Enhancing the Orientation Process for Nurse Practitioners Entering Primary Care

• Main Author: Czapiewski, Dustin Joel
• Format: Others
• Published: North Dakota State University 2017
• Online Access: http://hdl.handle.net/10365/25934

Novice nurse practitioners (NNPs) face many challenges when transitioning to practice, which include, but are not limited to, time management, interprofessional relationships, role ambiguity, transition shock, inconsistent onboarding, and lack of mentorship. The process of transitioning from an experienced registered nurse (RN) to a NNP creates role ambiguity, self-doubt, and feelings of inadequacy (Yeager, 2010). A structured orientation fosters a smoother transition, increases role satisfaction and confidence. When healthcare organizations are able to anticipate and minimize barriers, they increase the likelihood that NNPs experience a seamless and successful transition. The orientation process provides a roadmap for NNPs to navigate role acquisition, develop interprofessional relationships, and enhance job satisfaction. A well-planned and structured orientation should meet the needs of NNPs with and without familiarity with the organization’s operations. Feedback obtained from NPs about the inconsistencies and deficits in NP and PA provider orientation at the health care organization prompted evaluation, revision, and re-structure of the orientation process. The purpose of this project was to evaluate the orientation process at a healthcare institution. Using a plan-do-study-act (PDSA) model the orientation process was evaluated, barriers identified, and recommendations made to the organization. Two cohorts of NNPs were interviewed. Cohort 1 worked at the healthcare organization for 12-18 months, while Cohort 2 worked at the healthcare organization for 1-5 months. Both cohorts had the same general orientation; however, Cohort 2 had a more structured clinical orientation. Through the interviews, major themes emerged, and then categorized into the following: general-provider orientation, clinical orientation, clinical competencies, and electronic medical record (EMR). NNPs requested a more structured orientation process, wanted a designated preceptor or mentor, needed guidance on skill validation, and preferred individualized EMR education. Limitations include a small sample size, an inconsistent interview process, and variable orientation processes in the cohorts. There is a need for further research to identify best practices to improve and nurture the transition of the NNP to an expert nurse practitioner (NP). Outcome studies are needed that focus on how NNPs successful transition effects quality of patient care.