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

Abstract

Introduction 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. Methods 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. Results 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. Discussion 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.

Facilitating an early career transition pathway to community nursing: A Delphi Policy Study

“…We selected a Delphi policy approach, guided by a previous systematic review (Harvey, Hegney, Sobolewska, et al, ) and semi‐structured interviews (Harvey, Hegney, Tsai, et al, ). The approach was chosen to refine, substantiate and finalize an early career pathway model for Registered Nurses in the area of community care.…”

“…This study is phase three of a project, commissioned by the Queensland Government, Australia, to investigate and design a model for the early career transition pathway in the speciality of community nursing. This work builds on phase 1 comprising of a systematic review (Harvey, Hegney, Sobolewska, et al, ) and phase 2 consisting of a semi‐structured interview study of community nurse (Harvey, Hegney, Tsai, et al, ). The systematic review identified a deficiency in the published evidence, especially in the area of “pre‐entry,” a concept referring to a point in time before commencing a transition career pathway (Harvey, Hegney, Sobolewska, et al, ).…”

“…This work builds on phase 1 comprising of a systematic review (Harvey, Hegney, Sobolewska, et al, ) and phase 2 consisting of a semi‐structured interview study of community nurse (Harvey, Hegney, Tsai, et al, ). The systematic review identified a deficiency in the published evidence, especially in the area of “pre‐entry,” a concept referring to a point in time before commencing a transition career pathway (Harvey, Hegney, Sobolewska, et al, ). The semi‐structured interviews from phase 2 supported a deficiency in the “pre‐entry” time point, along with highlighting weaknesses in the formal orientation process and general support when transitioning into community practice.…”

Nurses’ experiences of transition to community-based practice

“…Analysis of the free text responses to the questions, clearly identified similar themes and sub-themes to the findings from our previous systematic review. [24] The need to have an experiential knowledge base upon which to make decisions within a dynamic clinical environment was evident, and it is this aspect that participants were concerned about most when discussing the pre-entry and incomer (as a new graduate) stage of transition. Participants believed that a lot more educational and organisational support was needed at the pre-entry stage into community practice to prepare them for their new role.…”

Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study

“…Nursing preparedness and the nursing skill mix to meet the needs of the higher acuity patients being managed by community and regional health services [3] is subsequently of higher importance. Moreover, the challenge is in attracting nurses to rural areas and keeping them there, with rural nursing and midwifery not often seen as an inspiring career pathway [4,5]. Australia has vast geographical areas serviced by regional and remote health services.…”