Low-skilled

When asked about the GPN role, six participants expressed a lack of knowledge of the role and its responsibilities, capabilities and skills. For example, when questioned about her thoughts on undertaking her first post within general practice, one participant commented:

‘I just wouldn’t really associate that with nursing, but I’ve never had a placement there. Well, I don’t know if that would be for me, I’m more of, hmm, a nurse.’ (Anne)

Anne’s perception of the nursing role was of managing acute events in secondary care. She discussed community and GPN roles interchangeably, which she believed was because her university provided these placements in the same rotation.

Other participants, who had not undertaken a GPN placement, expressed similar concerns about becoming deskilled in general practice, basing their perceptions on community placements, peer group discussions, discussions with secondary care staff while on placement and university feedback. The terminology used by those who had not witnessed the GPN role included ‘deskilled’, ‘not a nurse’ and ‘not a lot of my clinical skills’, which indicated a negative perception of GPNs’ skill levels.

In contrast, participants who discussed the GPN role from a patient’s perspective used words like ‘autonomous’, ‘decision-making’, ‘responsibility’ and ‘prescribing’. Participants who had witnessed the GPN role offered a more positive perception using terms such as ‘enjoyed’, ‘well supported’, ‘tight-knit’ and ‘well organised’.

Five participants expressed an interest in undertaking advanced practice roles. However, even within this context general practice was regarded as a lower-skilled area compared with secondary acute care, with one participant stating:

‘I think eventually, if I’m confident enough and I feel brave enough, I will go out into A&E and walk-in centres, but I might start out in a GP practice.’ (Belle)

Older workforce and family-friendly working hours

Participants discussed GPNs as an ‘older workforce’, linking this with working patterns perceived as more appropriate for those seeking an enhanced work-life balance. A commonly held perception was that the GPN role was suitable for nurses with childcare responsibilities or who did not want to work secondary care shift patterns, as two participants commented:

‘She wants to go straight into community because she wants to start having children immediately.’ (George)

‘It just felt like it was more for women that didn’t want the lifestyle of a ward – I will be honest with you, it tended to be a lot of older nurses.’ (Jane)

Slower pace of work

The pace of work in general practice was discussed as ‘easier’, ‘relaxed’ and ‘less stressful’. Several participants linked their perception of this slow pace with the presumed age profile of GPNs and the family-friendly hours.

One participant, Nancy, commented that she believed she would not be interested in a GPN role because it ‘isn’t as intense and fast-paced’, but added that she believed this would benefit patient care as the slower pace meant ‘you could spend more time with patients’.

Belle acknowledged that while the duration of GPN shifts might be comparable to those in secondary care, the pace of work was perceived as more manageable. Eleven of the 16 participants described the pace of work in secondary care in terms such as ‘busy’, ‘stressful’, ‘understaffed’ and ‘burnout’.

Participants who had undertaken a general practice placement used more positive terminology to describe the primary care environment. For example, Jane discussed a transient element to the pace of work, commenting that there were ‘busy days, and not so busy days.’ Conversely, Debbie stated that the pace of work needed ‘time management’ which implied some level of work-related pressure.

Lack of knowledge about terms and conditions

There was limited awareness of employment terms and conditions in general practice. Regardless of whether they had general practice experience, ten participants were unaware that these settings were not aligned with NHS employment terms and conditions. Three participants commented on the difference in terms and conditions between secondary care and general practice – for example, lower salaries and a perceived lack of a structured career pathway in general practice – with salary being the primary concern:

‘The pay banding, because it’s not matched to the NHS you will be stuck on the same pay for a few years whereas fellow students in my cohort will go onto wards and go up the pay band quicker.’ (Helen)

‘I’m assuming the terms and conditions will be similar, but I don’t know.’ (Penny)

‘It’s got its differences. Obviously, the environment is different, but I’m not really sure of the differences in terms and conditions.’ (Lynne)

Who advised secondary care as a first-post destination?

Fourteen participants had been told directly that secondary care experience would be necessary before becoming a GPN. The advice came from multiple sources, including secondary care nurses, universities and peers. Participants’ comments included:

‘They did say it was better that you had [hospital experience].’ (Irene)

‘Probably best to work on a ward for a year or two.’ (Nancy)

‘It was also emphasised at university as well.’ (Penny)

The primary source of advice that secondary care experience was necessary before becoming a GPN came from secondary care colleagues who participants had spoken to while on hospital placements. Those participants who had knowledge of general practice, or who had undertaken a general practice placement, could challenge this perception. Orla acknowledged that her GPN placement had empowered her to challenge the perception appropriately:

‘You don’t need the secondary care experience anymore – possibly before the placement I wouldn’t have known, really.’ (Orla)

However, another participant, Debbie, while acknowledging that secondary care experience before becoming a GPN was not required, did not feel confident in challenging her registered colleagues’ opinions.

What advice was given about first-post destination?

Participants believed that secondary care experience was required before becoming a GPN, particularly to consolidate their skills and receive peer support. One commented:

‘So, I want to start off in secondary care because I feel it will get me the opportunity to develop my clinical skills and have a supportive environment with other nurses and sisters and matrons.’ (Fiona)

Various participants expressed a need to ‘build up my skills’, ‘develop a range of skills’ and ‘develop my nursing judgement’, with a perception that these opportunities were not available in primary care. Ten participants stated that secondary care acute clinical areas were the most desirable first-post destinations and linked these settings with the development of nursing skills.

Preceptorship availability

Preceptorship programmes are a recognised model of providing professional support, guidance and clinical education to newly registered staff nurses (Nursing and Midwifery Council (NMC) 2020). Eleven participants stated that preceptorship programmes were only available in secondary care, although those with primary care experience (n=5) were aware they were also available in this setting.

Eleven participants expressed concern about their ability to develop confidence and competence in their first post and discussed secondary care as the preferred clinical area to support their professional development. Debbie likened registration followed by secondary care experience to ‘passing your driving test and then learning to drive’. Participants actively sought advice and support about being newly qualified from within their peer groups, universities and from colleagues on placements, as one commented:

‘They all kind of gave their opinions and views of nurses and newly qualified nurses, which is something you take on as they have been in the field longer than you have.’ (Belle)

What timescales were advised?

The perceived amount of secondary care experience required before taking on a role in primary care was 12-24 months. Each participant’s perception of the length of the required post-registration secondary care experience correlated with anecdotal discussions with their peers and registered nursing colleagues and recruitment adverts. Three discussed job adverts as affecting their career choices, with one stating:

‘I looked in the application and that said you can’t apply unless you have two years’ postgraduate experience.’ (Mary)

Participants were unclear if the requested timescale for secondary care experience was a requirement of the role or a recruitment preference. Some participants believed these timescales were a recruitment preference, because different geographical areas specified different timescales. One commented:

‘It’s weird that in [one NHS area] you have to have a year’s experience in hospital before they’ll let you work and in [another NHS area] they will take you straight from uni.’ (Irene)

Available career support

Overall, participants believed that career guidance and support should be part of their core nursing curriculum, but many obtained this from providers other than their universities, such as careers fairs. Thirteen participants believed it was the university’s responsibility to provide career advice, support and information. All participants knew of or had attended careers fairs in their university or in secondary care settings. Secondary care employers were always represented at careers fairs, as one commented:

‘They [careers fairs] did have the hospitals come in, so they had stands in the foyer, but there were no lectures or anything about how you should construct a CV or anything.’ (Fiona)

Clinical placements enabled participants to assess whether they wanted to work in secondary or primary care when registered, while staff in the practice area could assess students’ suitability for future roles, as one participant commented:

‘If you get a good picture of the placement, you do get a good feel for what you want to do later.’ (Nancy)

Another participant commented that her university had provided a broad range of career options and believed this was a supportive and productive way to provide access to various nursing fields:

‘We had a day where different trusts came into the university and there were a few nurses there and also a trainee practice nurse who had just qualified.’ (Jane)

However, Jane’s views contrasted with those of other participants who attended her university and who believed it had not offered sufficient career support or guidance.

Career support not available

Eight participants expressed a desire to receive increased support with basic career planning such as searching for roles, generating a curriculum vitae (CV), optimal timing for applications and interview techniques. Participants discussed their access to career advice using uncertain terms such as ‘unsure’, ‘don’t know’ and ‘not discussed’. Four acknowledged that career advice was available but with the caveat that they had to search for the information. One commented:

‘There were no initial lectures or anything about how you should construct a CV or anything, interview techniques and stuff like that, which could be quite beneficial.’ (Fiona)

Participants reported a lack of knowledge about how to search and apply for posts in non-secondary care environments, with most unaware of where to obtain general practice recruitment information. Others assumed that these posts would be advertised on the NHS jobs website. Two participants, Debbie and Helen, who cited general practice as their preferred first-post destination, discussed the challenges in sourcing relevant information. Another five stated that GPN posts were frequently discussed within their peer group, with many nursing students expressing an interest but lacking knowledge of how to apply. One of these participants commented:

‘No, not at all. No, we’ve not been given any information about [general practice nursing]; it’s just all about going to work on a ward, going to work in secondary care, you know the hospital and things like that.’ (Lynne)