Expert to novice: Understanding the challenges of transition to the specialist community public health nurse - health visitor role and its implications for role retention. A constructivist grounded theory.

Background: There are limited studies directly exploring transition to the UK based specialist community public health nurse-health visitor role. This contrasts with abundant evidence exploring transition to a newly qualified nurse which is recognised as difficult and influencing retention to the nursing profession. However, transition to the health visitor role differs fundamentally to transition to the newly qualified nurse as it involves moving from a role where individuals are typically already highly skilled and autonomous practitioners, into a new professional role. Aim: To develop a substantive theory of the transition to the health visitor role, to support future aspirant health visitors and their educators. Method: Using constructivist grounded theory, this longitudinal study provides an in-depth understanding of this important transition. It incorporates focus group and interview methods over a series of data collection points, throughout the period of the health visitor course and at 6 months post-completion, with eighteen student/newly qualified health visitors based in a UK university. Results: This demanding and multifaceted transition is influenced by a range of factors, including role identity, community of practice, individual resilience and the support provided by the wider health visitor team. Data analysis led to the development of a substantive theory incorporating the three core categories of Role Identity, Way of Working and Living the Journey which are illustrated through a conceptual model, providing a visual framework to support this complex transition process. Conclusion: This research provides a rich evidence-base for the multifaceted and challenging transition to the health visitor role. The greater understanding provided will support future health visitor students, educators and workforce development, potentially enhancing future retention. The findings resonate with similar role transitions, especially those involving a move from expert to novice, extending the relevance outside of the health visitor profession. Future research should include further evaluation of the substantive theory and model with further participants including a wider range of healthcare professional roles, exploration of managing multiple role identities and heightened definition of the health visitor role.