The Institute of Medicine’s The Future of Nursing report recommends the extension of NP fellowship programs to highlight and assess competencies after completion of licensure or an advanced practice degree program (2011). The decision to stay in the new role can diminish within the first year of clinical practice if professional growth and confidence is not facilitated (Bush, 2014). The initiative will evaluate NP satisfaction between NPs who have not completed a fellowship versus NPs who have utilizing online DNP discussion groups across the United States, Emory, and MD Anderson.
Transition Into Practice
Most health care centers have constrained orientation programs and require new NP graduates to immediately function at complex levels. Turnover and retention may quickly ensue if NPs are unable to transition to their fast-paced work environment. Quality studies have verified NPs provide safe, effective, and quality care for more than 40 years of practice (Bush, 2014). However, new graduate NPs experience increased anxiety the first year of transitioning into practice if they are unable to identify a mentor, or additional support. Wallace notes expertise requires extensive practice to move from novice to expert, generally 10,000 hours or 5 years and with new NPs only having up to 1,000 hours of mentored experience by the end of their formal academic training (2014).
Evaluation of Transition
One method of evaluating an operational definition for transition of an NP is through the Misener Nurse Practitioner Job Satisfaction Scale. The thought is transition can be facilitated by having NPs participate in an NP fellowship program which would instill knowledge, confidence, job satisfaction, and ultimately an expert clinician. If the NP does not rate a high job satisfaction scale, a successful transition likely would not occur (Bush, 2016). The tool incorporates a 3-page questionnaire and 6 subscales for satisfaction. The six factors (subscales) produced internal consistency reliability estimates of .94, .89, .84, .86 and .83, respectively with Cronbach’s alpha of entire scale at 0.96 (Ryan & Ebbert, 2013).
The results of the analyses found that individuals who had participated in an NP fellowship had significantly higher scores on a sense of value for “what you do”, monetary bonuses that are available in addition to salary, and compensation for services outside of normal duties and obtained statistical significance. The following analysis did not obtain statistical significance due to sample size but demonstrated means to be slightly higher with regard to those who completed a program with respect to the measures of sense of accomplishment, opportunity to expand scope of practice, opportunity for change in the work setting, freedom to question decisions, the ability to deliver quality care, respect for opinion, and acceptance from physicians outside of your practice.
Summary
Performing the Misener NP satisfaction scale between NPs who have participated in a fellowship vs. those who have not has demonstrated great promise in the NPs ability to deliver quality care, respect for opinion, sense of accomplishment, opportunity to expand scope of practice, opportunity for change in work setting and freedom to question decisions and practices. Support of graduate fellowship programs provides a reduction in the stress and increased confidence experienced during NP role transition. Alleviation of job dissatisfaction from the NP and employer standpoint via graduate fellowship programs will lead to less turnover rates for new NPs as well as improve patient services. Additionally, this will reduce increased costs to the employer due to turnover.