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Objective: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the relationship between the quality of reflective practice groups and nurses' professional quality of life. Background: Previous nursing research has indicated that reflective practice groups are positively associated with personal resources, job resources, and professional quality of life for nurses. The specific impact of the groups however, has not been distinguished from the impact of personal and job resources, and the explanatory mechanisms for the associations are unclear. Design/Methods: This study utilised a cross-sectional, quantitative research methodology with 184 Australian nurses from a regional teaching hospital who attended reflective practice groups (88.5% female). Surveys captured demographics, personal resources (i.e. self-efficacy), job resources (i.e. job autonomy, skill discretion, job social support, and group cohesion) and perceived quality of reflective practice groups, as measured by the Clinical Supervision Evaluation Questionnaire, alongside professional quality of life outcomes. Results: Participants who rated reflective practice groups as 'high quality' or more effective were associated with significantly higher scores for personal and job resources of self-efficacy, autonomy, skill discretion, social support, and group cohesion. These resources, in turn, correlated with more positive professional quality of life scores; in particular compassion satisfaction and burnout. Discussion: While the study used cross-sectional data and causality cannot be inferred, the findings do indicate a clear association between attending effectively facilitated reflective practice groups and greater personal and job resources. This may indicate that the groups provide nurses with an opportunity to build or enhance these resources. Furthermore, it is proposed that this could explain a mechanism by which reflective practice groups can indirectly impact positively on professional quality of life for nurses by building resources. Future research should explore causality longitudinally. Conclusion: This study provides evidence that nurses who perceive the groups favorably have greater social support, enhanced self-efficacy, more autonomy, and increased skill discretion. These factors also align with the restorative and formative benefits of supervision. Greater personal and job resources, in turn, can enhance professional quality of life. Whilst mediating pathways have been identified, it is still not possible to definitively attribute the development of these resources to group participation. Implications for Research, Policy, and Practice: There is growing evidence to support reflective practice groups as a viable form of group clinical supervision for nurses. It is important to ensure reflective practice groups are effectively facilitated. What is already known about the topic? Correlational data indicates that high quality reflective practice groups may offer a cost-effective form of group clinical supervision, for nurses; providing support and helping them deal with what can be a challenging professional environment. Reflective practice groups have been linked to a range of benefits across individual and organisational levels, including; 1) increased job satisfaction, 2) higher quality of patient care, less critical incidents, 3) higher rates of staff retainment and reduced leave, and 4) enhancing the integrity of the nursing profession through accountability and skill development. What this paper adds Despite these claims, little is known regarding the mechanisms underpinning these documented benefits. This study provides a theoretically driven explanation; that reflective practice groups provide an opportunity for job crafting, in which nurses actively build resources (i.e. skills development critical thinking and social support), mitigating some of the negative psychological consequences associated with nursing. This information can help guide policy, practice, and the development of effective interventions to provide support and supervision for nurses. [ABSTRACT FROM AUTHOR]

Objectives: To examine in a sample of nurses working in acute-care wards, self-reported perceptions of the: 1) patient; family; nurse; doctor; and health system-related barriers to the provision of optimal end-of-life care to people who are dying in hospital; and 2) five barriers which, if removed, would lead to the greatest improvements in hospital-based end-of-life care. Background: Nurses play a central role in caring for dying patients and can offer a unique perspective about the factors that impact the quality of end-oflife care delivered in hospitals. Study design and methods: Two hundred and fifteen registered and enrolled nurses from three metropolitan and three rural hospitals across three health services completed a questionnaire-based, cross-sectional study between April 2016 and June 2017. Results: Nurses perceive that doctors continue to treat for too long (79% ranked as a large barrier); families have unrealistic expectations about a patient's prognosis (73%); junior doctors are unwilling to alter the decision of senior doctors (67%); doctors do not adequately explain the dying process (66%); and doctors have inadequate training in end-of-life care (66%). Nurses indicated that doctors reducing the length of active treatment and families having a more realistic expectation about life-expectancy would lead to the greatest improvement in end-oflife care in hospitals. Discussion: In this study of nurses working in a wide range of acute care settings across rural and metropolitan locations, substantial barriers to the provision of high-quality end-of-life care were perceived across all facets of healthcare provision. Important barriers included the continuation of potentially futile treatment, inadequacy of symptom control, and poor communication between doctors, patients and their families. Conclusion: Nurses perceive a range of patient; family; provider; and health system-related challenges to the provision of optimal end-of-life care in hospital. Findings highlight potential areas for improvement as part of a coordinated approach to optimising the provision of end-of-life care in hospitals. Future goals should include larger-scale, longitudinal studies across various states and territories to inform the development of interventions that can help to address the identified gaps in service provision. Implications for research, policy, and practice: This study has highlighted the need to involve all stakeholders when designing interventions to improve end-of-life care. Nurses can provide valuable insight into the factors that can make the greatest impact in improving care provision. It suggests that the provision of high-quality end-oflife care in hospitals is complex, and that there is substantial overlap between items nurses perceive to be barriers in each of the five domains of care provision. To achieve sustainable improvement in the quality of end-of-life care provided in hospitals, a multi-factorial, and collegial, approach to designing interventions will be needed. What is already known about the topic? • End-of-life care is increasingly being provided in hospital settings. • Nurses are an important source of information and support for dying patients and their families. • Few studies have explored nurses' perceptions of the barriers to the provision of high-quality end-oflife care across all domains of healthcare provision. What this paper adds: • Important barriers include continuation of potentially futile treatment, adequacy of symptom control, and poor communication between doctors, patients, and their families. • Findings can support the design of more effective intervention strategies to mitigate identified barriers and achieve improvements in the quality of end-of-life care delivered in hospital. [ABSTRACT FROM AUTHOR]