Aim: To explore nurse specialists’ experiences of change and influence on practice two years after graduating with a postgraduate degree.
Background: In the absence of further study opportunities for nurses in their country of origin a master’s degree was developed and implemented to produce the first group of nurse specialists in Mozambique.
Design: Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed.
Methods: Qualitative data from focus group interviews with nurse specialists (n=12) led to three thematic data sets from which survey questions were formulated for the sequential quantitative study.
Findings: Themes that emerged from interview data were: “Change expectations”, “Ambiguous practice environments”, “Feeling powerless” and “Having some influence”. The most tangible areas of positive changes were in nurse specialists’ involvement in decision-making and evidence-informed practice. The majority found that change did not happen as anticipated - reasons for the paucity of change included the lack of nurse mentors to support new graduates (55.6%); lesser respect compared to doctors (44.4%) and poor understanding of the value of a master’s degree (44.4%). Improvements in service quality, research opportunities and the status of nursing (77.8%) were areas of greatest influence.
Conclusion: Approximately two years into practicing as nurse specialists very little measurable change has occurred according to their expectations of what should have changed in the workplace. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have impacted nurse specialists’ own ability and power to influence practice.
Summary statement
Why is this research needed?
- This is the first postgraduate course to prepare nurse specialists in a sub-Saharan country, Mozambique.
- Two years after graduating, nursing graduates occupy key positions in specialist units in the public health system.
- There is no empirical evidence of change and influence in the health system as a result of increased postgraduate capacity.
What are the key findings?
- Nurse specialists were concerned that there was an unanticipated lack of change in the workplace despite an improvement in their postgraduate capacity.
- Due to structural and political workplace factors, nurse specialists felt powerless to effect change and to influence clinical practice.
How should the findings be used to influence policy/practice/research/education?
- The findings point to a two-tiered strategy to be developed in order to dismantle barriers to the empowerment and advancement of nurse specialists.
- The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists.
- A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters