Nurse Practitioner Role Transition: A Concept Analysis

Nurse Practitioner Role Transition: A Concept Analysis Hilary Barnes, MSN, CRNP, PhD (candidate)

Hilary Barnes, MSN, CRNP, PhD (candidate), is Family Nurse Practitioner, Widener University, Chester, PA.

Keywords Concept analysis, nurse practitioner, role transition, transition, work role transition

Correspondence Hilary Barnes, MSN, CRNP, PhD (candidate), Widener University, Chester, PA E-mail: hbarnes@mail.widener.edu

Barnes

AIM. A concept analysis of nurse practitioner (NP) role transition. BACKGROUND. The Affordable Care Act is expected to provide 32 million Americans with health insurance, and NPs are gaining attention in addressing this increasing demand for healthcare providers. However, there is limited analysis of the transition from registered nurse to NP. Oftentimes, during this transition, there is a shift from an experienced, expert status to an inexperienced, novice status, with a subsequent loss of confidence in one’s ability and competence. This can hinder successful role development and affect employment continuity within the first year of practice. METHODS AND SOURCES. NP role transition was examined using Walker and Avant’s method of concept analysis. Electronic databases were searched using the terms role transition and nurse practitioner. Thirty articles from nursing, psychology, and business were included. FINDINGS AND CONCLUSIONS. The four defining attributes of NP role transition are absorption of the role, the shift from provider of care to prescriber of care, straddling two identities, and mixed emotions. Personal and environmental antecedents and consequences of the concept are identified. The development of empirical knowledge on NP role transition through further research is important in order for new-to-practice NPs to become high-quality, full-functioning providers.

The transition from registered nurse (RN) to nurse practitioner (NP) can be a significant adjustment in an individual’s career. The transition is rarely easy, and even during the most positive of experiences it can be stressful (Cusson & Viggiano, 2002). During NP role transition, there is the shift from an experienced, often expert status in the RN role to an inexperienced, novice status in the NP role. This change in profes- sional identity can lead to an individual’s loss of confidence, which can hinder successful role develop- ment. Consequently, this impaired role development can affect employment continuity and the decision to remain in the profession within the first year of prac- tice (Cusson & Strange, 2008).

Transitions, as a concept in nursing, have been described as complex and multidimensional (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). They are defined as the period of change between two

relatively stable states that comes with some degree of self-redefinition (Chick & Meleis, 1986). Transitions can occur at any time in an individual’s life; affect one’s environment, health, or relationships; and are shaped by many factors and forces (Heitz, Steiner, & Burman, 2004; Steiner, McLaughlin, Hyde, Brown, & Burman, 2008). Specifically, the changes that occur can be significant for an individual when the transi- tion involves a change in a job or career path (Chick & Meleis, 1986).

With the advent of the 2010 Patient Protection and Affordable Care Act (PPACA) and the pending changes to the U.S. healthcare system, it is anticipated that there will be a need for an increased number of pro- viders to care for the estimated 32 million Americans who will become eligible for health insurance (Mann, 2011; PPACA, 2010). As an integral part to this changing system, NPs are being viewed as part of the

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solution in addressing the nation’s primary care and healthcare needs (American Association of Nurse Practitioners [AANP], 2013a). However, there has been limited examination of the concept of NP role transition and a lack of development of an operational definition of the concept, along with identification of its attributes, antecedents, and consequences.

The purpose of this article is to analyze the concept of NP role transition and develop an operational defi- nition for its use. NP role transition is an important concept for nursing science and nursing practice. As NPs gain greater exposure and professional status in health care, helping new-to-practice NPs move through this transition quickly and smoothly is critical to maintaining continuity of care for patients and opti- mizing efficiency for healthcare systems.

Method

NP role transition was examined using Walker and Avant’s (2005) method of concept analysis. This method examines the basic elements of a concept to determine its defining attributes at the present time. It can be used to clarify a concept that may be unclear or ambiguous and provide a foundation for further development. Within nursing, there are many oppor- tunities to observe and experience phenomena. Concept analysis is important for describing and explaining these phenomena in order to develop the body of literature and advance nursing science (Walker & Avant, 2005).

Walker and Avant’s (2005) method was modified for nursing from Wilson’s (1963) classic procedure of concept analysis. The steps included in this analysis were the following: identifying the concept of interest, determining the purpose of the analysis, identifying uses of the concept, determining the defining attri- butes, identifying the antecedents and consequences, identifying a model case along with borderline and contrary cases, and discussing the empirical referents (Walker & Avant, 2005).