Candace Stidolph, Jennifer Kawi, Catherine E Dingley, Ann Marie Hart, Jarod Giger, Rebecca Benfield, Andrew Thomas Reyes
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引用次数: 0
Abstract
Introduction: A maldistributed primary care workforce and disparities in health outcomes are ongoing concerns for rural populations across the globe. Nurse practitioners (NPs) are a promising solution for mitigating rural healthcare inequities by reducing provider shortages and improving access to essential primary care services. The NP workforce is the fastest growing sector of primary care providers in the US. NPs are more likely than their physician colleagues to spend careers in rural and underserved settings practicing in isolation from other providers, with higher rates of turnover. An indistinct understanding of rural NPs' early career experiences highlights the need for a critical synthesis of the literature and key future recommendations. This integrative review aimed to analyze and synthesize various types of empirical reports and theoretical articles about new NPs' experiences in rural primary healthcare practice; identify current literature gaps; and discuss implications for education, policy, and further research.
Methods: Whittemore and Knafl's integrative method was used to inform the selection, review, and analysis of the literature. Search keywords were based on the Population, Effect of Interest, Measure, Study Design, Setting framework: (1) population (primary care NPs), (2) effect of interest (early career phase in a rural context), (3) measure (NP perspectives about their experiences), (4) study design (empirical, theoretical), and (5) setting (rural US and countries with a similar healthcare system and NP workforce, such as Australia, Canada, Ireland, Netherlands, and New Zealand). Four key databases (PubMed, Embase, Web of Science and CINAHL) were searched, followed by manual searching of reference lists to identify relevant empirical and theoretical literature; no time delimitation was applied in the search. A total of 174 sources were scanned. Data were iteratively compared, and significant patterns were extracted and organized into thematic clusters.
Results: The literature search yielded five studies that met the eligibility criteria: three phenomenological studies, one descriptive qualitative study, and one descriptive quantitative study. Three themes emerged: the trajectory of early career practice for rural NPs, commitment and persistence of new rural NPs, and adaptive and maladaptive early career factors for rural NPs.
Conclusion: This review included articles published in the US, although emergent themes may contribute to global knowledge about early career experiences in rural settings where advanced practice nurses are used. This review reinforced that NPs as a distinct professional population are underrepresented in rural workforce research, particularly during their early career phases. Scholarly literature about new rural NPs emphasized clinical preparedness and competence, workplace recruitment incentives, transition-to-practice experiences, and the importance of mentoring and professional networks. However, findings are limited primarily to the first year of practice. Future research priorities include exploring the ways to support rural NPs' wellbeing during the transition-to-practice phase, the barriers and facilitators to their job satisfaction by career stage, and factors contributing to burnout and turnover. Further exploration of community contexts and adaptive processes are indicated to inform meaningful NP educational refinements and effective retention policies. Understanding the experiences of rural NPs who are newcomers to rural life should also be explored.
初级保健人员分布不均和健康结果差异是全球农村人口持续关注的问题。执业护士(NPs)通过减少提供者短缺和改善获得基本初级保健服务的机会,是缓解农村医疗保健不平等的一个有希望的解决方案。NP劳动力是美国初级保健提供者中增长最快的部门。NPs比他们的医生同事更有可能在农村和服务不足的环境中度过职业生涯,与其他提供者隔离,流动率更高。对农村NPs早期职业经历的模糊理解突出了对文献和关键未来建议进行批判性综合的必要性。本综合综述旨在分析和综合各类关于新np在农村初级卫生保健实践经验的实证报告和理论文章;确定当前的文献空白;并讨论对教育、政策和进一步研究的影响。方法:采用Whittemore和Knafl的综合方法对文献进行选择、回顾和分析。搜索关键词基于人口、兴趣效应、测量、研究设计、设置框架:(1)人口(初级保健NP)、(2)兴趣效应(农村背景下的早期职业阶段)、(3)测量(NP对其经历的看法)、(4)研究设计(实证、理论)和(5)设置(美国农村以及具有类似医疗保健系统和NP劳动力的国家,如澳大利亚、加拿大、爱尔兰、荷兰和新西兰)。检索4个关键数据库(PubMed、Embase、Web of Science和CINAHL),然后手工检索参考文献列表,识别相关的实证和理论文献;在搜索中没有应用时间划分。共扫描174个源。对数据进行迭代比较,提取有意义的模式并将其组织成专题聚类。结果:文献检索产生了5项符合资格标准的研究:3项现象学研究,1项描述性定性研究和1项描述性定量研究。研究发现了三个主题:新农村np的早期职业实践轨迹、新农村np的承诺与坚持、新农村np的适应与不适应早期职业因素。结论:本综述包括在美国发表的文章,尽管新兴主题可能有助于全球了解农村环境中使用高级实践护士的早期职业经验。这一综述强调,非裔美国人作为一个独特的专业人群,在农村劳动力研究中代表性不足,特别是在他们职业生涯的早期阶段。关于新农村np的学术文献强调临床准备和能力、工作场所招聘激励、向实践过渡的经验以及指导和专业网络的重要性。然而,研究结果主要局限于第一年的实践。未来的研究重点包括探索如何支持农村新员工在向实践过渡阶段的幸福感,职业阶段对他们工作满意度的障碍和促进因素,以及导致倦怠和离职的因素。进一步探索社区背景和适应过程,为有意义的NP教育改进和有效的保留政策提供信息。还应探索了解农村新移民的经历,他们是农村生活的新来者。
期刊介绍:
Rural and Remote Health is a not-for-profit, online-only, peer-reviewed academic publication. It aims to further rural and remote health education, research and practice. The primary purpose of the Journal is to publish and so provide an international knowledge-base of peer-reviewed material from rural health practitioners (medical, nursing and allied health professionals and health workers), educators, researchers and policy makers.