Introduction: Membership is a unique post graduate award offered by the Faculty of Nursing and Midwifery (the Faculty) of the Royal College of Surgeons in Ireland (RCSI) in acknowledgement of the important work carried out by nurses and midwives.

Background: Membership of the Faculty was launched in 2021 and is only offered by a few colleges worldwide and exclusively in Ireland through RCSI. This award is an innovative and supportive mechanism by which nurses and midwives, nationally and internationally, are afforded the opportunity to actively engage with the Faculty, and its communities of practice at all stages of their careers.

Methods: Literature Review and focus group data were undertaken and analysed using thematic analysis. Data was analysed using Cooper’s (1989) five stage approach. Influences on the transition period were explored in the context of Chick and Meleis’s Transition Concept (Parahoo, 2016). Eligible articles were critically reviewed and scored using the Mixed Methods Appraisal Tool (MMAT) [1].

Aims: To lead and support the development of nursing and midwifery through the delivery of transformative learning experiences, impactful professional development and research to enhance healthcare and societal well-being through professional association with the Faculty of Nursing and Midwifery (The Faculty) Royal College of Surgeons in Ireland.

Results: Participants believed Membership would act as a stepping stone to their future development. The main focus was on CPD, transition periods and transitions for practice, reflection on practice and preceptorship. The need for continuous professional development and of maintaining and belonging to a professional group were highlighted.

Conclusions: Membership will provide applicants with resources to support advances in nursing and midwifery leadership, management, education, research and evidenced based compassionate clinical practices as well as offering many networking opportunities, which will help advance professional development.

Importance to nurse managers: As nurses and midwives face a future in which health service policies and nursing work practices changed due to Covid-19, Membership will provide a conduit to support the professions to adapt to new policies and future innovations during periods of personal and professional change.

Implications for Nursing Management: Nurse and midwife managers have the important role of developing their staff. This research identifies that one way they do is by ensuring that professional development programmes are available during the transition period following graduation but also later as nurses and midwives progress toward advanced and comprehensive nursing and midwifery roles. Even though this study refers to the Membership award findings will resonate with those delivering professional development programmes along the pathway to attainment of nursing practice professionalism.

• Faculty membership
• Professional award
• Transformative learning

Carney M (2022) Unique award for Nurses and Midwives: Blending achievements and forward thinking through Membership Education for Practice. Ann Nurs Pract 9(1): 1125.

The Royal College of Surgeons in Ireland RCSI University of Medicine and Health Sciences is ranked joint second globally for good health and wellbeing in the Times Higher education World Rankings [2]). RCSI is an international not-for-profit university with its headquarters in Dublin and is exclusively focused on education and research to drive improvements in human health worldwide. It is listed among the top 250 universities worldwide in THE World University Rankings [3], and its research is ranked first in Ireland for citations [4]

The Faculty established in 1974, plays a pivotal role in leading and supporting the development of nursing and midwifery professions nationally through the delivery of transformative learning experiences. The faculty provides education programmes in management, leadership, clinical nursing practice and research. Membership is a unique post graduate award offered by the Faculty in acknowledgement of nurses and midwives contribution to healthcare.

The Faculty believes that nursing practice is underpinned by continuing professional development (CPD) which is associated with the provision of safe, evidence-based care where knowledgeable nurses and midwives positively influence the experiences of, and the clinical outcomes of patients and clients in their care [5]. As transition into clinical practice for 

newly graduated nurses is a difficult time, with high stress levels that are defined by a demanding period of personal and professional acclimatisation, CPD professional development programmes offered by the Faculty will include areas relevant to the development of enhanced transitions throughout the lifespan and future nursing practice developments [6].

The Faculty also offers access to networking opportunities, which will help advance professional development. Membership introduced in 2021 is open to applicants   with a bachelors or postgraduate degree or equivalent and guidelines for equivalency are also available thus acknowledging Accreditation of Prior Experiential Learning (APEL) to experienced colleagues prior learning [4,7-13]. Life-long engagement provided by the Faculty is possible through its tiered education structure which incorporates the Fellowship, a prestigious award that has been in existence since 1982. Fellowship requires a master’s degree or higher and is open to any nurse or midwife from any scope of practice from primary to tertiary care and across the life span.

Aim

Membership aims to lead and support the development of nursing and midwifery practice through the delivery of transformative learning experiences, impactful research in professional development and by supporting the contribution of nurses and midwives to healthcare and societal well- being. Membership aims to promote the active engagement of registered nurses and midwives at all stages of their career through professional association with the Faculty.

Membership means subscribing to the mission, vision and values of the Faculty. The framework for Membership is based on the RCSI mission to educate, nurture and discover for the benefit of human health. This includes developing professional communications, promoting member engagement and providing access to Membership programmes. The faculty vision will be achieved by introducing a range of services to provide a forum and conduit through which members can be empowered and enabled in their professional development. A suite of services for members will address their engagement, growth, and career development needs throughout their career, regardless of discipline

Joining a professional body or organisation acknowledges that minimum standards have been achieved and confers certain privileges on the individual, as set down by the professional body or organisation, at each stage of their career development. Professional organisations’ provide nurses with access to professional networks that can open up opportunities for research, innovation and professional development [14,15].

Membership is available to qualified nurses and midwives who are registered by the Nursing and Midwifery Board of Ireland [16], or registered in their jurisdiction of practice and requires applicants to apply for, and be accepted as members by Faculty, following which Membership is conferred upon them. Focus is on the Membership Professional Reflection Assessment. Applicants must present evidence of professional development by incorporating this evidence into a dedicated Membership e-Portfolio that provides evidence of personal and professional qualifications and ongoing engagement with lifelong learning 

and CPD. Potential areas for applicants to focus on and apply to nursing practice, in their application, are the reflective process, clinical supervision, preceptorship, mentorship, clinical decision making and teamwork in their clinical practice. These areas were identified from prior research undertaken by the Faculty. The e-portfolio is reviewed by two internal examiners and an external Examiner reviews all aspects of the process thus ensuring that standards and quality assurance processes are maintained [17].

Membership for many professional groups is highly valued as a means of demonstrating professional interest, dedication, enthusiasm and motivation. This is achieved through making explicit individual   priorities   and   professional   commitment to quality and standards while supporting nursing practice and professional development. The perception of nurses and midwives as having being of ‘value’ to society is evident [18], and reflected in national [19], and international evidence [20], with reference to ‘Who do we trust more’? in identifying nurses’ as the most honest and trusted professionals. Consequently the year 2020, the WHO International Year of the Nurse and Midwife, was deemed the right time to introduce the process of Membership as an acknowledgement to them, especially as this was also the anniversary of the birth of Florence Nightingale.

A well-developed professional identity enhances nursing as a profession by contributing towards better healthcare delivery and outcomes. It is important that professional values are learnt within the culture of nursing to avoid the gap between theory and practice and to increase early positive socialisation [21]. CPD programmes being introduced for Membership include all forms of transitions from novice to expert. Membership will enhance nurses’ and midwives’ value to society even further [18].

Membership benefits include being able to use the Membership title-MFNMRCSI -Member of the Faculty of Nursing and Midwifery Royal College of Surgeons in Ireland. Members have access to an exclusive suite of value-added services/ amenities. These include college facilities for educational and professional gatherings, educational programmes and research forum. These activities are seen as opportunities for members to stay informed with ‘Communities of Practice’ [22,23].

Several methods were used to inform development of Membership and its future delivery.

Literature Review

The literature search strategy (2012-2021) combined four concepts deemed necessary for membership development: higher education and membership strategies, prior learning, CPD concepts and transition periods. CPD concepts include reflection, mentorship, preceptorship and clinical supervision (2019-2021). Results from searches were grouped according to these concepts and finally consolidated into the Membership proposal and subsequent future delivery of Membership programmes.

The literature review provided a yield of 61 papers, all of which were evaluated. Library databases searched included EBSCO host, Pub Med Central and CINAHL. Articles were included if they met criteria relating to relevance to membership development and future education for members. Results are 

presented in narrative form with the sample size presented first

followed by the years sourced.

These included higher college/membership education (n=15, 2011-2019); prior learning (n=13, 2011-2018); continuous professional development (n=17, 2019-21) and transition periods focusing on early years graduates (n=16, 2018-2021). The majority of studies were qualitative and of Irish, UK or Scandinavian origin. Data was analysed using Cooper’s (1989) five stage approach. Eligible articles were critically reviewed and scored using the Mixed Methods Appraisal Tool (MMAT) [1].

SWOT analysis

This method was undertaken by faculty board members (n=16) to progress the design and development of Membership (2016). Internal and external factors were identified and strengths and weaknesses within RCSI and the Faculty identified through thematic analyses.

Communication Forum

This method evaluated faculty meetings and minutes (n=36, 2016-2020). Analysis of data identified outcomes and future actions including application criteria and benefits to Membership.

Comparative analyses

Comparative analysis with the four existing RCSI faculties was undertaken in 2017 by thematic analyses of data (surgery, dentistry, radiography and sports and exercise medicine) to ensure parity and to better understand their processes and procedures.

Focus Groups: Qualitative needs analysis

This method was undertaken in 2018 by the Faculty Dean and Board. Data were gathered via two focus groups with twelve participants who were working as registered nurses in one regional hospital and in the largest general hospital in Ireland. Their needs and views on what membership should look like and the content needed to deliver the membership programme were explored. A Heideggerian Hermeneutic approach was the research method adopted. Data were analysed using Van Manen’s thematic analysis and influences on the transition period were explored in the context of Chick and Meleis’s Transition Concept [1].

Findings from the literature review formed the largest part of this study and are presented in combination with the discussion. The main focus was on CPD, transition periods and transitions for practice, reflection on practice and preceptorship. Findings identified the many facets of CPD. It was noted that new graduate nurses need regular support and opportunities to reflect on experiences in their new profession. Areas identified include reflection on practice, clinical supervision, mentorship, preceptorship, personal and job satisfaction and decision making with a focus on the transitions along the pathways from novice to expert. Transition was identified as ranging from 6 months to 24 months with CPD programmes varying in length [6]. Nurse shortages were identified as central to workforce issues in healthcare systems globally [24], and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Brook et al. (2018) (n=53) evaluated the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. They identified promising interventions to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27–52 weeks, with a teaching and preceptor and mentor component.

Transitions

These were identified as being complicated and multi- dimensional and gaining an understanding of the transition process and the factors that facilitate or stand in the way of healthy transition to professional nurses was deemed necessary [25]. CPD was recommended to support nurses during transitions. Berglund et al [6] in their phenomenological study (n=8) described newly graduated nurses’ expectations of transitioning into the nursing profession at the start of a clinical nursing introduction programme that included supervision, and critical reflection with peers. A study by Kumaran and Carney [26], explored the experience of role transition for newly-qualified nurses from an Irish perspective (n=10) and identified professional responsibility and accountability associated with the new role as being overwhelming and stressful for participants and the need for preceptor support and reflection on their practice while they incorporate their knowledge into clinical practice.

Transitions to practice

The concept of a ‘time-factor’ was advocated by Graf et al. [27], in their review of how contemporary transition theories apply to the newly qualified graduate nurse programmes. These researchers identified a need for new graduates to complete their university degree as advanced beginners in order to decrease the experience of transition shock and to keep pace with the rapidly changing demands of the clinical environment. Expectations of transition into the nursing profession via the ‘Clinical Nursing Introduction Programme (CNIP) as described by Berglund et al. [6], identified uncertainty, security, challenge, and growth along the threshold of a new identity. This research undertaken in Sweden indicated that newly graduated nurses should have the opportunity to receive education and structured support at the same time as they work independently and grow into their clinical practice. Also identified was the need to emphasise graduated nurses as learners who are progressing toward comprehensive nursing roles [28]. The availability and implementation of guidelines on transition of final year nursing students by educational institutions and healthcare facilities could ease the transition from being final year nursing students to becoming professional nurses as well as improving retention of newly qualified professional nurses [29]. These areas will be introduced for members as important topics in during Membership programmes. Despite the large amount of literature on new graduate nurses’ transition to practice, transition remains at the forefront of discussions within the nursing community [30] 

(n=26). These researchers describe transition experiences factors under three themes: Personal, Professional, and Organizational. Brook et al. [6], reports an intervention comprising mindfullness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses.

Reflection-on-practice

The literature review identified reflection as the way for healthcare professionals to reflect in, and on their work, thereby developing clinical and education skills [31-33]. Reflective practice is defined as ‘the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible [34]. A solid reflective approach generates a plan for future action [35-39]. Reflective teaching and learning is a conscious and continuous process that requires us to reflect on experiences [4,40]. Johansson et al. [41], explored the need for nurses to reflect on their new professional roles in describing CNIP which was for 14 months initially but may last for up to three years. Kumaram and Carney [26], identified reflection on practice as an important area by which to develop clinical and professional roles, not just during the immediate transition period but for several years after as they developed their professional roles.

Reflective practice is important because it demonstrate insight by identifying actions to help learning, development or improvement of practice [42]. Reflection develops greater insight and self-awareness and identifies opportunities to improve quality and patient safety in organisations [14], and helps an individual to challenge assumptions and consider opportunities for improvement. Developing the capacity to reflect should focus on the reflective process and how to use it productively rather than on a specific number or type of reflective notes [34]. However, a study by Mahon and O’Neill [43], explores if ‘unconscious biases may affect how we interpret past events and queries if one is actually unskilled and unaware of it. Unconscious biases are relatively unexplored in the nursing literature. These researchers suggest that even if biases limit our ability to learn from reflection nurses’ of all levels need to critically engage with the process. Membership supports these research findings. CPD programmes being introduced for Membership include reflection and reflective practice.

Preceptorship

The literature review identifies preceptorship as being an important professional development subject not just during the transition period but also because successful transition to practice depends on the nurse building confidence and gaining essential clinical reasoning abilities while orienting to their role [43]. Rush et al.[44], (n=76) identified best practices of formal transition programmes as being education, support, competency development, mentorship, peer support opportunities and critical thinking. Stacey et al. [45], explored the implementation of resilience based clinical supervision to support transition to practice in newly qualified healthcare professionals including nurses.

Ensuring preceptors are provided with education related to those areas are essential to successfully assisting nurses in their transition to practice. This is particularly pertinent in critical care settings where patient care is complex and where safe and effective patient care is dependent upon having nurses who are well prepared for their role through being provided guidance and support from trained preceptors [46]. CPD education programmes introduced for Membership include preceptorship in all its forms.

Mentorship

Research shows that mentorship is an effective strategy for facilitating the transition to clinical practice. However, lack of programmes providing mentorship prior to the students’ graduation from nursing school exists [47]. These researchers recommend bridging the academic and clinical environments through a mentorship programme that facilitates an easier transition to the workplace after graduation. Nurse Managers’ can advocate for mentorship programmes by partnering with educational institutions. This support can also be continued as new graduates’ transition into their careers [47]. Universities and hospitals need to adapt their current practice to align with the needs of new graduates due to large student numbers and to decrease the attrition rate [27,48]. The Faculty has introduced mentorship programmes for Membership.

Focus groups were analysed thematically. Data from thematic analyses identified four areas of practice as being important to participants for Membership. These are: how Membership should look’; nurses’ future on receiving the award of Membership; organisational benefits from Membership and the importance of continuous professional development to their career progression. Findings indicated that participants focused on how Membership should look to staff nurses and on the professional benefits believed to be important for nurses on being awarded Membership. Participants welcomed the introduction of Membership and believed it would act as a stepping stone to their future development.

Nurses’ future

Participants focused on the general nursing environment and on the need for organisations to recognise their qualifications and professional education. Concern was raised by participants that nurses and midwives were developing skills and expertise in their roles but not getting any recognition for this in terms of promotion or monetary reward. Some nurses viewed Membership as giving them this recognition for attaining a certain level of expertise that they felt they deserved. Developing an e Portfolio was viewed as one way to achieve this desired recognition in relation to applying for Membership and for keeping practice up to date with their regulatory body-NMBI [17].

Organisational benefits

Participants believed significant organisational benefits were possible from nurses with Membership through improved care delivery. They acknowledged that benefits to their patients may be significant as the better-prepared nurse will provide enhanced nursing care [49].

Continuous professional development

Participants identified the need for CPD to develop and enhance their career and on the importance of reflective practice. Participant comments were similar to those identified in the literature review as mentioned previously.

Future direction

Reflection is a way for healthcare professionals to reflect in, and on their work, thereby developing clinical and education skills and enabling a plan for future action. Reflective teaching and learning is a conscious and continuous process that requires us to reflect on experiences. The faculty will deliver programmes relating to transition experiences and the growth induced challenges as they progress toward advanced and comprehensive nursing and midwifery roles. Research shows that reflection- on-practice, mentorship, preceptorship and clinical supervision are effective strategies for facilitating the transition to clinical practice along the pathways from novice to expert.

The areas mentioned in this study all required specific attention in the development of Membership. The Faculty believes that now is the right time to introduce membership. To validate this view a large amount of research took place during the past four years by successive faculty deans, boards and sub-committee members and the faculty executive. In developing criteria for Membership the views, opinions and aspirations of nurses and midwives taking part in this research were considered. Surveys and interviews were used to seek views on how membership should evolve within Faculty. Of particular importance to applicants is the perceived “Value” of Membership. As Membership is not a qualifying examination for nurses and midwives the Faculty is taking an approach to its Membership Professional Assessment that is based on its unique positioning within RCSI. Membership will provide applicants with resources to support advances in nursing and midwifery leadership, management, education, research and evidenced based compassionate clinical practices as well as offering many networking opportunities, which will help advance professional development. As a result of Covid-19 and other significant influences, digitally engaged learning will be the focus over the coming years to support the professional development of nurses and midwives and nurse managers. Technology enables the benefits and improvements that technology can provide to members of Faculty. The Faculty will deliver programmes relating to transition experiences and the growth induced challenges as they progress toward advanced and comprehensive nursing and midwifery roles. CPD will form a large component of the education programmes offered for Membership [50-58].

Implications for Nursing Management

Nurse and midwife managers have the important role of ensuring the development of their staff. This research identifies the importance of managers in supporting the development and maintenance of professional practice. One way to do this is by ensuring that CPD programmes are available during the transition period following graduation but also later as nurses and midwives progress toward advanced and comprehensive nursing and midwifery roles. Even though this study refers to the Membership award, findings will resonate with those delivering professional development programmes along the pathway to attainment of professionalism. The study identified reflection, preceptorship, supervision and decision making as the main subjects requiring continuous attention for the benefit of recently qualified nurses and midwives.

Managers by demonstrating their professional interest and motivation can support their staff in making their individual developmental priorities explicit in acknowledging their professional commitment. Nurse Managers have an important role in developing and supporting professional development for senior staff. They may do this by providing resources to support advances in nursing and midwifery leadership, management, education and research and evidence based compassionate clinical practices as well as offering networking opportunities, which will help advanced professional development.

Nurses and midwives face a future in which health service policies and work practices changed during Covid-19. Research undertaken for Membership adds to current knowledge by providing a conduit to support the professions to adapt to new policies and future innovations during periods of personal and professional change that are mainly focused on professional development programmes and are applicable to all contexts and situations.

Ethical Considerations

The Faculty of Nursing and Midwifery approved the development of Membership. The Faculty and RCSI College Boards approved the award of Membership.

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