APRN Full Practice Authority Practice Transition: Stress and Emotions

Full Practice Authority (FPA) for Advance Practice Registered Nurses (APRNs) is in 23 states and the District of Columbia. As advocacy at local, state and national levels continues it is anticipated more states will change to a FPA practice environment. Successful FPA legislation creates a practice transition from a scope of practice dependent on some level of collaboration to independent practice. Professional transitions are stressful. The change from dependent APRN practice to independent practice in the same practice setting may cause unrecognized job stress in the APRN. Emotions may be considered an indicator of job stress. Job stress and emotions may lead to job dissatisfaction. Job dissatisfaction may negatively impact APRN’s intent to stay in the organization and contribute to burnout. Turnover of APRNs may reduce or limit access to care.

There is a growing number of studies evaluating APRN job satisfaction that have found APRNs are generally minimally satisfied to satisfied. Emotions has also been found to be an indicator of job stress. The literature revealed that job stress is negatively related to job satisfaction. Job stress and emotions in FPA practice transition and its impact on job satisfaction has not been described in the literature.

A project to establish a baseline understanding of APRN job satisfaction, job stress and emotions during FPA practice transition was conducted. APRN’s completed a survey containing questions to measure job stress, job satisfaction, practice transition stress, emotions about FPA and demographics. The results showed APRNs were minimally satisfied to satisfied. Job stress from work conflict, role ambiguity, intragroup conflict, intergroup conflict has a significant negative relationship to job satisfaction. Perceived control and task control had a positive relationship to job satisfaction. Practice transition stress was present and had a negative relationship to job satisfaction. Positive emotions were associated with FPA. APRNs who were in roles that were not aligned with their education and certification experienced stress and less positive emotions toward FPA. This project is the first description of the impact of APRN practice transition on job stress and job satisfaction. Practice transition does generate stress and emotions.

Strategies used to support APRNs during transition to FPA and address modifiable job stressors were 1) providing accurate, reliable information; 2) providing access to subject matter experts for personal specific questions during the transition to FPA; 3) implementing a formal orientation to FPA role for new hires and incumbents; 4) providing ongoing support for 6-12 months after the FPA transition, and 5) identifying APRNs that are misaligned and establish a plan to achieve alignment by fulfilling a role in the population that matches certification and license. The project conclusions and strategies would have relevance to organizations anticipating FPA practice transition. Attendees will gain an understanding of stress and emotions experienced during FPA transition and have practical strategies to plan for FPA transition proactively.