What do nurses practising in rural, remote and isolated locations consider important for attraction and retention? A scoping review.

INTRODUCTION: Nurses play a vital role in the provision of health care in rural, remote and isolated locations. Consequently, the current global nursing workforce shortage has significant and far-ranging implications for these communities where there are enduring issues with workforce maldistribution and shortage, instability, high staff turnover and health disparities. This article provides an analysis of existing literature on what rural, remote and isolated practising nurses view as important for the attraction and retention of this workforce in the Australian context. METHODS: A structured scoping review informed by Arksey and O'Malley's framework for conducting scoping studies was undertaken. Six electronic databases were searched in August 2022. Cosgrave's person-centred retention improvement framework (which includes attraction) for addressing health workforce challenges in rural contexts was used to guide the synthesis and interpretation of information from the included studies. Key themes were identified inductively, conceptualised within Cosgrave's framework and mapped to the overarching lifecycle stages of attraction, retention and resignation, also referred to as turnover or decision to leave. RESULTS: Twelve articles met the inclusion criteria for this review. Six themes related to attraction, retention and resignation were identified: (1) demanding role and scope of practice; (2) values divergence and professional opportunities; (3) continuing professional development and mentoring; (4) social, lifestyle and personal or family; (5) management and organisation; and (6) pay and incentives. The issues articulated within each of these themes overlapped, highlighting the complexities involved. CONCLUSION: Limited empirical research that combines a person-centred and whole-of-lifecycle approach to understanding the rural and remote nursing workforce was found. However, our analysis of existing evidence suggests that such approaches are required to appropriately plan for and target solutions that centre nurses' specific needs and experiences for the future nursing workforce. Relatedly, limited translational research on the nursing workforce that explicitly includes and engages with nurses was found. Such research is fundamentally needed to improve retention outcomes.

Exploring the integration of culturally and linguistically diverse nurses and nursing students in healthcare: A cross-sectional study.

AIM: To investigate the factors that influence the integration of CALD nurses and nursing students into the healthcare system and to explore their perception of integration. BACKGROUND: In many countries, strengthening the nursing workforce requires a ramping up of international recruitment. Culturally and linguistically diverse (CALD) nurses and nursing students experience significant challenges when integrating into new healthcare systems. DESIGN: Data for this cross-sectional observational study were collected electronically from CALD nurses (n = 15) and from nursing students (n = 87). METHODS: Three new instruments were developed and used to measure nurses' own role at work, cultural and linguistic diversity at work, and the professional competence development. Likert scale from 1 to 4 was used to evaluate the agreement rate. The study data were analysed using K-means cluster analysis to determine the integration profiles. RESULTS: Three integration profiles (A, B, and C) were identified based on the participants' self-assessed perceptions of integration. Perceptions of each profile ranged from low (≤2.49) to high (≥3.50), with most being intermediate (2.50-3.49). Further, the perceptions of integration were lowest in Profile A and highest in Profile C. The profiles differed statistically significantly in all other measured integration areas, except CALD nurses' language skills and in the nurses' ability to develop their skills. Individuals educated in Finland, who have clinical practice experience and assessed their language proficiency at least at an intermediate level, demonstrated better performance, a deeper understanding of the nurse's role in healthcare, greater confidence in their skills, and fewer experiences of discrimination. CONCLUSIONS: Integration is weakest among those with lower language skills and who completed their education outside of Finland. Healthcare organisations should develop integration models and mentoring programmes informed by new insights to support the integration of CALD nurses into the healthcare system. These models and programmes could help CALD nurses and nursing students to better understand their roles in healthcare.

Internationally qualified nurses' perspectives on transitioning specialty skills within Australia: A content analysis.

AIM: To explore internationally qualified nurses' perceptions regarding the facilitators and barriers to specialty skill transfer in Australia. DESIGN: The study utilised a descriptive research design with a cross-sectional survey. Data were collected from July to September 2022. METHODS: A self-designed survey was distributed through social media, snowballing and nursing professional organisations. The survey included six open-ended questions which were analysed using thematic content analysis. RESULTS: Sixty-three participants completed the open-ended questions in the survey. The findings identified a range of facilitators (support, previous experience, self-agency) and barriers (systems barriers, bias/discrimination, being undervalued, lack of trust) to skill transition. CONCLUSION: Recognising and addressing facilitators and barriers, coupled with creating customised pathways for specialty skill integration, are essential for optimising the utilisation of specialised skills in internationally qualified nurses. IMPACT: This study aims to explore the barriers and facilitators involved in maximising skill utilisation among internationally qualified nurses in Australia. Identifying these barriers and facilitators is essential for improving patient care, as it will guide the development of strategies for safe nursing service delivery and the optimisation of skill usage. These findings hold significant implications for policymakers, healthcare organisations and nurses, providing valuable insights into how to address these obstacles and capitalise on the factors that make skill transfer smoother and more effective. PATIENT OR PUBLIC CONTRIBUTION: Sixty-three internationally qualified nurses shared their experiences and opinions.

Nipah virus and implications for the nursing workforce and public health: A rapid review.

BACKGROUND: The Nipah virus has raised significant concerns in global health security. During the COVID-19 pandemic, the nursing workforce continues to face numerous challenges, including inadequate preparedness for pandemics, a shortage of nursing personnel, physical, and mental exhaustion. OBJECTIVE: This rapid review aimed to synthesize existing literature on the Nipah virus and its implications for the nursing workforce. DESIGN: A rapid review was conducted to synthesize the available literature on the Nipah virus, facilitating the provision of timely and pertinent information to policymakers and decision influencers. A systematic search strategy was implemented between January 22 and February 9, 2024, from PubMed, CINAHL (EBSCO), Scopus, and Google Scholar without year limitation. Out of 149 studies, six studies were evaluated using the Joanna Briggs Institute Critical Appraisal Checklists, and one study was excluded based on this evaluation, resulting in five studies being included. Then these were reviewed using narrative synthesis. The study adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: The selected research indicated that the virus was transmitted throughout the community and during hospital admissions, resulting in unexpected mortality. The healthcare staff, especially nurses, had a limited understanding of the infection. Although there is a lack of confidence in policy and decision-makers, many public health initiatives have been implemented such as providing education on infection prevention and control methods to healthcare personnel, including nurses and support staff. CONCLUSION: There is a need to integrate continuing professional development programs in both primary health care and specialized medical care to strengthen the preparedness of healthcare personnel for future pandemics. Support systems not only for healthcare staff members, especially nurses, but also for allied personnel working with them to create conducive working environments.

'The Emperor's new clothes?' Healthcare professionals' perceptions of the nursing associate role in two UK National Health Service hospitals: A qualitative interview study.

Background: The introduction of nursing associates in England in 2017 as a professional 'bridging' role aimed to mitigate chronic staffing shortages, enable career progression of healthcare assistants and release registered nurses to provide more complex care. Limited evidence exists about the alignment between the identity and purpose of nursing associate roles described by the UK independent regulator, the Nursing & Midwifery Council, and the expectations, obligations, and team dynamics encountered in practice. Purpose: Investigate the perceptions of nursing associate roles through the views and experiences of role holders, registered nurses, and healthcare assistants. Setting: Two British National Health Service (NHS) Hospital Trusts in London, England (UK). Methods: For this registered service evaluation, data were collected via in-person, semi-structured interviews. Verbatim transcripts were coded inductively. An adapted framework analysis method, suitable for use with Excel, was applied to support the identification of cross cutting themes. We used the Standards for Reporting Qualitative Research checklist for reporting this study. Results: Eleven registered nurses, five nursing associates, and five healthcare assistants participated. Their experiences seldom reflected the policy vision of the nursing associate role in practice. Several participants likened the nursing associate role to the fable of the 'Emperor's New Clothes' in which expectations and reality diverge. With this over-arching theme, four sub-themes were identified: (1) preparedness of organisational infrastructure to support this role; (2) credibility of the role in practice; (3) perceived organisational "blindness" to the ambiguities of the role and (4) increasing task orientation and segmentation in care delivery. Conclusion: There is a discrepancy between the identity of the nursing associate role as imagined in the policy agenda and its reality in practice. There is a need for more protected and well-defined training, clear role boundaries, and accessible career progression pathways for nursing associates. Moreover, honest dialogue at an organisational and policy level must continue, so that the challenges and opportunities of the nursing associate role are properly realised. Tweetable abstract: Emperor's new clothes! Experiences and views of new nursing associate roles in NHS (UK) acute hospitals @CarolynSpring3.

Effects of rural hospital closures on nurse staffing levels and health care utilization at nearby hospitals.

Our study examines the causal effect of rural hospital closures on nearby hospitals' nurse staffing levels and health care utilization. We use data from the 2014-2019 American Hospital Association Survey on nurse staffing level outcomes including licensed practical or vocational nurses (LPNs), registered nurses (RNs), and advanced practice nurses (APNs); and health care utilization outcomes, including inpatient and outpatient surgical operations and emergency department (ED) visits. Using propensity score matching and difference-in-differences (DID) methods, we find that rural hospital closures lead to an average increase of 37.3% in the number of nurses in nearby rural hospitals during the 4 years following the closure. This increase is found across all categories of nurses, including LPNs, RNs, and APNs. We also find a substantial increase in the provision of inpatient and outpatient surgical operations but there is no change in ED visits. We do not find any effects for nearby urban hospitals. Our study suggests that a large proportion of the nursing workforce relocates to nearby hospitals after a rural hospital closure, which mitigates the negative consequences of such closures and allows these nearby hospitals to provide a larger volume of highly profitable services.

Intraprofessional cultural competence in nursing regulation: A critical content analysis of standards and codes in the United Kingdom, New Zealand and Australia.

There is a global shortage of nurses, leading many countries to recruit internationally qualified nurses (IQNs) to fill the gap. However, IQNs encounter challenges in integrating into their new professional environment, particularly in their interactions with locally qualified nurses (LQNs). Intraprofessional cultural competence (IPCC), defined as 'a set of congruent behaviours and attitudes that enable professionals to work respectfully and effectively in cross-cultural situations', may be a strategy to address these challenges. Content analysis was used to examine nursing regulatory documents (Standards for Practice [Standards] and Codes of Conduct [Codes]) from the United Kingdom, New Zealand and Australia. Data were extracted and organised based on four key themes relevant to IPCC. The analysis revealed a focus on 'Mutual collaboration and professional relationships' in six regulatory documents, with explicit commitments to preventing racism and discrimination in the Australian and NZ Codes. However, issues such as racism, discrimination, bullying and harassment faced by IQNs are not comprehensively addressed, as the documents mainly prioritize culturally appropriate patient interactions over relationships between colleagues. Using regulatory documents to address IPCC may influence positive change such as improving communication, and preventing racism, bullying, discrimination and harassment within nursing.

Nursing Regulation Literature in Canada: Protocol for a Scoping Review.

BACKGROUND: Significant reforms are occurring in health practitioner regulation across Canada. Within the nursing profession, growing workforce challenges and health system demands have accelerated the pace of changes to nursing regulation policies and practices. There is significant political investment to modernize and harmonize nursing regulation across Canada, and evidence is needed to guide regulatory decision-making. To better understand the current state of scholarship and the gaps that exist, a comprehensive understanding of the available literature informing nursing regulation in Canada is first warranted. OBJECTIVE: The objective of this scoping review is to examine the nature, extent, and range of literature focused on nursing regulation in Canada. METHODS: The review will be conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. We will search electronic databases, including Ovid MEDLINE, Ovid EMBASE, CINAHL, Scopus, and Web of Science Core Collection. We will also search for grey literature using the websites of Canadian nursing regulatory bodies, nursing organizations, and other leading Canadian regulatory organizations. No limitations will be placed on the year of publication. The review will include papers that explore nursing regulation in Canada, including topics such as education program accreditation or approval, licensure, standards of practice and code of conduct/ethics development and enforcement, continuing competence, discipline and conduct, regulatory models, governance, and reform. We will extract data using a predeveloped tool. Data will be analyzed using descriptive statistics and conventional content analysis. RESULTS: A preliminary search in Ovid MEDLINE was undertaken on December 7, 2023, and a full search was conducted in 5 academic databases on March 15, 2024. Findings will be presented using evidence tables and a narrative summary. Reporting will follow the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This scoping review is expected to be completed in early 2025. CONCLUSIONS: The results will be disseminated through conference presentations and a publication in a peer-reviewed journal. The findings will provide a comprehensive overview of the state of nursing regulation literature across Canada and inform the development of a focused research agenda. TRIAL REGISTRATION: Open Science Framework osf.io/3qk8t; https://osf.io/bm7jv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56163.

The nurse-led equitable learning framework for training programs: A framework to grow, bolster and diversify the nursing and public health workforce.

BACKGROUND: Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. PURPOSE STATEMENT: This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. METHODS: The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. RESULTS: Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. CONCLUSIONS: Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.

The Impact of Coronavirus Disease 2019 on Nursing Education: Evidence, Experience, and Lessons Learned.

This article examines the multifaceted impact of the coronavirus disease 2019 pandemic on nursing education, with a focus on implications for critical care. Issues including the rapid transition to remote learning, stress and burnout, disengagement, challenges in clinical education, ethical dilemmas, and the influence of workforce dynamics on nursing education are discussed. The article explores challenges, opportunities, and the invaluable lessons learned from this unprecedented crisis. Understanding the evolving dynamics is essential for nursing education and practice, offering a pathway toward a more resilient and promising future for both individuals and the nursing profession as a whole.

How a critical care environment influences nurses' health and working capacity: a scoping review.

BACKGROUND: Internationally, the nursing workforce is ageing. Chronic conditions are becoming more prevalent amongst the ageing nursing workforce. With an increase in chronic conditions and an ageing nursing workforce, understanding environmental influences on nurses' health and work capacity is vital to supporting this workforce. AIM: A scoping review was conducted to explore the influence of a critical care environment on nurses' health and work capacity. DESIGN: A scoping review was conducted according to PRISMA-ScR guidelines. METHODS: Database extraction occurred in June 2023 and included MEDLINE Complete, PubMed, Scopus, CINAHL, and Embase. RESULTS: Eight studies met the inclusion criteria. Studies were conducted internationally with sample sizes from 20 to 500 critical care nurses (CCNs). CONCLUSIONS: Findings identified the critical care environment had an impact on nurses' health and working capacity. Many CCNs self-reported having a chronic condition that influenced their nursing practice. Further research is needed to explore how to mitigate the influence of a chronic condition to support this valuable workforce.

Forecast accuracy of demand for registered nurses and its determinants in South Korea.

BACKGROUND: Despite the significance of demand forecasting accuracy for the registered nurse (RN) workforce, few studies have evaluated past forecasts. PURPOSE: This paper examined the ex post accuracy of past forecasting studies focusing on RN demand and explored its determinants on the accuracy of demand forecasts. METHODS: Data were collected by systematically reviewing national reports or articles on RN demand forecasts. The mean absolute percentage error (MAPE) was measured for forecasting error by comparing the forecast with the actual demand (employed RNs). Nonparametric tests, the Mann‒Whitney test, and the Kruskal‒Wallis test were used to analyze the differences in the MAPE according to the variables, which are methodological and researcher factors. RESULTS: A total of 105 forecast horizons and 196 forecasts were analyzed. The average MAPE of the total forecast horizon was 34.8%. Among the methodological factors, the most common determinant affecting forecast accuracy was the RN productivity assumption. The longer the length of the forecast horizon was, the greater the MAPE was. The longer the length of the data period was, the greater the MAPE was. Moreover, there was no significant difference among the researchers' factors. CONCLUSIONS: To improve demand forecast accuracy, future studies need to accurately measure RN workload and productivity in a manner consistent with the real world.

Answering the call: Experiences of nurses of color during COVID-19.

In the years following the COVID-19 pandemic, issues such as high job demands, burnout, and turnover continue to influence the nursing workforce, with heavier impacts to marginalized groups. Understanding the work and life contexts of nurses of color can help guide strategies for workplace equity and meaningful support. This qualitative study explored the experiences of nurses of color in the United States during the pandemic, focusing on feelings about the profession and job decisions. The overarching theme was "answering the call," with subthemes of "COVID shone a light," "being consumed by COVID," and "is it worth it?" Participants shared how their racial identities shaped their perceptions and job decisions in positive and negative ways, noting how racism impacted many facets of their work and added to the stressors felt in the workplace and the community. Findings provide insight into the underrepresented perspectives of nurses of color and suggest strategies to eliminate racism in nursing.

Interventions that support novice nurses' transition into practice: A realist review.

BACKGROUND: Many transition-to-practice programs have been developed to support novice nurses during their first years into practice. These programs report improvements in retention, wellbeing and clinical competence, but the driving mechanisms of these interventions remain largely unclear. OBJECTIVE: To identify how transition-to-practice programs for novice nurses work and in what contexts they work successfully. METHODS: A realist review was conducted. Eligibility criteria included intervention studies aimed at novice nurses in their first two years of practice that reported outcomes on organizational or individual nurse level. The underlying theory of included transition-to-practice programs was extracted, and relevant contextual factors, mechanisms and outcomes were explored and synthesized into context-mechanism-outcome (CMO) configurations. The search was limited to studies between 2000 and 2023. RESULTS: A total of 32 studies were included, evaluating 30 different transition-to-practice programs with a wide range of intervention components including stress management, clinical education, professional and peer support, and ward rotations. Transition-to-practice programs were often designed without a theoretical foundation. Driving mechanisms behind the programs pertained to psychological, professional, and social development. Contextual factors that activated the mechanisms were enabling conditions for mentors and novice nurses, selection and motivation of novice nurses and organizational culture. CONCLUSIONS: Current transition-to-practice programs primarily focus on the individual and professional development of nurses. However, transition to practice can benefit from a systemic approach that includes development initiatives on the organizational level. REGISTRATION: PROSPERO ID CRD42021268080, August 15, 2021. TWEETABLE ABSTRACT: Context and mechanisms determine successful implementation of transition to practice programs for novice nurses. @transitiontopractice @nurseworkforce.

Equity and justice in health.

BACKGROUND: While justice is promised to all U.S. citizens, the truth is that the pathway to equity and justice in health is riddled with obstacles for many marginalized and minoritized groups. The United States ranks lower on crucial health measures than its high-income peer countries, reflecting differences in health outcomes for marginalized and minoritized populations. PURPOSE: Promoting equity and justice in health is vital as health shapes the daily experiences of individuals and communities, specifically those from marginalized and minoritized backgrounds. METHOD: This paper highlights the health care system and sociopolitical factors contributing to the longstanding structural barriers that impede health and the need for structural competence, advocacy, and activism in the nursing workforce. DISCUSSION: Understanding systemic issues underlying health inequities provides an opportunity to develop targeted strategies to eliminate practices perpetuating inequities and pave the way for everyone to have a fair and just opportunity to be as healthy as possible. CONCLUSION: Specific education, practice, research, and policy recommendations can advance equity and justice in health.

Organizational Cynicism and Turnover Intention Among Nurses: Do Perceived Organizational Support Moderates the Relationship.

Introduction: Understanding work dynamics is imperative for organizational efficiency in the healthcare industry. Therefore, achieving such a feat is akin to knowing the interplay between organizational cynicism, organizational support and turnover among nurses in the healthcare sector in Nigeria. Aim: This present study aimed to examine the moderating role of perceived organizational support on the association between organizational cynicism (cognitive, affective, and behavioral dimensions) and turnover intention among Nigerian nurses. Methods: The study is a descriptive cross-sectional survey research conducted on a sample of 515 nurses, aged between 29-55 years, with mean age = 34.3 and SD = 9.4 drawn across different government-owned hospitals from the southeast geographical region of Nigeria through snowball sampling method. Three instruments, the Turnover Intention Scale, Organizational Cynicism Scale and Survey of Perceived Organizational Support Scale were used for data collection, while the Hayes PROCESS Macro for SPSS version 23 was used for data analysis. Results: The results showed that organizational cynicism dimensions were positively associated with turnover intention among nurses, whereas organizational support negatively associated with turnover intention of Nigerian nurses. In addition, perceived organizational support moderated the association between organizational cynicism (affective and behavioral dimensions) and turnover intention among nurses. The study evidenced a strong association between organizational cynicism and turnover intention among nurses in their work setting. The study observed that organizational cynicism is a recipe for nurses' turnover intention and that organizational support decreased the extent to which nurses experience turnover intention. Conclusion: The results showed that organizational cynicism dimensions positively associated with turnover intention among nurses in Nigeria. In addition, the association between organizational cynicism (affective and behavioral) dimensions were moderated by perceived organizational support. The study suggests that perceived organizational support mitigates the positive relationship between organizational cynicism and turnover intention. The result provided further evidence of how perceived organizational support can influence motivation and morale in the workplace.

Low-value health care, de-implementation, and implications for nursing research: A discussion paper.

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial.

An integrative review of racism in nursing to inform anti-racist nursing praxis in Aotearoa New Zealand.

AIM: To synthesise international literature to identify mechanisms that maintain racism in nursing and understand the factors that contribute to designing and implementing anti-racist praxis to inform nursing in Aotearoa New Zealand. DESIGN: An integrative literature review was undertaken, integrating Indigenous Kaupapa Maori methodologies to ensure a cultural and philosophical lens. METHODS: Peer-reviewed literature published, between January 2011 and July 2023 were sourced. Of 1296 articles, 16 met the inclusion criteria and 4 were identified via citation chaining. In total, 20 articles were included. The Johns Hopkins Research Evidence Tool was applied, findings extracted, and thematic analysis completed utilising Indigenous Kaupapa Maori principles. DATA SOURCES: Databases, including CINAHL, Scopus, PubMed and Aus/NZ Reference Centre, were searched in July 2023. RESULTS: Two key themes were identified: (1) colonial active resistance to change; and (2) transformational, visionary, and proactive nursing. CONCLUSION: Nurses are well-positioned to confront the structures that maintain racism in health and education systems but are often actors in maintaining status quo. Anti-racist praxis can be a mechanism for nurses to reimagine, redefine and transform nursing care, leadership, and nursing education to begin to eradicate racism. REPORTING METHOD: This integrative review adhered to the 2020 Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION: Racism remains prevalent in nursing and the healthcare system. It is necessary to implement anti-racist praxis and policies that resist, deconstruct, and dismantle power and racism while validating Indigenous values, beliefs and practices. This is vital to deliver equitable health care. IMPACT: This integrative review presents lived realities and knowledge of Indigenous and racially minoritised nurses and scholars, alongside nursing allies to inform anti-racist praxis. This evidence signifies that it is time to walk the walk to challenge the colonising systems and processes that hold racism in place.

The voice of the second-level regulated nursing role: a qualitative approach.

BACKGROUND: With an international nursing shortage, there is a need to navigate towards an improved nursing workforce structure where each nursing role is valued and recognised for the work they contribute. The second-level regulated nursing role is seen as integral; however, there is role confusion, especially with the registered nurse, and high attrition. To implement strategies to retain an integral nursing workforce, there is a need to better understand the role from the experiences and expectations of the second-level regulated nursing role. AIM: To gain a better understanding of the second-level regulated nursing role in the Australian nursing workforce. DESIGN: Qualitative descriptive study from a larger mixed methods study. METHOD: Five focus groups in 2018. The findings were analysed through the lens of organisational behaviour. RESULTS: The findings identified that enrolled nurses' intrinsic and extrinsic motivators influenced levels of job satisfaction and sense of feeling valued. The findings also identified key determinants that influence job satisfaction and occupational stress: enrolled nurses' understanding of their role and scope of practice; the registered nurses' understanding of the enrolled nurses' role and their role when working with the enrolled nurse; and the organisation's understanding and recognition of their role. When these determinants align, there is job satisfaction, less occupational stress and enrolled nurses feel valued. At a professional level, the title does not reflect the role, and there are no career pathways. CONCLUSION: This study explained why recurrent challenges impact the role and what contributes to those in the role feeling valued. Challenges that affect job satisfaction and occupational stress for the second-level (enrolled) nurse are related to the working environment and with whom the nurse works. From a professional level, there are limited career opportunities that recognise and retain the enrolled nurse in their role.