Role Transition Experiences of Nurses Providing Advanced Practice HIV Care in Nigeria: A Qualitative Descriptive Study

Result: The transition was situational. There were three organizational patterns of implementation with distinct levels of nurse-awareness, engagement and role preparation. The facilitators included: Personal/Professional meanings derived from altruistic, patient-focused objectives (e.g. "to alleviate patient suffering"); Preparation and Knowledge through training and mentoring (in most cases), self-study using books, internet and other resources; Perceived confidence, sense of empowerment, ability and opportunity to apply knowledge and skill; Intraand inter-professional changes in attitude and recognition. A nursing culture to "step-down training" extended the role to other nurses. Inhibiting factors were: Resistance and criticisms from nurses, physicians, pharmacists and lab scientists; Lack of confidence in nurses' ability; and outright refusal by some physicians to allow new role. Patterns of response include: Peer education; Respect with assertiveness; Reliance on trained, experienced nurses as mentors; Selfdeveloped supportive networks; Transfer to other units to enable role transition; and Delegation of prior roles. Participants perceive their professional identity gradually changing to a higher level of connectedness and believe their new role has positively influenced patients, professional communities and society.