly graduated nurses acknowledged
developmental opportunities, such as working with patients
and their families, and other staff members; and in doing so,
they advanced their communication skills. Govender et al.
(2017) reported that it was rotation patterns and schedules
which triggered professional growth and provided CSNPs
with the opportunity to extend their skill set.
Similar observations can be found in international studies,
which affirm the developmental effects associated with the
student-to-nurse transition period. Ivey (2012) reports that
newly graduated nurses in the United States had positive
learning experiences during their year of transitioning,
especially in situations in which they were welcomed and
explicitly supported in their learning. Similarly, Harding
et al. (2013) found that newly graduated nurses in the United
States had an increase in knowledge and skills and that they
advanced their professional development. To promote and
sustain these effects, it has been argued that clinical sites
should more explicitly acknowledge the developmental
value of transitions, for example by increasing resources
provided to new nurses to join membership organisations
and by supporting them in the pursuit of certifications and
further and specialised training (Walsh 2018).
Development of condence through pracce exposure
In addition to skills development, some studies also highlight
that the CSP facilitated the development of a sense of
achievement and confidence (Roziers et al. 2014). For
example, Roziers et al. (2014) report that newly graduated
nurses from the Western Cape province increased the
confidence in their abilities to organise and prioritise duties,
communicate with staff members and patients, and to assume
more responsibilities and leadership roles.
Kumaran and Carney (2014) found that interpersonal and
communication skills gained during the transition period
increased the confidence of Irish nurse graduates. The
confidence was developed through practice exposure in the
transition period and it contributed to an enhanced self-image
and higher levels of assertiveness. These factors may facilitate a
smoother transition into new roles and prepare nurses to
assume more responsibilities (Kumaran & Carney 2014). While
Lea and Cruickshank (2015) described that new graduates
generally enjoyed their rotations, these can also cause feelings of
not belonging and may thus negatively impact their confidence.
Theme 2: Dicules in reconciling
theory and pracce
Theme 2 comprises two sub-themes that describe the
difficulties that CSNPs face in reconciling theoretical
knowledge with clinical practice (see Table 2).
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Theory to pracce praxis
Studies show that CSNPs faced considerable challenges in
incorporating theoretical knowledge gained from their
nursing education institution with practice experiences in the
CSP (Tsotetsi 2013; Zaayman 2016).
Beyers (2013) and Nkoane (2015) state that difficulties of the
reconciliation of theoretical and more practical knowledge
are linked to CSNPs’ poor levels of practice readiness.
Similarly, a qualitative study conducted by Nkoane (2015) in
public hospitals reports that theoretical knowledge provided
at nursing education institutions differs from the realities of
clinical practice. Furthermore, the study reported that senior
professional nurses do not provide adequate opportunities
for CSNPs to apply their theoretical knowledge in clinical
practice (Nkoane 2015). Also, this theme is corroborated by
studies from outside of South Africa’s CSNP, saying that the
school-to-work trajectory is very challenging because nurses
struggle with the integration of theoretical knowledge with
work practices (Feng & Tsai 2012; Ndaba & Nkosi 2015;
Roziers et al. 2014).
Poor pracce readiness, anxiety and stress
Some studies indicate that CSNPs experience anxiety,
confusion and stress because of their inability to align
theoretical knowledge from textbooks with the lived realities
of clinical practice (Ndaba & Nkosi 2015; Plessis & Seekoe
2013; Roziers et al. 2014; Shezi 2014).
In the international literature, negative experience and low
levels of practice readiness in the transition phase are linked
to diverging role conceptions: A study on newly graduated
nurses in Taiwan reports nurses experience difficulties in
the differentiation of ‘idealised role conceptions’ and
‘actualised role conceptions’, causing anxiety, stress and a
‘reality shock’ (Cheng et al. 2014). In addition, Odetola et al.
(2018) reported that the ‘disconnect’ between the theory and
practice is one of the main reasons for professional fear,
anxiety and feelings of incompetence among freshly
graduated nurses.
There are suggestions in the literature about how to reduce
or close the theory–practice gap which put nurse educators
and mentors in the forefront. They can help new graduates
by encouraging reflection (on-action) and critical thinking.
Another suggestion from Swedish and Nigerian settings is
that education should better prepare nursing students for
the working life by offering more practical opportunities
during their studies (Pennbrant et al. 2013). In the
workplace, the support of academic–clinician collaboration,
the building of a research culture and the improvement of
research access to encourage the use of evidence-based
studies to inform practice was suggested (Leach & Tucker
2018). However, the prerequisites for these measures are
the proper staffing and the provision of resources to
hospitals in rural and remote areas, which are often
inadequate today.
Theme 3: Contextual challenges
in the work place
In addition to the theory–practice gap, which refers to
tensions and contradictions between education institutions’
practise and practices of nurses’ (subsequent) working life,
CSNPs experience an array of challenges relating to specific
conditions within their workplaces. These challenges are
classified according to three interdependent dimensions,
namely (1) a lack of organisational and supervision structures,
(2) restricted human and material resources and a high
workload and (3) interpersonal challenges.
Lack of organisaonal and supervision structures
Several studies outline the lack of orientation, support,
supervision and mentorship made available to CSNPs
(Nkoane 2015; Thopola et al. 2013). For example, Govender
et al. (2017) reported that CSNPs experienced limited
orientation, mentoring and support as a result of staff
shortages, which made the immersion into the workplace a
stressful experience.
The lack of organisational or managerial support structures
in the health care system has also been acknowledged in the
wider literature. Although newly qualified nurses may
initially feel excited at the onset of the transition, the lack of
support structures can make newly acquired professional
responsibilities an overwhelming experience (Kumaran &
Carney 2014). Regan et al. (2017) reported that newly
graduated nurses in Canada faced significant challenges in
the immersion into their respective teams because of a lack of
supportive mentors. The literature suggests that supportive
relationships between graduates and their institutions need
to develop over time in that autonomous practice and critical
thinking (Hofler & Thomas 2016) are accompanied by the
provision of adequate orientation and the availability of
mentors and preceptors, and they can be supported through
the use of information and communication technologies
particularly in rural areas (Kaihlanen et al. 2018; Mbemba
et al. 2013).
Restricted human and material resources
and high workload
Several studies point to a deficit of human and material
resources in clinical sites which is viewed as a particular
challenge by nurses in the transition phase (Ndaba & Nkosi
2015; Nkoane 2015; Thopola et al. 2013). The lack of human
resources accumulates in high workloads for the local staff,
and particularly for the CSNPs, resulting in a number of
negative consequences (Andrén & Hammami 2011; Plessis &
Seekoe 2013; Shezi 2014). For example, Nkoane (2015) reports
that the shortage of both human and material resources
increased the workload of CSNPs which, in turn, resulted in
high levels of stress and frustration.
The problem of high workload has also been identified in the
literature beyond South Africa’s CSNP.
Several studies argued that high workload resulted in the
experience of stress and uncertainty among newly graduated
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nurses (Blomberg et al. 2016; Higgins, Spencer & Kane 2010;
Horsburgh & Ross 2013). For example, Regan et al. (2017)
describe that the shortage of human resources in Canadian
health care settings leads to heavy workloads of new nurses.
This phenomenon is compounded by the inability of newly
graduated nurses to effectively manage their workloads and
their reliance on ‘self-generated’ approaches to address these
issues (Bisholt 2012).
Interpersonal challenges
Several studies have pointed to interpersonal issues that
CSNPs face in their relationships with nursing and clinical
staff including poor communication, interpersonal
problems, strife and bullying (Beyers 2013; Ndaba & Nkosi
2015;). A study from hospitals in Gauteng CSNPs reported
poor communication and strife among staff, which were
linked to restricted learning opportunities (Tsotetsi 2013).
In addition, newly qualified nurses reported a sense of
loneliness and isolation as a result of not feeling accepted
at the workplace (Govender et al. 2017). Tsotetsi (2013)
argues that the ability to connect socially with the new
environment depends on the individual and can vary
considerably, but some studies clearly identify unacceptable
attitudes and behaviours from senior colleagues (D’ambra
& Andrews 2014; Rush et al. 2014). Lea and Cruickshank
(2015) identify negative attitudes and unsupportive
behaviours of experienced nursing staff towards newly
qualified nurses as key factors that jeopardise the
success of the transition period. In addition, power
imbalances among nursing and health professional
teams further compound the problem with CSNPs being
seen at the bottom of the ‘pecking order’ (Halpin, Terry &
Curzio 2017).
Some nurses are reported to find it difficult to challenge the
authority of superiors in the workplace and instead direct
negative attitudes and frustration towards younger nurses
and CSNPs (D’ambra & Andrews 2014). Against this backdrop,
literature recommends managerial interventions and
particularly the adoption of a participatory and dialogic
leadership style, which promotes healthy relationships
through social activities both in and outside of the work
environment (Amestoy et al. 2014; Obakpolo 2015; Shah 2017).
Theme 4: Need for professional support
structures, educaonal measures
and public guidelines
Theme 4 consists of three sub-themes: (1) the need for
professional structures, (2) education and training measures
and (3) the need for guidelines for the Community Service
Practice (see Table 2). The eight subcategories that CSN needs
are well-structured orientation programmes, coaching and
mentorship; creation of call centres; communication of
evidenced-based information to inform practice; and
continuous professional development (CPD), a well-
structured curriculum for proper preparation of nurses
(Hlosana-Lunyawo & Yako 2013; Zaayman 2016).
The need for professional structures
There is wide agreement that newly graduated nurses require
a period of structured support following their graduation
(Al Awaisi, Cooke & Pryjmachuk 2015; Blomberg et al. 2016;
Ebrahimi et al. 2016; Halpin et al. 2017; Ketelaar et al. 2015;
Pasila, Elo & Kääriäinen 2017; Rush et al. 2014; Zamanzadeh
et al. 2014). A number of studies outside of South Africa
support this claim, saying that support mechanisms such as
structured transitioning programmes facilitate newly
graduated nurses in their nursing education institution-to-
work trajectory (Baxter 2010; Park & Jones 2010; Parker,
Cleveland & Ah-Thion 2014a; Pasila et al. 2017). High-quality
programmes are necessary to provide reliable support
structures for newly graduated nurses in the first year of
practice (Whitehead et al. 2013). For example, the Nursing
and Midwifery Council of United Kingdom recommends the
development of globally accepted programmes of transition
for a minimum period of 4 months to support newly
graduated nurses (McCarthy & Murphy 2010). These
programmes include continued informal group or peer
support and mentoring (McCarthy & Murphy 2010).
There are particular aspects of practising nurses’ roles and
responsibilities which require specific support during their
transition into a new environment (Lea & Cruickshank
2015). Supportive strategies for newly graduated nurses
include timely induction, appropriate orientation of new
nurses, the provision of a supportive environment and
authentic mentorship which is offered by seasoned nurses
(Pineau et al. 2015; Regan et al. 2017). In addition, nursing
leadership is vital in creating an organisational and unit or
team culture that supports new nurses as they move along
the transition continuum (Regan et al. 2017). A review
conducted in the United States recommends several support
strategies, such as internship, orientation programmes,
mentorship and simulation-based graduate programmes to
improve support structures of newly graduated nurses,
which were found to be effective (Edwards et al. 2015). The
value of these measures was confirmed by another
integrative review on best practices of newly graduated
nurse transition programmes (Rush et al. 2013).
Educaonal and training measures
Education and training play a pivotal role in the transition
period. Firstly, inadequate prior training and preparation
highlights the demand for more practice-orientated degree
programmes (Hlosana-Lunyawo & Yako 2013; Zaayman
2016). For example, a study conducted in a nursing
education institution in the Western Cape confirms that
CSNPs feel that they are not adequately prepared for work
because of a lack of practice exposure. The demand for more
adequate, practice-centred education programmes is not
restricted to the geographical context under investigation.
For example, Azimian, Negarandeh and Fakhr-Movahedi
(2014) report on factors that impact on Iranian nurses’
abilities to cope with transition. The study identified
inappropriate educational preparation for practice settings
as one of the key challenges faced by newly graduated
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nurses (Azimian, Negarandeh & Fakhr-Movahedi 2014).
It can be recommended that nursing education institutions
should develop curricula which are more practice-based
and which would thus help nursing students build sufficient
skills and confidence prior to the commencement of the
community service period (Meleis 2015).
Secondly, there is also a need for training at the beginning of
the service itself, for example in the form of properly
structured induction programmes, such as extensive
workshops which help CSPNs adapt to their new work
environments more easily (Hlosana-Lunyawo & Yako 2013).
After the induction, new nurses could be further accompanied
through the provision of a well-structured evidence-based,
clinical and professional education support programme that
draws on their specific needs. These education programmes
should, for example, include opportunities for reflective
practice (Bull et al. 2015; Bulman 2013). In this respect, mobile
technology can also be used, particularly in support of
geographically distributed graduates.
A study from Nigerian settings explored WhatsApp groups
in which moderators shared relevant knowledge and
stimulated professional discussions over a period of 6 months
following a predefined, needs-orientated curriculum. The
newly graduated nurses had significantly higher knowledge
and exhibited fewer feelings of professional isolation
compared with a control group (Pimmer et al. 2019).
Need for guidelines for Community Service Pracce
To harmonise and anchor measures in existing programmes,
Rush et al. (2014) suggest guidelines for support
opportunities for new graduates which include resource
person(s), specific transition programmes for a period of at
least 9 months (including educational measures). This
would provide newly graduated nurses with substantial
support during their transition period. In addition to these
guidelines, Rush et al. also recommend the development of
public guidelines and clear policies that describe the
expectations and responsibilities of newly graduated nurses
in the transition programme (Rush et al. 2013). Examples of
such guidelines include those directed at community service
policy stakeholders, guidelines for supervision, guidelines
for support and guidelines to clarify the role of CSNPs
(Rush et al. 2013).
Limitaons
Although this systematic review identified high-quality
studies with relevant themes that were further bolstered by
findings from studies outside of the scope of this review,
there are a number of limitations that need to be taken into
account. Firstly, the number of available studies was limited
and future research to corroborate and extend the present
findings is necessary. In view of the predominant qualitative
nature of the topic under investigation which necessitated
the qualitative review approach, future projects should focus
on the quantification of the phenomenon. Experimental
research in particular might help to determine the efficacy of
different support measures highlighted in this review. Finally,
this review was limited to a specific programme within a
South African context and any generalisation must be treated
with caution.
Conclusions and recommendaons
A CSP offers rich opportunities to CSNPs for professional
learning, growth and development during the student-to-
work transition period. However, findings from this study
indicate that the CSP in South Africa is characterised by
significant individual and contextual challenges, constraints,
tensions as well as misalignments between theoretical
knowledge provided at nursing education institutions and
clinical practice. Improvements of the transition process are
likely to be achieved through the development of more
systematic support strategies. These strategies include
structured orientation programmes which will serve as
guidance for new nurses; authentic mentorship constructs
wherein seasoned nurses are recruited to serve as mentors
for newcomers; formal and informal support systems that
create a safe and strong network for CSNPs; and education
programmes such as peer support programmes that help
facilitate the sharing of experience among CSNPs. Further
recommendations include the development of mentorship
workshops and training for seasoned nurses in order to
provide emotional support to newly graduated nurses and
aid retention (Chachula, Myrick & Yonge 2015). To tackle
challenges linked to high workload, it is recommended that
the Department of Health develop policies that ensure
adequate and sufficient staffing in the rural and/or
underserved communities.
Lastly, this review identifies a need for further research to (1)
create more robust and evidence-based findings and (2) to
test various potential approaches and strategies to empower
CSNPs during this period of transition to aid learning, job
satisfaction and retention of new graduates (Parker et al.
2014b; Pasila et al. 2017; Halpin et al. 2017).
Acknowledgements
The authors thank the Swiss Programme for Research on
Global Issues for Development (r4d programme) for funding
of this project.
Compeng interests
The authors have declared that no competing interests exist.
Authors’ contribuons
R.O.A., J.C., F.D. and C.P. contributed to the conception and
design of the study. R.O.A., J.C. and F.D. were responsible for
the acquisition of data. R.O.A. and C.P. contributed to data
analysis and/or interpretation. R.O.A., J.C., F.D. and C.P.
drafted the manuscript and critically revised it for important
intellectual content. All authors read and approved the final
version of the manuscript to be published.
Page 11 of 12 Original Research
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Funding
The Swiss Programme for Research on Global Issues for
Development (r4d programme), which is a joint funding
initiative by the Swiss Agency for Development and
Cooperation (SDC) and the Swiss National Science
Foundation (SNSF), provided funding for this research (grant
number: r4d-grant IZ01Z0_160910).
Data availability statement
Data sharing is not applicable to this article as no new data
were created or analysed in this study.
Disclaimer
The views and opinions expressed in this article are those of
the authors and do not necessarily reflect the official policy or
position of any affiliated agency of the authors.
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... Brown and Crookes (2016) suggest that the newly graduated registered nurse is not 'work ready' and 'does not feel ready' and proper orientation programmes and development of the newly qualified registered nurse are essential. It would be important for institutions to ensure that autonomous practice and critical thinking are accompanied by the provision of adequate orientation and the availability of mentors and preceptors and can be supported through the use of information and communication technologies particularly in the rural areas (Abiodun et al. 2019). It would also be important for institutions to ensure the provision of adequate orientation and the availability of mentors and preceptors, and these processes can be supported through the use of information and communication technologies to facilitate autonomous practice and critical thinking (Abiodun et al. 2019). ...
... It would be important for institutions to ensure that autonomous practice and critical thinking are accompanied by the provision of adequate orientation and the availability of mentors and preceptors and can be supported through the use of information and communication technologies particularly in the rural areas (Abiodun et al. 2019). It would also be important for institutions to ensure the provision of adequate orientation and the availability of mentors and preceptors, and these processes can be supported through the use of information and communication technologies to facilitate autonomous practice and critical thinking (Abiodun et al. 2019). This is further corroborated by Makua (2016) who found that there is lack of professional development and support for community service nurses in most public institutions and that this may contribute to the lack of competency of these nurses. ...
... • Assigning of preceptors to final-year students for the duration of the year to assist them to prepare for the role change to community service nurse (Roziers et al. 2014). • The literature suggests that nursing education institutions should develop curricula that are more practice-based and which would help nursing students build enough skills and confidence prior to the commencement of community service period (Abiodun et al. 2019). ...
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Background: Community service nurses placed in the Western Cape Government public health facilities render essential healthcare to underserved populations. Anecdotal evidence from operational nurse managers indicated concerns that community service nurses may lack competence in basic required nursing competencies. Objectives: To investigate operational nurse managers’ perceptions of the competence of community service nurses in public health facilities in the Western Cape. Method: A quantitative survey was conducted with an all-inclusive sample of 297 operational nurse managers in the Western Cape. A self-administered questionnaire with 65 questions with a 4-point rating scale was used to rate perceived competence of community service nurses across the South African Nursing Council (SANC) competencies. Descriptive and inferential statistics were calculated per competency domain. Results: The survey (response rate: 59%) showed that the operational nurse managers perceived the community service nurses to be competent in the clinical patient care domain and mostly either developing proficiency or proficient in the SANC competencies of legal framework and ethical practice, interprofessional relationships, leadership, quality management and management competency domains. Conclusion: Community service nurses were found to be competent in the clinical patient care, possibly because of the integration of theory and practice focus of work-integrated learning in the programme. Education and practice supportive strategies for community service nurses should be developed to support the successful transition from students to community service nurses, especially around the development of research and critical thinking skills.
... In an effort to retain nurses and midwives through professional development, many countries in both developed and undeveloped regions have structured support programs to aid a successful transition to practice [1,3,5,10]. In these formal support programs, they are some commonalities on how the new graduates are supported, mentored and supervised by experienced midwives for a period to gain autonomy, competency and confidence in their new roles [3,10,11]. However, different models are used, for example, in New Zealand, a fully governmentfunded programme called the Midwifery First Year of Practice (MFYP) is used to support new graduate midwives [12]. ...
... In the same country, a small group of midwives, including graduates, work together in midwifery continuity of care models, where mentors assist new graduate midwives to build confidence and practice skills [8]. In the United Kingdom, the preceptorship model is used to provide new graduate nurses with professional development [13] and South Africa which is one of the sub-Saharan African countries they have community service program [11]. On the other hand, such formal transitioning programmes do not exist in most developing countries including Malawi. ...
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Background Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi. Methodology A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview guides; one for the newly qualified nurse-midwives and another one for the key informants. The interview guides had questions related to newly qualified nurse-midwives experiences of transitioning to practice and the support they received. Participants were from three selected hospitals in the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis. Findings Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practice in midwifery units emerged from the thematic analysis of the data. These included (1) Theory—practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict. Conclusion Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from education to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.
... To retain necessary human resources for home-based medical and end-of-life care, we should support active learning for new graduate nurses 1) . Previous studies reported that new graduate nurses cannot realistically work at home-visit nursing stations because these jobs require specialized and extensive experience 2, 3) . Therefore, Fukuyama et al. first conducted a qualitative study to explore actual conditions in practice, identifying challenges reported by new graduate visiting nurses 4) . ...
... A novel finding in this study is that experienced home-visiting nurses felt being well-mannered was the most important quality for new nurses. Therefore, we may need to focus more on developing appropriate bedside manner during nursing education 3,4) . ...
... To retain necessary human resources for home-based medical and end-of-life care, we should support active learning for new graduate nurses 1) . Previous studies reported that new graduate nurses cannot realistically work at home-visit nursing stations because these jobs require specialized and extensive experience 2, 3) . Therefore, Fukuyama et al. first conducted a qualitative study to explore actual conditions in practice, identifying challenges reported by new graduate visiting nurses 4) . ...
... A novel finding in this study is that experienced home-visiting nurses felt being well-mannered was the most important quality for new nurses. Therefore, we may need to focus more on developing appropriate bedside manner during nursing education 3,4) . ...
... Community service for nurses commenced in 2008 after proclamation of the Nursing Act No. 33 of 2005(South African Nursing Council, 2010. It has the dual purpose of providing much needed human resources to the rural and underserved areas of SA, while providing CSNs with a platform to transition from a well-structured and highly supervised education environment to a more flexible and independent clinical environment (Abiodun, Daniels, Pimmer, & Chipps, 2019;Laschinger et al., 2018). Research shows that during this phase of transition nurse graduates experience high levels of stress, anxiety and burnout (Parker, Giles, Lantry, & McMillan, 2014;Laschinger, & Grau, 2012), leading many to decide to leave the nursing profession within the first 2-5 years of practice (Parker et al., 2014;Rudman, Gustavsson, & Hultell, 2014;Du Plessis & Seekoe, 2013). ...
... Research shows that during this phase of transition nurse graduates experience high levels of stress, anxiety and burnout (Parker, Giles, Lantry, & McMillan, 2014;Laschinger, & Grau, 2012), leading many to decide to leave the nursing profession within the first 2-5 years of practice (Parker et al., 2014;Rudman, Gustavsson, & Hultell, 2014;Du Plessis & Seekoe, 2013). In SA the issue is further compounded by contextual challenges in the practice environment, such as lack of organisation and supervision structures, constrained human and material resources, high workloads and interpersonal challenges (Abiodun et al., 2019). ...
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Background The practice environment as experienced by community service nurses (CSNs) has not been explored in the South African context, and few studies have explored the influence of the practice environment on intrapersonal resources such as subjective well-being, compassion practice and psychological capital. Aim To describe the influence of the practice environment on CSNs’ subjective well-being, compassion practice and psychological capital, and the association between these variables and selected personal and situational demographic factors. Methods A cross-sectional design was employed with self-report questionnaires used to collect data from an all-inclusive sample of CSNs that studied in North West Province and began their community service year there in 2016 (N = 284; n = 60). Results CSNs perceive the practice environment as favourable (M = 2.60; SD = 0.65). CSNs are satisfied with life (M = 24.89; SD = 5.68), have high levels of positive affect (M = 39.13; SD = 7.97), compassion satisfaction (M = 5.44; SD = 0.71) and psychological capital (M = 5.67; SD = 0.95). Nurse foundations of quality of care and nurse participation in hospital affairs had the most influence on intrapersonal resources. The positive components of subjective well-being, compassion satisfaction and psychological capital were highly correlated. Situational demographic factors were associated with intrapersonal resources and perceptions of the practice environment. Conclusion Healthcare facilities should provide a positive practice environment for CSNs, that includes an orientation programme with formal organisational and supervision structures, in order to strengthen CSNs’ intrapersonal resources, improve their perceptions of the practice environment, and ultimately improve nurse and patient outcomes.
... Previous studies have suggested that working at an HVN station is not a realistic option for any new graduate because specialized and extensive experience is needed to work as an HVN 6,7) . Therefore, we conducted a qualitative study asking skilled HVNs to describe the characteristics doi: 10.2185/jrm.2021-031 ...
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Objective: In Japan, home-visiting nurse (HVN) stations are at the frontline of providing home-based medical care and end-of-life care. The nursing authorities aim to establish an education program that allows new graduate nurses to become home-visiting nurses. However, previous studies have indicated gaps in education between new graduates recently employed as HVNs and experienced home-visiting nurses. The present study further investigates the factors influencing the recruitment of new graduates as home-visiting nurses. Methods: Self-administered questionnaires were sent to 2,000 HVN stations randomly selected from the 5,565 registered home-visiting nurse stations throughout Japan. The survey covered three main areas, namely, those concerning the respondent (6 items), the home-visiting nurse station (8 items), and the nursing services provided (12 items). Results: Four of the 26 items were statistically significant, and only one of these was determined by multivariate logistic regression analysis to be an independent factor for accepting new graduates as home-visiting nurses. This factor was undergraduate home-visiting nurse training for student nurses (OR=1.916, CI=1.124–3.267). Conclusion: To increase the recruitment of new graduates as home-visiting nurses, these findings suggest that nursing schools nationwide and home-visiting nurse stations should further cooperate with the specific aim of increasing the provision of practical training at home-visiting nurse stations for pre-graduation student nurses.
... Moreover, the technology's impact on organizations, such as power relations, has been under-estimated. The current studies on MIM in organizations tend to focus on the effectiveness of the platform for various activities such as discussion (Hou & Wu, 2011), feedback (Soria et al, 2020), and teamwork (Kim et al, 2014;Abiodun et al, 2019). More importantly, there is a large number of studies on the impact of large enterprise systems such as Enterprise Resource Planning (ERP) on power relations in organizations (Jasperson et al, 2002;Esendermili et al, 2015) compared to communication technologies such as MIM. ...
... In terms of implications for further nursing research, the findings reinforce the need to re-study the impacts of improved orientation programs intended for newly graduated nurses. There are numerous publications (Abiodun, Daniels, Pimmer, & Chipps, 2019;Ke, Kuo, & Hung, 2017;Lindfors, Meretoja, Kaunonen, & Paavilainen, 2018;Pasila, Elo, & Kääriäinen, 2017) that synthesize and clarify the needs of newly graduated nurses in terms of orientation programs and their benefits. Using these findings, it would be possible to develop an orientation program taking into account the specific learning needs of newly graduated nurses and then assess the impacts of this program on different parameters pertaining to humanistic caring. ...
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Objectives This paper reports on nursing students’ and nurses’ lived experiences mediating their development of humanistic caring. Methods Using interpretive phenomenology, 26 participants were individually interviewed. A five-stage phenomenological analysis based on Benner’s (Benner, P. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness . Thousand Oaks, CA: SAGE) method occurred simultaneously. Results The analysis highlighted that the development of humanistic caring is affected by role models and counterexamples, environments in which humanistic caring is exalted or trivialized, communication-related courses, patient storytelling, and work overload. Conclusions It might be valuable to raise the awareness of nurse educators about their opportunity in shaping the development of students’ humanistic caring.
... In South Africa, the first transition year is a compulsory year of community service. This year is a critical transition year as these new nurse graduates are not placed in facilities of their choice, but in a compulsory placement, and their experiences have been associated with both positives and negative experiences (Abiodun et al., 2019;Regan et al., 2017). This study investigated the impact of a WhatsApp community of practice which was used to offer a support transition programme for new nurse graduates. ...
Article
Internationally, transition from student to registered nurse is a challenging and stressful period. This study investigated the use of an Instant Messaging application (WhatsApp) community of practice to support graduate nurses in their first year of practice in the Western Cape, South Africa. A preliminary survey was conducted to determine the technology readiness of 64 participants. Following the enrolment of a further 8 participants, 76 new graduate nurses were enrolled in the WhatsApp Community of Practice which ran over an 8-week period. A quantitative one-group pre and post study evaluation via Survey Face was conducted comparing socio-professional outcome measures. The analysis of the readiness survey showed high WhatsApp use and perceived ease of use and usefulness. Though only 9 males in the survey, age and gender had no impact on the reported use. Interactions with alumni, bridging and bonding social capital, professional integration and a sense of belonging to a community of practice significantly improved. For graduate nurses in non-urban settings, bonding, professional identity and theory practice integrations were significantly higher compared to urban graduates. The findings highlight the value of a WhatsApp community of practice for isolated graduated nurses, especially in critical phases of transition and their professional development.
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Background: Qualifying nurses from the four-year diploma or degree in nursing have to carry out compulsory community service in public health institutions before their qualifications are registered with the South African Nursing Council. Studies on nurses carrying out compulsory community service (CCS) have been reported on the stresses experienced during their CCS year but there has not been much reported on how the nurses experience their roles and responsibilities during the CCS year. Purpose: The purpose of the study was to explore pre-licensure nurses’ experiences of their roles and responsibilities when carrying out CCS in KwaZulu-Natal. Methods: A qualitative approach was used to obtain data from 27 purposively selected nurses carrying out CCS in three health districts of KwaZulu-Natal through individual semi-structured interviews. Data analysis was carried out using Tesch’s content analysis. Results: The main categories were: paying back the government or community, transition period for professional role, being thrown in the deep end, lack of role clarity, and frustrations with the policy. Conclusions: Although the participants did not have a clear understanding of the objectives of the CCS policy, they seem to have taken on their role as professional nurses with enthusiasm and valued the opportunity to develop professionally. Recommendations: It is recommended that nurse educators and nurse administrators provide more clarity about the CCS objectives and that there is a structured orientation programme for the nurses on their roles and responsibilities when carrying out CCS. It is also suggested that the SANC provide more clarity on the guidelines for nurses carrying out CCS.
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Background Transition from a nursing student to a Registered Nurse is a stressful and challenging process. Different postgraduate residency and orientation programmes have been developed to ease the first year of employment, but less attention has been paid to pregraduate programmes and how the final clinical practicum of nursing education should be conducted to facilitate this transition. Aim To review the empirical studies concerning interventions that aim to facilitate the transition from nursing student to Registered Nurse in the final clinical practicum of nursing education. The aim was to scrutinise the structures and contents of the interventions and factors connected with the facilitated transition. Method A scoping literature review was conducted with systematic searches in three electronic databases: CINAHL, MEDLINE and ERIC. The searches were limited to studies that were written in English, had available abstract and were published between 2005 and 2016. Two researchers assessed the studies regarding their eligibility with reference to the inclusion and exclusion criteria, and 17 articles were included in this review. Inductive content analysis was used to categorise the contents of studies. Results The structures of the interventions described included: the participation, learning environment, amount of clinical work, supervisor criteria and supervision methods. The contents of the interventions included supervisor support, transition supportive learning activities and the student's practicum duties. The factors that were connected with facilitated transition were the quality of the supervision, adjusting to a professional nurse's role, achieved comfort and confidence and achieved competence. Conclusion This scoping review offers insight into the diversity of interventions facilitating transition implemented in the final clinical practicum of nursing education. In order to unify these practices and determine the elements necessary to include, studies with stronger designs need to be conducted.
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Background As nursing evolves from an occupation based on tradition to an evidence-based profession, concerns are being raised about the apparent disconnect between best practice and actual practice; a concern referred to as the research-practice gap. Given that this gap may lead to sub-standard patient care, it is imperative that attention be given to furthering our understanding of the gap. Aim To cast light on the schism between research and nursing practice from the perspective of international nurse academics. Methods In this descriptive cross-sectional, mixed-method study, 149 senior nurse academics from Australasia, Europe, UK and North America were invited to complete an electronic questionnaire and semi-structured interview. Findings The survey returned 72 (48%) usable responses; 50 (66%) of these participants also completed an interview. Participants generally agreed that nurses should engage with research, but were divided regarding the extent to which nurses do engage with research. Factors contributing to the gap primarily related to the issues of ‘translation’ and ‘change’. Closing the gap was considered a shared responsibility, which centred on improving research ‘access’. Conclusion This study reveals that nurse academics, regardless of geography or experience, generally support the need to bring research and nursing practice closer together. While the findings do not further our understanding of the magnitude of the gap, they do provide some clarity as to where attention might best be focussed in order to narrow the gap. Exploring the perspectives of practicing nurses on the research-practice gap would be a natural progression of this research.
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Aim: To investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months post-qualifying. Background: Globally, thousands of new nurses qualify annually. They are crucial for the profession and healthcare service delivery. Work-related stress has multiple serious consequences, yet there is a lack of robust, empirical evidence that directly analyses newly qualified nurses and the stress they feel and experience in the workplace. Understanding what causes newly qualified nurses' stress is vital to retaining and nurturing this vital component of the workforce. Design: Longitudinal, explanatory sequential mixed methods, cohort study. Methods: At the point of qualification (n= 288), 6 months post-qualifying (n= 107) and 12 months post-qualifying (n= 86), newly qualified nurses completed the Nursing Stress Scale, with 14 completing a one-to-one interview at 12 months post-qualifying. Data were collected from 2010-2012. Inferential statistics, 'thematic analysis' and 'side-by-side comparisons in a discussion' were used for analysis. Results: Workload was consistently the highest reported stressor with inadequate staffing and managing multiple role demands given as explanations. Incivility within the workplace was a noted stressor. Conversely, being part of 'a good team' provided a civil, supportive, facilitative work environment. Entering nurse education with previous healthcare experience had a mediating effect on the reported frequency of stressors. Conclusions: Newly qualified nurses encounter multiple work-related stressors over their first 12 months post-qualifying, which are intrinsically entwined with their transition. Employing organisations need to be more proactive in managing their workload and addressing workplace incivility. This article is protected by copyright. All rights reserved.
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Objective: This systematic review describes the experiences of the orientation into nursing of newly graduated nurses. Design: Systematic review. Methods: Data was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC (ProQuest). Qualitative, peer reviewed, original studies published in English, Swedish or Finnish before February 2016 and exploring newly graduated nurses' experiences of the nursing orientation process were included. The studies were selected by screening titles, abstracts and full texts and the quality of the studies was assessed by two researchers independently. Data was analysed using content analysis. Results: Thirteen studies were chosen for the review. Newly graduated nurses' orientation experiences were divided into four main categories: experiences related to orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation and suggestions for changes based on orientation experiences. The findings establish that the orientation and the preceptor have a great impact on how newly graduated nurses experience the start of their career. Often, newly graduated nurses wish to continue their relationship with their preceptor after the orientation period. Conclusions: Results bring together both the positive and negative aspects that newly graduated nurses relate as regards their current orientation programmes. Attention needs to be paid to the variation and imbalance in the quality of orientation programmes and preceptors. A more formal form of mentorship needs to be developed further.
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Aim: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. Background: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. Method: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. Results: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. Conclusions: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. Implications for nursing management: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.