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

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.

The transition to advanced practice nursing: A systematic review of qualitative studies

BACKGROUND

Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes.

AIM

To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role.

DESIGN

A systematic review of qualitative studies.

DATA SOURCES

Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL.

REVIEW METHODS

This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis.

FINDINGS

A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition.

CONCLUSIONS

Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.

Breaking Bad News via Telehealth: Simulation Training for Nurse Practitioner Students

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic demonstrated educators must consider students' future practice will involve patient communication via telehealth, including breaking bad news.

METHOD

This mixed-methods analysis was conducted among 33 nurse practitioner (NP) students at two universities. Questionnaires were analyzed before and after a simulation training session with standardized patients to determine students' perceptions, learning satisfaction, confidence, and self-rated preparedness for delivering bad news via telehealth.

RESULTS

Students' self-rated levels of preparedness for delivering bad news were higher after participating in the simulation. Students found the teaching methods to be effective, enjoyable, motivating, and suitable to individual learning styles. Two themes emerged that described students' perceptions of the experience: valuable simulation processes and multifaceted learning applicable to future NP practice.

CONCLUSION

Breaking bad news via virtual platforms is new and challenging. Findings suggest this simulation experience provided a valuable tool for augmenting didactic training for NP students. [J Nurs Educ. 2022;61(9):528-532.].

Nurse practitioner and physician assistant onboarding in a family medicine practice

ABSTRACT

The nurse practitioner (NP) and physician assistant (PA) professions are rapidly growing. Historically, these professions have filled a health care delivery gap caused by lack of health care access and physician shortages. Many medical practices are more accustomed to adding new physicians as compared with adding new NPs or PAs. This article describes one institution's approach to develop and implement a successful NP/PA onboarding program. Several key components are discussed, including (1) established roles and responsibilities, (2) a clear timeline of the onboarding period including a foundational curriculum, (3) the mentor-mentee relationship, (4) the onboarding checklist, and (5) the onboarding itinerary. The objective was to have our NPs/PAs on a regular patient calendar within the 6-month period. The success rate with this has been 86%. In addition, there has been a 90% retention of NP/PA hires over the past 3 years. The authors believe this approach to NP/PA onboarding serves the patients well, providing excellent patient outcomes and patient experience.

The key to successful NP transition to practice

ABSTRACT

This article explores the experiences of the new NP's onboarding process based on data from two qualitative studies. Interviews with 27 new graduates were used to inform the design, implementation, and experience of an onboarding program in a small healthcare setting without robust internal resources or a human resource department.

Association Among Work Characteristics, Role Transition, and Job Burnout in Nurse Practitioners in Taiwan

Workplace burnout is common among nurse practitioners (NPs) and often occurs during role transition from a registered nurse to an NP. This study aimed to explore the predictors of job burnout in nurse practitioners (NPs). A quantitative cross-sectional design was conducted on 361 convenience sample of NPs from four hospitals in central Taiwan. Data on the demographic and working characteristics (hospital grade, years of experience as an RN and NP, practice setting, working shifts, working hours, average number of patients take care, salary, and performance bonus), Chinese version of the Nurse Practitioner Role Transition Scale, and Occupational Burnout Inventory were used. The enrolled NPs showed medium-level role transition scores (mean = 65.73, SD = 9.59), and the prevalence of personal burnout, client-related burnout, and over-commitment was 51.2%, 19.4%, and 49.9%, respectively. Role transition, hospital grade, practice setting, working hours, and number of patients take care were significant predictors of personal burnout, client-related burnout, and over-commitment after adjusting for cofounding variables, possibly explaining 52.8%, 42.1%, and 36.3% of variance, respectively. Hospital administrators should provide necessary assistance to help NPs transition to new role and ensure a positive work environment and reasonable workload so as to prevent the impact of job burnout on NPs.

Communication, leadership and organizational support facilitate successful transition into practice for nurse practitioners in the emergency department

BACKGROUND

Postgraduate programs, specialized academic programs, and national health organizations such as the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills, and factors for successful transition into practice.

PURPOSE

The purpose of this study is to examine the relationships and differences among the personal and community resources that promote successful transition for nurse practitioners (NP) who practice in the emergency department (ED) and the skills or procedures they find difficult to perform independently.

METHODS

A descriptive, correlational, comparative study design was conducted using an online survey administered to a convenience sample of NPs with 6 months to 5 years of experience as an NP.

RESULTS

Findings from this study identified factors associated with successful and unsuccessful transition into practice and help support positive outcomes for health care institutions, ED patients, and NPs practicing in this specialty area.

IMPLICATIONS FOR PRACTICE

Support in transition recognizes recommendations set by health care organizations in promoting professional development, safe clinical practice, job satisfaction, and retention. Further study will provide clarity in financial gains and improved patient health outcomes during a time in which complex disease processes and provider shortages continue to weigh heavily on society.

Emerging practices in onboarding programs for PAs and NPs

OBJECTIVE

To describe administrative factors that should be considered when designing an onboarding program for physician assistants (PAs) and NPs.

METHODS

Interview study of 13 administrators of onboarding programs. Interviews were transcribed and analyzed for themes by a team of researchers, with feedback from interviewees.

RESULTS

Five administrative themes are summarized: goals of onboarding, critical organization factors, organizational fit, designing the program, and costs of onboarding.

CONCLUSIONS

Careful planning and administration are essential to the success of onboarding programs. Although onboarding programs must be designed with unique institutional needs in mind, the considerations identified by our project might serve as a useful guide to PA and NP employers in the process of creating an onboarding program.

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.

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.