Neonatal nurse practitioner role transition: the process of reattaining expert status

Super-Mentors to Train Multiple Neonatal Advanced Practice Providers: Pros and Cons

BACKGROUND

Despite available training programs for neonatal advanced practice providers (Neo APP), including neonatal nurse practitioners and physician assistants, it is difficult to meet the demand for these providers. There are no publications regarding training models with greater than 1 Neo APP learner per mentor.

PURPOSE

To create and measure outcomes of a 12-month program to educate Neo APP "Super-Mentors" able to train 2 Neo APP learners simultaneously.

METHODS

Super-Mentors were selected and attended monthly classes to learn mentorship concepts and receive support. Learners received didactic content and support through a Fellowship program. Quantitative data regarding recruitment and retention, as well as Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) results were compared pre- and postprogram. Qualitative satisfaction measures via survey from 21 stakeholders were analyzed through a phenomenological approach.

RESULTS

Six Super-Mentors trained 14 Neo APPs, as compared to 7 in the previous year. One Neo APP left after training. Summative preprogram MNPJSS scores were better (5.1 ± 0.37) than postprogram (4.7 ± 0.47) ( P < .001). The most important preprogram subscale item was "vacation" versus "quality of assistive personnel" postprogram. Both pre- and postprogram scores reflected positive job satisfaction so differences may not be clinically significant. Qualitative program benefits included faster and increased onboarding, stronger relationships, and dedicated time. Challenges included role clarity among other stakeholders, learning culture, and spacial/technological logistics.

IMPLICATIONS FOR PRACTICE

Super-Mentors can train twice the number of Neo APP learners, with optimal preparation and support of all stakeholders, adequate space, and appropriate technology.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BACKGROUND

Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.

METHODS

We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).

RESULTS

We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.

CONCLUSIONS

We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Outcome Evaluation of a Health System Clinical Nurse Specialist Fellowship Program

PURPOSE

Healthcare is a complex adaptive system, requiring agile, innovative leaders to transform care. Clinical nurse specialists (CNSs) are uniquely positioned to influence change and achieve high-quality outcomes. Nurse leaders need strategies to onboard and retain CNSs considering high demand across the nation. The purpose of this program evaluation was to describe the core components and outcomes of CNS fellowship programs.

DESIGN

This program evaluation used the Kirkpatrick Model as a framework to assess learning and knowledge translation.

METHODS

The study was conducted within 3 Indiana healthcare organizations. Clinical nurse specialist leaders from each organization identified fellowship core components and analyzed team composition (ie, percentage of CNS team that was current/past fellows). Current and past CNS fellows were invited to participate in a survey evaluating program effectiveness, impact on role transition, project leadership, and outcomes achieved.

RESULTS

Overlap was identified among 85% (17/20) of the core components, team composition was 71% (25/35) past/current fellows, and retention was 100% (12/12). Of the 23 invited, 18 (78%) participated in the program evaluation. Program effectiveness was evaluated as very/extremely effective by 94% (17/18) of participants. Themes salient to independent practice transition were applying learning, achieving influence, and developing relationally, contributing to incremental gain of the CNS perspective (ie, CNS values and guiding principles influencing critical thinking and behavior).

CONCLUSION

Nurse leaders should consider fellowship implementation to recruit and retain CNS talent within organizations.

Growing the Neonatal Nurse Practitioner Workforce Through Mentoring: A Scoping Review

OBJECTIVE

The purpose of this article is to highlight evidence specific to the neonatal nurse practitioner (NNP) workforce related to successful mentoring programs. Specifically, the authors of this article explored recent evidence of mentorship to improve job satisfaction and retention of the NNP workforce.

BACKGROUND

NNPs are valuable members of neonatal healthcare team. Because of the aging NNP workforce, methods to recruit, train, mentor, develop, and retain new NNPs are imperative.

METHODS

Using a quality appraisal tool from the PRISMA extension for scoping reviews, articles were identified through electronic database searches using search terms related to mentoring, nurse practitioners, recruitment, and retention. Studies published in English between 2013 and 2023 were included. Peer-reviewed quantitative and qualitative articles were synthesized and critically appraised by 4 reviewers.

RESULTS

The authors identified 46 articles with a focus on mentoring in nursing of which 12 articles include mentoring for nurse practitioners. Research indicates that mentoring relationships are valuable in many healthcare roles and professions. Evidence is limited indicating the impact of mentoring in the highly specialized role of the NNP.

CONCLUSION

Mentoring is an invaluable component of professional nursing and counters incivility while advancing competency, job satisfaction, and retention. Additional research is needed regarding NNP-specific mentoring programs.

Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship

BACKGROUND

Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist.

PURPOSE

The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role.

METHODOLOGY

Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed.

RESULTS

"Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship" emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting.

CONCLUSIONS

The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship.

IMPLICATIONS

This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.

Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study

BACKGROUND

Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.

METHODS

Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.

RESULTS

Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.

CONCLUSIONS

Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.

Development and evaluation of a neonatal nurse practitioner mentoring workshop

ABSTRACT

New graduate neonatal nurse practitioners (NNPs) need more than an orientation; they need mentoring to facilitate successful role transition and enhance job satisfaction. A gap exists in the literature about mentoring participant training and launching of successful programs for NNPs. This article provides an overview of the development and evaluation of a nurse practitioner (NP) mentoring workshop before the start of a formalized mentoring program. Workshop participants attended a half-day education event with an emphasis on mentoring program expectations, mentor and mentee roles, and effective communication. After the workshop, participants completed an electronic survey to evaluate satisfaction with the teaching and areas for improvement. From January 2022 through January 2023, newly hired NPs paired with experienced NP mentors participated in this structured workshop. Twenty-eight participants in two cohorts evaluated the workshop to identify meaningful aspects of the presentations and areas for improvement. Participants reported high levels of satisfaction with the interactive components of the 4-hr workshop. An interactive mentoring workshop helps participants establish realistic expectations and mutual goals. Further study is needed to identify time- and cost-efficient strategies in the preparation of effective mentoring participants to enhance the quality of mentoring programs.

Implementation and Evaluation of a Nurse Practitioner Onboarding Program at a Large Healthcare Facility

A comprehensive, evidence-based onboarding program benefits healthcare workers and institutions. Many institutions do not have onboarding programs for new nurse practitioners (NPs). In this quality improvement initiative, a standardized onboarding program was developed. The impact on NP satisfaction and retention was evaluated. Lead NPs were identified as program managers. Program components included role introduction, competency validation, review of administrative essentials, ongoing progress logs, and program evaluations. The program resulted in increased NP satisfaction and retention.

Novice nurse practitioners' employment decisions and role transition experiences during COVID-19

BACKGROUND

While it is known how the COVID-19 pandemic affected providers already employed and working in health care settings, there is little data about the effect it may have had on novice nurse practitioners (NPs).

PURPOSE

The purpose of this study was to describe novice NPs' employment decisions and role transition experiences during the COVID-19 pandemic.

METHOD

Via an online survey, novice NPs were asked open-ended questions about how the pandemic influenced the decision to take their first position and their role transition experience, as well as what employers did well or could have done better to facilitate this transition.

FINDINGS

Participants described employment challenges that included a difficult job market with limited employment opportunities, decreased pay and benefits, fewer onboarding and mentorship opportunities, and less primary care experience. However, NPs reported the pandemic positively influenced their role transition experiences with decreased patient workload and greater use of telehealth.

CONCLUSION

Novice NPs were impacted by the COVID-19 pandemic in making employment decisions and transitioning into the NP role.

Physician assistant and nurse practitioner onboarding in primary care: The participant perspective

BACKGROUND

Many new graduate primary care physician assistants (PAs) and nurse practitioners (NPs) can experience stress and difficulty as they transition to practice. Feelings of anxiety and role ambiguity are common and can lead to costly turnover, impact care continuity, and place patients at risk for poor clinical outcomes. Onboarding, the process of helping new hires adjust to social and performance aspects of their new job and has the potential to ease transition to practice for PAs and NPs. Recent research has linked PA/NP onboarding programs to increased engagement, decreased turnover, and higher clinical productivity.

PURPOSE

To describe new graduate PA and NP perspectives of onboarding programs they completed in their first primary care position.

METHODOLOGY

Thirteen semistructured interviews were conducted with new graduate PAs and NPs who participated in onboarding programs. Interviews were transcribed and then analyzed using an inductive coding methodology.

RESULTS

Analyses revealed nine thematic concepts that are described within two frameworks. Structural components include improving competence, training on the electronic health record, promoting mentorship, orienting to organizational dynamics, tailoring ramp-up of patient scheduling, clarifying expectations, and providing clear organizational support. Psychosocial factors include creating comfort and building self-confidence.

CONCLUSION

Understanding participants' experiences with onboarding programs is essential for ensuring successful transition to practice for new graduate PAs and NPs.

IMPLICATIONS

These findings are beneficial to the health care workforce. Administrators can incorporate these findings into existing and future programs, and new graduate PAs and NPs can negotiate for the inclusion of these components in their first position.

PA and NP onboarding in primary care: The participant perspective

OBJECTIVE

To describe new graduate physician associate/assistant (PA) and NP perspectives of onboarding programs in their first primary care position.

METHODS

Thirteen semistructured interviews were conducted with new graduate PAs and NPs who participated in onboarding programs. Interviews were transcribed and then analyzed using an inductive coding methodology.

RESULTS

Analyses revealed nine thematic concepts that are described in two frameworks. Structural components are improving competence, training on the electronic health record (EHR), promoting mentorship, orienting to organizational dynamics, tailoring ramp-up of patient scheduling, clarifying expectations, and providing clear organizational support. Psychosocial factors are creating comfort and building self-confidence.

DISCUSSION

The results describe and delineate important components for onboarding that administrators can incorporate into existing and future programs.

CONCLUSION

Understanding participants' experiences with onboarding programs is essential for ensuring successful transition to practice for new graduate PAs and NPs.

Utilization and Meaningfulness of National Association of Neonatal Nurse Practitioners' Mentoring Toolkit Activities

BACKGROUND

Mentoring is a process in which a more skilled or experienced person builds a supportive relationship with a less experienced person to promote the latter's professional development. The National Association of Neonatal Nurse Practitioners (NANNP) supports the establishment of formalized mentoring programs for neonatal nurse practitioners (NNPs) and published a mentoring toolkit in 2017. Completing suggested activities outlined in the toolkit promotes the incorporation of evidence-based practice into the NNP professional role.

PURPOSE

This quality improvement project's purpose was to measure utilization and meaningfulness of NANNP mentoring toolkit activities.

METHODS

A convenience sample of 21 nurse practitioners was paired in 2 mentoring cohorts. Dyads were encouraged to meet monthly to complete NANNP mentoring toolkit activities in the context of a formalized mentoring program. Monthly data were collected to evaluate use and meaningfulness of the toolkit activities. Quantitative data included frequency and length of mentoring meetings, activities completed, and ratings of meaningfulness on a Likert-type scale.

RESULTS

Six of the 9 (67%) NANNP mentoring activities completed by the 2 cohorts were rated as "meaningful" or "very meaningful" by participants.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Activities from the NANNP mentoring toolkit provide structure to mentoring relationship development. Recognizing the challenge to recruit and retain NNPs, organizations are encouraged to explore creative solutions to develop and support formalized mentoring programs. Further research is warranted to validate use of NANNP toolkit activities in the establishment and evaluation of a formalized mentoring program in various neonatal intensive care unit settings.

Supporting Role Knowledge and Role Transition in Neonatal APRN Students

Advanced practice registered nurses (APRNs) play a critical role in alleviating provider shortages and expanding access to health care services for medically underserved populations. To meet these shortages, the APRN workforce is growing faster than the average for all occupations. This creates a critical need for effective transitioning from the role of student to APRN provider. Unfortunately, transitioning to the APRN role is not seamless and role confusion or challenges in role exposition can contribute to job stress and even role exodus. A recent quality improvement project supported student understanding of APRN roles and anticipation of role transition challenges for neonatal students preparing for roles as nurse practitioner and clinical nurse specialist. This strategy has the potential to contribute to successful role transition of neonatal nurse practitioner and neonatal clinical nurse specialist students.

Growing Neonatal Advanced Practice Providers via Mentorship Can Fill the Need: Program Description and Tool Kit

BACKGROUND

The need for neonatal advanced practice providers (APPs) has been described. Hospital training programs for neonatal physician assistants (PAs) have been developed by physicians. No publications exist about programs administered by neonatal APPs for both new graduate neonatal nurse practitioners (NNPs) and neonatal PAs.

PURPOSE

The purpose of this work was to mentor, train, and hire neonatal APPs in a program administered by neonatal APPs.

METHODS

We developed a 2-pronged approach to attract PAs and new graduate NNPs. Marketing strategies included receptions, information, and mentorship. A 12-month neonatal PA fellowship program included clinical mentorship and weekly didactics. Case-based presentations were provided by neonatal APPs, neonatologists, and allied professionals. The new graduate NNP program included clinical mentorship and monthly meetings with peer support, lectures, and case presentations. Neonatal APPs were clinical mentors. Team-building activities supported mentorship and collaboration among all care providers.

FINDINGS

In less than 5 years, 10 PAs and 11 new graduate NNPs have been trained and hired, as well as experienced neonatal APPs hired for this regional neonatology program. For the first time in years, locum tenens neonatal APPs are not required. We have developed a "tool kit" of content, activities, exercises, and evaluations to support successful attainment of expected competencies.

IMPLICATION FOR RESEARCH

Future studies can measure retention, satisfaction, and clinical outcomes.

IMPLICATION FOR PRACTICE

A successful training program has been implemented to meet the growing demand. We support the values of integrity, collaboration, and equity to facilitate this successful paradigm shift among all neonatal professional team members.

Advanced Practice Registered Nurse Transition to Practice in the Long-Term Care Setting: An Ethnography

Advanced practice registered nurses are successful in improving quality outcomes and filling provider care gaps in long-term care. However, little is known about the nurse’s transition to practice in this setting. A 12-month ethnography was conducted via participant-observation with nine advanced practice registered nurses in five long-term care facilities to understand practice environment influence on the nurses’ transition and on the reciprocal influence of the nurse on the practice environment. Transition was fraught with uncertainty as documented by five themes: where’s my authority, institutional acceptance, personal role fulfillment, provider relationships, and individual versus organizational care. These findings suggest that transition in this setting is complex, characterized by insecurity whether the individual is new to advanced practice or experienced. Transition in long-term care could be strengthened by formal programs that include clinical practice, reconceived mentorship for advanced practice registered nurses, and education designed to improve comfort and expertise with indirect care.

Do We Nurture Our Young? Qualitative Conceptual Analysis of Worst and Best Mentorship Experiences Among Neonatal Advanced Practice Providers

BACKGROUND

There is increasing demand for neonatal advanced practice providers (APPs) and a shortage of neonatal nurse practitioners (NNPs). In many neonatal intensive care units, neonatal physician assistants are trained and hired, as well as new graduate NNPs. Neonatal APPs are utilized as mentors in a regional neonatology program in the Pacific Northwest. As part of a long-term goal to develop an educational program for neonatal APP mentors, an initial survey was administered.

PURPOSE

The purpose of this survey was to raise personal insight and identify themes about 51 neonatal APP mentors' recollections of one's own worst and best mentorship experiences.

METHODS

The design used in this content analysis of survey responses included a phenomenological, qualitative approach. The participants received an online survey consisting of 2 questions asking them to describe their worst and best mentorship experiences. The blinded results were analyzed via content analysis by 2 coinvestigators.

RESULTS

Consistent themes about worst experiences include "Eat our young," "I am better than you," "Thrown under bus," and "Unwanted." Consistent themes about best experiences include "Validation," "Empowerment," "Positivity," and "Inclusion."

IMPLICATIONS FOR PRACTICE

Recommendations for successful neonatal APP mentorship based upon the recurrent themes include use of consistent, engaged, trained, and supported mentors, provision of on-time constructive feedback, avoidance of public criticism, private and public praise, focus on the learner, preparation for tasks, and semiautonomy, with adequate support.

IMPLICATIONS FOR RESEARCH

Absenteeism, recruitment, retention, and satisfaction data may be measured to determine whether structured mentorship programs are beneficial.

Clinical teaching behaviour effects professional identity and transition shock in new nurses in western china: A cross-sectional study

Aim

To examine the interrelationship between professional identity, clinical teaching behaviour and transition shock for new nurses in Western China.

Design

A cross‐sectional design.

Methods

A total of 779 new nurses were recruited in Gansu province and Lanzhou city from June to July 2019. Each patient was given three questionnaires to complete, and structural equation modelling was used to identify the relationships.

Results

The overall mean scores for the transition shock, professional identity and clinical teaching behaviour were 92.53(SD = 22.17), 89.74(SD = 16.57) 80.12(SD = 12.38), respectively. The most important aspects identified were the Physical aspect, the Sense of Mastery and Committing to Teaching. Professional identity and clinical teaching behaviour were negatively related to transition shock, a better sense of identity coupled with supportive clinical teaching were keys to a smoother journey from new to experienced nurses.

Job Satisfaction and Retention of an Advanced Practice Registered Nurse Fellowship Program

The purpose of this study was to determine how an advanced practice registered nurse (APRN) fellowship program affects job satisfaction and retention after the first year of practice. The Misener Nurse Practitioner Job Satisfaction Scale was administered to nine novice APRNs at a large Midwestern children's hospital after program completion. Job satisfaction scores and retention rates were measured. Results indicate that transition-to-practice programs are helpful in bridging the gap between graduation and professional practice as an APRN.

Development of the novice nurse practitioner role transition scale: An exploratory factor analysis

BACKGROUND

Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.

PURPOSE

The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.

METHODS

Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.

RESULTS

The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.

IMPLICATIONS FOR PRACTICE

In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.

Effects of completing a postgraduate residency or fellowship program on primary care nurse practitioners' transition to practice

BACKGROUND

To prepare new graduate nurse practitioners (NPs) for transition to practice, postgraduate residency or fellowship programs have been spreading across the nation in the past decade.

PURPOSE

We examined the effects of completing a postgraduate residency or fellowship program on role perception, practice autonomy, team collaboration, job satisfaction, and intent to leave among primary care NPs (PCNPs).

METHODS

We analyzed 8,400 PCNP respondents, representing a total of 75,963 PCNPs nationwide, to the 2018 National Sample Survey of Registered Nurses. We conducted multivariate logistic regression analyses to examine whether completing a postgraduate training program was associated with increased role perception, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave in their work, controlling for NP personal and practice characteristics.

RESULTS

About 10% of PCNPs completed some form of postgraduate training. Primary care NPs who had completed a residency or fellowship program were more likely to have a minority background (e.g., non-White and male) and also see more underserved populations (e.g., minority background, with limited English proficiency) than those without residency training. We found that PCNPs with residency training were more likely to report enhanced confidence in independent roles, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave than those without residency training.

IMPLICATIONS FOR PRACTICE

This study supports further expansion of such programs, which would have positive effects for NPs, health care organizations, and patients, necessitating a long-overdue conversation about real public funding for primary care graduate nursing education.

A Community Psychiatry Nurse Practitioner Fellowship: Preparing Nurse Practitioners for Mental Health Workforce Expansion

The increasing need for psychiatry services in medically underserved communities has proven to be challenging for health care systems. Caring for this population is complex and can be overwhelming for the inexperienced provider. Proper utilization of psychiatric and mental health nurse practitioners in this setting can expedite meeting the mental health needs of the community. A postgraduate fellowship program that provides supervision and additional training specific to community psychiatry facilitates the transition from novice provider to experienced clinician while aiming to improve retention rates. In this Open Forum, the authors outline the structure of a federally qualified health center's Community Psychiatry Nurse Practitioner Fellowship.

Empowering the novice family nurse practitioner: Promoting readiness to practice through immersion in an innovative educational strategy

ABSTRACT

The demand for primary care providers in the United States is on the rise with projected shortages by the year 2025. The number of primary care nurse practitioners (NPs) is expected to nearly double from 2013 to 2025 in an effort to respond to the growing demand for primary care services both regionally and nationally. Nurse practitioners are key to addressing the current and future shortage of health care providers, especially in primary care. However, novice NPs face a significant challenge when transitioning from the registered nurse role to the advanced practice role, which can affect job satisfaction and retention. The purpose of this project is to assess the implementation of a structured Clinical Transition Program (CTP) embedded within a family NP (FNP) educational program as a learning strategy to strengthen readiness to practice and promote successful role transition in the novice FNP graduate. The CTP includes primary care clinical placements as well as specialty clinical rotations and intentional clinical placements in varied settings, including those in rural and underserved areas. Participation in the program had a positive effect on perceived readiness to practice for students at graduation and 9 months after graduation. Nurse educators, armed with the knowledge of the importance of successful role transition for the new NP, must continue to develop, implement, and assess educational opportunities that promote and support readiness to practice within existing NP programs.

Facilitators and barriers to the novice nurse practitioner workforce transition in primary care

BACKGROUND AND PURPOSE

Little is known about the facilitators and barriers to the workforce transition of novice nurse practitioners (NPs) in primary care. This research aimed to identify factors contributing and detracting from a successful initial workforce transition for novice NPs in the primary care setting.

METHODS

A descriptive, cross-sectional study was conducted via online survey administered to a national sample of 177 NPs who graduated from an accredited NP program and were practicing in a primary care setting for 3-12 months. Open-ended responses were analyzed using the Krippendorff content analysis method.

CONCLUSIONS

This study demonstrated that facilitators of the novice NP transition are the presence of mentorship and social support, finding meaning in their work, job satisfaction, and work-life balance. Barriers to the novice NP transition are lack of support and respect, role ambiguity, and workload.

IMPLICATIONS FOR PRACTICE

More mentorship, support, role clarity, and respect are needed to facilitate the novice NP workforce transition. More research is needed on interventions that can be implemented by health care organizations to improve the facilitators of role transition identified in this study.

Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review

New graduate nurse practitioner (NP) postgraduate support programs and interventions have proliferated, sparking controversy. The Institute of Medicine/National Academy of Medicine recommends residency programs for new graduate NPs; however, the NP community debates whether new graduate NPs need additional training and whether such training compromises patient access to care. This systematic review aimed to synthesize evidence regarding the effectiveness of interventions and strategies to promote the professional transition of new graduate NPs. Interventions identified in the current literature included fellowship programs and a webinar. Strategies included mentorship, experiential learning, interprofessional training, and professional socialization. The studies reviewed primarily evaluated NPs' perceptions of the interventions' effects on their professional transitions. The findings from this systematic review highlight challenges in evidencing postgraduate support programs. The small number of available studies underscores a critical problem for the NP community: additional evidence is needed to inform whether and how to support new graduate NPs as they transition to practice.

Mentoring New Graduate Nurse Practitioners

There is a critical shortage of neonatal nurse practitioners (NNPs) in the United States. The NNP shortage increases workload and negatively affects job satisfaction, which ultimately impacts patient safety. Therefore, it is imperative to identify strategies to improve job satisfaction and retention. Authors of current evidence supported the connection between mentoring and role transition, job satisfaction, and intent to stay. Mentorship is key to the success of new graduate nurse practitioners as they develop confidence in the nurse practitioner (NP) role. The aim of this integrative review is to examine the existing evidence regarding mentoring of advanced practice nurses and the potential impact on the NNP workforce.

An educational intervention to enhance nurse practitioner role transition in the first year of practice

BACKGROUND AND PURPOSE

Role transition is a natural process that occurs when the registered nurse pursues additional education to become a nurse practitioner (NP). Role transition generates feelings of anxiety and insecurity, leading to a longer and more tumultuous adjustment. This study investigated whether an evidence-based role transition webinar would support NP role transition during this critical period.

METHODS

This study was a nonrandomized, pretest-posttest, and single-group study using a convenience sample to address the research question: "Does completion of a role transition webinar enhance the perception of new NPs of their ability to perform well in their role?"

CONCLUSIONS

The educational webinar was shown to have a positive influence on some aspects of the participant's reported perceptions of NP role transition. Having practical and assessable educational interventions to optimize NP role transition and determining factors that contribute to the success of these interventions would be prudent.

IMPLICATIONS FOR PRACTICE

This is the first quantitative study to investigate the positive association between an online educational intervention and NP role transition. A timelier and less tumultuous transition would allow NPs to perform more effectively in their new role.

Nurse Practitioner Role Transition and Identity Development in Rural Health Care Settings: A Scoping Review

AIM

The purpose of this scoping review was to explore the literature regarding the nurse practitioner (NP) role transition and professional identity development at rural health care settings.

BACKGROUND

Because of the shortage of primary care providers, NPs are meeting the demand for primary care in rural areas.

METHOD

Arksey and O'Malley's six-stage methodological framework for scoping reviews guided this systematic literature review, which resulted in selection of 145 sources.

RESULTS

Three major themes emerged: NPs in rural clinical practice, defining NP professional identity, and role transition to an NP identity.

CONCLUSION

Further research is needed to guide education program leaders on curriculum development. Rural health care facilities and nursing programs should partner in the orientation and continuing education needs of NPs to prepare and support their role transition and professional identity development. NPs will be instrumental in providing access to quality primary health care in rural communities.

How does role transition affect the experience of trainee Advanced Clinical Practitioners: Qualitative evidence synthesis

BACKGROUND

Advanced Clinical Practitioners have been developed to address current and future gaps in the medical workforce. Insight into problems associated with Advanced Clinical Practitioner transition may help present and future trainees adapt to their changing and demanding health environment.

AIMS

To identify potential problems experienced by trainee Advanced Clinical Practitioners during transition and what the implications might be for workforce planning.

DESIGN

A qualitative evidence synthesis to examine the issue of role transition for Advanced Clinical Practitioners.

DATA SOURCES

The electronic databases accessed (1997-2016) were MEDLINE, EMBASE, CINAHL, BNI, AMED and PubMed and also included Researchgate, thesis publications, hand searching and NHS staffing reports.

REVIEW METHODS

Eleven studies were identified between 1997 - 2016. Thematic synthesis was undertaken, creating codes, descriptive and analytical themes. Quality appraisal of individual studies was conducted using the tool of Walsh and Downe.

FINDINGS

Six analytical themes were identified that addressed the key issues of transition discussed in the 11 articles and which were directly related to the proposed research project: experience of change, orientation to role, mentorship, clinical skills, clinical supervision and Masters' level education.

CONCLUSIONS

Findings from all 11 articles were similar. Where these six themes were ignored, there was often either a failure to reach expected goals or resignation from the role. Future employers must ensure that they establish a comprehensive orientation and education programme to be certain that qualified Advanced Clinical Practitioners are suitably prepared for their role in health care.

Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden

New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

Novice Physician Assistant Learning During the Transition to Practice: A Q Study

PURPOSE

The purpose of this study was to describe how novice physician assistants (PAs) transfer learning from formal training into clinical practice.

METHODS

This Q study was conducted as a part of a larger mixed-interpretive investigation of the experiences of novice PAs during the first 2 years of practice. A set of 45 statements was naturally sampled from 10 previously conducted semistructured qualitative interviews with novice PAs. Fifteen different novice PAs then sorted the statements. The data were analyzed using by-person factor analysis (Q methodology). The resultant factor array was used to generate a summary, a sketch, and a monologue for each shared social perspective.

RESULTS

Three shared social perspectives concerning transfer of learning during the transition to practice emerged: (1) partnership, (2) self-reliant, and (3) insecure perspectives. Novice PAs sharing the partnership perspective experienced few, if any, individual or environmental obstacles to transfer of learning. Novice PAs sharing the self-reliant perspective experienced environmental obstacles-but few, if any, individual obstacles-to transfer of learning. Novice PAs who shared the insecure perspective experienced both individual and environmental obstacles to transfer of learning.

CONCLUSIONS

The results of this study describe variability in the novice PA experiences of learning transfer during the first 2 years of practice. The results have implications for PA educators and those involved in helping novice PAs develop as clinicians.

Novice Nurse Practitioner Workforce Transition Into Primary Care

The purpose of this integrative review was to analyze the current state of the science related to the novice nurse practitioner (NP) transition into primary care. A systematic review of the literature was conducted using the databases Pubmed, MEDLINE, Ovid, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with the terms nurse practitioner, role, and transition to search articles published after 1997. Three major themes emerged from the literature related to the novice NP transition into primary care. These themes were categorized as “experiencing role ambiguity,” “quality of professional and interpersonal relationships,” and “facing intrinsic and extrinsic obstacles.” Strategies to reduce role ambiguity, improve the quality of professional relationships, and mitigate extrinsic obstacles faced by novice NPs may improve their transition into the primary care workforce. Educational institutions, employers, and novice NPs all have a stake in the successful transition from student to primary care practitioner and should be engaged in developing effective NP transition-to-practice programs.

Novice nurse practitioner workforce transition and turnover intention in primary care

PURPOSE

Little is known about the workforce transition and turnover intention of novice nurse practitioners (NPs) in primary care (PC). This research aimed to describe the individual characteristics, role acquisition and job satisfaction of novice NPs, and identify factors associated with their successful transition and turnover intention in the first year of PC practice.

DATA SOURCES

A descriptive, cross-sectional study was conducted via online survey administered to a national sample of 177 NPs who graduated from an accredited NP program and were practicing in a PC setting for 3-12 months.

CONCLUSIONS

This study demonstrated that greater professional autonomy in the workplace is a critical factor in turnover intention in novice NPs in the PC setting.

IMPLICATIONS FOR PRACTICE

Further research is needed regarding the novice NP workforce transition to provide adequate professional autonomy and support during this critical period.

Journey to Becoming a Neonatal Nurse Practitioner: Making the Decision to Enter Graduate School

BACKGROUND

Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice.

PURPOSE

To describe how nurses decide to enter graduate school to become nurse practitioners.

METHODS

A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs.

RESULTS

Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program.

IMPLICATIONS FOR PRACTICE

Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools.

IMPLICATIONS FOR RESEARCH

Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.

The Future of Neonatal Advanced Practice Registered Nurse Practice: White Paper

In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles.

Mentoring and Self-Efficacy: Implications for the Neonatal Nurse Practitioner Workforce

BACKGROUND

Mentoring facilitates positive self-efficacy. Individuals with high self-efficacy emulate professional resiliency and possess a strong sense of optimism in their ability to adapt, overcome, and persevere in the professional arena.

PURPOSE

The purpose of this study was to identify characteristics that encourage mentoring relationships between neonatal nurse practitioner (NNP) students and preceptors, as well as student perceptions of mentoring relationships.

METHODS

A 29-item survey composed of demographic items, the Freeman Mentoring Survey, the Self-Efficacy Scale, and the Confidence Scale, along with qualitative questions, was disseminated to NNP students enrolled in their final clinical practicum course from August to October 2014.

RESULTS

Students who sought out their own preceptor "by choice" reported higher self-efficacy scores (P = .046) and mentoring scores (P = .047). Students who perceived their preceptor as a mentor (91%) expressed readiness to assume the role of advanced practice registered nursing after graduation. An average of 37.2 hours is required for a student to adapt to a clinical site and preceptor.

IMPLICATIONS FOR PRACTICE

Mentorships between preceptors and NNP students, grounded in the provisions of trust, stability, encouragement, and hope, facilitate positive self-efficacy for the student learner. All NNPs must commit to the integration of mentoring programs in the clinical setting as well as seek out teaching-coaching opportunities with NNP students to demonstrate their unwavering commitment to the NNP workforce.

IMPLICATIONS FOR RESEARCH

Further investigation of the impacts of mentoring relationships upon job satisfaction, recruitment and retention, the teaching-coaching role, and scholarship activities of actively practicing NNPs is indicated.

Nurse Practitioner Role Transition: A Concept Analysis

AIM

A concept analysis of nurse practitioner (NP) role transition.

BACKGROUND

The Affordable Care Act is expected to provide 32 million Americans with health insurance, and NPs are gaining attention in addressing this increasing demand for healthcare providers. However, there is limited analysis of the transition from registered nurse to NP. Oftentimes, during this transition, there is a shift from an experienced, expert status to an inexperienced, novice status, with a subsequent loss of confidence in one's ability and competence. This can hinder successful role development and affect employment continuity within the first year of practice.

METHODS AND SOURCES

NP role transition was examined using Walker and Avant's method of concept analysis. Electronic databases were searched using the terms role transition and nurse practitioner. Thirty articles from nursing, psychology, and business were included.

FINDINGS AND CONCLUSIONS

The four defining attributes of NP role transition are absorption of the role, the shift from provider of care to prescriber of care, straddling two identities, and mixed emotions. Personal and environmental antecedents and consequences of the concept are identified. The development of empirical knowledge on NP role transition through further research is important in order for new-to-practice NPs to become high-quality, full-functioning providers.