Year

2024

Degree Name

Doctor of Philosophy

Department

School of Nursing

Abstract

Background: The nursing profession faces significant challenges in building and maintaining a skilled workforce to meet the escalating healthcare demand. Factors such as population health trends, an aging nursing workforce, and poor retention rates contribute to increasing health needs and nursing shortages.

Forensic mental health, which represents the interface between law and mental health, functions in diverse community settings. Registered nurses in inpatient forensic mental health settings are responsible for providing comprehensive nursing care and treatment while navigating the complexities of criminal justice processes. Heightened security and management of potentially violent patients with complex backgrounds create specific workforce challenges for any nurse employed in the setting. Given the multifaceted challenges and the growth of forensic mental health services, organisations must support and retain nurses in this clinical area.

Compared to research on new graduate nurses, there is limited attention to the transition of registered nurses into different areas, including forensic mental health. Understanding their transition experiences is crucial for ensuring local workforce systems adequately support these nurses.

Aim: This Doctoral study sought to explore the transition of registered nurses into forensic mental health employment.

Methods: This sequential explanatory mixed-methods study commenced with a cross-sectional online survey of registered nurses working in an inpatient forensic mental health hospital. Semi-structured interviews with a subgroup of survey respondents were subsequently undertaken.

The survey collected demographic data, reasons for choosing forensic mental health employment and experiences of their commencement of employment, induction, satisfaction, and interpersonal challenges during the transition. Validated tools, the Revised Professional Practice Environment Scale and the Nurse Retention Index were included. Descriptive statistics summarised demographic information, and independent sample t-tests were used with the validated tools.

Semi-structured interviews, guided by survey findings and nursing transition literature, were undertaken face-to-face, recorded, and transcribed verbatim. Data analysis employed Braun and Clarke's1 six-step thematic analysis approach.

Findings: The online survey achieved a 51.1% (n=69) response rate. Over half of the respondents (n=37, 53.6%) acquired their nursing qualifications overseas. The survey emphasised the importance of pre-existing interest in forensic mental health and encouragement from hospital staff as influential factors in job-seeking. During their first year of transition, respondents encountered feelings of isolation, a lack of support, and anxiety while providing patient care. Regarding the work environment, respondents positively perceived 'internal work motivation' but faced challenges in 'handling disagreement and conflict'. While many expressed an intent to continue their nursing careers, almost half (n=29, 45.3%) were undecided about leaving the forensic mental health setting.

Eleven participants were interviewed. The initial phase of their transition presented obstacles, including adapting to new knowledge, changes in clinical responsibilities, exposure to patients' background offences, and security processes. Interpersonal challenges were also experienced. This included navigating inconsistent clinical practices, managing professional and personal groups, and seeking support from management. Despite these initial difficulties, participants discovered opportunities for authentic engagement with patients during their transition.

Conclusion: The multifaceted experiences transitioning into forensic mental health employment emphasise the interconnectedness of professional identity, belongingness, and organisational climate. The pivotal role of workplace belongingness emerged, influencing integration through inclusive relationships and open dialogues. Organisational climate, particularly positive line manager behaviours, significantly impacted well-being during the transition. Addressing leadership challenges and fostering a positive atmosphere can enhance staff satisfaction and transition experiences, establishing supportive environments for a committed nursing workforce in forensic mental health.

FoR codes (2008)

1110 NURSING

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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.