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Faculty of Science, Medicine & Health - Honours
University of Wollongong Thesis Collections
Theses
2017
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Christine Ashley
University of Wollongong
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Ashley, Christine, Exploring the Transition of Registered Nurses from Acute Care to Primary Health Care
Settings, Doctor of Philosophy, School of Nursing, University of Wollongong, 2017.
https://ro.uow.edu.au/thsci/157
Research Online is the open access institutional repository for the University of Wollongong. For further information
contact the UOW Library: [email protected]
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Background: Internationally, the health needs of communities are changing as a result of the ageing
population and the complexity associated with providing care to people with chronic conditions. This has
resulted in the need for a sustainable health workforce skilled in the provision of primary health care
(PHC). In Australia, there is evidence that registered nurses (RNs) are being recruited from acute care
employment in order to meet nursing workforce shortages in PHC. However, little is known about how
and why RNs transition, how efficiently they are able to transfer their skills, their transitioning experiences
between settings and their future career intentions. This study provides new knowledge to inform
recruitment and retention strategies, workforce policy and nursing education.
Aim: To investigate the transition experiences and future career intentions of Australian RNs who move
from acute care to PHC employment.
Methods: A sequential mixed methods design was selected based on pragmatic underpinnings. Role
theory provided the theoretical framework to inform the research design. The study consisted of a
national online survey of RNs who had transitioned from acute to PHC employment within the previous
five years (n=111), and semi-structured interviews with thirteen purposefully selected survey respondents.
Findings: Reasons why nurses chose to transition to PHC were most commonly cited as relating to
personal rather than professional issues. Improved work/life balance, better work hours and flexible work
arrangements were highly rated, and made up for lower remuneration in the PHC sector. Barriers and
enablers to successfully transitioning were also identified, with the nature of orientation and access to
other supports such as preceptors and mentors varying greatly across the PHC sector. Availability of
funding and/or time to undertake professional learning and knowledge development, and performance
review opportunities varied according to the nature of PHC settings and factors such as geographic
location and size of the workplace. Despite the positive attitudes of study participants towards the PHC
environment and PHC nursing, a reasonable number were unwilling to commit long term to a career in
PHC. Reasons cited included concerns about loss of clinical skills and availability of career paths in PHC.
Conclusion: This study has highlighted the need to improve the professional profile of PHC nursing in
order to attract nurses to this sector. If nurses are to be retained in PHC employment, they must be
professionally supported by preceptors and mentors within a positive work environment throughout their
transition. Opportunities to retain clinical skills, access to professional development and equitable
remuneration are likely to encourage nurses to remain in PHC employment.
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Thesis
DDeeggrreeee NNaammee
Doctor of Philosophy
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School of Nursing
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primary health care, nursing, transition, role theory, workforce
This thesis is available at Research Online: https://ro.uow.edu.au/thsci/157
Exploring the Transition of Registered
Nurses from Acute Care to Primary Health
Care Settings
Christine Ashley
RN, RM, BHlth Sc (Dist), MN, GC Ethics & Legal Studies,
Dip.PM, Cert.IV TAA
A thesis submitted in fulfilment of the
requirements for the degree of
Doctor of Philosophy
School of Nursing
Faculty of Science, Medicine and Health
Thesis Certification
I, Christine Margaret Ashley, declare that this thesis, submitted in fulfilment of the
requirements for the award of Doctor of Philosophy, in the School of Nursing,
Faculty of Science, Medicine and Health at the University of Wollongong, is
wholly my own work unless otherwise referenced or acknowledged. This
document has not been submitted, either wholly or in part, to any other
educational institution.
Signed: _________________________ Date:
ii
Verification
This statement verifies that the greater part of the work in the named
manuscripts is attributed to the candidate. Christine Ashley conceived and
designed the study, and undertook data collection and analysis. She prepared
the first draft of each of the manuscripts for publication, and responded to
editorial suggestions of co-authors. Christine Ashley then prepared articles for
submission to the relevant journals and responded to reviewers’ and editors’
comments in order to finalise the manuscripts.
Professor Elizabeth Halcomb, Principal Supervisor
School of Nursing, Faculty of Science, Medicine & Health
iii
Acknowledgements
There are many people who have helped me to complete this work. First, I
would like to express my sincere gratitude to my Chief Supervisor, Professor
Elizabeth Halcomb for her continuous support during my PhD candidature. Her
patience, motivation, knowledge and skill kept me going throughout the
research process and when writing up this thesis. I cannot imagine having a
better mentor to assist me.
I would also like to thank my other two supervisors, Associate Professor Angela
Brown and Associate Professor Kath Peters whose wisdom, support and
collegiality have made my supervision meetings not only constructive, but also
fun. I am also grateful for the support provided by Dr. Rosemary Bryant during
the early stages of my candidature, and prior to her retirement.
My sincere thanks goes to Marijka Batterham for her guidance and advice on
statistical aspects of the study, and to Elizabeth Smyth for sharing her expertise
in statistical data analysis.
A big thank you to all the primary health care nurses who willingly shared their
experiences, and thank you also to everyone in the School of Nursing who were
so helpful to me as I navigated the intricacies of academic life as an external
student. Research Week each year was a great opportunity to network and
learn from academics and students, and was much appreciated.
An unexpected bonus of undertaking my doctoral studies was the opportunity to
meet with other students in the School of Nursing. What a great source of
friendship and support this provided. Special thanks goes to Sue McInnes for
sharing her own student experiences with me throughout our candidature over
an occasional glass of wine…
Sadly, neither of my beloved parents lived long enough to see my work
completed, but I know they would have been enormously proud. A huge thank
you goes to my children and other family members and friends for their
encouragement and willingness to show genuine interest in my study. In
particular, words don’t describe how much I have appreciated my husband
Norman’s ongoing support. Apart from supplying endless coffees and
sandwiches, he has attempted to share the passion for my study, and has
personally sacrificed so much to enable me to achieve my dream.
Finally, I would like to dedicate this thesis to my beautiful extra-special
granddaughter, Bailey. Nothing is insurmountable. I know you too will follow
your dreams in the years ahead.
iv
Publications and presentations
Peer reviewed journal publications
1. Ashley, C., Halcomb, E., & Brown, A. (2016). Transitioning from acute to
primary health care nursing: an integrative review of the literature.
Journal of Clinical Nursing, 25(15/16), 2114-2125. doi:10.1111/
jocn.13185
2. Ashley, C., Halcomb, E., & Brown, A. (2017). A study exploring the
protean responses of nurses transitioning to primary health care. Nurse
Researcher, 24(3), 25-30. doi:10.7748/nr.2017.e1461
3. Ashley, C., Halcomb, E., Peters, K., & Brown, A. (2017). Exploring why
nurses transition from acute care to primary health care employment.
Applied Nursing Research, 38, 83-87. doi:10.1016/j.apnr.2017.09.002
4. Ashley, C., Halcomb, E., Brown, A., & Peters, K. (2017). Experiences of
registered nurses transitioning from employment in acute care to primary
health care – quantitative findings from a mixed methods study. Journal
of Clinical Nursing, In press. doi:10.1111/jocn.13930
5. Ashley, C., Brown, A., Halcomb, E., & Peters, K. (2017). Registered
nurses transitioning from acute care to primary health care employment:
A qualitative insight into nurses' experiences. Journal of Clinical Nursing,
In press. doi:10.1111/jocn.13984
6. Ashley, C., Peters, K., Brown, A., & Halcomb, E. (2017). Work
satisfaction and future career intentions of experienced nurses
transitioning to primary health care employment. Journal of Nursing
Management, Accepted 13 November. In press.
v
Other publications
1. Ashley, C. (2016). Making the move to primary health care - unearthing
the experiences of acute care nurses transitioning to primary health care
employment. Australian Nursing & Midwifery Journal, 24(2), 34.
2. Ashley, C. (2016). Undertaking doctoral primary health care research –
personal reflections of a late career student. Australian College of
Nursing Primary Health Care eBook, 32.
3. Ashley, C., Halcomb, E., Peters, K., & Brown, A. (2017). “The best move
I ever made…..” Australian College of Nursing Primary Health Care
eBook, 27
4. Ashley, C., Halcomb, E., Peters, K., & Brown, A. (2017). Differing
challenges experienced by acute care nurses transitioning to rural,
remote or metropolitan primary health care employment Australian
Nursing & Midwifery Journal, 25(5), 39.
Conference presentations and posters
1. Ashley, C., & Halcomb, E. (2014, November 2-4). Transition Shock –
what are we going to do about it? Paper presented at the ‘Staying
Ahead of the Game’ Australian College of Nursing National Forum,
Adelaide, South Australia.
2. Ashley, C., Halcomb, E., & Brown, A. (2015, May 14–16). Transitioning
to primary health care: Uncovering the experiences of registered nurses.
An integrative review of the literature. Paper presented at the ‘Brave to
Bold’ Australian Primary Health Care Nurses National Conference,
Brisbane, Australia.
3. Ashley, C., Halcomb, E., & Brown, A. (2016, May 5-7). Transitioning from
acute care to primary health care – experiences of Australian registered
nurses. Paper presented at the ‘Nurses - the Heart of Primary Health
Care’ Australian Primary Health Care Nurses National Conference,
Melbourne, Australia.
vi
4. Ashley, C., Brown, A., & Halcomb, E. (2016, June 8-9). Ensuring an
efficient primary health care nursing workforce: exploring the transition
experiences of nurses moving to primary health care employment. Paper
presented at the 'Reform and Innovation in Primary Health Care Policy
and Practice’ Primary Health Care Research Conference. Canberra,
Australia.
5. Ashley, C., Halcomb, E., Peters, K., & Brown, A. (2017, May 4-6).
Lessons learnt from the reflections of experienced nurses who transition
to primary health care employment. Paper presented at the ‘State of the
Art’ Australian Primary Health Care Nurses Association National
Conference National Conference, Hobart, Australia.
6. McInnes, S., Ashley, C., & Halcomb, E. (2017, May 4-6). Challenges
facing nursing research in primary health care. Paper presented at the
‘State of the Art’ Australian Primary Health Care Nurses Association
National Conference, Hobart, Australia.
7. Ashley, C. (2017, May 12-13). Onboarding expertise to meet challenges
and create solutions. Paper presented at the 'A Call to Action, Solutions
for Now and Beyond' Australian College of Mental Health Nurses Primary
Mental Health Care Conference, Canberra, Australia.
8. Ashley, C., Halcomb, E., Brown, A., & Peters, K. (2017, May 27-June 1).
What happens when nurses transition from acute to primary health care
nursing? Findings from a national mixed methods study in Australia.
Paper presented at the ‘Nurses at the Forefront Transforming Care’
International Council of Nurses Congress. Barcelona, Spain.
9. Ashley, C., Halcomb, E., Brown, A., & Peters, K. (2017, May 27-June 1).
Exploring the reasons why nurses transition from acute to primary health
care nursing: a mixed methods study. Paper presented at the ‘Nurses at
the Forefront Transforming Care’ International Council of Nurses
Congress. Barcelona, Spain.
vii
Abstract
Background: Internationally, the health needs of communities are changing as
a result of the ageing population and the complexity associated with providing
care to people with chronic conditions. This has resulted in the need for a
sustainable health workforce skilled in the provision of primary health care
(PHC). In Australia, there is evidence that registered nurses (RNs) are being
recruited from acute care employment in order to meet nursing workforce
shortages in PHC. However, little is known about how and why RNs transition,
how efficiently they are able to transfer their skills, their transitioning
experiences between settings and their future career intentions. This study
provides new knowledge to inform recruitment and retention strategies,
workforce policy and nursing education.
Aim: To investigate the transition experiences and future career intentions of
Australian RNs who move from acute care to PHC employment.
Methods: A sequential mixed methods design was selected based on
pragmatic underpinnings. Role theory provided the theoretical framework to
inform the research design. The study consisted of a national online survey of
RNs who had transitioned from acute to PHC employment within the previous
five years (n=111), and semi-structured interviews with thirteen purposefully
selected survey respondents.
Findings: Reasons why nurses chose to transition to PHC were most
commonly cited as relating to personal rather than professional issues.
Improved work/life balance, better work hours and flexible work arrangements
were highly rated, and made up for lower remuneration in the PHC sector.
viii
