Advanced Practice Registered Nurses Role Transition; A Mini Literature Review

Problem Statement

The loss of providers across the healthcare continuum results in numerous positions of direct patient care that APRNs are poised to fill. According to the American Association of Nurse Practitioners (AANP), there are more than 355,000 NPs licensed in the United States. In 2022, 88.9% of NPs were certified in primary care and out of the 88.9%, only 70.2% delivered primary care (Nurse Practitioners in Primary Care). APRNs face role transition difficulties such as feeling overwhelmed, change of environment, change of skill and competency level, and lack of support. Facing difficulties will decrease quality of care that will impact financials, as patients will need to seek out care and or increase hospitalizations.

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Education

Master’s degree programs for APRN include fundamental classes such as advanced pharmacology, pharmacotherapy, pathology/physiology, advanced physical assessment skills, and transition roles. Role content can be incorporated into the overall curriculum, specific to courses and or assignments, or a stand-alone course could be designed for the end of the program that offers DEA information, certification information, along with graduation material. Strategies known to facilitate role transition for APRN students include role rehearsal, reflective journaling, student selection of preceptors, interdisciplinary collaboration and finding a role mentor that can guide, answer questions, and often just listen. Focusing on role transition later in the educational process helps promote adaptation and adjustment to the APRN role in the clinical setting after graduation and promotes professionalism. Preparing students with courses in business, economics, and political role integration would nurture novices and allow networking across diverse areas of practice, incorporating business strategy and work ethics that is needed for the role transition. Economics plays a large role within the APRN role, as they need to be aware of insurance policies including lab and prescription costs. The APRN often has 15 minutes to complete an assessment, prescribe, and educate the patient before they need to move on to the next patient.

Clinical Education

Clinical education is an important factor in APRNs difficult transition to practice and their employment choices. Providing primary care services is a complex nonlinear skill, and many novices may be intimidated by its complexity [3]. Master of Science in any nursing program has didactic, clinical and simulation requirements. The nursing student explores and learns new knowledge that they will apply (application) during their clinical practicums. Clinical

education allows APRNs students to apply their advanced nursing knowledge to practice. One of the most important clinical education resources that nursing students rely on during their experiential learning is preceptorship [3]. Preceptorship is normally encountered by an APRN during graduate school when obtaining clinical experience. Preceptorship is a process of a nursing student’s learning experience in a clinical environment guided by the student’s preceptor and faculty [4]. Clinical education is essential to the learning process and critical to hands on approach. A clinical learning environment framing could introduce the additional perspective of required outcomes and implications for the university and open up a scholarly discourse about alignment between education and health delivery systems [5]. Lack of structure in regard to education quality and the learning needs of the new nurse often is a barrier for the APRN to have a positive transition to a new practice role [6].

Certification

Upon fulfilling the needs for graduation, APRN students must pass a national certification exam. Certification must be acquired in most states before obtaining a state APRN license. Certification is the belief that certification measures the nurses’ abilities to provide safe and competent care at a higher level. Various studies demonstrate that Certification does promote optional health outcomes in patient population [7]. Successful certification validates to healthcare organizations that an nurse has mastered a body of knowledge and has gained expertise in the advanced practice role and the population of interest [8]. In many studies that were reviewed nurses felt that certification provides empowerment but also increased their self-confidence.

Transition

The transition from RN to APRN requires a change in role from providing care that is ordered by a health care provider (HCP) to the APRN who is demonstrating autonomy by prescribing patient care to a Registered Nurse. The process of a successful role transition requires APRN to reflect and let go of their former role as a RN, disconnect from previous social links and support, integrate new knowledge, alter behavior, learn new roles, and provide leadership. autonomy, fear and even confusion. Often this leads APRN out of their comfort zone of being an experienced RN for a new career as in experienced advance practice registered nurse is one of the greatest difficulties of the APRN transition to practice [9].

Mentoring

Mentoring is not new to nursing, as many healthcare organizations offer mentoring for the novice RN and many Universities have mentoring programs for novice faculty.

Mentoring is valued in the nursing profession and essential to building an evidence-based practice culture [10]. Evidence demonstrates that competent mentors aid in facilitating role transitions. APRNs’ have the skill set, knowledge, and competency to provide safe and patient centered care. They are lacking a mentor who is available for the extra Guidance [11].