March 26, 2015 — Summary of "Recruitment and Retention Strategies for Expert Nurses in Abortion Care Provision," McLemore et al., Contraception, Feb. 20, 2015.
While registered nurses (RNs) "have a strong tradition of participating in sexual and reproductive health care ... the participation of nurses is considered to be one of many current barriers to abortion care provision," according to a study by Monica McLemore of the University of California-San Francisco School of Nursing and colleagues.
According to the researchers, "expert RNs" are "'those who do not exclusively rely on analytical principles (rules, guidelines or maxims) to connect their understanding of a situation to an appropriate action'" and "'who can zero in on the accurate region of a problem without wasteful consideration of a large range of unfruitful possible problem situations.'"
In their study, McLemore and colleagues aimed "to explore perspectives and experiences of recruitment, retention and career development of expert RNs in abortion care provision."
The researchers analyzed a subset of data from a larger study of RNs from 14 sites in the San Francisco Bay Area. The subset included 16 RNs, all of whom "had to have exposure to women needing or seeking abortions in the last [five] years" to be included in the study.
For the study, researchers conducted 25- to 90-minute interviews between November 2012 and August 2013. The interviewers asked the RNs "to discuss their careers in nursing, summarizing their work experiences"; "think of a time when a woman needing an abortion presented to their unit and to recount that day"; and answer various follow-up questions.
The study participants were about evenly divided between RNs with fewer than five years of experience and RNs with more than 10 years of experience.
The researchers wrote that exposure to abortion care "quickly emerged as a dominant theme relevant to recruitment," with sub-themes of "exposure through education" and "through previous employment."
In terms of education, the researchers said many of the study participants volunteered or did non-nursing jobs "in abortion care to meet the volunteer requirements/pre-requisites for their RN school applications." However, they wrote that many study participants attested as to how "educational exposure to providing abortion care is optional in most schools of nursing."
Regarding exposure through employment, the researchers found that going from being a student to an employee provides RNs with the chance to choose an employer based on their interests. Further, they noted that employees who had "had a personal history of abortion or sought out professional opportunities to participate in abortion care during their training ... were more likely to seek work in abortion care."
The researchers found that "[o]nce RNs have been successfully recruited, on the job orientation and training must occur given the disparities in basic knowledge regarding abortion care provision."
Respondents said a key aspect of retention was "the need for personal flexibility," in the context of their attitude toward their work and other personnel, as well as in "their reactions to the unpredictable nature of abortion care," according to the researchers. In particular, researchers found that designated staff RNs emphasized the importance of flexibility in patient advocacy "in the context of needing to provide space for the agency of women, especially when negotiating with others for care provision."
The researchers also found that respondents identified "'growing our own'" as another key aspect of retention. According to the study, the concept refers to "an employer-based commitment to providing RNs with on the job knowledge and skill acquisition that allows them to develop into expert RNs."
The researchers also found that there is little "infrastructural support for career development in nursing outside of acute care settings," noting that many of the study participants indicated a "need for employers to assist in the development of these opportunities."
Specifically, the RNs cited the need for "[e]ngaging in activities of legitimacy," such as "participation in professional meetings, membership in societies, developing quality and process improvement projects, acknowledgement as full members of a team, engagement with clinic leadership and policy and procedure development."
Further, some respondents said employers should provide RNs with more skill-advancement opportunities, such as through advanced education.
McLemore and colleagues write the data "show that a clear trajectory exists for development of expert nurses in abortion care provision." However, the researchers also wrote that "[t]here are several infrastructural barriers to RN participation in abortion care," including;
~ A "lack of visibility of the RN workforce in abortion care";
~ A "lack of professional certification" and "access to competency development"; and
~ "[O]utdated assumptions that the peri-operative or labor and delivery ... skill set is adequate for gaining expertise in abortion care."
The researchers offered several recommendations, including that "future workforce development efforts ... include and engage nursing education institutions and employers to design structured support for [the expert nurse] trajectory" and "integrate values clarification exercises and observational rotations for RN students in abortion care provision."
In addition, they wrote that "[i]n the abortion care provision context, the infrastructure within nursing" to retain staff via the concept of growing our own "needs to be built and does not currently exist." Further, they noted that efforts to assist RNs' career development should include integrating them "in more traditional nursing professional organizations to increase the visibility of RNs doing abortion care, and to expand the pool of future providers."
In summary, McLemore and colleagues wrote that their findings "should encourage employers to provide opportunities for exposure to abortion care, develop activities to recruit and retain nurses, and to support career development." The findings also "highlight approaches to support trajectories to develop expert nurses in abortion care provision," they concluded.