Prior Registered Nurse Experience and Self-Perceived Confidence to Practice in the Nurse Practitioner Role

Friday, 20 July 2018

Jenna B. Cate, BSN, RN1
Justin P. Burgett, BRS, RN1
Meredith S. Mason, BSN, RN1
Savannah S. Medearis, BSN, RN2
Jason P. Peter, BSN, RN1
Matthew A. Worley, BSN, RN1
Kate Kemplin, DNP, RN1
(1)School of Nursing, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
(2)Schoo of Nursing, The University of Tennessee at Chattanooga, Chattanooga, TN, USA


This research aims to identify if there is a correlation between previous experience as a registered nurse (RN) and perceived self-confidence of graduate-level nurse practitioner (NP) students regarding their new role as clinical provider. We hypothesize there will be a correlation between more nursing experience and higher perceived self-confidence to practice as an NP after graduation. Our hypothesis was formulated based on Bandura’s Self-Efficacy theory, Benner’s Novice to Expert theory, and Kolb’s Experiential Learning theory (Bandura, 1994; Benner, 1982; Kolb, 1984).

Transitioning into a new role can create considerable anxiety and self-doubt, particularly when the new role requires great responsibility. According to Hamric, Hanson, Tracy, & O'Grady (2013), quality performance may deteriorate when performers are subjected to intense scrutiny from themselves or others. The role of an advanced practice nurse is one that is dynamic and encompasses many aspects such as ethical decision making, proficiency in clinical skills, and therapeutic communication skills. Once a new graduate takes his or her first position as Nurse Practitioner (NP), the transition in this role can take anywhere from six months to two years and sometimes longer (Hamric et al., 2013; Poronsky, 2013). During this transition time, there is a shift that takes place from experienced Registered Nurse (RN) role to a novice NP role (Barnes, 2015). This shift from experienced RN to novice NP can cause “loss of confidence in one’s ability and competence” (Barnes, 2015).

As a novice in the field, new NPs lack the confidence to make clinical decisions that are needed as a provider (MacLellan et al., 2014). It is this lack of confidence in a new role that can cause feelings of self-doubt and thus, cause a feeling of “in-betweenness” that is felt during role transition (MacLellan et al., 2014). The more years of practice as an RN before graduating as an NP, increases the perceived preparedness that is felt by the novice NP (Hart & Macnee, 2007). It is the lack of self-perceived confidence and preparedness during transition that could call for a change to be made in graduate NP programs. “Our survey results indicate that in many ways, formal NP education is not producing NPs who feel adequately prepared for practice and suggests several areas where NP educational programs need to be strengthened” (Hart & Macnee, 2007, p. 41). This study hopes to fill gaps in the literature by finding whether a relationship exists between years of experience as an RN and self-perceived confidence as a graduate student NP to obtain current evidence based research for standardization of graduate NP program curricula.


A convenience sampling method was used to obtain participants for this research. Participants were voluntarily recruited from universities in the United States via email solicitation through university faculty. The participants were asked to answer a survey through Qualtrics which required approximately 10 - 15 minutes to complete. The questions included demographic information such as age, gender, school, area of practice, years of nursing experience, and area of NP study (such as family, acute care, or psychiatric etc.) and a validated NP preparedness questionnaire based on the work of Anne Marie Hart, PhD at the University of Wyoming School of Nursing (Hart & Macnee, 2007). The data collected is anonymous; no personal information was obtained from the participants other than generalized demographic information.


There was no statistically significant difference in the self-perceived self-confidence between groups of registered nurses of various years of experience. The participants reported no difference in confidence between groups based upon learning environment (online, hybrid, or in-person). However, there were statistically significant differences in the data between participants’ level of confidence and their reported confidence in the areas of health assessment, pharmacology and pathophysiology.


If the confidence levels of students are not impacted by their years of experience, graduate schools of nursing could adjust entrance requirements which could allow for additional numbers of graduating NPs in practice. Study findings also revealed no statistically significant difference in NP student preparedness for practice between online and campus programs. This finding indicates that no one form of learning is superior to the other in preparing NP students for practice. Additional research is warranted to determine the effects of self-confidence and its role on practice as it relates to health assessment, pathophysiology, and pharmacology of the graduating NP student