Transitioning Novice Nurse Practitioners into Practice through a Blended Mentoring Program

The role of the advanced practice registered nurse (APRN) has grown tremendously within the past 15 years. Continued growth is expected as APRNs fill the gap in patient care responsibilities as a result of the reduction in resident physician work hours. Years of research have demonstrated the difficulty novice APRNs experience as they transition from RN to APRN. Support for the novice APRNs has been found to be a facilitating factor in the transition; however, there is no consensus in the literature as to what type of support is most beneficial. The Institute of Medicine (IOM) suggests a residency program for all novice APRNs, but these are typically one to two years in length and costly. This project attempts to demonstrate a blended mentoring program, combining traditional face-to-face mentoring with e-mentoring, provides necessary social support during the transition from RN to novice APRN.

            The role of the nurse practitioner (NP) is continually growing and meeting patient care needs in many areas of the health care system (Harris, 2014; Institute of Medicine [IOM], 2010; Keough, Stevenson, Martinovich, Young, & Tanabe, 2011; Scholtz, King & Kolb, 2014). Certified nurse practitioners (CNPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs) all have the collective title of advanced practice registered nurse (APRN) (APRN Consensus Work Group, 2008). Certified nurse practitioners have very diverse roles and are certified and licensed in one of six population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health, and psychiatric-mental health (Rounds, Zych, & Mallary, 2013).

            Further specialization of the nurse practitioner (NP) role is common and builds upon the educational foundation of the role and population foci. Within an acute care hospital-based role, CNPs are providing comprehensive physical assessment and diagnosis, medication management, and coordination of complex care for patients in intensive care, cardiac intensive care, neurosurgical intensive care, transplant, oncology and bone marrow transplant, trauma, and many other areas (Bahouth et al., 2013; Brown, Besunder & Bachmann, 2008; Furfari, Rosenthal, Tad-y, Wolfe, & Glasheen, 2014; Harris, 2014; Keough et al., 2011; Kleinpell & Goolsby, 2012; Scholtz, King & Kolb, 2014).  The reduction in resident physician work hours, mandated by the Accreditation Council for Graduate Medical Education (ACGME), combined with the long history of safe, quality care provided by nurse practitioners (NP), facilitated the expansion of the NP role (Bahouth, Esposito-Herr, & Babineau, 2007). With such diverse roles in an acute care hospital setting, transitioning from a staff registered nurse (RN) to a novice NP can be very challenging.

            Transitioning from a staff RN to a novice NP has not been an easy process for many NPs. Cusson and Strange (2008) conducted a qualitative descriptive study of 70 neonatal nurse practitioners (NNPs) who met the following inclusion criteria: had experienced a transition from NNP student to a clinical NNP role, were actively practicing as an NNP, and demonstrated a willingness to complete and return a survey that was mailed to them. It was unclear if the participants worked in an acute care hospital but it can be assumed, based on the NNP role, most, if not all, were working in an acute care hospital. Cusson and Strange (2008) reported a large number of study participants described the difficult transition that takes place when a practitioner shifted from being a provider of care to a prescriber of care. The mental shift involved with the new role can be overwhelmingly difficult for some novice nurse practitioners as new ways of problem-solving, learning new skills, disconnecting from previous role functions, and learning new responsibilities predominate the first months of advanced practice (Link, 2009). In addition, Fenwick et al. (2012) conducted a qualitative study and investigated experiences of newly graduated nurse midwives transitioning to advanced practice. The study included 16 newly graduated nurse midwives’ in Australia working in standard hospital maternity settings. The workloads for these novice practitioners were described as “diabolical,” “unmanageable,” and “incredibly busy” early in their orientation (Fenwick et al., 2012, p. 2056). A lack of communication and social support exacerbated the situation.

            Supportive hospital-based work environments have been shown to increase retention, job satisfaction, recruitment, and ease transition to advanced practice (Cleary, Matheson, & Happell, 2009; Cragg & Bailey, 2009; Fenwick et al., 2012; Pasaron, 2013; Scholtz et al., 2014; Shacklock, Brunetto, Teo, & Farr-Wharton, 2014). Offering comfort, advice, encouragement, and assistance, which are the key elements of social support, can help one through times of duress and/or overwhelming challenges (Cutrona, Russell, & Gardner, 2005). Social support of novice NPs early in their orientation provides an appropriate foundation which, in turn, reduces stress and eases the transition process (Bahouth et al., 2013; D’Aurizio, 2007). When an employee feels supported and enjoys coming to work, work engagement is high (Shacklock et al., 2014; Woodka, 2014). Therefore, it is beneficial to investigate ways to provide social support during transition from a staff RN to a novice NP. Offering a comprehensive social support system for transition from a staff RN to a novice NP may facilitate role transition.

         Mentoring programs are one way to provide a peer social support network for new employees (Bahouth & Esposito-Herr, 2009; Brown, Besunder, & Bachmann, 2008; D’Aurizio, 2007; Girot & Rickaby, 2008; Procter et al., 2011). Greene and Puetzer (2002) characterized mentoring as a method for decreasing feelings of isolation and increasing social support of health care workers. Pop (2011) studied mentoring programs for hospital-based NPs and found mentoring programs offer social support for role transition of the novice NP, validating the results demonstrated by Cragg and Bailey (2008). The social support of an experienced NP allowed novice NPs to feel more confident in a new role in a shorter period of time and facilitated the NP’s transition from an RN to NP (Pop, 2011; Roth, 2008; Scholtz et al., 2014). 

        

         In summary, transitioning from a staff RN to a novice NP has been reported to be a very stressful and tumultuous process which can be psychologically and physically debilitating, leaving a novice feeling isolated and doubting their capabilities (Boychuk-Duchscher, 2009). Supporting novice NPs has been shown to decrease feelings of isolation, increase confidence, and ease transition to practice. Mentoring programs are one facet of providing social support and, therefore, easing the transition for novice NPs. As the role for NPs continues to grow and develop, it is essential for organizations to provide social support for novice NPs. For those novice NPs who participate in the mentoring project, the project is designed to identify the impact on perceived social support.