Purpose: The purpose of this qualitative study was to explore nursing specific processes associated with communities of practice (CoPs) in specialized acute care settings with a focus on their potential role in Registered Nurse (RN) integration and professional development. The following research questions were formulated to support the achievement of this purpose: (a) What are the key features, roles, and processes of a community of practice (CoP) in specialized acute care nursing practice settings?; (b) What are the social processes that are integral to the integration of RNs into their chosen specialized acute care nursing practice settings; (c) What role, if any, do CoPs serve in the integration process of RNs into their chosen specialized acute care nursing practice settings? Research Design: This research was conducted using a constructivist grounded theory approach. Sample/Setting: The Canadian Nurses Association (CNA) has designated 20 areas as specialties, examples of which include Cardiovascular Nursing, Emergency Nursing, Neuroscience Nursing, Perinatal Nursing, Perioperative Nursing, and Oncology Nursing. From these 20 CNA designations, three specialized areas were chosen for this study. To safeguard the confidentiality of study participants, the units are identified only as A, B, and C. These nursing units were situated within the same urban tertiary institution in a mid-sized Western Canadian city. In total, 19 RNs employed in specialized care units participated in this research. Methods/Procedure: The study was conducted from March 2012 through September 2013 following ethical and operational approval from all required institutions. During this 18-month period, 19 RN participants were engaged in a total of 25 interviews and several participants were invited to submit personal reflective journals, with 8 sets of journals submitted and included as part of the study data. Following transcription, the interviews as well as the journal entries were entered into the ATLAS.ti software program to aid with organization of study coding. Data analysis was completed following the constructivist grounded theory approach of Charmaz (2006). Findings: Key findings from this research included the identification of competence in the specialized RN role as a main concern for participants. The achievement of competence was influenced by two Basic Social Processes (BSPs) relating to the transition and integration of new RNs into their specialized environments. For each of these BSPs, there are additional phases that further define the experience. Developing a Sense of Specialized RN Self (transition) included the phases Finding RN Fit, Sharing Passion and Community Values, and Embracing Life-Long Learning. Integrating into Specialized RN Practice (integration) included the phases Learning the Ropes and Settling In. The social context for this development was a CoP in each specialized unit and the particular aspects of these nursing community groups were also uncovered during the course of this research and are detailed in the study findings. Conclusions: These research results have highlighted the importance of delineating the fundamental differences in the processes of RN transition and integration. The findings have also provided a foundation for a newly emerging consideration of CoPs in nursing and their potential role in supporting the transition and integration of RNs. Knowing more about how CoPs function in their workplaces may allow RNs, either newly graduated or new to their specialty areas, to be more successful in their own transition and integration experiences.

This project study addressed the problem of knowledge and skills lost by new graduate RNs while delayed in transitioning to professional nursing practice. There is a paucity of knowledge about how new RNs experience their delay and how a delay may affect their future clinical performance. Mezirow's transformation learning theory was the conceptual framework for this qualitative case study. Research questions addressed new RNs' understanding of their experiences during a delay to professional practice. A purposeful sample included 8 new RNs who had completed a New Graduate Residency Transition Program (NGRTP) after a delay to practice of 6 months to 3 years. Four managers of the RN participants were also included in the sample. Data were collected through audio-recorded semistructured interviews and manager questionnaires. Qualitative data were coded and analyzed to identify themes. Findings indicated that while waiting for a RN position, the delay to practice new RN (DTP-RN) passed through stages that reflected clinical and professional needs. The consequences of the new RNs' delay to practice may impact the required NGRTP process. Findings influenced the development of a white paper to educate hospital nurse educators and managers about the DTP-RNs' unique needs. Recommendations include a NGRTP designed to meet the transition needs of the DTP-RN. Implementation of recommendations for a NGRTP may enhance the DTP-RNs' successful transition into professional practice with a result of greater job satisfaction and decreased RN turnover.