Qualitative Annotated Bibliography
For this assignment you will continue to review current research from Souths Online Library and provide a critical evaluation on that research through an annotated bibliography. An annotated bibliography is a brief summary and analysis of the journal article reviewed. For more information on annotated bibliographies please visit Purdues OWL: Purdue Online Writing Lab
A total of two annotated bibliographies are to be submitted (not to exceed one page each). The articles must come from nursing scholarly literature and may not be older than 5 years since publication. Please note that the articles must be research based and reflect a qualitative methodology (review our reading assignments). Web pages, magazines, textbooks, and other books are not acceptable.
Each annotation must address the following critical elements:
Explanation of the main purpose and scope of the cited work
Brief description of the research conducted
Value and significance of the work (e.g., studys findings, scope of the research project) as a contribution to the subject under consideration
Possible shortcomings or bias in the work
Conclusions or observations reached by the author
Summary as to why this research lends evidence to support the potential problem identified specific to your role specialization ( Family Nurse Practitioner )
Contents lists available at ScienceDirect
Nurse Education in Practice
journal homepage: www.elsevier.com/locate/nepr
Doctorate Studies
Nurse practitioners experiences with role transition: Supporting the
learning curve through preceptorship
Viktoriya Pleshkana,, Leslie Husseyb
a Loewenberg College of Nursing, University of Memphis, 4055 North Park Loop, Community Health Building, Memphis, TN, 38152, USA
b School of Nursing, College of Health Professions, Walden University, 100 Washington Ave S. Suite 900, Minneapolis, MN, 55401, USA
1. Introduction
Registered nurse (RN) to nurse practitioner (NP) role transition is
characterized by significant changes in nurses’ role, including increased
levels of autonomy and new responsibilities of being a prescriber. The
problem begins with the gap between NPs’ education and the level of
skills required at the start of NP practice. To close the gap between
education and practice, preceptorships have been used to support NPs’
clinical learning, both before and after graduation. However, pre-
ceptorships used prior to graduation have not had major changes since
the 1960s and preceptorships used after NPs graduate are scarce
(AACN, 2015; Giddens et al., 2014; LeFlore and Thomas, 2016). Pre-
ceptorships are essential for NPs clinical skill acquisition.
1.1. Background
NPs are RNs with advanced nursing education and clinical training
who are licensed to diagnose and prescribe in the United States
(Coombs, 2015). In recent years, the demand for NPs grew due to the
shortage of primary care (PC) services (Giddens et al., 2014). The
number of practicing NPs has increased by more than 100,000 since
2009 with the current total number of practicing NPs exceeding
234,000 (American Association of Nurse Practitioners [AANP], 2017a).
To accommodate this increased need, the number of NP programs also
proliferated to approximately 350 (AANP, 2017b). Because NPs obtain
their skills through experiential learning, clinical education is the
foundation of NP programs. However, the clinical training model has
not had major changes in 45 years (AACN, 2015; Giddens et al., 2014;
LeFlore and Thomas, 2016).
The RN to NP role transition has been identified as difficult and
stressful (Brown and Olshansky, 1997; Flinter and Hart, 2016; Steiner
et al., 2008). Though many other medical professions offer residencies
to their new graduates, most NPs start practicing independently right
after graduation (Hevesy et al., 2016). The ill-supported clinical edu-
cation during school is followed by the lack of transition support after
graduation (AACN, 2015; Brown and Olshansky, 1997; Donley et al.,
2014; Flinter and Hart, 2016; Logan et al., 2015; Roberts et al., 2017;
Steiner et al., 2008; Webb et al., 2015). Employers expect newly
graduated NPs to care for a wide range of complex patients. Novice NPs
expressed concerns about the lack of training to perform procedures,
such as suturing, fracture care, X-ray readings, etc. (Jones et al., 2015).
Lack of clinical skills may have an impact on NPs transition to practice.
Preceptorship is fundamental to NPs’ experiential learning, both
before and after graduation and vital for NPs’ successful transition to
practice (Brown and Olshansky, 1997; Jones et al., 2015; Leggat et al.,
2015; Wiseman, 2013); however, the literature on preceptorship and
transition is scarce (Jarrell, 2016; Poronsky, 2012). Before graduation,
NP students struggle with their preparedness for clinical experiences
and with the availability of their preceptors and clinical sites. Many
preceptors have expressed concern about students’ preparation level
and questioned their preparation for practice (Roberts et al., 2017). The
challenges of obtaining clinical sites and preceptors have been well
documented (Drayton-Brooks et al., 2017). Further, preceptors are
struggling to accommodate NP students learning needs without having
their workload adjusted (Giddens et al., 2014; Keough et al., 2015;
Poronsky, 2012). Though preceptorship is at the core of NP clinical
education, it is in great need of restructuring and support.
Although many other medical professionals are being supported
through well-structured clinical education and residency programs,
formal NP preceptorship is uncommon after graduation (Wilkes and
Feldman, 2017). With the lack of formal preceptorship to support no-
vice NPs’ role transition after graduation, the major source of pre-
ceptorship for NPs comes through a formal collaborative relationship
with their assigned physicians (Jones et al., 2015). However, the MDs’
abilities to train may be limited. Medical and nursing paradigms differ
significantly and yet, MDs are expected to guide NPs in their role
transition. Physicians’ knowledge of NPs’ role and scope of practice is
important for these professionals’ effective collaboration. However,
MDs have little familiarity with NPs’ role, education, and training
(Schadewaldt et al., 2013; Van der Biezen et al., 2017), which is the
most common barrier to a successful NP and MD collaboration
(Schadewaldt et al., 2013). Lack of formal preceptorships after the
graduation contributes to NPs difficult transition to practice.
It is important to explore the current state of preceptorship support.
https://doi.org/10.1016/j.nepr.2019.102655
Received 17 October 2018; Received in revised form 27 October 2019; Accepted 6 November 2019
Corresponding author.
E-mail addresses: [emailprotected] (V. Pleshkan), [emailprotected] (L. Hussey).
Nurse Education in Practice 42 (2020) 102655
1471-5953/ 2019 Elsevier Ltd. All rights reserved.
T
http://www.sciencedirect.com/science/journal/14715953
https://www.elsevier.com/locate/nepr
https://doi.org/10.1016/j.nepr.2019.102655
https://doi.org/10.1016/j.nepr.2019.102655
mailto:[emailprotected]
mailto:[emailprotected]
https://doi.org/10.1016/j.nepr.2019.102655
http://crossmark.crossref.org/dialog/?doi=10.1016/j.nepr.2019.102655&domain=pdf
Several studies were conducted about NPs’ role transition after gra-
duation (Brown and Olshansky, 1997; Chappell, 2014; Flinter and Hart,
2016). Scholars confirmed that NPs’ role transition and preceptorship
need support. However, how this transition process is currently sup-
ported through preceptorship remains largely unknown. The problem is
that NPs role transition is difficult and poorly supported through an
outdated preceptorship model. Learning about the current state of
preceptorship model may add insight into how it can be improved.
2. Theoretical foundation
The theoretical lens of this study consisted of the combination of
two theories, Schlossberg’s transition theory, and Collins, Brown, and
Holum’s Cognitive Apprenticeship Model (CAM). The concept of tran-
sition was guided by transition theory, and the concept of preceptorship
was guided by CAM.
3. Aim
The purpose of this study was to explore the NPs experiences with
their role transition while in a preceptorship. Understanding how NPs
transition to practice and how a preceptorship supports their transition
may inform educators and employers on how to strengthen the transi-
tion.
4. Method
4.1. Study design and approach
The nature of this study was qualitative. The approach to this
qualitative inquiry was Van Manen’s (1990) hermeneutic phenomen-
ology. When used together, the descriptive and interpretive approaches
allow a deeper understanding of the participants’ experiences (Matua &
Van Der Wal, 2015). Using phenomenology allowed for a description of
participants’ experiences, while applying hermeneutics allowed ex-
tracting the essence of participants’ lived experiences in a specific
context (Van Manen, 1990). Hermeneutic phenomenology design as-
sisted with obtaining and explaining descriptive data in a study specific
context.
4.2. Sample
After receiving an Institutional Review Board Approval from the
Walden University (Approval Number 01-16-18-0522648), a con-
venience sample of 16 currently practicing NPs who had been employed
as a NP for at least three months but no longer than five years and who
had a current collaborative agreement with an MD, was recruited
through the Greater Memphis Area Advanced Practice Nurses
Association, social media sites, and snowballing.
4.3. Data collection
Sixteen participants were interviewed by the author using a seven
question interview protocol. One face-to-face, three Skype, and 12
phone semi-structured interviews were conducted. The interview
questions were based on an extensive review of literature and the
transition and CAM theories described above. Each interview ranged
from 37 to 95 min. Audio recordings were manually transcribed and
transferred into the MAXQDA program.
4.4. Data analysis
All data were transcribed manually by the authors using the
MAXQDA qualitative data analysis software. Data analysis was con-
sistent with the chosen hermeneutic phenomenological design guided
by Van Manen’s approach. Sixteen transcribed interviews were coded
using Van Manen’s analysis strategies. During the initial stages of open
coding, transcripts were read several times. Field notes created during
the transcription process were analyzed. Over 200 codes were derived
and each was assigned a memo (code’s short description). Next, data
were analyzed according to the two participants’ role transition stages
(pre and post-graduation), clinical settings where their experience took
place, participants’ relationships with their preceptors, and their reac-
tions to their role transition experiences. Seven major themes were
identified. MAXQDA analysis program assisted in proper data display
and its easy retrieval.
4.5. Trustworthiness
To ensure data trustworthiness, data credibility, transferability,
dependability, and confirmability were established. Clear, detailed de-
scriptions, prolonged engagement with participants and data, rich data,
and triangulation were ensured. Prolong engagement with participants
was achieved by conducting interviews. Longer interviews allowed es-
tablishing of trust between researcher and participant leading to a more
comfortable discussion of the phenomenon by the participant.
Triangulation in data collection was established through multiple data
collection methods. Namely, to collect data, field notes and partici-
pants descriptions were used.
4.6. Ethical considerations
All study participants were provided with the written information
regarding the study purpose and research process. All participants re-
ceived information about the study prior to and during the interviews.
All participants were informed of the voluntary nature of their parti-
cipation and ability to cancel at any time. All participants consented via
e-mail and received an Amazon certificate of $10 dollars after the in-
terview.
5. Results
In exploring participants experiences with their transition to prac-
tice and preceptorship before and after the graduation, the following
seven themes emerged from the data, (a) transition preparation and
learning; (b) preceptorship during role transition and learning; (c)
learning to care for complex patients; (d) learning in clinical environ-
ment; (e) transitioning to a greater autonomy and new responsibilities;
(f) embracing the role and identity confusion, and (g) transition reac-
tions (Table 1).
5.1. Theme I: Transition preparation and learning
In this theme, participants’ preparation for clinical experiences pre
and post-graduation was explored during their role transition. Prior to
graduation except for the occasional meet and greet clinical or-
ientation, there was no other preparatory work before the participants’
start of their clinical rotations. Participants were not aware of their
preceptors’ expectations or work style until the start of their clinical
rotations, P5: I don’t feel like I understood what was going to be
Table 1
Themes.
Theme Number Theme Name
Theme I Transition preparation and learning
Theme II Preceptorship during role transition and learning
Theme III Learning to care for complex patients
Theme IV Learning in clinical environment
Theme V Transitioning to a greater autonomy and new responsibilities
Theme VI Embracing the role and identity confusion
Theme VII Transition reactions
V. Pleshkan and L. Hussey Nurse Education in Practice 42 (2020) 102655
2
expected of me in clinical. Immediately after graduation, many par-
ticipants reported feeling unprepared to practice independently, P2:
You kind of just get thrown and figure it out. Many reported lack of
orientation for their clinical experiences while in school. Similarly,
post-graduation, many reported lack of adequate onboarding process.
5.2. Theme II: Preceptorship during role transition and learning
The second theme contained the data related to the instructional
strategies used to precept NPs pre and post-graduation. Before gra-
duation, the most effective instructional strategy reported was see one,
do one, in which the preceptor demonstrated the skill and then ob-
served the student perform the skill, after which, the student performed
more independently. However, such hands-on experiences were rare:
P16: the only procedure I really got to do in clinicals doing a pelvic
exam. Preceptors’ teaching styles were reported to be inconsistent
among various preceptors and clinical settings. Preceptors’ workload
and lack of day to day feedback frequently prevented them from pro-
viding participants with adequate instruction, P12: 40 patients a
day, so I don’t know if they had time to sit down and explain a lot of
stuff to me. Case discussions and debriefings were frequently omitted
from students’ learning experiences due to the time constrains.
After graduation, participants learned their NP role through self-
teaching and asking questions, P1: most of the things that I have
learned and that I do it is because I looked it up and I researched it
myself. Though all participants had collaborative agreements with
their MDs expecting them to mentor, many reported minimal to no help
from their collaborators: P14: post-graduation I had collaborators
on paper and I did not have anyone to really break down my day to
I wish I may be had some support Being left alone to learn and
master their new skills generated feelings of stress and fear.
Both before and after graduation, participants reported their pre-
ceptors’ lack of time to teach them, which affected participants’ ability
to learn their clinical skills. Overall, dependence on their preceptors for
clinical decision making prior to the graduation was changed to a lack
of formal preceptorship after graduation. Because most did not have
access to a formal preceptor and many participants collaborators were
unavailable to mentor, self-teaching was employed extensively by all
participants post-graduation.
5.3. Theme III: Learning to care for complex patients
Theme III included participants’ experiences with learning how to
care for complex clients before and after graduation. Participants’ ex-
periences with learning complex patient care while in the program were
random, P16: it was like completely random because you were just
lucky to get what you could get. When advancing to clinical practice
after graduation, participants reported rude awakening as they did
not feel prepared to care for complex patients independently right after
graduation. Participants reported the lack of support from their em-
ployers administration as they did not yet feel equipped to care for
complex clients and were in need of such support, P16: So complex
patients is what I really struggled on when I first became an NP
trying to like cram all that in, assess the patient, talk to them, figure out
everything to order and change in like 15 min, it was very, very over-
whelming at first. Participants particularly struggled with poly-
pharmacy, comorbidities, noncompliant clients, complex diagnoses,
underserved, and less known patients. Without having adequate
structured support, participants struggled with managing their time as
well as took some of their work home. Learning to care for complex
clients was preceptor and cite dependent while in NP program, which
translated into an overwhelmingly steep transition post-graduation.
5.4. Theme IV: Learning and clinical environment
Participants’ experiences with clinical sites and preceptors prior to
graduation and collaboration support post-graduation were explored.
Before graduation, most NPs reported the greatest challenge was
finding and securing clinical sites and preceptors, which often led to
mismatch between the preceptors, sites, and student’s learning needs,
P8: . it was so hard you pretty much take anyone you could get and
there was no way of telling if they were going be good teacher. A
mismatch between the clinical sites and students’ learning needs led to
limited training opportunities available to NP students.
While locating the sites was one of the most stressful components of
many participants’ experiences, frequent preceptor change with a lim-
ited number of clinical hours spent with each preceptor led to shorter
clinical rotations. In this study, short clinical rotations along with
mismatch and lack of selectiveness when securing sites and preceptors
led to a decrease in students’ autonomy during their clinical rotations.
After graduation, participants’ relationship with providers they were
learning from was reported as important to their successful transition to
practice. Those participants who were learning alone reported more
challenging transition experiences. Lack of selectiveness in sites and
preceptors prior the graduation translated into the participants’ need for
their employers support, which was often not available.
5.5. Theme V: Transitioning to a greater autonomy and new responsibilities
Participants experiences with advancing to a greater level of au-
tonomy and new role responsibilities were explored. Increased de-
pendency on preceptors along with decreased hands-on clinical ex-
periences led to reduced autonomy during school clinical experiences,
P14: . I never had a situation that I had to do it on my own in any of
my rotations. When in NP program, participants reported little in-
dependent decision making, prescribing, or practicing differential di-
agnoses.
After graduation, a sudden increase in autonomy, accompanied by
the lack of support, led to participants feeling unprepared, P14:
very challenging lots of frustration, lots of thinking I chose the wrong
profession . Participants reported having particular difficulties with
autonomously prescribing multiple medications, coding, diagnosing,
and laboratory testing interpretation. Many reported day dreaming of
returning to their safer RN role; however, too much was already in-
vested in NP degree. While participants were overwhelmed with their
new responsibilities, they also appreciated the new autonomy level and
began to embrace it when becoming more comfortable with new re-
sponsibilities.
5.6. Theme VI: Embracing the role and identity confusion
Participants’ experiences with identifying with their new role of an
advanced practice nurse were explored. While some participants re-
ported that practicing in an RN role was helpful in learning how to be
an NP, others reported it being confusing, P16: I would go from I am
the one making the decisions and ordering stuff during the week on
patients too, now on the weekend I can’t do any of that, I am just like
following orders, so it was really weird to live in both of those worlds at
the same time. After graduation, when in an NP role, participants re-
ported that it was hard not to perform in both roles, RN and NP since
their new role functions were not clearly defined. Such unclear role
boundaries led to confusion about the scope of an NP role.
5.7. Theme VII: Transition reactions
Participants’ reactions to their experience with the transition before
and after graduation were explored. While feeling stressed out about
finding preceptors and sites when in the program was commonly re-
ported, participants did not express concerns about their new role re-
sponsibilities, P11: I was not stressed out or anxious at all when I was
an NP student, because the responsibility was not on me and now the
responsibility is on me. After graduation, most of reported emotional
V. Pleshkan and L. Hussey Nurse Education in Practice 42 (2020) 102655
3
reactions to NP transition experience were negative. Participants felt
fearful of making a mistake that could negatively affect their patients’
health, P14: can you imagine killing somebody unintentionally, acci-
dently because you did not get the right support; that left me very
stressed out, very unfulfilled in my role as an NP, I thought I was going
to be coming in making a world of difference I feel alone It was
important to explore participants feelings as part of their role transition
experience because human feelings and reactions constitute an im-
portant part of any experience.
6. Discussion
Findings suggested that NPs’ difficult transition to practice was re-
lated to the lack of their preceptorship support in NP school and in NP
work settings. The data showed ill-supported preceptorships when in
NP programs. Lack of preceptorships after graduation was accompanied
by employers expecting novice NPs to function at an expert level, fre-
quently with minimal guidance. Understanding how NPs transition to
practice and how their role transition is supported through preceptor-
ships can be used to inform NP educators and organizations that hire
NPs of the changes needed to strengthen NPs role transition.
The study findings provided insights into how NPs’ role transition is
supported through preceptorship during the two transition stages, pre
and post-graduation. An abrupt increase in autonomy from pre-gra-
duation to post-graduation transition stage accompanied by the lack of
support was this study’s central finding. The awareness of new re-
sponsibilities did not take place until the post-graduation transition
stage, which was the result of overreliance on preceptors for clinical
decision making while in the program. Similarly, Cusson, and Strange
(2008) found that the time of performing independently coincides with
the time of becoming aware of new responsibilities. The abrupt increase
in autonomy coincided with identity confusion.
Struggling to identify with their new role as an advanced nurse,
trying to merge the roles of nursing and medicine, participants reported
their role boundaries were blurred. This finding was consistent with
Jangland et al. (2016) who reported that being positioned in between
the two roles caused identity confusion. Similarly with Brown and
Olshansky (1997), feelings of being an imposter were reported in this
study. NPs enjoyed their new autonomy after settling into their role,
confirming that increased autonomy level facilitates NP role transition
(Faraz, 2017, 2019; Horner, 2017). However, the abrupt change from
overreliance on preceptors while in the program to a poorly supported
role transition post-graduation caused NPs to feel fearful and alone,
which was consistent with previous studies on NP role transition
(Barnes, 2015b; Brown and Oshlansky, 1997; Hart and Macnee, 2007;
Heitz et al., 2004). This variation between the pre and post-graduation
autonomy level combined with blurred role boundaries may be a culprit
of NPs difficult role transition.
When exploring NPs’ experiences with preparation for their clinical
rotations, consistent with Babcock et al. (2014), Flott and Linden
(2016), and Roberts et al. (2017), this study’s findings confirmed that
having an EMR access, becoming familiar with clinical site’s workflow,
as well as preceptors’ and students’ expectations were critical. Frequent
preceptor changes and shorter clinical rotations led to preceptors’ lack
of comfort with their NP students, which caused an increase in ob-
servation-only clinical hours. Similarly to Hallas et al. (2012) results,
participants’ clinical hours did not translate into attaining all necessary
competencies prior the graduation. Though hands on clinical experi-
ences were always desired by participants, they experienced many
observation-only clinical hours while adjusting to their new preceptors
and learning the workflow of their clinical sites. To assist NP students
with preparation for their clinical rotations, it may be beneficial to
assign some observation-only clinical hours prior starting clinical ro-
tations. It may also be of benefit to minimize preceptor and site changes
to increase students’ clinical hours with each preceptor to allow
learning of more complex skills. Lack of NP students’ preparation for
their clinical rotations was followed by rushed and variable pre-
ceptorship process.
When exploring preceptorship during NPs’ role learning, incon-
sistent preceptors’ teaching styles, lack of feedback, and preceptors’
heavy workload were identified. Bazzell and Dains (2017) reported the
lack of guidelines to train preceptors and Marfell et al. (2017) under-
lined the importance of feedback in mentoring. Preceptors’ heavy
workload assignments combined with the lack of training on how to
precept impacted NP students learning of their clinical skills. While
preceptorship processes varied significantly, securing preceptors was
also a challenge.
Challenges with finding and securing clinical sites were identified
and consistent with AACN, 2015, Drayton-Brooks et al. (2017), and
Erikson et al. (2014) findings. Poorly supported preceptorship com-
bined with difficulties in finding clinical sites and preceptors impeded
NPs’ clinical skills acquisition when in the program. Consistent with
Hart and Bowen (2016) and Wilkes and Feldman (2017), this study
showed that formal preceptorship was uncommon post-graduation
leaving NPs to learn from others informally. Though, mentorship is
essential to one’s successful transition to practice (Barnes, 2015a; Faraz,
2016; Farrell et al., 2015; Hill and Sawatzky, 2011; Zapatka et al.,
2014), patient care takes priority decreasing time available for men-
toring NPs (Bazzell and Dains, 2017; Forsberg et al., 2015; Giddens
et al., 2014; Keough et al., 2015; Poronsky, 2012; Roberts et al., 2017).
Training preceptors and decreasing their workload pre graduation, as
well as creating formal preceptorships post-graduation, may provide a
stronger foundation for NPs’ role transition.
When exploring how NPs learned to care for complex clients, lack of
predictability of learning opportunities led to NPs graduating without
having sufficient knowledge in managing patients on multiple medi-
cations or those with multiple comorbidities causing them to doubt
their skills. These findings were consistent with Jones et al. (2015) who
found that NPs lacked preparation to care for complex elder patients. To
address the gap in knowledge related to treating complex patients, it
becomes necessary to include competencies specific to the complexities
of patient care. Consistent with Hart and Bowen (2016), Jones et al.
(2015), and Logan et al. (2015), many participants reported feeling
unprepared to practice post-graduation. Similarly with the results of
Fitzpatrick and Gripshover (2016), O’brien et al. (2009), and Sargent
and Olmedo (2013), participants struggled to fulfill unrealistic em-
ployers’ expectations in an absence of formal onboarding processes.
After the graduation, post-graduation residency programs should pro-
vide NPs with much needed mentorship component to close the gap
between graduation at an entry level and employers’ requirements for
expert NPs.
7. Limitations
This study was limited to NPs who were employed in an NP role in
the United States for at least three months but no longer than five years.
Additionally, data accuracy depended on participants’ recall. Because
all participants had already graduated and started working in their new
role, it was more difficult for them to recall their pre-graduation ex-
periences. Recruitment was limited to those participants who vo-
lunteered their participation. It is possible that NPs experiences with
transition could steer them in their decision of whether to participate in
this study. Due to the qualitative nature of this study, transferring the
results outside the study setting and the population is not possible
unless additional studies are conducted.
8. Conclusion
Understanding how NPs’ transition to practice process is supported
through preceptorship is important in strengthening NPs’ clinical skills
acquisition during the two transition stages, before and after gradua-
tion. This study showed that while in school, NPs’ experiences with
V. Pleshkan and L. Hussey Nurse Education in Practice 42 (2020) 102655
4
clinical skill acquisition were variable and ill-supported. Overreliance
on clinical preceptors while in a program translated into an un-
supported and stressful transition to practice post-graduation.
Participants described that their role change after graduation started
with excitement as they welcomed and embraced the new role, but
quickly changed to the realization of new responsibilities of a new role
combined with feeling unprepared to care for complex patients and the
lack of transition support. Educators and employers have an opportu-
nity to strengthen NPs’ transition to practice through restructuring the
weakest but one of the most important elements of NP role transition,
preceptorship. Training and adjusting preceptors’ schedules to allow
learning to take place when in the program should provide NP students
with the support necessary for them to increase autonomy of their
clinical decision making. After the graduation, well-structured on-
boarding programs and post-graduation residency programs should be
employed to allow for a more gradual increase in autonomy to establish
NPs safe transition to practice. The successful role transition process
may lead to more NPs choose to stay in a role; thus, improving the
quality and availability of health care services.
Funding sources
None.
Ethical approval details
IRB approval was obtained from the Walden University (Approval
Number 01-16-18-0522648). All participants consented via e-mail and
received an Amazon certificate of $10 dollars after the interview.
Declaration of competing interest
None.
Acknowledgements
Donna Bailey, PhD.
References
American Association of Colleges of Nursing, 2015. White paper: current state of APRN
clinical education. Retrieved from. http://www.aacnnursing.org/Portals/42/News/
White-Papers/APRN-Clinical-Education.pdf?ver=2017-10-18-151801-160.
American Association of Nurse Practitioners, 2017a. NP fact sheet. Retrieved from.
https://www.aanp.org/all-about-nps/historical-timeline#2000-s.
American Association of Nurse Practitioners, 2017b. Education. Retrieved from. https://
www.aanp.org/education/61-education/faq-np-prep/306-how-many-np-programs-
are-there.
Babcock, P., Rosebrock, R., Snow, B., 2014. Tips for mentoring advanced practice nursing
students. AACN Adv. Crit. Care 25 (4), 322325. https://doi.org/10.1097/NCI.
0000000000000055.
Barnes, H., 2015a. Exploring the factors that influence nurse practitioner role transition.
J. Nurse Pract. 11 (2), 178183. https://doi.org/10.1016/j.nurpra.2014.11.004.
Barnes, H., 2015b. J
