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Aims: To validate the 'safe and effective staffing tool' and explore the impact of COVID‐19 on the quality of Australian primary health care (PHC). Design: A national survey was conducted from October to December 2020. Methods: The online survey was distributed via social media and professional organisations to PHC nurses. Results: Three‐hundred fifty‐nine PHC nurses participated. A two‐factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α =.915) and each subscale (α =.879/α =.864). Nearly three‐quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non‐nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID‐19 had impacted negatively on the detection and management of non‐COVID related health conditions. Conclusion: The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID‐19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID‐19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high‐quality care to optimise health outcomes and maintain nurse satisfaction. Impact: This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses. [ABSTRACT FROM AUTHOR]

Aim: To explore primary healthcare nurses' psychological well‐being related to the COVID‐19 pandemic. Design: Qualitative descriptive study. Methods: Semi‐structured interviews were conducted with 25 participants between June and August 2020 who indicated their willingness to participate in an interview following a national survey. Interviews were audio‐recorded and transcribed verbatim by professional transcribers. Data were analysed using thematic analysis. Results: The importance of professional and public support and acknowledgement of the nurses' role during the pandemic positively influenced feelings of being valued. The psychological impact of negative experiences increased anxiety and stress levels. Participants reported a range of self‐care strategies, including increased vigilance with infection control at home and work and attention to physical exercise and diet. Most participants remained positive about their roles and career decisions, although some indicated that the negative psychological impacts prompted re‐evaluation of their career. Conclusions: Primary healthcare nurses have been exposed to a range of personal and professional stressors during the pandemic that have impacted their psychological well‐being. Awareness of stressors and an understanding of what has helped and what has impacted well‐being are important in guiding future workplace support systems. Further work to explore the long‐term impact of these stressors and the effectiveness of coping strategies employed by primary healthcare nurses is warranted. Impact: Managers and professional organisations need to consider the personal and professional stressors that have impacted on primary healthcare nurses' psychological well‐being to promote health and well‐being among nurses following COVID‐19. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle‐aged Australians around their health, lifestyle risks and chronic disease. Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. Design: A qualitative descriptive study using semi‐structured interviews. Reporting was guided by the COREQ checklist. Methods: Thirty‐four participants aged 40–65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi‐structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Conclusions: Understanding the perceptions of health of middle‐aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person‐centred health promotion and chronic disease prevention strategies in this age group. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the experiences of acute care registered nurses transitioning to primary healthcare settings. Background: The worldwide increasing demand for primary healthcare services has resulted in skilled acute care nurses transitioning to primary healthcare settings to meet workforce requirements. Little is known about the experiences and challenges associated with the transition. Knowledge of this will enable employers to design appropriate support processes and transitioning nurses can make informed choices. Methods: Semistructured interviews were conducted with nurses who had transitioned into primary healthcare employment in the last 5 years. Data analysis was undertaken using Braun and Clarke’s (2006) thematic analysis approach. Results: Thirteen nurses were interviewed, and two themes identified—role learning: the new environment, and role socialisation: transition validation. Role learning was influenced according to the quality of orientation programmes, previous experience, clinical knowledge and professional support. Support and professional respect from mentors and/or employers greatly assisted with role socialisation and the transition experience. Conclusions: Transitioning to primary healthcare employment provides unique challenges which must be considered by employers if they are to attract and retain experienced acute care registered nurses. Relevance to Clinical Practice: Understanding the experiences of nurses who transition from acute to primary healthcare employment can inform the design of orientation programmes and ongoing professional supports to address barriers and challenges. Targeted orientation and support has the potential to enhance recruitment and retention of experienced nurses in primary health care. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the experiences of registered nurses who transition from acute to primary health care ( PHC) employment. Background Internationally the provision of health care in PHC settings is increasing. Nurses are moving from acute care employment to meet the growing demand for a PHC workforce. However, little is known about the transition experiences of these nurses. Design A sequential mixed-methods study comprising a survey, and semi-structured interviews. This study reports on survey findings relating to the transition experience. Methods Convenience and snowballing techniques were used to recruit 111 registered nurses who had transitioned from Australian acute settings to PHC employment within the last 5 years. An online survey gathered data relating to personal and professional demographics, type of PHC setting and transition experiences. Results Most respondents ( n = 90, 81.1%) reported receiving some orientation, although the length and content varied considerably. Those working in metropolitan locations were more likely to report concerns associated with their orientation, with respondents from rural or remote locations more likely to have access to a preceptor than city/metropolitan respondents. Just under half of respondents found prioritising workload ( n = 47; 42.7%) or organisational knowledge ( n = 45; 40.9%) difficult or very difficult, and 47.7% ( n = 53) felt isolated or unsupported. 49.5% ( n = 55) reported being overwhelmed with the new role either sometimes or regularly. Barriers to transitioning successfully included limited employer support to attend professional development activities. Conclusions Availability of specific support measures may assist in the transition process. Findings from our study should be considered by employers when recruiting nurses new to PHC, and when designing orientation and ongoing education programmes. Relevance to clinical practice This study highlights the challenges faced by nurses who transition from acute care into PHC employment. Understanding the barriers and facilitators to successful transitions enhances the process for future recruitment and retention of PHC nurses. This evidence can inform managers, educators and policymakers in developing support programmes for nurses moving into PHC. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Background Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Design Concurrent mixed methods design. Methods Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Findings Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. Conclusion The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. Background The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. Design A cross-sectional online survey. Method Nurses employed in primary health care settings across Australia were recruited (n = 1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Results Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. Conclusions This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Relevance to clinical practice Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. Background Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. Design An integrative review, guided by Whittemore and Knafl's (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. Methods Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. Results Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. Conclusion There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. Relevance to clinical practice There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper reports an integrative review of the literature on nursing competency standards for nurses working in primary health care and, in particular, general practice. Background Internationally, there is growing emphasis on building a strong primary health care nursing workforce to meet the challenges of rising chronic and complex disease. However, there has been limited emphasis on examining the nursing workforce in this setting. Design Integrative review. Methods A comprehensive search of relevant electronic databases using keywords (e.g. 'competencies', 'competen*' and 'primary health care', 'general practice' and 'nurs*') was combined with searching of the Internet using the Google scholar search engine. Experts were approached to identify relevant grey literature. Key websites were also searched and the reference lists of retrieved sources were followed up. The search focussed on English language literature published since 2000. Results Limited published literature reports on competency standards for nurses working in general practice and primary health care. Of the literature that is available, there are differences in the reporting of how the competency standards were developed. A number of common themes were identified across the included competency standards, including clinical practice, communication, professionalism and health promotion. Many competency standards also included teamwork, education, research/evaluation, information technology and the primary health care environment. Conclusion Given the potential value of competency standards, further work is required to develop and test robust standards that can communicate the skills and knowledge required of nurses working in primary health care settings to policy makers, employers, other health professionals and consumers. Relevance to clinical practice Competency standards are important tools for communicating the role of nurses to consumers and other health professionals, as well as defining this role for employers, policy makers and educators. Understanding the content of competency standards internationally is an important step to understanding this growing workforce. [ABSTRACT FROM AUTHOR]

Aims and objectives. Lessons for cross-border standard development learned in the consultation to create the Australian National Framework for the Development of Decision-Making Tools for Nursing and Midwifery ( National DMF). Background. Although existing tools are broadly consistent, no cross-border or internationally accepted version exists of scope of practice decision-making guides. Development of a national framework in Australia’s federated political system required commitment to wide consultation and consensus. Concurrent moves towards national registration stimulated timely completion of the work. Contextual factors such as differentiation of the profession of midwifery from nursing and varying understanding of scope of practice concepts in eight Australian jurisdictions were challenges. Design. A consultative policy development framework was used. Methods. Thematic analysis of written responses to a draft document and of focus group feedback informed the production of the National DMF. Results. A widely accepted National DMF allowing nurses and midwives in Australia to engage in planned changes to professional practice, grounded in the professional judgement of the individual nurse or midwife, and collaboration with the consumer. Conclusions. The project’s grounding in consensus influenced the process and outcomes of consultation. A nationally consistent framework, incorporating useful decision-making tools for two professions and principles to guide implementation and evaluation, was a distinct achievement. The article adds to accumulated knowledge by: • identifying the professional and political factors influencing consultation and outcomes in cross-border standard development and • exploring key considerations for future projects to produce national or international professional standards that are relevant across borders and across professions. Relevance to clinical practice. Decision-making tools that assist nurses and midwives in determining their scopes of practice and guide them in delegating aspects of consumer care to other health care workers are an essential component of any suite of professional practice standards. [ABSTRACT FROM AUTHOR]