Nursing students’ experiences of a post-licensure practical nurse bridging program: a qualitative systematic review
Authors: McCloskey Rose , Keeping-Burke Lisa , Morris Patricia , Witherspoon Richelle , Knight Holly , Cave Sara 
Published: May 2023

Objective:
The objective of this systematic review was to synthesize qualitative evidence on students’ experiences of a post-licensure practical nurse to registered nurse bridging program.

Introduction:
A worldwide shortage of registered nurses has prompted governments and educational institutions to develop alternate pathways to nursing licensure. One strategy used to increase the supply of registered nurses is bridging programs. Such programs grant practical nurses academic credit for previous educational and practical experience, which allows them to complete a bachelor of nursing degree in a shorter length of time. Understanding the experience of students enrolled in bridging programs will help identify their specific needs and the educational support needed for them to successfully transition into the registered nurse role.

Inclusion criteria:
This review considered qualitative studies that examined the experiences of practical nurses enrolled in bridging programs. Studies published in English were included with no date limits applied to the searches.

Methods:
The literature search was conducted in CINAHL, MEDLINE, Embase, and ERIC. The search for unpublished articles included ProQuest Dissertations & Theses and GreyNet International. Papers were screened independently by 2 reviewers against the inclusion criteria. Papers that met the criteria were appraised using the JBI critical appraisal checklist for qualitative research. Key findings were extracted from the included studies using a standardized tool and classified as unequivocal or credible. The review followed principles of meta-aggregation in line with the JBI approach. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis.

Results:
Twenty-four studies, published between 1989 and 2020, were included in the review. A total of 83 findings were extracted and aggregated into 11 categories. From the 11 categories, 4 synthesized findings were developed and are summarized as: i) growth through professional advancement reflects that bridging students report personal growth and professional transformation when they return to school and study to become a registered nurse; ii) need for support indicates that bridging students recognize and appreciate a need to have positive support networks in their lives, mainly with their family, co-workers, and classmates; iii) expecting more reflects that, as adult learners with prior nursing experience, bridging students anticipate receiving more support from the educational institutions and higher levels of clinical expertise and competence amongst faculty than what is provided; and iv) finding balance indicates that bridging students struggle to balance and manage multiple roles and responsibilities in their lives as they return to school to study to become a registered nurse.

Conclusion:
The findings of this review highlight that, as adult learners with prior nursing experience, when post-licensure practical nurses return to study there is often a need to balance multiple roles and responsibilities. It is with the support of family, co-workers, classmates, and faculty that bridging students are able to manage competing personal and academic demands. While many bridging students express disappointment with some of the learning opportunities and/or faculty expertise associated with the nursing program, they ultimately achieve growth through both personal and professional advancement upon program completion and becoming a registered nurse.

Systematic review registration number:
PROSPERO CRD42021278408