This study was conducted to understand the process of transition that Enrolled Nurses (ENs) and Internationally Qualified Nurses (IQNs) undertake to become Registered Nurses (RNs) in Australia. Using the qualitative method of grounded theory, 35 participants were interviewed to explore and explicate the process of their educational journey during a Bachelor of Nursing (BN) program and during their first year following graduation. Participants consisted of nursing students and graduates of a Bachelor of Nursing program in regional Queensland. Additional participants were drawn from graduates of other BN programs in Australia, as well as academic staff, librarians, and student support staff.
Nursing education and nurses’ credentials in Australia have progressed over time. This reflects the changing complexity of health care needs and contributes to an evolving scope of practice and professional identity for nurses. Registration requirements for nurses have become more stringent to ensure nurses have the knowledge, skills, and professional comportment needed to ensure the protection of the public. While many Enrolled Nurses and Internationally Qualified Nurses may have perceived they were enacting the same roles and responsibilities as Registered Nurses (RN) in Australia, participants in this study came to realise differences in their previous roles and knowledge vis-a-vis current RN requirements. Value was seen in their new learning and expanded scope of practice. The historical changes to nursing education in Australia have been described in detail as part of the context for understanding nursing education in Australia.
Two distinct participant cohorts (a retrospective and prospective cohort) were recruited. Graduate nurses were interviewed in phase one of the study to describe and reflect on the entirety of the process that they had taken from before enrolment in a BN program to one year post graduation. In the second phase of the study participants who were currently enrolled in years 1-3 of the BN program were recruited to provide raw data about the process as it unfolded. The two approaches to data collection: data recall or retrospective data together with data gathered in real time, or prospective data provided largely congruent accounts; however, each cohort provided a unique perspective on the process of Repatterning.
Grounded theory methods facilitated the creation of core categories as a means of understanding a phenomenon, and in this study, RepatteRNing emerged as the core category that explained the process that participants engage in and around and which the categories and conceptual elements coalesced to create a common theoretical narrative. Repatterning is the substantive middle range theory that emerged. Repatterning explains the process of reintegrating a new understanding of nursing as a Registered Nurse in Australia. The theory is, based on assimilating new learning and a new scope of practice that acknowledges previous knowledge and practice, for the ENs and IQNs who pursued BN education. RepatteRNing contextualises and integrates five overlapping stages: YeaRNing, ChuRNing, ReleaRNing, and AdjouRNing and EaRNing which inductively emerged from the exhaustive, iterative, and constant comparative analysis of participant data. In addition to the five phases, there are 19 sub-categories that characterise the social process of RepatteRNing for the EN and IQN.
As part of the data collection and analytic process and to ensure that the theory ‘fit’ and ‘worked’ for participants, confirmatory interviews were conducted with 35 participants to add clarification and richness of detail to their narratives. Follow-up interviews arose from a place of theoretical sensitivity and ensured the achievement of data saturation and complete category descriptions and densification of verbatim illustrations of the categories. Key staff members who taught or supported student learning and student success were asked to review the substantive theory as it evolved to determine “fit” and “work”. Finally, student and staff participants were asked to review opportunities in which the middle range theory of Repatterning could be used, in part or in whole, to facilitate EN/IQN student learning and transition in the future.