Clinical Nurse Specialists' Perceptions of Transitioning Into a Rural Community-Based Transitional Care Role.

Area of Science:

• Nursing
• Healthcare Management
• Transitional Care

Background:

• Value-based care models necessitate transitional care programs.
• Limited understanding exists regarding nurses' perceptions during hospital-to-community role shifts.
• Nurse perceptions are vital for optimizing transitional care nurse (TCN) training and role development.

Purpose of the Study:

• To explore the experiences of nurses transitioning from clinical nurse specialist (CNS) to transitional care nurse (TCN) roles.
• To identify challenges and facilitators in the CNS to TCN role transition.
• To gather recommendations for improving TCN roles and training.

Main Methods:

• Qualitative study involving 5 nurses transitioning from CNS to TCN roles in rural Vermont.
• Individual, face-to-face interviews using a semi-structured guide.
• Data analyzed using the constant comparative method.

Main Results:

• Key themes included enhanced patient-centered care, inter-TCN collaboration, expert-to-novice transition, system navigation, role discomfort, altruism, and autonomy.
• Nurses provided recommendations for improving the TCN role and training.
• Minor themes supported the identified major themes.

Conclusions:

• Findings offer insights for improving CNS to TCN role transitions.
• Transitional care nurse programs are vital for hospital-to-home patient transitions.
• Addressing gaps in community resources and TCN training is essential for program sustainability.