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.

Newly qualified registered nurses' and midwives' experiences from rural health district placement in Namibia.

BACKGROUND: The transition period for newly qualified registered nurses/midwives (NQRN/Ms) is a fundamental phase in their career. Yet, transition experiences have been studied mostly within urban and/or specialised healthcare settings in high-resource countries. This study aimed to explore and describe the experiences of NQRN/Ms in a rural health district in Namibia. METHODS: A qualitative, descriptive, explorative, and contextual design was followed. The sample consisted of eight participants who were purposively selected. Data were collected via in-depth individual interviews and analysed following a reflexive thematic analysis. The researchers were guided by Lincoln and Guba's strategies for establishing trustworthiness. FINDINGS: Themes conceptualised from the analysis include encounters with rural community members; encounters with colleagues; staffing, management, and supervision; shortage of resources; poor infrastructure; unreliable communication networks; and the lack of social life. CONCLUSION: The NQRN/Ms had mixed experiences related to a variety of aspects such as social life, resources, colleagues and community members. These findings can be used to improve undergraduate nursing curricula, as well as to create graduate job preparation workshops and support networks.

Preceptors and the New Neonatal Nurse Practitioner Educational World.

The need for neonatal nurse practitioner (NNP) preceptors has never been greater. Precepting is a professional responsibility with both rewards and challenges. The recent pandemic has brought about new challenges, not the least of which is burnout from clinical, learner, and environmental demands. A new educational model from the American Association of Colleges of Nursing and the National Task Force outlines educational and preceptor requirements aimed at improving the advanced practice educational experience for students and preceptors. Available research provides evidence of what preceptors value and how to develop best practices with academic institutions to advocate for their students. This article will discuss new nursing educational models and the role of the NNP preceptor and analyze current best practices in preceptor recruitment and retention while discussing national trends impacting personal and professional NNP practices.

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.

A multidisciplinary learning approach: training, preparation and role transition.

AIM: To explore trainee and qualified advanced practitioner learning experiences, how training has prepared learners for clinical practice and role transition. Evaluation of a multidisciplinary learning approach was sought, identifying its impact on developing collaborative learning and working partnerships. DESIGN AND METHODS: A small-scale, mixed-methods cross-sectional study was used to gather descriptive data. Convenience sampling was used with two groups: trainees and qualified advanced (paediatric) nurse practitioners/advanced clinical practitioners (ANPs/ACPs). All participants had completed or were undertaking master's level training. An anonymous, voluntary online survey was used to gather quantitative and qualitative data reflecting participant learning experiences. Evaluation research methodologies and their application were examined through exploration of three advanced practice frameworks and a well-established framework for evaluation of training. FINDINGS: Overall, responses indicate positive learning experiences, and that current and previous ANP/ACP training in the UK does adequately prepare trainees for practice. However, further improvements in curriculum content are suggested. Consistent with the literature, collaborative multidisciplinary teaching, learning and mentorship were identified as key elements in the learning process and role transition.

The impact of an intentional APRN student clinical experience on role transition towards becoming a clinically competent practitioner; pilot study.

AIMS: This study was to determine if there is a greater difference in Advanced Practice student nurse self-reported transition towards practice and professional identity for an experimental group compared with a control group. The information gathered is expected to: (a) provide a curriculum baseline for focused clinical objectives as well as preceptor training, and (b) to meet these objectives in alignment with the expectations for graduation and subsequent post-graduation transition into practice. DESIGN: Pilot exploration using quasi-experimental, mixed methods included a quantitative five-point Likert Scale and a self-reported qualitative phenomenological analysis. METHODS: This study evaluated responses from all participants through a series of three self-report periods during a 14-week clinical semester. RESULTS: Based on the self-reported data, the experimental group made minor additional progress with respect to their growth and professional identity transition compared with the control group. CONCLUSION: This study fostered the need for further studies to support residency programs that aid newly graduated nurse practitioners as they transition into the advanced practice role. IMPACT: The cost to replace these practitioners can be as high as twice their annual salary. The adjustment to an advanced practice role is difficult as postgraduate training is currently optional in many States. According to Brown, et al. (Nurse Educator, 2015, 40:148), novice Advanced Practice Nurses report being underprepared for this new role, particularly diagnostic interpretation skills. Supporting the advanced practitioner with a structured curriculum is imperative to achieve successful skills development, transition to practice, and professional identity.

Exploring the factors that affect the transition from student to health professional: an Integrative review.

BACKGROUND: The nature of a new health professional's transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice. METHODS: Whittemore and Knafl's methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach. RESULTS: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. CONCLUSION: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.

Interpersonal Psychotherapy for Gender Dysphoria in a Transgender Woman.

We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment.

A rapid review of educational preparedness of advanced clinical practitioners.

AIM: The aim of this study was to synthesize available data on current educational provision related to preparation for the advanced clinical practice role. DESIGN: A mixed methods rapid review of the literature. DATA SOURCES: A search of Ovid Medline and Ovid EMBASE for English language papers published 2006-2018 resulted in 38 publications, which met the criteria for inclusion. REVIEW METHODS: Using Tricco's seven-stage process, following an identification of relevant papers and data extraction, a data-based convergent synthesis was used to convert quantitative papers into qualitative data prior to completing a narrative synthesis. RESULTS: The four themes identified from data synthesis were consolidation; theory to practice gap; competency and mentoring. A lack of preparedness for new advanced clinical practitioners completing an educational programme was noted with a need identified for a clinically focussed consolidation period to enable practitioners to develop their skills under supervision in the clinical environment. CONCLUSION: As the needs for different models of health care evolve with the expansion of advanced practice, appropriate education and clinical supervision are important aspects in the delivery of programmes that allow individuals to be competent and confident practitioners providing safe and effective health care. IMPACT: There is a paucity of papers on educational preparedness of advanced clinical practitioners. Our findings demonstrate a lack of preparedness and the need for a clinically focussed consolidation period with good role models and mentors following completion of a Master's programme. Employers and higher education institutions need to ensure a protected period of time is available for newly qualified advanced clinical practitioners to allow consolidation of clinical practice.

Factors that influence transition to advanced roles by RN to BSN nurses, in three selected hospitals of Central-Uganda.

BACKGROUND: Despite the global rise in the number of nurses upgrading from Registered Nursing (RN) to a Bachelor of Science in Nursing (BSN), studies have indicated that successful role transition is difficult once the nurses return to their previous workplaces. Guided by the Transitional Theory, this study investigates the factors that influence the transition from basic to advanced roles among RN to BSN nurses in Uganda, Africa. METHODS: This study employed a descriptive correlational design. Using convenience sampling, fifty-one (51) RN to BSN nurses completed the semi-structured questionnaires. RESULTS: All the study participants (100%) described themselves as having transitioned from RN to BSN role. In bivariate linear regression, personal factors that were found to predict successful role transition included holding a managerial role, being aware and prepared for the role transition, and positive role transition experiences. Role transition motivators that predicted successful role transition included: job promotion, internal desire for self-development, and career development. One community factor - that is the support of doctors/physicians during the RN to BSN transition - predicted unsuccessful role transition. Societal factors deterring successful role transition included lack of support from other colleagues and the perception that BSN learning was not applicable to the RN clinical setting. In multivariate linear regression, only sub-scales of personal factors such as advanced skills mastery and positive personal experiences predicted successful role transition. CONCLUSION: The study suggests that personal factors influence successful role transition more than external factors.

Role transition: A descriptive exploratory study of assistant nurse clinicians in Singapore.

AIM: To explore the role-transition experiences of assistant nurse clinicians after their first year of appointment. BACKGROUND: The National Nursing Taskforce was set up in Singapore to examine the professional development and recognition of nurses. It created the assistant nurse clinician role as an avenue for the nurses' career development. The role was intended to assist nurse managers to guide the nursing team in the assessment, planning, and delivery of patient care. METHODS: A qualitative descriptive study design was adopted. A purposive sample of 22 registered nurses from six acute care institutions and two polyclinics in Singapore participated in the face-to-face interviews. An inductive content analysis approach was used to analyse the data. RESULTS: Four themes emerged: (a) promotion to assistant nurse clinician is a form of recognition and vindication; (b) there was uncertainty about the expected role of the assistant nurse clinician; (c) experience eases transition; and (d) there was a need for peer support, mentorship, and training. CONCLUSIONS: The job description of the assistant nurse clinician needs to be better defined to provide greater clarity about their clinical and administrative duties and what is expected of their performance. IMPLICATIONS FOR NURSING MANAGEMENT: It is essential for nurse managers to provide successful role-transition strategies to help the newly appointed assistant nurse clinicians to become efficient and effective leaders.

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.

Evaluation of a structured preceptorship programme.

Preceptorship is a period in which newly qualified staff nurses receive support from an experienced nurse to smooth their transition into the service. District nurses (DNs) from the authors' trust informally expressed the need for a better transition between the completion of district nursing education and entry into the workforce. Hence, a structured preceptorship programme was developed and delivered. This article describes this service initiative and its evaluation by preceptors (n=14) and preceptees (newly qualified DNs; n=13). Both groups valued having a structured preceptorship programme. Preceptees agreed that having a named preceptor was very important, and preceptors felt that the role which they played was rewarding. Both groups felt that the role of the DN was a specialist role and that the preceptorship programme helped to support newly qualified staff make the transition into qualified DNs, clinical team leaders and, ultimately, caseload holders. A large-scale study of DN practice is required to develop a national consensus on the structure and content of preceptorship programmes for district nursing.

Challenging graduate nurses' transition: Care of the deteriorating patient.

AIM AND OBJECTIVE: To explore graduate nurses' experiences of caring for deteriorating patients during the first year of practice. BACKGROUND: Hospital-based transition programmes have been established to ease graduate nurse transition. Despite this, novice nurses persistently cite caring for deteriorating patients as a clinical challenge. Few studies have explored the unique needs of novice nurses during such encounters, even less research has been undertaken from their perspective. DESIGN: Qualitative interpretive phenomenological analysis. METHOD: One-on-one, semi-structured, in-depth, audio-recorded interviews were conducted between July-November 2014. A purposive sample of eight novice nurses working in acute care, ICU and the ED was recruited through the use of flyers. RESULTS: Three major patterns with related themes illuminate the experience of caring for deteriorating patients as it is lived by graduate nurses. Dwelling with uncertainty occurred during initial encounters with deteriorating patients with its deeply felt impact upon these novices causing them to question their capability of becoming a nurse. 'Success' or 'failure' of their performance during these encounters extended to their view of themselves as nurses and impacted transition. Building me up was influenced by participants' expressed need for and importance of trusted relationships with preceptors, nurse colleagues and/or educators as they learned to care for deteriorating patients. A new lifeline: Salient being emerged as change in participants' identity and increased self-understanding as professional nurses. CONCLUSION: Caring for deteriorating patients impacted graduate nurses because they viewed such encounters to be 'high stakes' not only for their patient but also for themselves. Crucial to their development were trusted relationships with preceptors, nurse colleagues and/or educators. RELEVANCE TO CLINICAL PRACTICE: The findings identify needs of graduate nurses' during a high-stakes patient encounter and shed light upon one aspect of transition. Clinical leaders may use the findings from this study to improve preceptor development and transition programme curricula.

Driven by Ambitions: The Nurse Practitioner's Role Transition in Dutch Hospital Care.

INTRODUCTION: Insight into nurse practitioners' (NPs') role transition can help NP students and new graduates in taking on new responsibilities in a changing and demanding healthcare context. The aim of the research was to explore the role transition from nurse to NP using the components of Meleis's Framework of Transitions. METHOD: A qualitative descriptive design was used. Individual interviews (n = 9) and two focus group discussions (n = 12) were held with NPs. Data were analyzed with the directed content analysis method. FINDINGS: The Framework component transitions' nature was characterized by changes in the healthcare system, combined with professional and educational role changes. Transition conditions showed that the respondents felt distressed after they became accountable for a patient's care and well-being. Although the respondents were authorized to do medical procedures, they initially lacked nursing role models and NP protocols. Process indicators showed ongoing transition; the respondents were still developing clinical competencies and confidence in patient care while relying on earlier acquired nursing competencies. Outcome indicators showed that the respondents found themselves successful in the medical extension of two different nursing roles: continuity of medical care for hospitalized patients in acute and intensive care settings, and being responsible for continuity of care for chronic patients in outpatient clinics. CONCLUSIONS: Role transition was characterized by coping with feelings of distress at the cost of time and effort. The respondents' strategies to adapt to new expectations, combined with organizational support, determined the outcomes as well as the start of new transitions. CLINICAL RELEVANCE: NPs' role transition in hospital care implies a dynamic ongoing process that needs to be supported, with the ultimate goal to improve patient outcomes.

Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors.

BACKGROUND: Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. AIM: To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. METHODS: The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. FINDINGS: The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. CONCLUSION: The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.

Professional identity and role transitions in clinical managers.

PURPOSE: The purpose of this paper is to investigate how clinicians' professional background influences their transition into the managerial role and identity as clinical managers. DESIGN/METHODOLOGY/APPROACH: The authors interviewed and observed 30 clinicians in managerial positions in Norwegian hospitals. FINDINGS: A central finding was that doctors experienced difficulties in reconciling the role as health professional with the role as manager. They maintained a health professional identity and reported to find meaning and satisfaction from clinical work. Doctors also emphasized clinical work as a way of gaining legitimacy and respect from medical colleagues. Nurses recounted a faster and more positive transition into the manager role, and were more fully engaged in the managerial aspects of the role. PRACTICAL IMPLICATIONS: The authors advance that health care organizations need to focus on role, identity and need satisfaction when recruiting and developing clinicians to become clinical managers. ORIGINALITY/VALUE: The study suggests that the inclusion of aspects from identity and need satisfaction literature expands on and enriches the study of clinical managers.

Exploring the Factors that Influence Nurse Practitioner Role Transition.

The transition from registered nurse (RN) to nurse practitioner (NP) is often a stressful career change. Data are lacking on the factors affecting NP role transition. This study examined the relationships between NP role transition, prior RN experience, and a formal orientation. From a sample of 352 NPs, only a formal orientation contributed significantly to the regression model indicating a positive relationship with NP role transition (b = 6.24, p < .001). Knowledge of the factors that explain NP role transition is important to inform the discipline how best to support NPs during entry into practice.

A description of U.S. post-graduation nurse residency programs.

BACKGROUND: Concern regarding newly licensed registered nurses' abilities to cope with the increasing complexity of care has led to the development of a variety of nurse residency program (NRP) initiatives. The unknowns are the extent to which and how various program elements are implemented across NRPs. Without understanding the extent to which NRPs deliver the same program, determination of their impact on care is limited. The purpose of this study was to describe U.S. NRPs and thereby identify the extent of treatment fidelity across programs. METHODS: Program attributes were measured using a 24-item survey based on the outcomes production conceptual framework. The survey was sent to known NRP directors or chief nursing officers at the 1,011 U.S. hospitals having 250 or more inpatient beds; 203 surveys (a 20% response rate) were returned. RESULTS: Almost half (48%) of hospitals reported operating an NRP. NRP models included University HealthSystems Consortium (22%), facility based (54%), and "other" (24%). Significant (p < .01) differences were noted among and within program model types in terms of career planning, project requirements and types, and mentoring. CONCLUSIONS: The extent of differences within and across program types indicates a lack of treatment fidelity needed to detect objectively the impact of the NRP as a discrete intervention on patient outcomes. NRP expansion may be limited by the number of hospitals of a size most likely able to support such programs.

Helping community-based students on a final consolidation placement make the transition to registered practice.

The pressure of role transition on new nurse registrants has affected recruitment and retention, which, along with an ageing workforce, has resulted in a global shortage of nurses that is now reaching crisis point. This article examines and discusses what can be done to attract and prepare the future workforce in the community, focusing on helping students to make the transition to registered practice that begins during their final consolidation of practice placement. There is currently limited evidence on the effectiveness of how community placement teams prepare finalist students for registered practice and this could be seen as an opportunity lost given the urgent need to recruit more registered nurses to work in primary care. Recommendations for enhancing this crucial stage of the student journey are made, and a case for the need to know more from students about how they experience their final practice placement when allocated to a community setting is presented.