Advanced practice nurses (APNs) and physician assistants (PAs), collectively referenced as advanced practice providers (APPs) are pivotal to healthcare redesign (Buerhaus, 2018). The Future of Nursing Institute of Medicine (IOM) report specified the need for advanced practice nurses in healthcare who are able to practice at the top of their scope in order to fill the need for access to high quality, cost-effective care (IOM, 2010). Yet, the transition to practice for new APP providers has been described in literature as stressful, challenging, and in need of improvement (Poghosyan et al., 2017). The high costs associated with APP recruitment, onboarding, and turnover for APPs within our organization required investigation. Advanced practice leaders and researchers undertook a mixed-methods research study.
Methods:
Semi-structured interviews (n=15) with pre-formulated questions were conducted with a purposive sample of APPs within a large healthcare system from February to August, 2016. Practice settings for the participants reflected a range of rural, urban, ambulatory care, and acute care settings. All providers were diverse in their role preparation and experience. Focus groups varied from 2 – 11 participants, and data saturation was achieved. Qualitative analysis of interview data was done using thematic analysis. A summary of key points by the moderator while participants were present allowed for validation/revision of the summarization by focus group participants.
Results:
In total, ten themes emerged from the physician focus groups, whereas 11 emerged from the APP focus groups. Commonalities were noted between physician and APP perspectives on role transition. Both groups identified the lack of a formalized structure for APP onboarding as a barrier to role transition, recommending that organizations should develop formalized structures or processes. Likewise, participants identified dedicated time for teaching and mentorship as necessary but lacking in practice settings. Perceived clinical gaps of novice APPs during the transition into practice was another theme present within physician and APP focus groups. APP role transition elicited various emotional responses, such as fear, anxiety, and isolation, which have been described in the literature (Faraz, 2016).
Conclusions:
A rigorous, collaborative, post-graduate APP transition-to-practice fellowship specifically designed to address primary care healthcare needs was implemented in 2016. The curriculum, informed by the quantitative (described elsewhere) and qualitative research findings, is categorized into three domains: clinical, systems, and professional. Discussions embedded within the curriculum include faculty case mentoring, role transition, and stress relief workshops, which are designed to alleviate the emotional responses research findings. The curriculum plan addresses noted clinical gaps. Designed as one-year program, Fellows are admitted twice per year in the spring and fall. Simulations and skills labs are embedded as part of the curriculum, complementing the weekly didactic curricular experience. Through attainment of accreditation in spring 2018, the fellowship is deemed as a high quality program with demonstrated programmatic outcomes that have met targets even in its infancy. Retention of practitioners and improved patient satisfaction are notable quality outcomes for these initial fellow cohorts. Plans for expansion of this successful fellowship are underway, as the demand for such post-graduate programs remains high (Rugen et al., 2018).