The purpose of the poster presentation is to outline the development of a comprehensive advanced practice nurse (APN) orientation program directed toward improving the transition of APNs into today’s healthcare work environment and improve APN job satisfaction and retention.
Background:
The need for hospital acute care advanced practice nurses continues to grow (Yeager, 2010). Studies have shown that APN practice provides safe, effective, efficient, and patient-centered care that is evidence-based (AANP, 2015; AANP, 2013; Kilpatrick et. al, 2015). The nurse-practitioner (NP) care model has shown to decrease length of stay and hospital costs thereby increasing hospital profits (AANP, 2013). Kutzleb (2015) found that the NP care model coordinates, manages, and monitors outcomes in chronic disease and high-risk patient populations, decreasing readmissions and increasing patient quality outcomes. This makes the APN an essential member of the acute care healthcare team, and APN retention fundamental to continuity of care.
Problem:
With the need for increased acute care advanced practice nurses, comes the healthcare organization responsibility to orient new APNs to a complex work environment. After an increased APN turnover rate during the last two years, the APN committee identified high APN turnover rates and poor job satisfaction among APNs as two barriers to providing a professional nurse practitioner (NP) model.
Intervention:
A needs survey was conducted to assess the current APN’s experience when on-boarding to the organization. There was a 69% response rate with all 69% survey responses indicating a need for change to the current APN orientation process. The data was analyzed and grouped by effective and ineffective processes identified by the survey. Then the data was presented to the committee for discussion and review. A literature review was conducted and summarized to the committee regarding APN orientation programs and mentor models, and then a committee was formed to address revising the existing program.
The quality improvement project included focusing the orientation program on essential identified elements: orientation to the healthcare organization, administrative requirements, the credentialing process, APN council introduction, important contact information, identification of system resources, and interdisciplinary team introduction and shadowing in addition to specialty clinical education and immersion experiences. Essential APN resources for professional development were also developed and created in an APN manual. Mentorship and peer support with feedback and networking was also embedded into the program.
On hire the new APN is now sent all administrative paperwork for general organizational requirements and for credentialing with instructions to complete prior to the first day of employment. Bahouth & Besposito-Herr (2009) and Yeager (2010) found streamlining the administrative activities allowed for earlier assimilation into the work environment. Yeager (2010) also identified shadowing experiences and critical thinking tools to assist the new NP in moving from the Novice to Expert model, as described by theorist Benner (1985) as credited earlier by Dreyfus and Dreyfus. However, this transition requires both a planned process and experience (Gardner, 2012; Benner, 1985). Based on the Benner model of transitioning from novice to expert, a newly directed work environment for APNs was created to facilitate this process.
A welcome letter from the APN council and the assigned mentor is included in the employment packet. Leggat, Balding, and Schiftan (2015) found that pairing an experienced nurse practitioner with a new or less experienced practitioner showed an improvement in effective clinical leadership competencies. Each new APN is assigned a peer within their workgroup and a mentor that practices in another specialty area. The resource manual is also provided to the APN to reference throughout the orientation period. Didactic, simulation–based education, and peer support are provided prior to transitioning to full clinical practice (Bahouth & Besposito-Herr, 2009). Depending on the area of practice, specific clinical education and immersion experiences will then follow.
Conclusions
Preliminary qualitative data from new APNs indicate that the improvements have been beneficial to new APNs. The effectiveness of the new project is being evaluated by on-going surveys and APN retention rates.
Nursing Implications
Future implications for the APN orientation program include improving transition to a healthy work environment and APN practice, resulting in improved clinical leadership and APN retention.