Investigating the processes and influences involved in the transformational journeys of Registered Nurse Degree Apprentices: A realist informed qualitative study.

AIM: This study aimed to investigate students' learning journeys across the duration of a new registered nurse degree apprenticeship programme and to develop an understanding of the contextual factors, mechanisms and outcomes involved. BACKGROUND: Registered nurses are the largest group of healthcare workers globally, but shortages exist. To encourage existing UK healthcare employees into nursing, national investment was made into Registered Nurse Degree Apprenticeships. In 2018 a UK health service organisation and a university collaboration led to development of a nursing degree apprenticeship programme. Research into these novel undergraduate programmes in nursing is lacking, with scarce evidence or understanding of processes and experiences involved in such programmes. DESIGN AND METHODS: An exploratory qualitative design informed by realistic evaluation was employed. Three sequential semi-structured interviews were conducted with an entire cohort (n=8) across the 18-month programme (24 interviews). Focused interviews were also undertaken with practice assessors (n=8) involved in the apprentices' journey. Initial thematic analysis was followed by application of Realist Evaluation principles and a temporal lens to move beyond qualitative description. RESULTS: Analysis identified four interrelated temporal themes, each comprising contextual factors, mechanisms and outcomes acting to inhibit or facilitate transition across the apprenticeship journey: (1) Starting out (Latent Ambition, enhanced motivation and expectations): programme availability and conditions enabled enactment of ambitions to become qualified nurses, preconceived assumptions regarding roles influenced expectations. (2) Initial stages (Identity dissonance, transition to academia, becoming a student nurse) related to changing identity and re-conceptualisation of their role to student nurse, alongside transitioning into higher education. (3) Travelling through (Being an apprentice, social capital, self-efficacy and confidence) facilitated confident integration into placements, although over confidence could be risky. Academic struggles prompted some episodes of emotional dissonance. (4) Moving beyond to become registered nurses (Confidence, empowerment and loyalty in the transition to becoming a nurse) saw apprentices transform, with revised understandings of nursing, increased empowerment and self-efficacy. All expressed gratitude and loyalty for the apprenticeship opportunity, with all securing jobs in their employing organisation. CONCLUSION: This study is one of the first of its kind, providing detailed insight into processes experienced by students over the duration of a novel apprenticeship programme. Analysis identified several factors that facilitated and inhibited progress in participants' 'learning journeys', mapping context, mechanism, outcome configurations which came into play at various stages. These were influential in successful completion of the programme by all apprentices, resulting in the development of competent Registered Nurses.

The influence of practice experiences on feelings of role proficiency in emergency nurse practitioners: A phenomenological study.

INTRODUCTION: This research explores how emergency nurse practitioners (ENPs) become role proficient given experience variation and lack of role standardisation. AIM: To understand how ENPs experiences in practice influence their feelings of role proficiency. METHODS: A hermeneutic phenomenological study was undertaken utilizing an interpretive standpoint. A two-phase approach was adopted with ten participants using a digital diary informing a semi-structured interview. A three-stage data analysis approach was applied. FINDINGS: Six themes emerged: the meaning of role proficiency, relationships, confidence, learning and knowledge, exposure and experience, and care. Models of proficiency and its development are presented. DISCUSSION: Proficiency is defined where confidence in the components that proficiency consists of and their application to each clinical presentation is required. Proficiency is a continuum supported by regulatory mode theory. Inconsistency of role understanding gives rise to three ENP groups, resistors, maintainers, and innovators. CONCLUSION: Role clarity is required to establish a consistent culture within organisations founded on the voice of the ENP as captured in this research. This model of proficiency be incorporated in ENP role development for current and future ENPs.

Mental Well-Being in UK Higher Education During Covid-19: Do Students Trust Universities and the Government?

This paper draws upon the concept of recreancy to examine the mental well-being of university students during the Covid-19 pandemic. Briefly, recreancy is loss of societal trust that results when institutional actors can no longer be counted on to perform their responsibilities. Our study of mental well-being and recreancy focuses on the role of universities and government regulators within the education sector. We surveyed 600 UK students attending 161 different public higher education providers in October 2020 during a time when many UK students were isolated in their residences and engaged in online learning. We assessed student well-being using the Short Warwick-Edinburgh Mental Well-being Scale (scored 7-35) and found the mean score to be 19.9 [95% confidence interval (CI) 19.6, 20.2]. This level of well-being indicates that a significant proportion of UK students face low levels of mental well-being. Structural equation modeling (SEM) analysis indicates that high recreancy-measured as a low trust in universities and the government-is associated with low levels of mental well-being across the student sample. While these findings are suggestive, they are also important and we suggest that government and university leaders should not only work to increase food and housing security during the Covid-19 pandemic, but also consider how to combat various sector trends that might intensify recreancy.

COVID-19 vaccines and vaccine administration.

This article provides an overview of current COVID-19 vaccines available within the UK, including their mode of action, storage and handling. It outlines the recommendations on priority groups for vaccination and provides insight into the training recommendations for vaccinators.

Global citizens.

Nurses and nursing students from the UK and overseas are learning in each other's countries.