Nurse practitioner and physician assistant transition to practice: A scoping review of fellowships and onboarding programs.

BACKGROUND: Newly graduated nurse practitioners (NPs) and physician assistants (PAs) benefit from transition-to-practice (TTP) support to move successfully into practice. Transition-to-practice programs (i.e., onboarding programs and fellowships/residencies) hold promise for improving workforce outcomes. PURPOSE: The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODOLOGY: Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included for review if they addressed fellowships/residencies or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS: The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships/residencies, NPs, and programs set in United States nonrural, acute care settings, and academic health centers. CONCLUSIONS/IMPLICATIONS: There is a gap in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, there are few articles that assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.

NP and PA transition to practice: A scoping review of fellowships and onboarding programs.

OBJECTIVES: Newly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODS: Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS: The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers. CONCLUSIONS: A gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.

Risk factors of food insecurity among students at diverse post-secondary education institutions: a cross-sectional examination.

OBJECTIVE: Identify the prevalence of food insecurity (FI) and compare sociodemographic, mental, physical, behavioral, and environmental risk factors for FI among students at a private university, community college, and historically black college or university (HBCU). PARTICIPANTS: Adult students attending a private university, community college, or HBCU (n = 4,140) located within the southeastern United States. METHODS: Using an online survey (2017-2019), FI, sociodemographic, mental, physical, behavioral, and environmental data were collected to understand their association with FI. RESULTS: Up to 37.1% of students experienced FI. Identifying as black, other/multi-racial, having poor sleep, federal loans, depressive symptoms, high stress, social isolation, or a chronic condition were associated with FI. These associations varied by institution. CONCLUSIONS: FI is prevalent within diverse post-secondary institutions that serve traditional and nontraditional students with risk factors varying between institutions. The prevalence of FI and risk factors can inform institutional policy responses to ameliorate the effects of FI.

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.

Transition-to-practice programs for newly graduated advanced practice registered nurses and physician assistants: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the evidence on transition-to-practice programs for newly graduated advanced practice registered nurses and physician assistants, and describe how they differ. Additional objectives include summarizing what outcomes are evaluated and what gaps remain within the literature. By consolidating this information, health care administrators may more easily reference transition-to-practice methods to enhance their own programs for advanced practice registered nurses and physician assistants.z. INTRODUCTION: Transition to practice involves 2 program types: onboarding and postgraduate training. However, no existing reviews describe the state of the literature regarding these program types, and how they compare with regard to location, setting, and outcomes. Because transition-to-practice programs may improve workforce outcomes, understanding how these programs differ, and what gaps exist, is needed to help these programs grow. INCLUSION CRITERIA: This review will include articles describing transition to practice for advanced practice registered nurses and/or physician assistants, including onboarding and fellowship/residency programs. Articles will be included regardless of geographic location if they take place within a professional, clinical setting. METHODS: The scoping review will follow the JBI approach. Databases to be searched include MEDLINE (PubMed), CINAHL, Cochrane Central Register of Controlled Trials, Embase, ProQuest Dissertations and Theses, Scopus, and Web of Science. All included manuscripts will be screened by two reviewers and relevant data will be extracted. These data will summarize what transition to practice programs are used, how they differ, and what gaps exist.

National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation.

Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, 'Whole Person' care program promoting mental and physical self-care and patient empowerment. Despite evidence of effectiveness, little is known about implementation for TCMLH and similar programs. In this first-of-its-kind, multi-methods evaluation conducted between 2015-2020, we report on implementation strategies and intervention adaptations with a contextual analysis to describe TCMLH translational efforts in Veterans Health Administration (VHA) facilities across the United States. Quantitative and qualitative data were collected via listening sessions with TCMLH facilitators, open-ended survey responses from facilitators, and quarterly reports from clinical implementation sites. We used the Consolidated Framework for Implementation Research (CFIR) to analyze, interpret, and organize qualitative findings, and descriptive statistics to analyze quantitative data. Most TCMLH programs (58%) were adapted from the original format, including changes to the modality, duration, or frequency of sessions. Findings suggest these adaptations occurred in response to barriers including space, staffing constraints, and participant recruitment. Overall, findings highlight practical insights for improving the implementation of TCMLH, including recommendations for additional adaptations and tailored implementation strategies to promote its reach.