|Year : 2022 | Volume
| Issue : 1 | Page : 1-9
International trends of nursing career path: A systematic review
Moudi Albargawi1, Noof Albaz2, Sarah M Alyousif3, Abdullah Mohammed Alzahem4
1 Nursing Department, College of Nursing, King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
2 King Abdullah International Medical Research Center; Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 King Abdullah International Medical Research Center; Ministry of National Guard - Health Affairs; Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
4 King Abdullah International Medical Research Center; Department of Medical Education, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences; Ministry of National Guard - Health Affairs; Advanced General Dentistry, King Abdulaziz Medical City, Riyadh, Saudi Arabia
|Date of Submission||26-Feb-2022|
|Date of Acceptance||04-Apr-2022|
|Date of Web Publication||2-May-2022|
Nursing Department, College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, P.O.Box.3660 Riyadh, 11481, Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: The Kingdom of Saudi Arabia needs a nursing career path to guide nurses to advancement in their profession. On-the-job professional development activities allow nurses to increase their knowledge and skills without needing to leave the work environment. However, a clear career path for nurses' professional development is still lacking. Aim: Our systematic review aims to identify the national and international trends regarding on-the-job training for nursing career path development. Methods: We conducted an electronic search for studies published from 2000 to 2019 using the Cumulative Index to Nursing and Allied Health Literature, PubMed, and Medline databases. We included studies in our review if they described on-the-job professional development activities for nurses, were written in English, and were published in indexed journals. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the guideline for conducting systematic reviews in medical education. Results: We included a total of 18 studies. The sample size ranged from 2 to 1600 participants. The on-the-job professional development activities we conducted were of short, medium, and long durations. In all studies, the activities increased nurses' knowledge and skills. No data were reported about nurses' retention in most of the studies. Only one study reported that using e-learning and clinical training with nurse–mentors in a community setting for a long period of time increased their retention. Conclusion: Numerous on-the-job professional development activities are available for nurses. However, a clear career path for nursing professional development needs to be developed, especially for nurses holding diplomas.
On-the-job professional development activities allow nurses to increase their knowledge and skills without needing to leave the work environment. However, a clear career path for nurses' professional development is still lacking. Our systematic review aims to identify the national and international trends regarding on-the-job training for nursing career-path development. We conducted an electronic search for studies published from 2000 to 2019 using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Medline databases. We included a total of 18 studies. The on-the-job professional development activities we included in the review were of short, medium, and long durations. In all studies, the activities increased nurses' knowledge and skills. No data were reported about nurses' retention in most of the studies. Only one study reported that using e-learning and clinical training with nurse–mentors in a community setting for a long period of time increased their retention. Accordingly, a clear career path for nursing professional development needs to be developed, especially for nurses holding diplomas.
Keywords: Career path, education, nursing profession, Saudi Arabia
|How to cite this article:|
Albargawi M, Albaz N, Alyousif SM, Alzahem AM. International trends of nursing career path: A systematic review. Saudi J Health Sci 2022;11:1-9
| Introduction|| |
Scope of practice is an essential factor that motivates nurses to stay in their profession, especially when they have a clear path for professional enhancement and development. Career growth and professional development can increase employee satisfaction. Furthermore, career development can increase nurses' self-esteem and self-efficacy, improve their skills, and enhance their desire to stay in the clinical setting. Consequently, a career path for nursing would help guide Saudi nurses in their self-improvement and career advancement. However, in the Kingdom of Saudi Arabia, there is no clear career path for nurses, especially those with a diploma. Most Saudi nurses now earn a Bachelor of Science in Nursing (BSN). Nevertheless, there are still some Saudi nurses who only hold a diploma, despite efforts to help them complete their education through bridging programs that facilitate a smooth transition from diploma to bachelor's degree., In addition, leading nursing organizations consistently suggest that nurses should have a bachelor's degree to meet current health-care needs and improve patient outcomes.,
The Kingdom of Saudi Arabia recently implemented substantial changes in its health-care sector to meet public needs, as well as the goals outlined in Saudi Vision 2030., Education and practice in the nursing profession have been affected by these rapid changes because Saudi Vision 2030 highlights the need for high-quality health-care services., Accordingly, to accomplish the goals of the program, nurses must have the required knowledge and skills to care for their patients. The enhancement of nurses' skills and expertise is critical to help decrease the nursing attrition rate.
Retention is essential because the Kingdom of Saudi Arabia is facing a significant shortage of Saudi nurses. At present, Saudi nurses account for only 36.5% of total nursing staff, with a substantial proportion of these acting in administrative positions. Many Saudi nurses leave the profession shortly after graduating. Alboliteeh et al. surveyed a total of 741 Saudi nurses, a majority of whom held a diploma (73.8% of males and 85% of females). About one quarter of them reported that they intended to leave the profession within 2 years. Saudi Vision 2030 will address nurses' training, education, and scope of practice. Identifying factors that increase nurses' desire to stay in their jobs is necessary.
Accordingly, Saudi nurses who hold diplomas or bachelor's degrees are encouraged to enhance their knowledge and skills. Some teaching hospitals in the Kingdom of Saudi Arabia offer professional development activities for nurses, including those who hold diplomas. For example, King Faisal Specialist Hospital offered a 1-year program to update nurses' knowledge based on international recommendations and practice. Likewise, from 1997 to 2000, King Abdulaziz Medical City in Riyadh offered a short professional development program to train Saudi nurses with diplomas to meet international standards through the integration of theoretical knowledge and practical competencies. King Fahad Medical City offered a 1-year training course for Saudi nurses on providing care for newborns in intensive care units. In addition, it offered a 1-year postbasic nursing diploma program in three specialties: cardiovascular, critical care, and oncology and midwifery. In 2018, the Saudi Commission for Health Specialties certified a home health-care center in Al Madinah to offer training for a home health-care nursing diploma to improve the competencies of nurses and help them provide high-quality patient care. Similarly, King Faisal Specialist Hospital and Research Center developed a local nursing program in partnership with Monash University to train Saudi nurses in their home towns and cities.
Although some professional development activities are available for Saudi nurses, nurses still need a clear career path that enables them to advance in their profession. Furthermore, many nurses are not aware of the types of on-the-job training provided in hospitals., Therefore, there is an urgent need to identify available professional development activities for nurses to increase their retention and ensure their professional success. In this review, we identified on-the-job professional development activities, including hands-on training, e-learning training, coaching and mentoring, workshopping, short and long courses, and residency programs.
Our review was aimed at identifying the international trends regarding on-the-job training for nursing career path development. Accordingly, the review was centered around answering the following question: what necessary on-the-job training activities for nurses are available for their career development? This review is part of a larger project for the Saudi Arabia Ministry of Health aimed at identifying a career path for nurses with a diploma. However, we attempted to capture all on-the-job training activities for nurses with any academic degree, rather than homing in on diploma-holding nurses, because only a limited number of studies have focused on this population. Accordingly, our objective was to identify available career development training for nurses that increases their knowledge, skills, and retention.
| Methods|| |
We conducted a systematic review of the literature to identify on-the-job training activities for nurses' professional development. We used three health care-focused databases in our search: Cumulative Index for Nursing and Allied Health Literature, Medline, and PubMed. We performed the review using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the guideline for conducting systematic reviews in medical education.
Inclusion and exclusion criteria
We used specific criteria to minimize bias. Studies met our inclusion criteria if they (a) had participants who were nurses, (b) included on-the-job training activities for nurses, (c) were published in indexed journals between 2000 and 2019, (d) were written in English, and (e) consisted of experimental and observational research. We excluded studies if they (a) were focused on undergraduate or postgraduate students, (b) consisted of letters, (c) were case studies, (d) were nonrefereed studies, or (e) were descriptive studies.
The review team determined the key search terms after consultation with a librarian. We used a range of keywords in the literature search, such as nursing, nurses, career, path, option, profession, Saudi Vision 2030, and education. To narrow the search keywords, we combined them using AND as follows: “Nursing Career Path” became “Nursing AND Career AND Path;” “Nursing Education Career Path” became “Nursing AND Education AND Career AND Path;” “Nurses Career Option” became “Nurses AND Career AND Option;” and “Saudi Vision 2030 and Nursing Profession” became “Saudi AND Vision 2030 AND Nursing AND Profession.” To further narrow the field, two filters were applied: career development and on-the-job training.
Quality of articles and outcome variables
The team assessed the quality of the articles using the Joanna Briggs Institute's critical appraisal tools. The measured outcomes for this review included nurses' knowledge and skills and the duration of the activities and nurses' retention.
Two independent reviewers conducted the data collection process in two stages. In the first stage, the two reviewers assessed the studies independently, looking at the title, abstract, and keywords. When the information provided by the titles and abstracts was insufficient to decide between inclusion and exclusion or whether the titles and abstracts were significantly relevant to the research question, the reviewers retrieved and evaluated the full texts. When the reviewers disagreed, they consulted a third independent reviewer. We created tables to present details about the included and excluded articles and the reasons for exclusion. The analysis plan included similarities and differences between studies.
The team combined the results from the selected studies and identified and summarized the most-reported findings in tables. They also categorized aspects of the nursing career path into subclassifications according to the duration of the activities (short, medium, or long).
| Results|| |
The PRISMA flowchart summarized the number of included, screened, and excluded articles [Figure 1]. A total of 287 studies were screened. Sixty two (22%) were found to meet the initial inclusion criteria, and reviewers read the full manuscript. We considered 18 (29%) studies in this review and present their detailed descriptions in [Table 1].
From 2002 to 2005, we found no studies that addressed on-the-job professional development activities for nurses. However, after 2006, we saw a rapid increase in the number of studies that addressed this topic [Table 2]. The sample size ranged from 2 to 1600 participants. The sample size was not reported in three studies. Four studies focused on academic on-the-job training activities, 10 were clinically focused, 3 were focused on community settings, and 1 was focused on leadership. Most studies had a cross-sectional design (67%), and nearly half (47%) used surveys to assess the outcomes. Not all studies met all items in the critical appraisal tools, and these were of low to middling quality.
Educational methods for on-the-job professional development activities
The reviewed studies featured a common pattern of precepted training, simulations, and e-learning. Other types of learning methods were used either alone or in combination, such as lectures, role play, delegation classes, problem-based learning, large- and small-group activities, competency portfolios, games, and concept maps. Nurses found the use of simulations with reflective debriefing helpful for prioritizing and organizing their nursing assessments and clinical judgments, and it informed their decisions. E-learning was an effective method of enhancing knowledge and skills; moreover, it permitted nurses to participate in the activities at a convenient time. However, one study's authors reported that some nurses benefited more from face-to-face instruction than e-learning classes.
Nurse's knowledge and skills
Authors of all 18 studies reported that on-the-job professional development activities increased nurses' knowledge and skills. In addition, in the academically focused studies, the activities increased nurses' intention to continue their education and improve patient care. In one study, participants reported that the activities increased their confidence in providing mentoring. Participants in two studies reported gaining employment, obtaining advanced degrees, or becoming registered nurses. Studies that focused on clinically related activities reported that the activities enhanced nurses' job satisfaction and improved collaboration among health-care teams. In one study, although the prescribed on-the-job professional development activities improved nurse turnover rates, they were not effective in improving nurses' practice of putting on and removing sterile gowns. We found that studies that used community-focused activities were reported to link theory with practice to enhance the quality of services. In one study, the activities helped increase nurses' retention and promotion. Participants in one study reported that the on-the-job professional development activities were less effective in the ambulatory care setting. The authors of the leadership-focused study reported that the activities gave the nurses a sense of empowerment and increased their awareness. However, only a few participants reported that they planned to engage in future career development activities.
Duration of the activities and nurses' retention
We classified the duration of the on-the-job professional development activities into three categories: short, medium, and long [Table 1]. Four studies had a short-duration activity, eight had a medium-duration activity, four had a long-duration activity, and two were of unknown length. Short-duration activities ranged from 1 day to 2 weeks, and only in one study did the activity not improve nurses' retention. Medium-duration activities ranged from 2 to 8 months. Unfortunately, no authors reported the effect of the activities on nurses' retention. Long-duration activities ranged from 1 to 2 years, and only the authors of one study reported that the activity enhanced nurses' retention. The duration of this activity was 2 years, and participants were asked to participate in 1-day e-learning classes every month through a web-based platform. In addition, the participants had a mentored clinical practice at community health centers, which required them to complete six sessions per week.
| Discussion|| |
In this review, we summarized national and international trends for on-the-job professional development activities for nurses. We found and considered 18 studies that met our inclusion criteria in our review. The consistency of the evidence is weak in that most studies were of low-to-medium quality with different sample sizes. In addition, a full description of the number of participants or their characteristics was missing in some studies. However, this review can serve as a guide to develop a career path for nurses by which they can advance their skills and knowledge while working in clinical settings.
Overall, short-, medium-, and long-duration activities were effective in improving nurses' knowledge and enhancing their skills. Researchers used different strategies when conducting these activities. In some studies, the researchers used traditional teaching strategies, innovation, or a combination of both. The implementers of most short- and medium-duration activities did not report whether they were effective in increasing knowledge retention or nurses' retention. In all studies, all activities increased nurses' knowledge and skills. However, researchers did not report the magnitude of the effect of this increase. In a study by Eslamian et al., to investigate the challenges nurses encountered when engaging in continuing professional development activities, participants reported that some educational classes were not effective because too many materials were presented in a limited time, or the overall time of the activity was too long. The results we present in our review could have been influenced by the duration of the activities and the content presented in each one.
In our review, e-learning, precepted or mentored training, and simulation were commonly used learning methods. According to the literature, the use of simulation was effective in enhancing knowledge retention. For example, in a simulation workshop with a group of physicians, the results showed that they were able to recall information even after 1 year. However, in this review, most researchers did not report the long-term effect of the activities on nurses' retention or knowledge retention, even for long-duration activities. In the long-duration studies, authors reported that nurses either received promotions, resumed their education, or obtained a certificate. Only one study resulted in increasing nurses' retention. That study featured e-learning and mentored training.
In our review, we found that e-learning facilitated nurses' participation in professional development activities at their own convenience. This finding is congruent with the results reported in the literature. For instance, Dalhem and Saleh reported e-learning to be an effective teaching method for working nurses that eliminates the constraints of time and place and increases their knowledge and skills at a time convenient to them. However, e-learning might not be a preferable method of learning for some nurses, especially those who have minimal computer skills., Similarly, in one study we reviewed, certain participants benefited from face-to-face classes more than from e-learning. In addition, they were less satisfied with e-learning classes because they lacked computer skills. Although some nurses had a negative perception of e-learning, the literature shows that it can increase knowledge retention. In a study by Badiei et al., nurses who received training through continuous electronic education were more able to retain knowledge after 1 to 4 weeks than nurses who received educational booklets. Similarly, Short et al. reported that using an automated continuing professional development program enhanced knowledge retention for up to 12 months.
In this review, preceptorship/mentored clinical practice increased nurses' satisfaction, skills, and knowledge. The authors of a systematic review that appraised seven systematic reviews to identify strategies to minimize nurses' turnover in adult health-care settings, preceptorship, and mentorship were some of the effective interventions that increased retention and decreased turnover. In addition, they reported that combining different interventions were more useful for increasing retention and combining multiple learning strategies enhanced nurses' retention in clinical practice and improved their satisfaction. This was supported in this review that when mentored training was combined with other learning methods such as e-learning, nurses' retention was improved. However, studies in this review did not report any data on whether the activity was helpful in enhancing nurses' knowledge retention. In addition, other studies included in this review featured the use of multiple learning teaching strategies; however, none of their authors reported any effects on nurses' retention.
| Conclusion|| |
Access to a career path in nursing is essential for nurses' professional development and the improvement of patient care. However, a clear path is still lacking for nurses in the Kingdom of Saudi Arabia, especially those holding a diploma. On-the-job professional training for nurses could make them eligible for significant upgrades (e.g., from diploma holder to registered nurse) or promotions. Therefore, policymakers could benefit from the results presented in our review by organizing on-the-job training programs that use e-learning and precepted or mentored clinical training to enhance nurses' knowledge in various specialties. A certificate could be offered to nurses after completing the program that enables them to work in more specialized areas, continue their education, gain a leadership role in clinical settings, or receive a promotion. For example, if diploma-holding nurses completed a long-term on-the-job training program, they could be upgraded to registered nurses or promoted to a senior position in nursing. Policymakers in Saudi Arabia could also change the categories of nursing specialties to increase nurse retention, and nurses could upgrade their categories after meeting the requirements every 3–4 years. The suggested nursing categories are nurse assistant (diploma), registered nurse III (BSN), registered nurse II, (BSN + a minimum of 2 years' experience), registered nurse I (BSN + experience + additional certification), nursing specialist (Master of Science in Nursing [MSN]), nurse practitioner (NP), or clinical nurse leader (CNL), senior nursing specialist (MSN, NP, or CNL + a minimum of 2 years' experience), and nursing consultant (Doctor of Nursing Sciences or Doctor of Nursing Practice).
We identified some limitations in our review. First, the quality of the evidence was medium to low. Second, evidence was limited because of the small samples in some studies with no comparison data. Third, authors evaluated their evidence by using surveys, which may have flaws in terms of finding relationships. Fourth, many factors could have influenced the effectiveness of outcomes of professional training activities, such as duration of the activities, content, sample size, sample characteristics, and type of teaching method. Therefore, we encourage future researchers to recruit larger samples and use different methods of evaluation than surveys. We hope that continuing research will lead to much-needed, structured professional training activities for nurses.
Authors would like to thank Dr. Mohamud Mohamud, and Dr. Nazish Masud, for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]