Doctor of Philosophy
School of Nursing
Background: The growing burden of chronic conditions and an ageing population has prompted an increased focus on health care services delivered in the community. General practice nurses (GPNs) have an important role in community-based care and significantly contribute to positive health outcomes. The increasing complexity of health care needs have amplified the demands for nurses in general practice. However, the GPN workforce is ageing with many GPNs approaching retirement. To ensure the GPN workforce has sufficient nurses to meet these demands it is important to understand how nurses new to practice perceive the role. To date, little is known about how undergraduate nursing students are prepared to work in this setting or their perceptions of general practice nursing as a career.
Aim: This thesis explores final-year undergraduate nursing students’ perceptions of general practice nursing, and preparedness to work in general practice following graduation.
Methods: This sequential explanatory mixed methods study encompassed an online cross sectional survey of final-year undergraduate nursing students, followed by telephone interviews with a subgroup of survey respondents. The survey comprised validated tools, modified for use in general practice, and investigator developed items. The modified Confidence and Interest in Critical Care Nursing (CICCN) tool(1) was used to determine predictors of confidence and interest to work in general practice. Intention to work in general practice was measured using the modified Attitudes, Subjective Norms, Perceived Behavioural Control, and Intention to pursue a career in Mental Health Nursing scale (ASPIRE) scale(2). Finally, the modified ‘Profession Scale’ from the Scale on Community Care Perceptions (SCOPE) tool(3) evaluated perceptions of the general practice work environment and characteristics important in choosing an employment setting. Data were analysed using descriptive and inferential statistics. Purposively selected survey respondents participated in semi-structured telephone interviews, conducted using a qualitative descriptive approach. These interviews were audio recorded and transcribed verbatim before being analysed using thematic analysis(4).
Findings: Of the 355 survey respondents, 92.7% (n=329) identified as female. Respondents had a mean age of 28 years (Range 18-58 years). Some 34.1% had a clinical placement in general practice within the Bachelor of Nursing (BN) program. Survey findings revealed respondents had moderate interest to work in general practice. Clinical placement exposure and high confidence to work in general practice were significant predictors of interest and intention to work in general practice. Exposure to general practice nursing within the BN program, and clinical placement experience in this setting also significantly influenced respondents’ perceptions of the general practice work environment. Perceived work environment of general practice influences the views of undergraduate nursing students regarding career options. Sixteen participants were interviewed. Responses confirmed the impact of exposure on perceptions of general practice nursing, demonstrated by the diversity of participants’ perceptions of the GPN’s ways of working, breadth of their role, and the nature of their relationships with patients. Participants identified a range of barriers that may impact their interest and intention to seek employment in general practice following graduation. Perceptions of limited opportunities for skill development that may later compromise future employment was a factor that did not make general practice nursing a priority career path Similarly, perceptions of current employment conditions in this setting, and perceived lack of support for transition to general practice for new graduate nurses in general practice, also influenced participants’ views of general practice as a new graduate career choice.
Conclusions: Both survey and interview findings revealed an overall moderate interest to work in general practice at some point in their career. There were some concerns around the GPN’s scope of practice, opportunities for advancement, and availability of transition support for new graduate nurses in general practice. However, these perceptions were often influenced by participants’ indirect experience of general practice nursing. This suggests the need to evaluate BN programs and assess how theoretical general practice nursing content, as well as clinical experience in this setting, could be integrated within undergraduate education. To improve new graduates’ preparation and interest to pursue a career in diverse clinical settings, universities need to identify innovative strategies that provide clinical exposure beyond traditional hospital-based clinical placement models. Further research is needed to investigate models of transition support that might be used in general practice to improve the recruitment of new graduate nurses. Lastly, prioritisation of organisational, educational, and funding support for GPNs are crucial to improve perceptions relating to work conditions and therefore enhance undergraduate nursing students’ interest and intention to pursue work in general practice.
Calma, Kaara Ray B, An exploration of final-year undergraduate nursing students’ perceptions of general practice nursing, Doctor of Philosophy thesis, School of Nursing, University of Wollongong, 2022. https://ro.uow.edu.au/theses1/1520
FoR codes (2020)
4205 Nursing, 390110 Medicine, nursing and health curriculum and pedagogy, 420503 Community and primary care
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.