APRN transition to practice: Program development tips

Outcomes of pediatric-focused advanced practice provider fellowship programs: An integrative review

BACKGROUND

An increased demand for pediatric-focused advanced practice providers (APPs) exists to address the health care needs of children with medical complexity. Postlicensure advanced practice fellowship programs have been developed to help improve novice provider transition to practice, reducing attrition.

OBJECTIVES

The objectives of this integrative review are to (1) identify outcome measurements of pediatric-focused advanced practice fellowship programs and (2) evaluate the outcome measures to guide future implications for practice.

DATA SOURCES

A systematic integrative literature review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses. PubMed, CINAHL, Embase, and Google Scholar were searched in August and September 2022. Articles met inclusion criteria if they included new graduate APPs, reported the intervention of a pediatric fellowship program, and shared outcome measurements. Studies were excluded if they did not directly report on fellowship program outcome measures. Thirteen studies met inclusion criteria and were summarized and appraised for quality using the Johns Hopkins Evidence-Based Practice Model.

CONCLUSIONS

Four themes from the literature included the favorable impact of advanced practice fellowship programs on (a) job satisfaction, (b) retention, (c) clinical and professional performance, and (d) financial outcomes. Variable strategies were used to measure outcomes across programs.

IMPLICATIONS FOR PRACTICE

Postlicensure pediatric-focused advanced practice fellowship programs seem to improve retention and job satisfaction, increase provider confidence, and bring a favorable return on investment for the organization. Future work should include investment in developing validated, standardized assessment tools to support future development of these programs in the pediatric population.

Designing an impactful APRN residency program for rural communities

ABSTRACT

The largest healthcare system in New Mexico, in collaboration with the University of New Mexico College of Nursing, identified an opportunity to increase and retain the number of family practice NPs and certified nurse midwives in rural communities by creating an immersive 1-year rural residency program for newly graduated advanced practice registered nurses (APRNs). This article describes the journey to design this program and build its infrastructure with the aim of addressing the needs of both APRNs during their transition to practice and patients in rural areas, while providing a return on the healthcare system's business investment. Program results are also reported. Program funding was provided by a Health Resources and Services Administration grant, the Presbyterian Healthcare Services executive team, and the Presbyterian Healthcare Foundation.

Beyond competence and retention: Developing a comprehensive evaluation framework for a rural primary care nurse practitioner residency program

ABSTRACT

With the rise in nurse practitioner (NP) residency programs, evaluations have largely focused on retention and competency completion for residents. There is a need for expanded evaluation to ensure the sustainability of NP residency programs, to ensure timely adaptations to address resident satisfaction, and to solidify a long-term pathway of NPs well prepared for rural practice. We created a family nurse practitioner (FNP) residency program with a comprehensive evaluation framework to prepare residents for practice in rural settings. The evaluation framework was developed through collaborative engagement of an external evaluation team, program leadership, and clinical site representatives. The evaluation framework of the FNP residency program combined resident assessment and holistic program evaluation, using a rapid continuous quality improvement (QI) approach. The evaluation considered three distinct perspectives: the resident, the peer coach, and the clinical site. The rapid continuous QI approach allowed program leadership to respond swiftly to programmatic challenges, improve the residency program in response to residents' reported experiences, and emphasize sustainability for continued program impact, while assessing residents' learning and performance. The program's data-driven evaluation approach has demonstrated its success in meeting the goals of the Health Resources and Services Administration funding by increasing the number of primary care providers in rural settings. The program's expansion and continued success have further validated the efficacy of this evaluation framework in assessing, improving, and ensuring the sustainability of APRN residency programs. This article calls for the adoption of similar evaluation strategies in future residency programs to promote their long-term success and impact in rural health care settings.

Battling the "Imposter": Our Experience in the Development of an Advance Practice Provider Fellowship

In the face of ever-evolving shifts in health care, the demand for advanced practice providers (APPs), including nurse practitioners and physician assistants, continues to grow as the nation faces provider shortages and increased patient complexity. Because of different educational backgrounds and previous professional experience, there is a gap in readiness for practice following completion of academic programs, leading to high rates of turnover and financial implications for health care institutions. The creation of APP fellowship programs is a strategy many health institutions implement to provide enhanced support for new graduate APPs. These programs offer fully licensed and credentialed nurse practitioners and physician assistants additional experience within medical specialty areas. The establishment and operational cost associated with an APP fellowship program is a significant barrier health systems face. This article discusses how Saint Luke's Health System developed an APP fellowship program to address these barriers. The model addresses specific fellow needs and has contributed to improved employee retention rates, increased clinical competency, and overall provider satisfaction within Saint Luke's Health System. The evolution of the model, successes, barriers, and opportunities for future program growth are discussed within this article.

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.

An Evaluation of the Postgraduate Physician Assistant/Associate and Nurse Practitioner Orthopedic Surgery Fellowship and Residency Websites in the United States

Background Although considerable research on physician fellowship training program websites has demonstrated critical deficiencies in accessibility and content, there is no published study regarding the website content of physician assistant/associate (PA) and nurse practitioner (NP) orthopedic surgery postgraduate residency/fellowship programs in the United States. Therefore, this study aims to conduct a web-based content analysis to assess the available information on program websites and identify the potential areas for improvement. Methods The methodology for this study was replicated from prior research on graduate medical education (GME) websites. Twenty-two PA and joint PA/NP orthopedic surgery postgraduate residency/fellowship training program websites were assessed between August and September 2022. The criteria comprised 17 items related to postgraduate education and recruitment content. All program websites were evaluated for pertinent content relevant to prospective applicants applying to orthopedic surgery residency/fellowship programs. Descriptive statistics were performed. Results Out of the 22 PA and joint PA/NP orthopedic postgraduate websites evaluated, all had a functional website link. Only one orthopedic surgery postgraduate website met all 17 criteria. All program websites assessed contained program descriptions and contact information. Other information present on websites included program admission requirements 95% (21/22), salary/benefits 77% (17/22), interview requirement 73% (16/22), faculty listing 68% (15/22), journal club 59% (13/22), program objectives/goals 59% (13/22), and acceptance process 54% (12/22). Less than half of the program websites contained the following information: listing of current PA/NP postgraduate trainees, sample rotation schedule, orientation activities, curriculum, wellness/well-being strategy, graduation and research requirements, and link to program handbook. However, accredited PA orthopedic surgery program websites contained more content relevant to prospective applicants than non-accredited programs. Conclusion This is the first study to provide a detailed analysis of PA and joint PA/NP postgraduate orthopedic surgery residency/fellowship program websites. Not surprisingly, there is a wide variation in the available content on these websites. Study results provide further evidence to support the urgent need to improve program website content for prospective applicants.

The Development and Implementation of a Postgraduate Pediatric Primary Care Advanced Practice Nursing Fellowship

Recent calls for the expansion of postgraduate residencies in nursing have led to an increase in advanced practice nursing residencies and fellowships concentrating on the adult population, whereas pediatric advanced practice nursing fellowships remain limited. The development and implementation of a postgraduate pediatric primary care advanced practice nursing fellowship and the positive impact on a children's health system are described.

Professional values and role socialization of new NPs

ABSTRACT

This cross-sectional study focuses on assessing factors related to role socialization of new NPs. Participants identified caring as the most important professional value, followed by activism and professionalism. Role socialization factors including a sense of belonging and forming professional identities were higher for experienced NPs.

Development of an advanced practice preceptor evaluation tool

BACKGROUND

Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor.

PURPOSE

The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program.

METHODOLOGICAL ORIENTATION

A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation.

SAMPLE

The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years.

CONCLUSIONS

All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role.

IMPLICATIONS FOR PRACTICE

This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.