A confirmatory factor analysis of the novice nurse practitioner role transition scale.

As interest in supporting new nurse practitioners' (NPs) transition to practice increases, those interested in measuring the concept will need an instrument with evidence of reliability and validity. The Novice NP Role Transition (NNPRT) Scale is the first instrument to measure the concept. The preliminary exploratory factor analysis revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation. Using a cross-sectional design and data from 210 novice NPs, the purpose of this study was to confirm the NNPRT Scale's internal factor structure via confirmatory factor analysis (CFA). The sample was primarily female (97.5%), White (75.9%), and certified in primary care (53.5%). The CFA confirmed the five-factor structure, and model fit was improved by moving and omitting items (χ2 [619] = 1277.799, p < 0.001; Root Mean Square Error of Approximation = 0.071 [0.066-0.077]). The final NNPRT Scale includes 37-items, and internal consistency reliability was calculated at 0.95. Convergent validity evidence was supported by a positive, significant correlation with receiving a formal orientation in the first NP position; a negative, significant correlation with turnover intention; and a lack of a relationship with years of prior registered nurse experience. The NNPRT Scale is an instrument with sound evidence of reliability and validity. The NNPRT Scale will be useful for researchers, administrators, and clinicians looking to explore factors that affect NNPRT, as well as by clinicians and administrators implementing programs to support novice NPs' transition to practice.

An Innovative Distance-Based Mentorship Program for Nurse Practitioner Student-Alumni Pairs.

ABSTRACT: Little research exists on mentoring programs for nurse practitioner (NP) students. This pilot project aimed to develop, implement, and evaluate a distance program with NP alumni mentoring NP students across the United States. Mentor-mentee pairs (113) were hand-matched and surveyed at six months to collect program data. Most mentees wanted more job-hunting and resume-writing tips; mentors were interested in receiving strategies for mentoring and calendar reminders of important school events. Alumni were interested in helping prepare future NPs by serving as mentors but needed training. Distance mentorship programs may require additional structured guidelines and resources to facilitate success.

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.

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.

Development of the Doctor of Nursing Practice Nurse Practitioner Minimum Data Set (DNP NP MDS).

BACKGROUND: While the number of Doctor of Nursing Practice (DNP) programs has grown steadily, there is limited data on how national organizations are collecting data on DNP-prepared nurse practitioners (NPs) and no standard instrument exists to collect data on DNP-prepared NPs. PURPOSE: The purpose of this study was to develop a universal minimum data set (MDS) for the DNP-prepared NP population. METHOD: Instrument development consisted of several sequential stages, including conceptualization and item generation, preliminary evaluation of items, field testing the survey, and analysis of scale development data. FINDINGS: A set of 16 core variables and 19 additional variables were developed to collect standardized data on the demographics, education, and practice patterns of DNP-prepared NPs. Pilot testing revealed high correlations between the activities DNP-prepared NPs are prepared for and typically participate in a typical workweek and in their career. The MDS demonstrated high reliability in our sample. DISCUSSION: The DNP NP MDS can be used for data collection by various stakeholders, including national organizations, to facilitate improved tracking of outcome data for the DNP-prepared NP workforce. It can also provide data-driven support for the need and significance of the DNP degree for NPs.

Driving toward a culture shift: Case studies of social mission in nursing education.

BACKGROUND: Nursing schools need to provide students with the appropriate tools to develop competencies and resources to actualize moral courage to advance health equity and center social mission. PURPOSE: The purpose of this study was to describe six nursing programs that exemplify a variety of ways that social mission goals are pursued in different contexts. METHOD: Using a case study approach, we selected nursing schools that excelled in at least one of the following social mission domains: education program, community engagement, governance, diversity & inclusion, institutional culture & climate and research. We conducted video interviews with the administration, faculty and students. FINDINGS: Main themes were: (1) central university/college commitment; (2) allocation of school resources; (3) faculty buy-in; (4) community partnerships; and, (5) an institutional culture of inclusion. DISCUSSION: While each school approaches social mission differently, there are commonalities across cases including a number of necessary factors for schools to advance their social mission goals.

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.