Neonatal Nurse Practitioner Role Transition

Abstract

Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs. The data consisted of participants' written responses to open-ended questions. Four themes emerged that depicted a linear progression of the transition process from school preparation to beginning feelings in the new role and then development into a more confident practice. Theme 1: First impressions emphasized the ambivalence novice NNPs experienced regarding their preparedness for the role during a stressful and exciting adjustment period. Theme 2: The transition demonstrated the overwhelmingly similar feelings of anxiety, insecurity, exhaustion, and lack of confidence that plagued decision making. Theme 3: Making it as a real NNP indicated that the 1-year mark was a consistent, significant timeframe for feeling like a real NNP. Theme 4: The helpers and hinderers revealed the vulnerability of the novice NNPs to harsh criticism as well as the importance of support, especially from nurse colleagues. NNPs are a valuable resource; thus, enhancing transition is a worthy goal.

Novice nurse practitioner workforce transition and turnover intention in primary care

“…The majority of NPs who reflected on their educational experiences felt only somewhat or minimally prepared in clinical skills after completing their basic NP education (Cusson & Strange, 2008;Hart & MacNee, 2007;Kelly & Mathews, 2001;Rosenzweig et al, 2012;Sargent & Olmedo, 2013;Steiner, McLaughlin, Hyde, Brown, & Burman, 2008). While there is scarce literature on the impact of educational background on transitioning to the first PC NP role, researchers have found no significant difference in academic performance between traditional and nontraditional (non-nurse college graduate [NNCG]) master's students in their educational NP programs (Munro & Krauss, 1985;Sime, Corcoran, & Libera, 1983;Smith & Shoffner, 1991).…”

“…However, Rich (2005) found no correlation between duration of prior RN experience and level of competency in NP clinical skills as determined by NP self-report, but physicians working with the NPs rated those with fewer years of RN experience as having greater competency in clinical skills than those with more years of RN experience. More recent studies have shown mixed results, as more RN experience led to improved adaption to the NP role (Cusson & Strange, 2008;Kelly & Mathews, 2001), while others validated the lack of correlation between prior RN experience and NP role transition (Barnes, 2015;Steiner et al, 2008).…”

“…There is empiric evidence for the importance of mentorship during the NP transition to practice (Harrington, 2011;Hayes, 1998Hayes, , 2001Hill & Sawatzky, 2011), but limited information regarding successful mentoring programs and successful mentoring of NP students (Poronsky, 2012). Mentorship by a colleague (SullivanBentz et al, 2010), and a formal orientation program (Bahouth & Esposito-Herr, 2009;Barnes, 2015;Cleary, Matheson, & Happell, 2009;Cusson & Strange, 2008, Flinter, 2012 have been associated with improved NP role transition, but more information is needed on the ideal structure and content of successful mentoring and mentorship programs (Poronsky, 2012).…”

“…Social support, including support from peers, physicians, family, and patients, has been identified as integral to coping during the transitional period from NP student to practitioner (Chang, Mu, & Tsay, 2006;Cusson & Strange, 2008;Heitz, Steiner, & Burman, 2004;Kelly & Mathews, 2001;Steiner et al, 2008). Social support contributes to personal development and positive adjustment, and helps provide a buffer against the effects of stress (Sarason, Levine, Basham, & Sarason, 1983).…”

“…Social support contributes to personal development and positive adjustment, and helps provide a buffer against the effects of stress (Sarason, Levine, Basham, & Sarason, 1983). Because the role transition of the novice NP can be stressful (Brown & Olshansky, 1997;Cusson & Strange, 2008;Chang et al, 2006;Heitz et al, 2004;Kelly & Mathews, 2001), and positive adjustment is an indicator of a successful transition, social support is especially vital to the novice NP during the transitional period.…”