Exploration of the graduate nursing program in a forensic mental health setting: A qualitative enquiry

BackgroundForensic mental health nursing is a specialised practice area. Graduate programs are essential for recruitment and retention. There have, however, been very few studies exploring forensic mental health graduate programs.AimThe aim of this study was to explore the experience of graduate nurses who completed a 2-year graduate program in a forensic mental health service in the state of Victoria Australia, and the nurses who support the graduates in the program.MethodsAn exploratory study was conducted gathering data via one-to-one interviews, with purposive sample of 20 forensic mental health nurses.FindingsAnalysis resulted in the interpretation of two themes; essential ingredients and ‘hitting hurdles’.DiscussionGraduate nurses commence with limited knowledge, experience challenges, and organisational pressures.ConclusionTransition to practice was enhanced with consistent support, university education, and program structure.     

Factors that influence the recruitment and retention of graduate nurses in rural health care facilities

Rural nursing is a distinct practice and rural nurses in Australia constitute the largest group in the rural health workforce. However, the rural workforce is ageing and the turnover of nurses in rural areas is high. In addition, rural health services are experiencing recruitment and retention difficulties; very little is known about the recruitment and retention of new graduates nurses in rural health areas and the potential long-term investment they could offer to rural health services. A qualitative study explored the journey of transition for new graduate nurses employed in graduate nurse transition programs in northern New South Wales. This paper presents two major themes from the study that describe the factors that influenced the new graduate nurse to seek and accept a graduate nurse position within a rural health setting and the factors that influenced their retention. Findings indicate that previous connection with a rural area and positive experiences in a rural health care facility during undergraduate preparation were significant factors influencing the graduate nurses' decision to pursue a rural graduate nurse position. No guarantee of a permanent appointment upon completion of the graduate program, and graduates' disappointment with graduate nurse programs, were important factors influencing their retention within rural health care facilities.     

Development of a mentorship programme for new graduate nurses in mental health

A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper.     

Perceptions from the front line: Professional identity in mental health nursing

In the context of a growing population of people experiencing mental illness worldwide, mental health nurses are a crucial workforce. Their recruitment and retention, however, is in decline. Drawing on qualitative data obtained from interviews with mental health nurses (MHN) in Victoria, Australia, the paper employs a range of concepts from role theory to explore professional identity within mental health nursing. The data highlight three key issues in relation to the future recruitment and retention of MHN: (i) the ambiguity of the MHN role; (ii) the weak definition and lack of understanding of the scope of the MHN role by nursing students; and (iii) a lack of communication about MHN as a profession to a wider audience. These findings indicate three avenues through which recruitment and retention in mental health nursing could be improved: (i) public communication; (ii) training and educating of the next generation of MHN; and (iii) more accurately defining the role of the MHN.     

Improving public health nursing education: recommendations of local public health nurses

OBJECTIVES: This paper reports recommendations for improving public health nursing (PHN) undergraduate, graduate, and continuing education (CE) made by staff-level public health nurses working in local health departments (LHDs). Implications for academia and practice are discussed. DESIGN: A cross-sectional written survey was used to collect data from 424 public health nurses in 76 LHDs in Wisconsin (68% response rate) in 2003. Recommendations for improving undergraduate, graduate, and CE were made through responses to open-ended survey questions. Content analysis was conducted to identify major themes among responses. RESULTS: Major themes emerging from the recommendations for undergraduate education included the need for more clinical public health experiences and population-focused practice content. Graduate education improvement recommendations included addressing access barriers and increasing organizational incentives. Improved access and more public health content were the major recommendations for improving CE. CONCLUSIONS: Implications for academia focus on increasing opportunities for students to experience population-focused PHN and to learn organizational and collaborative practice skills, supporting PHN preceptors and building evidence for PHN intervention through research. Implications for practice include the need to expand opportunities for students with LHDs and to collaborate with academic partners for education and research.     

Nurses are the key to improving mental health services in low‐ and middle‐income countries

Mental health nursing is a critical issue for most countries. Nurses in low‐ and middle‐income countries are often the primary providers of care for people with mental disorders. Some are highly qualified professionals who train other providers to identify and treat mental disorders. However, in other instances, particularly in low‐income countries, nurses have had very little or no mental health training and receive no support from mental health professionals. The lack of sufficient mental health professionals in these countries creates an environment where nurses without training are often the only providers available to care for people with mental disorders. In September 2007 the World Health Organization and the International Council of Nurses produced a report summarizing the responses to some of the questions on a survey of nursing mental health practices in 177 countries and territories. The summary of the open‐ended questions (e.g. what are the key issues for nurses providing mental health care in your country?) is reported for the first time in this article. Subsequent to the release of the Nurses in Mental Health Atlas, an online forum was held. There were 615 subscribers to this forum from over 80 countries. This article summarizes the rich insights and recommendations from both the survey's open‐ended comments and the online forum. The issues discussed include: the varied and complex roles for nurses in mental health care; nursing education; prescribing practices; nurse recruitment and retention; human rights; research; and technical expertise.     

Coaching and mentoring new graduates entering perinatal nursing practice

The challenges of the nursing shortage have and continue to impact all aspects of health care today. Specialty areas and critical care areas have created job opportunities and are now providing education programs for both experienced as well as new graduate nurses. Orientation is a critical time for new graduate nurses of differing ages who come from varied personal, educational, and work backgrounds with varied life and job experiences. For the successful completion of orientation, coaching and mentoring are key components in the retention and recruitment of nurses into the profession.     

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.     

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses' perceptions and experiences of graduate nurses' medication knowledge

This paper explores clinical nurses’ perceptions and experiences of graduate nurses’ pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge. While clinical nurses indicated that graduate nurses had enormous deficits in their pharmacology education, these deficits were not confined to graduate nurses—all nurses experienced difficulties in understanding and demonstrating pharmacological concepts in the clinical practice setting. Second, there was an unstructured approach to addressing the continuing education needs of graduate nurses. Third, theoretical and clinical principles of pharmacology knowledge were perceived to be important for practice. Fourth, improvements for nursing education involved the need for undergraduate students to take greater responsibility in monitoring and administering medications and the need for more structured learning experiences. The ultimate goal of consolidating pharmacology knowledge for graduate nurses is to optimise medication use, thereby improving the health outcomes of patients. Current teaching and learning opportunities appear to be inadequate in their efforts to enhance and improve graduate nurses’ pharmacology knowledge. These inadequacies need to be addressed if the ultimate goal is to become a reality.     

Realities of Mental Health Nursing Practice in Rural Australia

Mental health nursing as a distinct speciality has been in decline in New South Wales (NSW), Australia, for two decades. Arguably, this decline has worsened both consumer outcomes and the workplace experiences of mental health nurses. This article reports on a study designed to ascertain the nature of contemporary mental health nursing practice in New South Wales. The study utilised focus group research methodology, with participants recounting the realities of their day-to-day professional practice and perceptions of their professional identity. The findings indicate a contracting, if not moribund, profession; a decrease in the value attached to mental health nursing; and a pattern of persistent underfunding by successive governments of mental health services. An analysis of present and historical trends reveals there is a pressing need for a restructure and re-formation of mental health nursing in rural areas. This article links the shortage of mental health nurses in NSW to the closure of the mental health nursing register, a shift to comprehensive/generalist nurse education models, a perceived lack of nurses’ professional standing, and natural attrition without suitably qualified replacements. Mental health nurses in this study perceived that they were not valued by other health professionals or by their own managers. Participants in this study reported mental health nursing in rural areas was an unattractive career choice. These findings are important to the understanding of recruitment and retention issues in rural mental health nursing in Australia.     

Male Nurses' Perceptions of the Facilitators and Barriers to Recruitment,Retention, and Job Satisfaction

This project aimed to determine male nurses' perceptions of facilitators and barriers to the recruitment, retention, and job satisfaction of men in nursing. Sixteen male nurses from a single academic health science center participated in video interviews using open-ended questions. Interviews were recorded, transcribed, and analyzed for themes. Six themes emerged, and based on the themes, recommendations for nurse leaders were delineated. Intentional and evidence-based recommendations must be implemented to improve male nurses' recruitment, retention, and job satisfaction, thus leading to a more gender-diverse workforce that improves the provider experience and contributes to quality care.     

The developing role of transition to practice programs for newly graduated mental health nurses

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.     

The motivations to nurse: an exploration of factors amongst undergraduate students, registered nurses and nurse managers

Aim  To identify what motivates individuals to engage in a nursing career.
Background  Recruitment and retention of nurses is a worldwide concern that is associated with several compounding factors, primarily the high attrition of its new graduates and an ageing workforce. Given these factors, it is necessary to understand why individuals choose to nurse, what keeps them engaged in nursing, and in what ways healthcare systems can support career development and retention.
Method  This paper presents initial interview data from a longitudinal multi method study with 29 undergraduate student nurses, 25 registered nurses (RNs), six Nurse Unit Managers (NUMs) and four Directors of Nursing (DoNs) from four hospitals across a healthcare organization in Australia.
Results  Thematic analysis yielded four key themes that were common to all participants: (1) a desire to help, (2) caring, (3) sense of achievement and (4) self-validation.
Conclusions  These themes represented individuals' motivation to enter nursing and sustain them in their careers as either nurses or managers.
Implications for nursing management  Managers need to be cognisant of nurses' underlying values and motivators in addressing recruitment and retention issues. Strategies need to be considered at both unit and organizational levels to ensure that the 'desire to care' does not become lost.     

Ethical issues in the recruitment and retention of graduate nurses: a national concern

Australia like other countries is facing a crisis in the recruitment and retention of nurses. Adding to this crisis is the insufficient supply of new graduate nurses to meet current and future workforce demands. Unless changes are implemented that will bring likely demand and supply into balance, it is predicted that by the year 2010 (just seven years away) there will be a shortage of 40,000 nurses in Australia. Significantly, the current shortage of nurses is resulting in hospitals, regions, states and countries competing fiercely with each other to recruit and retain sufficient numbers of nurses to meet their workforce needs. In some instances this situation has given rise to graduate nurse recruitment strategies that are highly questionable from an ethical perspective. In this paper attention is given to showing why the strategies used are unethical and how they might be addressed such as by adopting a national code for the ethical recruitment of nurses.     

Mental health nurses' views on therapeutic optimism

Registered nurses (RN) coordinate acute mental health units on a 24‐hour basis and it behoves researchers to actually ask these nurses what they think contributes to their ability to work with patients in optimistic ways. In this study, 40 RN working in acute mental health settings were asked a series of questions to explore positive aspects of nursing work, which includes therapeutic optimism. Three themes were identified: (i) different ways nurses foster therapeutic optimism; (ii) perceptions of how an optimistic environment is fostered, and (iii) improvement of ward culture. Findings show the pivotal role mental health nurses have in improving teamwork, good communication, sharing, and collaboration, in addition to preceptoring and supervision. Furthermore, effective clinical management is essential to therapeutic optimism and, in this research, is considered to be the aspect of acute mental health nursing most relevant to improving the ward culture.     

Critical care nursing education and practice in Canada and Australia: a comparative review

Critical care nursing is an area of policy concern with respect to staffing projections, skill mix and educational preparation in both Canada and Australia. Despite many similarities between the health systems of these two countries, differences exist in both undergraduate and graduate specialty nursing education. In Australia, specialist education is primarily delivered via the tertiary sector as a formalised qualification, whereas the current Canadian model displays significant variation in duration, content, and mode of delivery. This paper provides a comparative perspective on the educational preparation of critical care nurses in these two countries. Consideration of alternative models of specialty nursing education may provide a method to improve recruitment and retention of staff while maintaining quality of care.     

Mental health nurses' perceptions of good work in an acute setting

Frequently, research and conference papers explore difficult or problematic areas of practice that can inadvertently render daily nursing accomplishments invisible and create the perception of a discipline in crisis. In this qualitative study, we explore the views of registered nurses about achievements in the workplace and good nursing work in an acute inpatient mental health setting in Sydney, Australia. Mental health nurses were asked a series of questions about their experiences and understanding of what constitutes good nursing work as well as their sense of optimism about their work. A total of 40 structured face-to-face interviews were completed. Among the responses to questions about achievements and good nursing practice, five broad themes were identified: i) teamwork; (ii) interpersonal interactions with patients; (iii) providing practical and holistic support to patients; (iv) patients' mental health improvements; and (v) optimism-pessimism continuum. Findings contribute to a discussion of good nursing work in acute mental health settings, as well as self-perceptions of optimism and hopefulness, which are important contributors to positive, supportive health-care settings and patient recovery.     

Mental health nursing: Daring to be different,special and leading recovery‐focused care?

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.     

What do graduate registered nurses want from jobs in rural/remote Australian communities?

bennett p., barlow v., brown j. & jones d. (2012) Journal of Nursing Management  20, 485–490 What do graduate registered nurses want from jobs in rural/remote Australian communities? Aim To explore and describe the needs of new graduate registered nurses in a rural and remote (R&R) setting within Australia. Background Rural practice has distinctive challenges for nurses. Nurses make up the largest and most widely distributed health workforce in Australia, outnumbering doctors 8 : 1 in R&R areas. Evaluation Literature was used to evaluate the graduate registered nurses’ needs in R&R communities. Key issues Three main themes emerged: expectations, support and workloads. Themes reflected enablers and disablers of retention of nurses as they transition from student role to new graduate practice. Conclusion New graduates are aware of their limitations as new practitioners. There is an expectation that their employers will provide a supportive learning environment for them to gain the skills necessary to become proficient and valuable employees. Implications for nursing management This commentary paper identifies the need for a structured, supported new graduate programme that recognizes and meets the needs, both clinical and social, of new graduate registered nurses in the R&R context.