DEPARTMENT
Professional Issues
The Care Model of the Future: Supporting APRNs Through an Innovative Transition to Practice Program Amy Scholtz, MSN, RN, Karen King, MSN, RNC, & Susan Kolb, MSN, CRNP
KEY WORDS Advanced practice registered nurse, orientation, onboarding, transition to practice
Health care delivery models are shifting to increased autonomy for advanced practice registered nurses (APRNs). Newly acquired accountability can lead to Section Editor Andrea Kline Tilford, MS, RN, CPNP-AC/PC, CCRN, FCCM Rush University College of Nursing Chicago, Illinois Amy Scholtz, Coordinator for Advanced Practice Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA. Karen King, Manager, Nursing Education, The Children’s Hospital of Philadelphia, Philadelphia, PA. Susan Kolb, Director for Ambulatory and Advanced Practice Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA. Conflicts of interest: None to report. Correspondence: Amy Scholtz, MSN, RN, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; e-mail: [email protected]. J Pediatr Health Care. (2014) 28, 276-279. 0891-5245/$36.00 Copyright Q 2014 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. Published online January 14, 2014. http://dx.doi.org/10.1016/j.pedhc.2013.11.002
276
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increased stress among new APRNs. This shift in care resulted in the need to support all APRNs beyond orientation and provide peer-to-peer support. Using a structured transition to practice or fellowship framework, our large, freestanding, academic medical center that currently employs more than 400 APRNs implemented an APRN Fellowship program. This yearlong, innovative APRN Fellowship is composed of didactic classroom sessions and skill-based and critical thinking simulations. This article describes the development and structure of this novel program. BACKGROUND National health care reform, a shortage of primary and specialty care physicians, and the new Accreditation Council for Graduate Medical Education resident duty hours standards have given health care organizations the opportunity to evaluate their current care delivery models. These health care changes may lead these organizations to make changes to provide safe, efficient, and effective care. These drivers gave this large, urban, pediatric, academic medical center the impetus to develop an innovative care model. Embracing the recommendation of the Institute of Medicine Future of Nursing report (2010) that APRNs function to the full extent of their education and training, our hospital and health care system recognized the APRN as an essential component of this new model of care. During the past several years, our hospital and health care system have hired a significant number of APRNs to fill the void created by recent health care Journal of Pediatric Health Care
changes. We currently employ more than 400 APRNs, primarily nurse practitioners (NPs), who practice across a large network, including inpatient (acute and critical care), subspecialty, and outpatient primary care settings. The increasing number of APRNs, along with their growing scope of practice, prompted a key group of stakeholders to evaluate the orientation and ‘‘onboarding’’ of all APRNs. All new hires received a comprehensive competency-based orientation, including self-assessment. The duration of the individualized orientation ranged from 3 to 6 months based on the practice needs of their specialty area. Despite an individualized orientation plan, gaps in knowledge and practice still existed. New APRNs completed an online survey to identify strengths and opportunities for improvement in the orientation process. One quarter of newly hired APRNs responded to the survey and reported a need to standardize the education delivered during the orientation process and provide support during the transition into the APRN role. The respondents also identified a desire for more networking opportunities with their APRN peer group. These results correlate with the results of a national study of APRNs that indicate many challenges, including support, work conditions, administrative infrastructure, and professional relationships during role transition (Cragg & Bailey, 2012). Many challenges are associated with the transition into an APRN role for both new graduates and experienced APRNs. Despite literature that describes the role of the APRN, identified gaps still exist. Hart and Macnee (2007) analyzed 562 responses from two large national NP conferences and found that an overwhelming majority (87%) expressed interest in, and believed they would have benefited from, a residency program after graduation. Many of the NPs surveyed described a lack of support during their transition into the NP role and feelings of fear and uncertainty (Hart & Macnee, 2007). Kelly and Matthews (2001) conducted focus groups with 21 recent NP graduates and found several key elements to role success that were not discussed in their formal education, including role clarification, connectedness to the organization, and support opportunities. These aspects are critical to a successful transition into practice and are often overlooked during formal education and when considering a job opportunity. In addition, relationships with other APRN staff and role clarity were the most important factors facilitating role transition (Brown & Olshansky, 1998; Heitz, Steiner, & Burman, 2004). There is a paucity of literature about programs that assist the transition of APRNs into practice. Most articles describe orientation or onboarding rather than a comprehensive APRN residency program. Bahouth and Esposito-Herr (2009) describe a formal acute care NP orientation; however, the program was brief www.jpedhc.org
(12 weeks), and the primary outcome was accelerating startup time to independent practice. Goldschmidt, Rust, Torowicz, and Kolb (2011) describe a comprehensive orientation program in an acute care cardiac center. This program focused on the feeling of connectedness that can occur when APRNs have a structured orientation program with clearly identified goals and timelines, an identified preceptor, and specialty-specific education (Goldschmidt et al., 2011). Several descriptions of orientation programs for specific specialty populations or practice areas such as cardiology, primary care, and critical care units exist in the literature, as well as descriptions of specific roles, including the Clinical Nurse Specialist (CNS) (Miga, Rauen, & Srsic-Stoehr, 2009; Urden & Stacy, 2011) and Certified Nurse Midwife (CNM) (Hunter, Kvale, & Romick, 2000). Although these descriptions were helpful, they may not be generalizable to other populations and roles and only addressed the clinical aspects of orientation. To address the issues facing newly hired APRNs at our institution, a comprehensive APRN transition to practice program was developed. All new APRN hires, both novice and experienced, are required to participate in the APRN Fellowship program. The program consists of five discreet didactic course days over 1 year to support transition to practice for any APRN new to practice and/or new to our institution. FELLOWSHIP CONTENT A team of APRN coordinators, an educational nurse specialist, the director of advanced practice nursing, and the director of nursing education, along with the senior talent strategist responsible for the recruitment of APRNs, developed the APRN Fellowship Program. We implemented the program to meet the needs of both novice and experienced APRNs new to our hospital and health care system. Program goals included (a) developing an infrastructure to support the APRNs as they transitioned into their new role; (b) creating a clearinghouse for common themes, challenges, issues, and best practices; and (c) providing opportunities for networking, mentorship, peer leadership, and support in an ongoing manner. Benner’s Novice to Expert Theory, which describes the passage through five levels of skill acquisition and professional development, provided a framework for the content of this program (Benner, 1982). APRNs from all clinical practice areas participate in the program, and the content and format are based on the composition of each group in terms of roles (CNS, NP, and CNM) and experience level of the group (new graduate vs. experienced practitioners), as well as practice area (critical care, acute care, subspecialty care, or primary care). Each new hire traveled through the program with their assigned group to encourage connectedness and foster peer support. The team May/June 2014
277
TABLE. Fellowship day themes Fellowship day Day 1 Day 2 Day 3 Day 4
Day 5
Theme Role transition Clinical practice and effectiveness of the advanced practice registered nurse role Quality and patient safety Competency, ongoing professional practice evaluation, billing, coding, and documentation National perspective, local and national professional growth opportunities
identified five themes that provided the basis for the program content (Table). It was evident from observations, as well as from comments and feedback, that the need existed to standardize the information given to each new hire from the hospital/nursing department level. New APRN hires do not attend the department of nursing general orientation and therefore do not have the opportunity to learn about the hospital and department system processes applicable to their role. In The APRN response, information Fellowship on the hospital and program provides department strategic goals and initiatives APRNs with are included in the opportunities to APRN Fellowship propractice technical gram. Experienced, interprofessional exand psychosocial pert faculty provide diskills away from the dactic content, as well bedside in a safe as the opportunity for collaboration and netand simulated working. Interactive, environment with didactic content and their peers and to simulation skills sessions are blended to receive feedback maximize these interfrom experts. actions and increase the participants’ knowledge regarding key hospital goals. The groups also have time built in each day for open discussions on relevant topics, as well as time to share best practices and common challenges in their roles. New APRNs may or may not have the opportunity to practice all of their required skills while participating in orientation, and even if they have the opportunity to practice at least once, they may not feel comfortable or competent in performing this skill. The APRN Fellowship program provides APRNs with opportunities to practice technical and psychosocial skills away from the bedside in a safe and simulated environment with their peers and to receive feedback from experts. In a simulated environment, new APRNs 278
Volume 28 Number 3
are able to make mistakes and learn from their mistakes, while learning from other expert APRNs and physicians. Simulation emphasizes the application and integration of knowledge, skills, and critical thinking and is a successful teaching method in both clinical and formal education (Rauen, 2004). Simulation decreases the challenges of patient availability and instructional time required that makes practicing skills difficult (Issenberg et al., 1999). The APRN Fellowship team evaluates the content of the program on an ongoing basis. Each fellowship group completes evaluations at the end of each day to evaluate the speakers and content objectives. Participants also complete an evaluation of the overall program and process measures. Participant comments and feedback allowed for ongoing changes in both format and structure. EVALUATION AND OUTCOMES The purpose of the APRN Fellowship program is to support the transition to practice for the new and experienced APRN in an ongoing manner. Program outcome measures include recruitment and retention, APRN satisfaction, patient and family satisfaction, productivity, engagement, and a decrease in patient safety events. Evaluation of costs associated with the program and program effectiveness will be measured, along with self-reported perception of competence and confidence in the APRN role. In addition, evaluation of networking opportunities and benefits of simulation training for technical and teamwork skills are ongoing. In the past 2 years, 108 APRNs have enrolled in the program, including 99 NPs, 8 CNSs, and 1 CNM (Figure 1) from all practice areas (Figure 2). Twentynine percent of program participants were experienced and 71% of program participants were novices/new graduates. Fifty-five APRNs have completed or
FIGURE 1. Number of advanced practice registered nurse participants by role. CNM, Certified nurse midwife; CNS, clinical nurse specialist; CRNP, certified registered nurse practitioner. This figure appears in color online at www.jpedhc.org.
Journal of Pediatric Health Care
FIGURE 2. Number of advanced practice registered nurse participants by practice area. APRN, Advanced practice registered nurse; ED, emergency department; ICU, intensive care unit. This figure appears in color online at www.jpedhc.org.
role and is critical to the success of not only the care delivery model as a whole, but of the APRN role at our institution. The APRN Fellowship has widespread application, because there is a critical need for the APRN role across the United States given the changes in health care delivery systems nationally. This program provides a framework for replication by other advanced practice professionals, including certified registered nurse anesthetists and physician assistants. Successful role transition will not only improve the experience for new APRNs but will ultimately improve patient safety and outcomes. We thank Evie Lengetti, Chris Macaulay, Mike Donahue, Jessica McElroy, and Katherine Finn Davis for their contributions and ongoing support of this program. REFERENCES
graduated from the program, and we anticipate that another 30 will enroll in the program by end of calendar year 2013. Preliminary evaluations have indicated a number of positive outcomes associated with participation in the program, including increased networking and patient referral opportunities. Since the Successful role inception of the protransition will not gram, we have had a turnover rate of less only improve the than 2%, and anecdotal experience for new reports indicate that APRNs but will the APRN fellowship ultimately improve program has been a key driver in the final patient safety and decision in selecting outcomes. our organization by new hires. Both novice and experienced participants have reported that the program provided them with the opportunity to share best practices and discuss common issues related to the APRN role. The value of increased interprofessional collaboration has also been demonstrated. IMPLICATIONS FOR PRACTICE Role transition is an extremely stressful time. APRNs are caring for patients with higher acuity and complexity than in the past. Increased stress and challenges can potentially lead to decreased job satisfaction and in turn put APRNs at risk for turnover. The APRN Fellowship program supports transition to practice for advanced practice nurses. This program addresses all aspects of the transition to a new APRN
www.jpedhc.org
Bahouth, M., & Esposito-Herr, M. (2009). Orientation programs for hospital-based nurse practitioners. Advances in Critical Care, 20(1), 82-90. Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402-407. Brown, M., & Olshansky, E. (1998). Becoming a primary care nurse practitioner: Challenges of the initial year of practice. The Nurse Practitioner, 23(7), 46-66. Cragg, B., & Bailey, P. (2012). Nurse practitioner graduate transition to practice (PowerPoint presentation). Retrieved from http:// resources.cpha.ca/CPHA/Conf/Data/2009/A09-177e.pdf Goldschmidt, K., Rust, D., Torowicz, D., & Kolb, S. (2011). Onboarding advanced practice nurses: Development of an orientation program in a cardiac center. The Journal of Nursing Administration, 41(1), 36-40. Hart, A. M., & Macnee, C. (2007). How well are nurse practitioners prepared for practice: Results of a 2004 questionnaire study. Journal of the American Academy of Nurse Practitioners, 19(1), 35-42. Heitz, L., Steiner, S., & Burman, M. (2004). RN to FNP: A qualitative study of role transition. Journal of Nursing Education, 43(9), 416-420. Hunter, L. P., Kvale, J. K., & Romick, P. (2000). Using imagery for role transition of midwifery students. Journal of Midwifery & WomenÕs Health, 45, 337-342. Institute of Medicine. (2010). The future of nursing report. Washington, DC: National Academy Press. Issenberg, S. B., McGaghie, W. C., Hart, I. R., Mayer, J. W., Felner, J. M., Petrusa, E. R., . Ewy, G. A. (1999). Simulation technology for health care professional skills training and assessment. Journal of the American Medical Association, 282, 861-866. Kelly, N., & Matthews, M. (2001). The transition to first position as nurse practitioner. The Journal of Nursing Education, 40(4), 156-162. Miga, K. C., Rauen, C. A., & Srsic-Stoehr, K. (2009). Strategies for success: Orienting to the role of a clinical nurse specialist in critical care. AACN Advances in Critical Care, 20(1), 47-54. Rauen, C. (2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24(3), 46-51. Urden, L. D., & Stacy, K. M. (2011). Clinical nurse specialist orientation: Ready, set, go! Clinical Nurse Specialist, 25(1), 18-27.
May/June 2014
279
Professional Issues
The Care Model of the Future: Supporting APRNs Through an Innovative Transition to Practice Program Amy Scholtz, MSN, RN, Karen King, MSN, RNC, & Susan Kolb, MSN, CRNP
KEY WORDS Advanced practice registered nurse, orientation, onboarding, transition to practice
Health care delivery models are shifting to increased autonomy for advanced practice registered nurses (APRNs). Newly acquired accountability can lead to Section Editor Andrea Kline Tilford, MS, RN, CPNP-AC/PC, CCRN, FCCM Rush University College of Nursing Chicago, Illinois Amy Scholtz, Coordinator for Advanced Practice Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA. Karen King, Manager, Nursing Education, The Children’s Hospital of Philadelphia, Philadelphia, PA. Susan Kolb, Director for Ambulatory and Advanced Practice Nursing, The Children’s Hospital of Philadelphia, Philadelphia, PA. Conflicts of interest: None to report. Correspondence: Amy Scholtz, MSN, RN, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; e-mail: [email protected]. J Pediatr Health Care. (2014) 28, 276-279. 0891-5245/$36.00 Copyright Q 2014 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. Published online January 14, 2014. http://dx.doi.org/10.1016/j.pedhc.2013.11.002
276
Volume 28 Number 3
increased stress among new APRNs. This shift in care resulted in the need to support all APRNs beyond orientation and provide peer-to-peer support. Using a structured transition to practice or fellowship framework, our large, freestanding, academic medical center that currently employs more than 400 APRNs implemented an APRN Fellowship program. This yearlong, innovative APRN Fellowship is composed of didactic classroom sessions and skill-based and critical thinking simulations. This article describes the development and structure of this novel program. BACKGROUND National health care reform, a shortage of primary and specialty care physicians, and the new Accreditation Council for Graduate Medical Education resident duty hours standards have given health care organizations the opportunity to evaluate their current care delivery models. These health care changes may lead these organizations to make changes to provide safe, efficient, and effective care. These drivers gave this large, urban, pediatric, academic medical center the impetus to develop an innovative care model. Embracing the recommendation of the Institute of Medicine Future of Nursing report (2010) that APRNs function to the full extent of their education and training, our hospital and health care system recognized the APRN as an essential component of this new model of care. During the past several years, our hospital and health care system have hired a significant number of APRNs to fill the void created by recent health care Journal of Pediatric Health Care
changes. We currently employ more than 400 APRNs, primarily nurse practitioners (NPs), who practice across a large network, including inpatient (acute and critical care), subspecialty, and outpatient primary care settings. The increasing number of APRNs, along with their growing scope of practice, prompted a key group of stakeholders to evaluate the orientation and ‘‘onboarding’’ of all APRNs. All new hires received a comprehensive competency-based orientation, including self-assessment. The duration of the individualized orientation ranged from 3 to 6 months based on the practice needs of their specialty area. Despite an individualized orientation plan, gaps in knowledge and practice still existed. New APRNs completed an online survey to identify strengths and opportunities for improvement in the orientation process. One quarter of newly hired APRNs responded to the survey and reported a need to standardize the education delivered during the orientation process and provide support during the transition into the APRN role. The respondents also identified a desire for more networking opportunities with their APRN peer group. These results correlate with the results of a national study of APRNs that indicate many challenges, including support, work conditions, administrative infrastructure, and professional relationships during role transition (Cragg & Bailey, 2012). Many challenges are associated with the transition into an APRN role for both new graduates and experienced APRNs. Despite literature that describes the role of the APRN, identified gaps still exist. Hart and Macnee (2007) analyzed 562 responses from two large national NP conferences and found that an overwhelming majority (87%) expressed interest in, and believed they would have benefited from, a residency program after graduation. Many of the NPs surveyed described a lack of support during their transition into the NP role and feelings of fear and uncertainty (Hart & Macnee, 2007). Kelly and Matthews (2001) conducted focus groups with 21 recent NP graduates and found several key elements to role success that were not discussed in their formal education, including role clarification, connectedness to the organization, and support opportunities. These aspects are critical to a successful transition into practice and are often overlooked during formal education and when considering a job opportunity. In addition, relationships with other APRN staff and role clarity were the most important factors facilitating role transition (Brown & Olshansky, 1998; Heitz, Steiner, & Burman, 2004). There is a paucity of literature about programs that assist the transition of APRNs into practice. Most articles describe orientation or onboarding rather than a comprehensive APRN residency program. Bahouth and Esposito-Herr (2009) describe a formal acute care NP orientation; however, the program was brief www.jpedhc.org
(12 weeks), and the primary outcome was accelerating startup time to independent practice. Goldschmidt, Rust, Torowicz, and Kolb (2011) describe a comprehensive orientation program in an acute care cardiac center. This program focused on the feeling of connectedness that can occur when APRNs have a structured orientation program with clearly identified goals and timelines, an identified preceptor, and specialty-specific education (Goldschmidt et al., 2011). Several descriptions of orientation programs for specific specialty populations or practice areas such as cardiology, primary care, and critical care units exist in the literature, as well as descriptions of specific roles, including the Clinical Nurse Specialist (CNS) (Miga, Rauen, & Srsic-Stoehr, 2009; Urden & Stacy, 2011) and Certified Nurse Midwife (CNM) (Hunter, Kvale, & Romick, 2000). Although these descriptions were helpful, they may not be generalizable to other populations and roles and only addressed the clinical aspects of orientation. To address the issues facing newly hired APRNs at our institution, a comprehensive APRN transition to practice program was developed. All new APRN hires, both novice and experienced, are required to participate in the APRN Fellowship program. The program consists of five discreet didactic course days over 1 year to support transition to practice for any APRN new to practice and/or new to our institution. FELLOWSHIP CONTENT A team of APRN coordinators, an educational nurse specialist, the director of advanced practice nursing, and the director of nursing education, along with the senior talent strategist responsible for the recruitment of APRNs, developed the APRN Fellowship Program. We implemented the program to meet the needs of both novice and experienced APRNs new to our hospital and health care system. Program goals included (a) developing an infrastructure to support the APRNs as they transitioned into their new role; (b) creating a clearinghouse for common themes, challenges, issues, and best practices; and (c) providing opportunities for networking, mentorship, peer leadership, and support in an ongoing manner. Benner’s Novice to Expert Theory, which describes the passage through five levels of skill acquisition and professional development, provided a framework for the content of this program (Benner, 1982). APRNs from all clinical practice areas participate in the program, and the content and format are based on the composition of each group in terms of roles (CNS, NP, and CNM) and experience level of the group (new graduate vs. experienced practitioners), as well as practice area (critical care, acute care, subspecialty care, or primary care). Each new hire traveled through the program with their assigned group to encourage connectedness and foster peer support. The team May/June 2014
277
TABLE. Fellowship day themes Fellowship day Day 1 Day 2 Day 3 Day 4
Day 5
Theme Role transition Clinical practice and effectiveness of the advanced practice registered nurse role Quality and patient safety Competency, ongoing professional practice evaluation, billing, coding, and documentation National perspective, local and national professional growth opportunities
identified five themes that provided the basis for the program content (Table). It was evident from observations, as well as from comments and feedback, that the need existed to standardize the information given to each new hire from the hospital/nursing department level. New APRN hires do not attend the department of nursing general orientation and therefore do not have the opportunity to learn about the hospital and department system processes applicable to their role. In The APRN response, information Fellowship on the hospital and program provides department strategic goals and initiatives APRNs with are included in the opportunities to APRN Fellowship propractice technical gram. Experienced, interprofessional exand psychosocial pert faculty provide diskills away from the dactic content, as well bedside in a safe as the opportunity for collaboration and netand simulated working. Interactive, environment with didactic content and their peers and to simulation skills sessions are blended to receive feedback maximize these interfrom experts. actions and increase the participants’ knowledge regarding key hospital goals. The groups also have time built in each day for open discussions on relevant topics, as well as time to share best practices and common challenges in their roles. New APRNs may or may not have the opportunity to practice all of their required skills while participating in orientation, and even if they have the opportunity to practice at least once, they may not feel comfortable or competent in performing this skill. The APRN Fellowship program provides APRNs with opportunities to practice technical and psychosocial skills away from the bedside in a safe and simulated environment with their peers and to receive feedback from experts. In a simulated environment, new APRNs 278
Volume 28 Number 3
are able to make mistakes and learn from their mistakes, while learning from other expert APRNs and physicians. Simulation emphasizes the application and integration of knowledge, skills, and critical thinking and is a successful teaching method in both clinical and formal education (Rauen, 2004). Simulation decreases the challenges of patient availability and instructional time required that makes practicing skills difficult (Issenberg et al., 1999). The APRN Fellowship team evaluates the content of the program on an ongoing basis. Each fellowship group completes evaluations at the end of each day to evaluate the speakers and content objectives. Participants also complete an evaluation of the overall program and process measures. Participant comments and feedback allowed for ongoing changes in both format and structure. EVALUATION AND OUTCOMES The purpose of the APRN Fellowship program is to support the transition to practice for the new and experienced APRN in an ongoing manner. Program outcome measures include recruitment and retention, APRN satisfaction, patient and family satisfaction, productivity, engagement, and a decrease in patient safety events. Evaluation of costs associated with the program and program effectiveness will be measured, along with self-reported perception of competence and confidence in the APRN role. In addition, evaluation of networking opportunities and benefits of simulation training for technical and teamwork skills are ongoing. In the past 2 years, 108 APRNs have enrolled in the program, including 99 NPs, 8 CNSs, and 1 CNM (Figure 1) from all practice areas (Figure 2). Twentynine percent of program participants were experienced and 71% of program participants were novices/new graduates. Fifty-five APRNs have completed or
FIGURE 1. Number of advanced practice registered nurse participants by role. CNM, Certified nurse midwife; CNS, clinical nurse specialist; CRNP, certified registered nurse practitioner. This figure appears in color online at www.jpedhc.org.
Journal of Pediatric Health Care
FIGURE 2. Number of advanced practice registered nurse participants by practice area. APRN, Advanced practice registered nurse; ED, emergency department; ICU, intensive care unit. This figure appears in color online at www.jpedhc.org.
role and is critical to the success of not only the care delivery model as a whole, but of the APRN role at our institution. The APRN Fellowship has widespread application, because there is a critical need for the APRN role across the United States given the changes in health care delivery systems nationally. This program provides a framework for replication by other advanced practice professionals, including certified registered nurse anesthetists and physician assistants. Successful role transition will not only improve the experience for new APRNs but will ultimately improve patient safety and outcomes. We thank Evie Lengetti, Chris Macaulay, Mike Donahue, Jessica McElroy, and Katherine Finn Davis for their contributions and ongoing support of this program. REFERENCES
graduated from the program, and we anticipate that another 30 will enroll in the program by end of calendar year 2013. Preliminary evaluations have indicated a number of positive outcomes associated with participation in the program, including increased networking and patient referral opportunities. Since the Successful role inception of the protransition will not gram, we have had a turnover rate of less only improve the than 2%, and anecdotal experience for new reports indicate that APRNs but will the APRN fellowship ultimately improve program has been a key driver in the final patient safety and decision in selecting outcomes. our organization by new hires. Both novice and experienced participants have reported that the program provided them with the opportunity to share best practices and discuss common issues related to the APRN role. The value of increased interprofessional collaboration has also been demonstrated. IMPLICATIONS FOR PRACTICE Role transition is an extremely stressful time. APRNs are caring for patients with higher acuity and complexity than in the past. Increased stress and challenges can potentially lead to decreased job satisfaction and in turn put APRNs at risk for turnover. The APRN Fellowship program supports transition to practice for advanced practice nurses. This program addresses all aspects of the transition to a new APRN
www.jpedhc.org
Bahouth, M., & Esposito-Herr, M. (2009). Orientation programs for hospital-based nurse practitioners. Advances in Critical Care, 20(1), 82-90. Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402-407. Brown, M., & Olshansky, E. (1998). Becoming a primary care nurse practitioner: Challenges of the initial year of practice. The Nurse Practitioner, 23(7), 46-66. Cragg, B., & Bailey, P. (2012). Nurse practitioner graduate transition to practice (PowerPoint presentation). Retrieved from http:// resources.cpha.ca/CPHA/Conf/Data/2009/A09-177e.pdf Goldschmidt, K., Rust, D., Torowicz, D., & Kolb, S. (2011). Onboarding advanced practice nurses: Development of an orientation program in a cardiac center. The Journal of Nursing Administration, 41(1), 36-40. Hart, A. M., & Macnee, C. (2007). How well are nurse practitioners prepared for practice: Results of a 2004 questionnaire study. Journal of the American Academy of Nurse Practitioners, 19(1), 35-42. Heitz, L., Steiner, S., & Burman, M. (2004). RN to FNP: A qualitative study of role transition. Journal of Nursing Education, 43(9), 416-420. Hunter, L. P., Kvale, J. K., & Romick, P. (2000). Using imagery for role transition of midwifery students. Journal of Midwifery & WomenÕs Health, 45, 337-342. Institute of Medicine. (2010). The future of nursing report. Washington, DC: National Academy Press. Issenberg, S. B., McGaghie, W. C., Hart, I. R., Mayer, J. W., Felner, J. M., Petrusa, E. R., . Ewy, G. A. (1999). Simulation technology for health care professional skills training and assessment. Journal of the American Medical Association, 282, 861-866. Kelly, N., & Matthews, M. (2001). The transition to first position as nurse practitioner. The Journal of Nursing Education, 40(4), 156-162. Miga, K. C., Rauen, C. A., & Srsic-Stoehr, K. (2009). Strategies for success: Orienting to the role of a clinical nurse specialist in critical care. AACN Advances in Critical Care, 20(1), 47-54. Rauen, C. (2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care Nurse, 24(3), 46-51. Urden, L. D., & Stacy, K. M. (2011). Clinical nurse specialist orientation: Ready, set, go! Clinical Nurse Specialist, 25(1), 18-27.
May/June 2014
279
