Making a smooth transition into community nursing settings

By: By Donna Roupas, MSN, RN, NCSN; Karen Lynne Golie, BSN, RN; and Kelly Powers, PhD, RN, CNE

Preparation is key to success.

Advances in healthcare have led to an expanding aging population and more individuals living with chronic health problems. At the same time, an emphasis on containing costs has led to efforts to prevent or reduce expensive hospital stays that expose patients to dangers such as hospital-acquired infections. As a result, the need for nurses to provide care outside of the walls of hospitals continues to grow. (See About community nursing.) 

About community-based nursing   

Policy changes resulting from the Affordable Care Act and restructuring of the health insurance industry have fueled a focus on transitioning care from hospital to home and on improving population health. The importance of community nursing was highlighted in the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health. 

These forces have contributed to an increase in the number of nurses employed in non-hospital settings. The 2017 National Nursing Workforce Survey found that 55.7% of RNs work in hospitals, a decrease from 62.2% in 2010. With almost 4 million RNs licensed in the United States, nurses have many opportunities to pursue careers in community settings, including: 

  • ambulatory care
  • clinics 
  • correctional facilities
  • health departments
  • home health
  • primary care 
  • residential living facilities
  • schools

Benefits and challenges of community-based nursing   

Working in a community setting provides nurses with opportunities for greater autonomy, leadership-skill improvement, interprofessional collaboration, care diversity, and long-term patient relationships focused on preventive care and self-management. However, many nurses are hesitant to take on community roles. This may be fueled by perceptions that these roles are less interesting or that prior hospital experience is required. Some new nurses who may lack education about and exposure to community settings don’t consider these positions because they worry about working independently. 

Whether you’re a novice or experienced nurse, making the transition from school or a hospital setting to the community may present some challenges, but can ultimately lead to a rewarding career opportunity.

Transition challenges

When new graduate nurses enter professional practice in any setting, they frequently feel unprepared and overwhelmed. Boychuk Duchscher’s Transition Shock theory describes how new graduates feel when they realize the stark differences in responsibilities, relationships, and expectations between their student role and their new practicing nurse role. This shock can impact the nurse’s self-confidence and perception of being accepted, which can lead to turn­over and even departure from the profession.  

Experienced nurses who move from one specialty or setting to another also may have difficulty transitioning to new roles as they work to fill knowledge gaps, master new skills, and adapt to a new culture. Disorientation, confusion, and doubt can cause any nurse’s resilience to waiver during transition periods. 

Patricia Benner’s Novice to Expert theory describes how new graduates and experienced nurses moving into new areas of practice can feel like novices because they lack setting-specific experience. However, as they gain experience, they become more adept in their technical skills, critical thinking, and ability to reason through complex situations. They evolve from an outside observer to an individual fully involved in the workplace community. 

Key strategies for positive transitions

Helping nurses build confidence and a feeling of being valued as part of the team is critical to ensuring successful transitions into new roles. Nursing school faculty, managers, and individual nurses entering community settings can take steps to ease the transition. These stakeholders play a vital role in ensuring community-based nursing positions are filled with competent and forward-thinking professionals.

Positive exposure begins in nursing school

Today, nurses in the novice and advanced beginner stages of their career have more opportunities to accept community-based nursing positions. Prior hospital experience, once a common requirement for nurses transitioning into community roles, is considered less necessary now. Instead, new nurses are being recruited for their ability to take initiative for their own learning, bring new perspectives to the workplace, and offer innovative ideas for using technology. However, if new graduates aren’t exposed to community nursing roles they may not be aware these positions are available to them.

Highlighting community nursing as a valued specialty is crucial for sparking students’ interest. Nursing faculty can help by providing education and taking steps to ensure smooth transitions for new graduates.

Building familiarity with non-hospital environments and providing clinical opportunities with community partners can improve students’ knowledge of role expectations, increase their confidence, and influence their perspectives when considering their first job. For example, rather than defaulting to hospital-based simulations, case studies, and patient scenarios, faculty can incorporate community-based case options.

In addition to helping students build a solid knowledge base and skill set through repeated exposure to community-based nursing while in school, faculty can leverage their relationships with community partners to help students secure quality clinical placements. Likewise, community-setting nurse managers should reach out to faculty to promote their organizations and engage students. Faculty also can teach students about what to expect in community settings and coach them to look for opportunities with successful transition-to-practice (TTP) or residency programs. If such programs aren’t in place, faculty with community expertise can partner with sites to help them adopt or establish them.

Workplace transition support

To meet the needs of newly hired nurses with minimal practice experience and limited knowledge about community-based nursing, practice managers must formulate transition plans that mirror the best practices of hospital-based TTP programs. Unfortunately, little literature exists on these programs in non-hospital settings. In 2015, a multi-hospital study by Spector and colleagues found improved nurse satisfaction and retention, improved competence, and fewer reported errors when they participated in a TTP program. The researchers then studied the program with new graduates transitioning to non-hospital settings. Outcomes were better for nurses who participated in a TTP program, but improvements were less impressive than in the hospital-based study. Researchers concluded that these programs must be tailored to the specific setting type and include specialty content.

As community sites seek to employ new graduates, research continues to emerge that identifies aspects of TTP programs that promote successful transition. Successful transition programs generally include pairing a nurse with a trained preceptor, peer support, formal education, and purposeful ongoing feedback.

Preceptors are instrumental to acclimating nurses to their new role. Preceptor guidance and support are crucial, and practice managers and educators should identify or develop an educational curriculum that preceptors can use with new nurses consistently. Managers also should develop incentive programs to recognize and reward preceptors for their hard work. In addition, practice managers can facilitate long-lasting mentorship relationships by helping new nurses identify and connect with a competent coach. These long-term relationships serve to support nurses when they’re no longer working with a dedicated preceptor.

Individual nurse responsibility

Individual nurses also have a role to play in their transition to community settings. They can start by seeking out resources and tools that increase their knowledge, build self-confidence, and offer professional and personal support. This is especially important in community settings where autonomous practice is the norm.

Nurses should consider joining professional organizations and subscribing to nursing journals related to their new specialty area. National organizations’ websites frequently provide practice guidance, including policies, resources, and tools. In addition, membership can provide the opportunity to network with peers through social media, email discussion groups, webinars, virtual meetings, and conferences. Peer-reviewed journals can provide excellent evidence-based practice information, and access may be provided through organization membership. Local specialty organizations also can be valuable assets for forming close relationships with peers who can offer tips, ideas, resources, and support, as well as facilitate access to knowledgeable and experienced mentors. (See Community nursing resources.)

Community nursing resources   

The following list is a sampling of the many professional organizations available to support nurses as they transition into community settings.  

Another way nurses can actively promote a smooth transition is to take advantage of community placements during nursing school. They should search for positions that offer structured and supportive environments that will increase their knowledge and skills. (See A transitioning case study.)

A transitioning case study  

Joanna currently works at a hospital and is finishing up her RN-to-BSN education. She’s decided that it’s time for a career change and is looking to transition into community-based nursing. Faculty and hiring managers have a vital role in helping her transition successfully, but Joanna also should take steps herself to help make this career change a success.  

Faculty steps 

  • Teach about the variety of important roles nurses perform in the community.
  • Facilitate exposure to quality community-based clinical placements that are relevant and interesting.
  • Provide the opportunity to practice navigating community-based scenarios by integrating them into the curriculum.
  • Give students the chance to become familiar with the job expectations of community-based nurses by facilitating extended and repeated clinical experiences.
  • Prepare students to search for post-graduation positions that offer the ability to learn from a preceptor as part of a transition-to-practice program.

Manager steps  

  • Support new nurse hires through orientation focused on augmenting prior learning and experience.
  • Incorporate a formal education component that includes content and case studies specific to the new specialty area, including common concerns.
  • Develop a training curriculum that focuses on properly choosing, managing, supporting, educating, and rewarding preceptors.
  • Include experiences that enable interprofessional collaboration and communication to improve new nurses’ knowledge of resources and partnerships.
  • Prioritize support by developing an on-site mentorship program or creating a support network of peers in similar agencies. 

Nurse steps  

  • Join national and specialty nursing organizations.
  • Take advantage of national organizations’ online access to journals, discussion boards, and mentorship programs.
  • Subscribe to nursing journals in general and specialty areas or ask about journal access through the workplace.
  • Seek out continuing education opportunities specific to nurses transitioning to practice or a new specialty area.
  • Connect with nurses in specialty areas through local organizations, conferences, webinars, online meetings, social media, and email discussion groups.

Strengthening the workforce

Community settings need nurses to fill vital roles. Transitioning into a community nursing role may present challenges, but preparing the groundwork in school, offering support on the job, and taking advantage of supportive peers and mentors can help nurses increase their confidence and competence. Nursing faculty, managers, and individual nurses all play key roles in helping to strengthen the community-based nursing workforce.

Donna Roupas is an adjunct nursing instructor at the Wingate University School of Nursing in Wingate, North Carolina. Karen Lynne Golie is a public health nurse at Cabarrus Health Alliance in Kannapolis, North Carolina. Kelly Powers is an assistant professor at the University of North Carolina at Charlotte School of Nursing.


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