Improving Role Transition, Recruitment, and Retention through a Structured APRN Orientation Program

Purpose: The primary goal of this study is to show improved clinical proficiency, recruitment, and retention among novice APRNs within a veterans’ affairs medical center through participation in a structured comprehensive orientation program specific to APRNs. The desired outcome of this project is to resolve the clinical and professional practice gaps that exists due to insufficient onboarding programs specific to APRNs.

Background/significance: The shortage of primary care physicians in addition to the nursing shortage in the US has significantly increased the need for advanced practice registered nurse (APRNs) providers (Faraz, 2019). However, improper role transition into practice settings have attributed to APRNs leaving healthcare organizations within their first year of practice (Faraz, 2019; Doerksen 2010). Unanticipated challenges, role confusion, inadequate support, and fragmented onboarding processes have been cited as causative factors for recruitment and retention difficulties among novice APRNs within healthcare organizations (Bahouth, Blum, & Simone, 2013). Additionally, there have been instances when key resources were not made available, contributing to inefficiency start up processes and patient safety. As a result, novice nurse practitioners experience job dissatisfaction, stagnant professional growth, improper use of skills within their scope of practice, lack of appropriate reporting structures, and dysfunctional colleague collaboration (Bahouth et al., 2013). Orientation and residency programs assist with the transitional support needed by novice APRNs as well as recruit and retain clinically proficient providers.

Methods: A structured APRN orientation program designed with preceptorship, mentorship, didactic education, and professional socialization is initiated for five APRN trainees who are completing their final year of graduate school. The study is a time series, one cohort, intervention design. Descriptive statistics are conducted to analyze and measure the progression and outcome of the trainee’s transition and clinical proficiency utilizing a modified version of the VA Center of Excellence in Primary Care Education evaluation (CoEPCE) tool.

Results: The results are expected to demonstrate evidence for the significance of a structured NP orientation program for improving clinical proficiency, recruitment, and retention of APRNs.

Conclusions/implications: Supporting the novice APRN in their role transition and beyond will enhance clinical proficiency and job satisfaction, thus resulting in improved retention. Improved retention of APRNs will increase access to care and patient safety. For healthcare organizations to meet the needs of their communities, both novice and experienced nurse practitioners will require a structured orientation program that allows for optimal professional development to successfully transition within the hospital setting.
References
1. Bahouth, M. N., Blum, K., & Simone, S. (2013). Transitioning into Hospital Based Practice: A Guide for Nurse Practitioners and Administrators. New York, NY: Springer Publishing Company.
2. Doerksen, K. (2010). What Are the Professional Development and Mentorship Needs of Advanced Practice Nurses? Journal of Professional Nursing, 26(3), 141–151.
3. Faraz, A. (2019). Facilitators and barriers to the novice nurse practitioner workforce transition in primary care. Journal of the American Association of Nurse Practitioner31(6):364–370