Evaluation of Transition to Practice Training for Advanced Practice Clinicians

The purpose of this project was to evaluate the effectiveness of a current transition to practice program, assess the transitional needs of local Advanced Practice Clinicians (APC) entering the workforce within a large healthcare facility, and develop proposed enhancements to the current program. For the purpose of this project, APCs were defined as nurse practitioners (NP), physician assistants (PA), certified nurse midwives (CNM), and clinical nurse specialists (CNS). APC's learn advanced clinical judgement and high-level clinical decision-making skills to provide the best care to their patients. Specific discussion focused on the unique challenges for NPs at the completion of their education, including transitioning from an experienced registered nurse (RN) to inexperienced NP, and learning collaborative communication in the role of provider. These challenges exist and still many NPs and other APCs lack continued mentorship and support from colleagues or structured transition programs during this difficult transition. Research identified that structured transition to practice programs among APCs working in primary care build confidence in clinical decision-making, provide an environment of continued mentorship, and allow real-time feedback to improve future patient encounters. Emotional challenges and fears during role transition include feelings of anxiety, frustration, inadequacy, uncertainty, and specifically for NPs even longing to return to one's prior role as an RN. Standardized transition to practice programs have proven to reduce employee turnover by improving job satisfaction, improving collaborative communication, and improving confidence. The objective of this project was to evaluate a current transition to practice program, compare to the needs of local APC's entering the workforce within a large healthcare facility, and develop proposed enhancements to the current program. A survey was developed to assess if the current program was meeting the needs of APC's in transition. The results of the survey were compared with literature findings on the transitional needs of APCs, and used to identify gaps in the current program contents. The current program exceled in areas of role definition of the APC, including scope of practice and team communication. Literature findings indicated the need for clearly defined mentorship, however results of the survey revealed a lack of consistent structured mentorship. Aspects of the survey results and literature findings were used to develop recommendations to enhance the current program. The results were disseminated through a presentation to key decision makers within local APC leadership, and were well received. An executive summary was submitted to the National Nurse Practitioner Symposium recommending implementation of similar programs with clearly established mentorship across APC professions. The Institute of Medicine reports a current lack of providers within primary care, with expected shortages to continue to increase in the coming years. An effective transition program will help APCs be even more successful in filling the gap in access to care with increased confidence, and an overall quicker and more positive transition