Investigating the processes and influences involved in the transformational journeys of Registered Nurse Degree Apprentices: A realist informed qualitative study.

Aim: This study aimed to investigate students' learning journeys across the duration of a new registered nurse degree apprenticeship programme and to develop an understanding of the contextual factors, mechanisms and outcomes involved.

Background: Registered nurses are the largest group of healthcare workers globally, but shortages exist. To encourage existing UK healthcare employees into nursing, national investment was made into Registered Nurse Degree Apprenticeships. In 2018 a UK health service organisation and a university collaboration led to development of a nursing degree apprenticeship programme. Research into these novel undergraduate programmes in nursing is lacking, with scarce evidence or understanding of processes and experiences involved in such programmes.

Design And Methods: An exploratory qualitative design informed by realistic evaluation was employed. Three sequential semi-structured interviews were conducted with an entire cohort (n=8) across the 18-month programme (24 interviews). Focused interviews were also undertaken with practice assessors (n=8) involved in the apprentices' journey. Initial thematic analysis was followed by application of Realist Evaluation principles and a temporal lens to move beyond qualitative description.

Results: Analysis identified four interrelated temporal themes, each comprising contextual factors, mechanisms and outcomes acting to inhibit or facilitate transition across the apprenticeship journey: (1) Starting out (Latent Ambition, enhanced motivation and expectations): programme availability and conditions enabled enactment of ambitions to become qualified nurses, preconceived assumptions regarding roles influenced expectations. (2) Initial stages (Identity dissonance, transition to academia, becoming a student nurse) related to changing identity and re-conceptualisation of their role to student nurse, alongside transitioning into higher education. (3) Travelling through (Being an apprentice, social capital, self-efficacy and confidence) facilitated confident integration into placements, although over confidence could be risky. Academic struggles prompted some episodes of emotional dissonance. (4) Moving beyond to become registered nurses (Confidence, empowerment and loyalty in the transition to becoming a nurse) saw apprentices transform, with revised understandings of nursing, increased empowerment and self-efficacy. All expressed gratitude and loyalty for the apprenticeship opportunity, with all securing jobs in their employing organisation.

Conclusion: This study is one of the first of its kind, providing detailed insight into processes experienced by students over the duration of a novel apprenticeship programme. Analysis identified several factors that facilitated and inhibited progress in participants' 'learning journeys', mapping context, mechanism, outcome configurations which came into play at various stages. These were influential in successful completion of the programme by all apprentices, resulting in the development of competent Registered Nurses.