transition a literature review. journal of advanced nursing

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Transition: a literature review

2006, Journal of Advanced Nursing

Related Papers

Nabeel Al-Yateem

Nursing Open

Ulrika Lindmark

Research Policy

A Georges L Romme

ELEMENTA, vol. II, p. 7-10.

Tommaso Sgarro

Amanda Fowler

AIM AND OBJECTIVE: To critically review contemporary transition theories to determine how they apply to the newly qualified graduate registered nurse programmes. BACKGROUND: Graduate nurse transition to employment is the time of significant change which has resulted in high attrition rates. Graduates are often challenged by their expectation of nursing practice and the reality of the role. The transition from hospital-based training to university-based training has resulted in the need for primary employment to commence with graduate/orientation/internship programmes to help support new graduates transition into clinical practice. One transition model, Duchscher\u27s stages of transition theory, utilised three former theories to develop a final model. DESIGN: A narrative critical literature review. METHOD: The theories selected for the review were Kramer\u27s reality shock theory, Benner\u27s novice to expert theory, Bridges transition theory and Duchscher\u27s stages of transition ...

Kristof Van Assche , Martijn Duineveld , Roel During

In this chapter we will elaborate upon the relationship between the analysis and representation of long term societal change as well as the recommendations for actual practices that are based on this analyses and representation. We argue that the promise of transition management as a strategic science to solve socio-political problems in our society is partly based on unrealistic theories and empirical misrepresentations. This is primarily due to the fact the descriptions of transitions have not always been accurately constructed. Within transition management, the Foucauldian conceptualization of power is still disregarded as an analytical tool for the production of ‘realistic’ representations of governance. The second reason is that there is, by definition, an inevitable gap between descriptions and prescriptions. We conclude that an amoral and realistic analysis of what is happening in actual practice is not only necessary for the (scientific) production of realistic representations of long term societal change but will also teach researchers and knowledge users to be realistic and therefore modest about their ability to ‘manage’ or direct their desired changes in society.

Occupational Therapy in Mental Health

Adele Breen-Franklin

International Journal of Nursing Studies

Elisabeth Hall

Ucla Asia Institute

Marian Katz

Journal of Nursing and Health Studies

jan sitvast

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• Open Advanced Search
• Enterprise Plans

Get 20M+ Full-Text Papers For Less Than $1.50/day.  Start a 14-Day Trial for You or Your Team.

Learn more →.

Sorry, your browser isn't supported.

Upgrading to a modern browser will give you the best experience with DeepDyve.

• Google Chrome

Transition: a literature review

• References BETA
• Recommended
• Add to Folder

Have problems reading an article? Let us know here.

Thanks for helping us catch any problems with articles on DeepDyve. We'll do our best to fix them.

How was the reading experience on this article?

Check all that apply - Please note that only the first page is available if you have not selected a reading option after clicking "Read Article".

Include any more information that will help us locate the issue and fix it faster for you.

Thank you for submitting a report!

Submitting a report will send us an email through our customer support system.

References (57)

Antonia Nelson (2003)

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN , 32 4

J. Levasseur (2002)

Advances in Nursing Science , 24

J. Creswell (1998)

J. Draper (2003)

Nursing inquiry , 10 1

A. Walker (2001)

Contemporary Nurse , 11

D. Kralik, T. Koch, Suzanne Eastwood (2003)

Journal of advanced nursing , 42 1

Heli Vaartio, K. Kiviniemi, T. Suominen (2003)

European journal of oncology nursing : the official journal of European Oncology Nursing Society , 7 3

M. Bury (1982)

Sociology of health & illness , 4 2

Karen Schumacher, Afaf Meleis (1994)

Image--the journal of nursing scholarship , 26 2

Lucy Bailey (1999)

Sociology , 33

B. Powers, T. Knapp (1990)

I. Brudenell (1996)

Western Journal of Nursing Research , 18

A. Motenko, S. Greenberg (1995)

Social work , 40 3

M. Catanzaro (1990)

Holistic Nursing Practice , 4

N. Chick, A. Meléis (1986)

K. Froggatt (1997)

International journal of palliative nursing , 3 1

V. Turner (1971)

A. Gravelle (1997)

Journal of advanced nursing , 25 4

W. Bridges (1980)

B. Young, M. Dixon-Woods, Michelle Findlay, D. Heney (2002)

Social science & medicine , 55 10

B. Paterson (2001)

Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing , 33 1

C. Berterö (1998)

European journal of cancer care , 7 1

D. Kralik, A. Loon, Kate Visentin (2006)

Educational Action Research , 14

Tina Koch, D. Kralik (2001)

Journal of advanced nursing , 36 1

A. Meléis, L. Sawyer, E. Im, DeAnne Messias, K. Schumacher (2000)

Advances in Nursing Science , 23

I. Skärsäter, K. Dencker, I. Bergbom, L. Häggström, B. Fridlund (2003)

Issues in Mental Health Nursing , 24

H. Boeije, M. Duijnstee, M. Grypdonck, A. Pool (2002)

Social science & medicine , 55 6

K. White (1995)

Journal of psychosocial nursing and mental health services , 33 8

A. Brouwer-Dudokdewit, A. Savenije, M. Zoeteweij, A. Maat-Kievit, A. Tibben (2002)

Family process , 41 4

E. Elmberger, C. Bolund, K. Lützén (2002)

Cancer Nursing , 25

L. Sawyer (1999)

Journal of Transcultural Nursing , 10

A. Meléis, P. Trangenstein (1994)

Nursing outlook , 42 6

A. Loon, T. Koch, D. Kralik (2004)

Accident and emergency nursing , 12 4

Martin‐McDonald Martin‐McDonald, Biernoff Biernoff (2002)

Nephrology Nursing Journal , 29

D. Kralik (2002)

Journal of advanced nursing , 39 2

D. Kralik, T. Koch, B. Brady (2000)

Journal of advanced nursing , 31 4

A. White (2003)

European Journal of Cardiovascular Nursing , 2

E. Hilton (2002)

Journal of gerontological nursing , 28 7

G. Powell-Cope (1995)

Qualitative Health Research , 5

Elizabeth Banister (1999)

Qualitative Health Research , 9

J. Neil, L. Barrell (1998)

Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses , 23 6

M. Arman, Arne Rehnsfeldt (2003)

Qualitative Health Research , 13

K. Martin-McDonald, David Biernoff (2002)

Nephrology nursing journal : journal of the American Nephrology Nurses' Association , 29 4

R. Mann, P. Abercrombie, J. Dejoseph, J. Norbeck, Renee Smith (1999)

M. Glacken, G. Kernohan, V. Coates (2001)

International journal of nursing studies , 38 1

D. Kralik, T. Koch, K. Wotton (1997)

Journal of advanced nursing , 26 2

A. Gennep (1960)

A. Forss, C. Tishelman, C. Widmark, L. Sachs (2004)

Sociology of health & illness , 26 3

B. Sorofman, T. Tripp-Reimer, G. Lauer, M. Martin (1990)

M. Luborsky (1994)

Medical anthropology quarterly , 8 4

B. Gwilliam, C. Bailey (2001)

International journal of palliative nursing , 7 10

C. Fraser (1999)

The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses , 31 1

B. Loveys (1990)

M. Shaul (1997)

Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses , 22 4

T. Miller (2000)

Qualitative Health Research , 10

F. Selder (1989)

Nursing & health care : official publication of the National League for Nursing , 10 8

Glacken Glacken, Bolund Bolund, Lutzen Lutzen (2002)

• Journal of Advanced Nursing /
• Volume 55 Issue 3
• Subject Areas /
• Nursing (miscellaneous)

Aim. This paper reports a comprehensive literature review exploring how the term ‘transition’ has been used in the health literature. Background. The meaning of transition has varied with the context in which the term has been used. The last 3 decades have seen altered understandings in the concept of transition in the social science and health disciplines, with nurses contributing to more recent understandings of the transition process as it relates to life and health. Method. The CINAHL, Medline, Sociofile and Psychlit databases were accessed and papers published between 1994 and 2004 were retrieved to answer the questions ‘How is the word transition used?’ and ‘What is the concept of transition informing?’ Transition theoretical frameworks were also explored. Findings. Widespread use of the word ‘transition’ suggests that it is an important concept. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self‐identity is essential to transition. Time is an essential element in transition and therefore longitudinal studies are required to explore the initial phase, midcourse experience and outcome of the transition experience. Conclusion. Transition is the way people respond to change over time. People undergo transition when they need to adapt to new situations or circumstances in order to incorporate the change event into their lives. Transition is a concept that is important to nursing; however, to further develop understandings, research must extend beyond single events or single responses. Longitudinal comparative and longitudinal cross‐sectional inquiries are required to further develop the concept.

Journal of Advanced Nursing – Wiley

Published: Aug 1, 2006

Recommended Articles

There are no references for this article..

• {{#if ref_link}} {{ref_title}} {{ref_author}} {{else}} {{ref_title}} {{ref_author}} {{/if}}

Share the Full Text of this Article with up to 5 Colleagues for FREE

Sign up for your 14-day free trial now.

Read and print from thousands of top scholarly journals.

Continue with Facebook

Log in with Microsoft

Already have an account? Log in

Save Article to Bookmarks

Bookmark this article. You can see your Bookmarks on your DeepDyve Library .

To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.

Sign Up Log In

Subscribe to Journal Email Alerts

To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you don’t already have one.

Copy and paste the desired citation format or use the link below to download a file formatted for EndNote

Reference Managers

Follow a Journal

To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you don’t already have one.

Access the full text.

Sign up today, get DeepDyve free for 14 days.

Our policy towards the use of cookies

All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.

cookie policy

Europe PMC requires Javascript to function effectively.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page.

Search life-sciences literature (43,917,979 articles, preprints and more)

• Available from publisher site using DOI. A subscription may be required. Full text
• Citations & impact
• Similar Articles

Transition: a literature review.

Author information, affiliations.

Journal of Advanced Nursing , 01 Aug 2006 , 55(3): 320-329 https://doi.org/10.1111/j.1365-2648.2006.03899.x   PMID: 16866826 

Abstract 

Full text links .

Read article at publisher's site: https://doi.org/10.1111/j.1365-2648.2006.03899.x

References 

Articles referenced by this article (60)

The hidden suffering among breast cancer patients: a qualitative metasynthesis.

Arman M , Rehnsfeldt A

Qual Health Res, (4):510-527 2003

MED: 12703413

Title not supplied

AUTHOR UNKNOWN

Transition to becoming a leukaemia patient: or putting up barriers which increase patient isolation.

Eur J Cancer Care (Engl), (1):40-46 1998

MED: 9582750

Encountering the downward phase: biographical work in people with multiple sclerosis living at home.

Boeije HR , Duijnstee MS , Grypdonck MH , Pool A

Soc Sci Med, (6):881-893 2002

MED: 12220091

A hereditary disorder in the family and the family life cycle: Huntington disease as a paradigm.

Brouwer-Dudokdewit AC , Savenije A , Zoeteweij MW , Maat-Kievit A , Tibben A

Fam Process, (4):677-692 2002

MED: 12613124

A grounded theory of balancing alcohol recovery and pregnancy.

Brudenell I

West J Nurs Res, (4):429-440 1996

MED: 8797367

Chronic illness as biographical disruption.

Sociol Health Illn, (2):167-182 1982

MED: 10260456

Transitions in midlife adults with long-term illness.

Catanzaro M

Holist Nurs Pract, (3):65-73 1990

MED: 2184167

Citations & impact 

Impact metrics, citations of article over time, article citations, 'there was a pivotal moment'. the dynamics, transitions, adaptations and trajectories of nursing at the front-line in the uk during the covid-19 pandemic..

Conolly AR , Maben J , Abrams R , Harris R , Kelly D , Kent B , Couper K , Rowland E

PLoS One , 19(2):e0295394, 29 Feb 2024

Cited by: 0 articles | PMID: 38422041 | PMCID: PMC10903883

Newly employed nurses' transition into their new role in the ambulance service- a qualitative study.

Jepsen K , Lindström V , Wihlborg J , HÖrberg A

BMC Nurs , 23(1):93, 04 Feb 2024

Cited by: 0 articles | PMID: 38311770 | PMCID: PMC10838444

Avoidable Care Transitions: A Consensus-Based Definition Using a Delphi Technique.

Makhmutov R , Meyer G , Ellen ME , Fleischer S

Innov Aging , 7(8):igad106, 21 Sep 2023

Cited by: 0 articles | PMID: 37941831 | PMCID: PMC10629938

Exploring the Relationship Between Health-Illness Transition Experiences and Distress Among Patients With Pancreatic Cancer.

Goldberg JI , Flynn JR , Baser RE , Nelson JE , Capezuti E , Schulman-Green D

Oncol Nurs Forum , 50(5):625-633, 01 Aug 2023

Cited by: 0 articles | PMID: 37677764 | PMCID: PMC10825807

Free full text in Europe PMC

The Psychological Impact of Per- and Poly-Fluoroalkyl Substances (PFAS) Pollution in the Veneto Region, Italy: A Qualitative Study with Parents.

Menegatto M , Lezzi S , Musolino M , Zamperini A

Int J Environ Res Public Health , 19(22):14761, 10 Nov 2022

Cited by: 1 article | PMID: 36429487 | PMCID: PMC9690247

Similar Articles 

To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

A concept analysis of health-related quality of life in young people with chronic illness.

Taylor RM , Gibson F , Franck LS

J Clin Nurs , 17(14):1823-1833, 01 Jul 2008

Cited by: 76 articles | PMID: 18578756

Acceptance and denial: implications for people adapting to chronic illness: literature review.

Telford K , Kralik D , Koch T

J Adv Nurs , 55(4):457-464, 01 Aug 2006

Cited by: 89 articles | PMID: 16866841

Searching for meaning in negative events: concept analysis.

Skaggs BG , Barron CR

J Adv Nurs , 53(5):559-570, 01 Mar 2006

Cited by: 25 articles | PMID: 16499677

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

Benjamin C , Flynn M , Hallett C , Ellis I , Booth K

Int J Nurs Stud , 45(1):95-109, 08 Dec 2006

Cited by: 5 articles | PMID: 17157849

Bodily change following faecal stoma formation: qualitative interpretive synthesis.

Thorpe G , McArthur M , Richardson B

J Adv Nurs , 65(9):1778-1789, 01 Sep 2009

Cited by: 21 articles | PMID: 19694841

Europe PMC is part of the ELIXIR infrastructure

Transition: a literature review

• Scinapse’s Top 10 Citation Journals & Affiliations graph reveals the quality and authenticity of citations received by a paper.
• Discover whether citations have been inflated due to self-citations, or if citations include institutional bias.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Lippincott Open Access

Development of the novice nurse practitioner role transition scale: An exploratory factor analysis

Hilary barnes.

1 School of Nursing, University of Delaware, Newark, Delaware,

Asefeh Faraz Covelli

2 School of Nursing, The George Washington University, Washington, District of Columbia,

Jonathan D. Rubright

3 National Board of Medical Examiners, Philadelphia, Pennsylvania

Background:

Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.

The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.

Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.

The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.

Implications for practice:

In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.

Introduction

Rapidly evolving care delivery, including increased provider workloads, greater complexity of patient care needs, and global pandemics place health care providers at risk for decreased well-being and poor workforce outcomes. In particular, poor nursing well-being is problematic because it is linked to decreased patient satisfaction and poor quality of care ( McHugh et al., 2011 ), prompting the need to focus on supporting workforce well-being as an intervention to enhance care delivery and productivity ( Klein et al., 2019 ; Sikka et al., 2015 ). It is important that providers are particularly vulnerable to poor well-being during transition to a new professional role, which can be taxing for novice clinicians ( Moran & Nairn, 2018 ).

More specifically, nurse practitioners (NPs) are at risk for poor transition experiences when starting their first NP position ( Barnes, 2015 ; Brown & Olshansky, 1997 ; Cusson & Strange, 2008 ; Faraz, 2019 ; Kelly & Mathews, 2001 ). Novice NP role transition (NNPRT) has been described as both stressful and turbulent, and two decades of research has found this time is rarely easy and often marked by the shift from an experienced, expert status in the registered nurse (RN) role to an inexperienced novice in the NP role. This change in professional identity often leads to decreased confidence and job satisfaction, which can impair role development ( Barnes, 2015 ; Brown & Olshansky, 1997 ; Kelly & Mathews, 2001 ) and lead to an increased intent to leave one's current position ( De Milt et al., 2011 ; Faraz, 2017 ; Sargent & Olmedo, 2013 ). These negative workforce outcomes not only affect employment continuity but also the decision to remain in the profession ( Cusson & Strange, 2008 ), affecting cost to employers, patient care continuity, and placing patients at risk for poor clinical outcomes ( Chanfreau-Coffinier et al., 2019 ; Katz et al., 2015 ; Lam et al., 2020 ).

With these known costs to patients specifically and to the health care system generally, NNPRT is an important phenomenon to study. This is especially urgent because the NP workforce is growing, with approximately 28,000 NPs yearly entering a workforce ( Salsberg, 2018 ) that delivers safe, high-quality, and cost-efficient patient care in the United States ( Buerhaus, 2018 ; Swan et al., 2015 ). Supporting novice NPs is critical to improving the patient experience and the effectiveness and efficiency of care ( Perlo et al., 2017 ; Sikka et al., 2015 ). Changes in how novice NPs are supported, whether in the form of organizational or educational interventions, are needed. To understand and empirically evaluate such interventions, a means to measure this concept is needed.

No published instrument currently exists to measure NNPRT. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT and, subsequently, its association with NP workforce and patient outcomes. To bridge this literature gap, the authors developed a novel instrument that measures NNPRT, pilot tested it in a sample of novice NPs, and examined the internal factor structure ( McCoach et al., 2013 ). In this article, we describe the development of the NNPRT Scale and the results of the exploratory factor analysis (EFA).

Conceptual framework

The authors developed a conceptual framework to guide development of the NNPRT Scale. A concept analysis of NP role transition identified the personal and environmental factors that promote, or inhibit, a successful NP role transition experience ( Barnes, 2015 ). More recently, Faraz (2016 , 2017 ) expanded the concept, from the results of a literature review and qualitative study, to include contemporary workforce needs ( Perlo et al., 2017 ; Sikka et al., 2015 ). This collective body of work revealed three domains driving NNPRT: 1) educational preparedness ; 2) role acquisition with subdomains role ambiguity, self-confidence, perceived competence, and mentorship; and 3) job satisfaction with subdomains professional autonomy, quality of professional and interpersonal relationships, time to complete work, job benefits, sense of meaning, and work–life balance. This conceptual framework guided initial item generation of the NNPRT Scale (Figure ​ (Figure1 1 ).

Novice NP role transition conceptual framework that guided item development. NP = nurse practitioner.

Initial item and scale development

Instrument development was conducted in several sequential stages. Following item generation, face and content validity were assessed via expert review and feedback from a sample of recent NP graduates. Items were refined based on this feedback. Subsequently, pilot data were collected from a new sample of novice NPs working in their first NP position to support initial psychometric testing. These steps are outlined in more detail below. Institutional Review Board approval for this study was obtained before data collection.

Item generation

The process of instrument development begins with the generation of a sufficient number of items to assess content validity ( McCoach et al., 2013 ). Guided by the NNPRT conceptual framework (Figure ​ (Figure1), 1 ), the authors developed a pool of 77 items across the three domains, and six additional items were adopted with permission from an earlier NP role transition instrument that has not been published in the peer-reviewed literature (Dr. Regina Cusson, personal communication, November 26, 2018; Strange, 2015 ). The initial NNPRT Scale included 83 items: five under educational preparedness , 30 under role acquisition , and 48 under job satisfaction .

The varying proportion of items across the three domains was supported by evidence of the relative importance of each domain to NNPRT. For example, receiving a graduate-level education is described as an antecedent of NNPRT; that is, all initial NP education occurs before working as an NP ( Barnes, 2015 ). Within the context of the actual role transition experience (i.e., after the NP starts the first position), educational background is described as a lack of feeling prepared for practice ( Faraz, 2016 , 2017 ). Item development under educational preparedness focused on this theoretical definition (i.e., NPs' feelings of being prepared for entry-level practice). Comparatively, evidence supports that the other two domains, role acquisition and job satisfaction , and the 10 subdomains are more influential to NNPRT because they are present during the actual experience of NNPRT ( Faraz, 2019 ; Kelly & Mathews, 2001 ; Sargent & Olmedo, 2013 ; Zapatka et al., 2014 ). Therefore, item development was weighted to reflect the relative importance of these two domains to the overall concept.

Finally, we chose a 6-point Likert response scale (1 = very strongly disagree to 6 = very strongly agree ). Using more response points, compared with Likert scales with five or fewer responses, can improve the sensitivity of the scale. Scales with 6 points can provide consistent responses across participants ( McCoach et al., 2013 ).

Face and content validity

Face and content validity of the NNPRT Scale items were established via feedback from a panel of experts on NP role transition and a sample of recent NP graduates.

Expert review

We solicited feedback on the NNPRT Scale items from a panel of four NP role transition experts. Individuals were selected based on their reputations as experts and their scholarship on NP role transition, education, and training. Experts were asked to rate the relevance of each item to the concept of NNPRT using a 4-point Likert scale (1 = not relevant to 4 = highly relevant ). Experts had the option to provide comments or suggest revisions for each item. Data were collected Spring 2019 via an online Qualtrics survey.

For each item, we calculated the content validity index ([CVI]; McCoach et al., 2013 ) by summing the number of experts that rated the item 3 ( quite relevant ) or 4 ( highly relevant ) and dividing by the number of experts ( N = 4). The higher the CVI, the greater the agreement across experts of the item's relevancy to the concept; thus, a CVI equal to 1 indicates complete agreement among experts. Forty-seven items had CVIs equal to 1; all but one item was kept. The omitted item (“I wish I had stayed in the RN role”) was removed based on reviewers' comments questioning the ability of participants without RN experience to respond to the item. Twenty-seven items had CVIs of 0.75, which is lower than the recommended 0.80 for retaining items ( McCoach et al., 2013 ); however, given that our group consisted of four experts, agreement among three would calculate to a maximum CVI of 0.75. Thus, we evaluated each of these items individually considering the experts' comments, the item's similarity with higher scoring items, and the research team's knowledge of the concept. Based on this analysis, 11 items were removed and retained items were reworded as necessary. Of the seven items that had a CVI of 0.5, we omitted three and retained and revised four items based on reviewers' comments and alignment with the concept. The two items with a CVI of 0.25 were omitted. Based on experts' comments and each item's CVI, we omitted a total of 17 items from the original pool of 83 items.

NP graduate review

The refined set of 66 items was administered to a convenience sample of seven recent NP graduates from the first two authors' institutions. Participants were asked to provide feedback on the items and rate each item's importance to NNPRT. All respondents received a $10 gift card for participating. Feedback was collected in the Summer of 2019 via a REDCap survey. Based on comments provided about the importance of items to NNPRT, we omitted an additional nine items. By eliciting feedback from experts and recent NP graduates, we established face and content validity of the NNPRT Scale and retained 57 items for the next stage of instrument development.

Initial psychometric testing of the novice nurse practitioner role transition scale

Sample and data collection.

We used a cross-sectional, nonexperimental survey design to collect data from a convenient sample of novice NPs. Data collection occurred online via a secured, confidential Qualtrics survey over a 3-month period at the end of 2019 and early 2020. Study participants were recruited through the American Association of Nurse Practitioners (AANP) “Career Starter Membership,” which is designed for new NPs within the first year of their career ( AANP, 2020 ). Three email blasts describing the study and containing a link to the survey were delivered by the AANP to a random sample of 2,000 “Career Starter” members. A $10 gift card was offered to participants in the initial email blast and the gift card amount was increased to $25 in follow-up emails to increase the response rate. We also recruited novice NPs through snowballing efforts using our professional and academic networks.

On clicking the survey link, participants were directed to a survey landing page describing the study, their rights as a study participant, and ensuring confidentiality of responses. Participants were required to check a box indicating their decision to participate in the study (“I consent, begin the study”) or not (“I do not consent, I do not wish to participate”). When an individual agreed to participate, they were directed to the next page to determine eligibility. The inclusion criteria to participate in the study were: 1) working as a NP; 2) working in the first NP position; 3) working in the first NP position for less than 12 months; and 4) 18 years or older. Participants needed to meet all eligibility requirements to proceed to the survey. If an individual agreed to participate and met the eligibility criteria, the NNPRT Scale was presented, followed by a demographic survey. The survey took approximately 15–20 min to complete. All participants who completed the survey were offered the opportunity to receive a gift card for their time by providing their name and email address on a second secured survey that was kept separate from their study responses. No participant information was shared between the NNPRT survey and the incentive request.

Novice nurse practitioner role transition scale

The NNPRT Scale measured an individual's perception of their NP role transition experience. Higher total scores indicated a more positive role transition experience, and lower scores indicated a less positive role transition experience. The total score is calculated by summing all items for each respondent and dividing by the number of items. The range of possible total scores is 1–6.

Demographic survey

Demographic information included personal characteristics (e.g., age, gender, race, income), professional characteristics (e.g., initial NP education and licensing, national NP certification, years of prior RN experience), and current employment characteristics (e.g., practice setting and specialty, receiving a formal orientation, and hours worked).

Data analysis

Analyses were conducted using STATA-15.1/SE. Data were cleaned and seven items were reversed coded. We removed participants who did not meet inclusion criteria or had incomplete NNRPT Scale data. We retained responses with complete NNPRT Scale data regardless of the completeness of the demographic survey responses. We examined response patterns for any aberrant response behaviors, such as response set bias (e.g., “very strongly agreeing” with all items regardless of the item's content) ( Polit & Beck, 2017 ). If response bias was a concern, the participant was removed. The final sample included 89 novice NPs. Sample characteristics were calculated using frequencies, percentages, ranges, mean values, and standard deviations.

Item analysis and reliability

Item analysis included calculating descriptive statistics (e.g., histograms, mean, median, SD, range) for each item and the total NNPRT Scale score. An initial total score was calculated using 57 items. Using a correlation matrix, correlations between each item and the total score were evaluated ( McCoach et al., 2013 ). Items that were correlated with each other at 0.85 or greater were identified as high correlations may indicate redundancy among the items. In the event of two highly correlated items, we reviewed the item stems and decided which of the pair to retain and which to omit ( McCoach et al., 2013 ). To assess the instrument's internal reliability, we calculated Cronbach alpha for the total score along with a leave-one-out analysis to identify whether the reliability coefficient improved with the removal of any single item ( Cronbach, 1951 ).

Exploratory factor analysis

Exploratory factor analysis is an important and necessary stage in instrument development to explore the underlying factor structure and identify the smallest number of factors that explain how items correlate with each other ( McCoach et al., 2013 ). Although a conceptual framework guided item generation, an EFA does not impose an a priori theoretical structure on the items and allows the unknown factor structure to emerge from the data ( Browne, 2001 ; McCoach et al., 2013 ). Given our small sample size, we used a principle axis factor analysis because it can handle potentially nonnormal data and has a greater ability to recover weak factors ( Briggs & MacCallum, 2003 ; Cudeck, 2000 ). Additionally, to assess sampling adequacy, we ran a Kaiser–Meyer–Olkin (KMO) test; a KMO value greater than 0.60 suggests data are adequate for conducting an EFA ( Kline, 1994 ).

To determine the appropriate number of factors to extract from the data, we used five approaches: Kaiser's (1960) criteria, scree plot ( Cattell, 1966 ), parallel analysis ( Horn, 1965 ), Velicer's (1976) minimum average parcels (MAP), and interpretability ( Fabrigar et al., 1999 ; Gorsuch, 1983 ). Using Kaiser's (1960) criteria, we identified factors with eigenvalues greater than 1.0. However, this approach often overestimates the number of factors ( McCoach et al., 2013 ); thus, we employed the additional approaches listed above. The scree plot involved plotting the eigenvalues from our observed data on a curve, and the point at which the curve stops decreasing and flattens suggests the number of factors to retain ( Cattell, 1966 ; McCoach et al., 2013 ). We then ran a parallel analysis, which calculates eigenvalues from simulated data ( Horn, 1965 ; McCoach et al., 2013 ). We ran the parallel analysis using 1,000 random data sets and then overlaid the results onto a single plot with the scree plot. Factors with eigenvalues in the observed data that are larger than the simulated data suggest “true” factors ( McCoach et al., 2013 ). We also calculated the MAP, which is the average squared partial correlation between items and identifies the smallest value associated with the fewest number of factors ( McCoach et al., 2013 ; Velicer, 1976 ). The final step, interpretability, included coupling the collective results from these approaches with our knowledge and understanding of the theoretical expectations of NNPRT to decide on the final number of factors to extract in our EFA ( Fabrigar et al., 1999 ; Gorsuch, 1983 ).

Using the extracted factor structure, we estimated an oblique rotation (promax) that allowed the extracted factors to correlate ( McCoach et al., 2013 ). The rotated factor matrix was examined and items with pattern coefficients of 0.40 or greater were identified as contributing to a factor and retained. Items were removed if the pattern coefficient was less than 0.40 on all factors or if the item cross-loaded on two or more items with values of 0.32 or greater, and anytime an item was removed from the instrument, we reran each step of the EFA ( Cabrera-Nguyen, 2010 ).

Sample characteristics

Participant demographics for the final sample ( N = 89) are shown in Table ​ Table1. 1 . The sample was 93.2% female, 69.3% White, and was on average 38 years old (range: 25–57 years). The majority of participants (88.8%) held a national NP certification in primary care. A Master's degree was the highest reported degree for initial NP education (83.2%). Almost half of participants (47.2%) completed their didactic NP coursework (not clinical) primarily online, with 36.0% completing a program that delivered didactic content via a combination of online and face-to-face delivery methods. Among participants who reported prior RN experience (97.8%), 87.2% reported working as a RN for more than 5 years. Eight percent of participants reported participating in a NP residency or fellowship program; however, almost two thirds of those who did not, received a formal orientation in their first position (62.2%). There are currently no national data sources with characteristics of novice NPs. However, characteristics of the novice NPs in our sample were similar to samples recruited for two recent studies on the novice NP workforce ( Faraz, 2019 ; Faraz & Salsberg, 2019 ).

Note: N = 89 unless otherwise noted. Selected response categories provided. Percentages may not equal 100 due to rounding. CHC = community health clinic; FQHC = federally qualified health center; NP = nurse practitioner; RN = registered nurse.

Preliminary item analysis and reliability

From the correlation matrix (57 items), we identified four item pairs with correlations greater than 0.85. After reviewing the item stems, we removed three items from the NNPRT Scale leaving 54 items. The reliability (Cronbach alpha) of the 54-item NNPRT Scale was 0.96. Total reliability did not improve with the removal of any item. Individual item analysis and correlation matrix results are available on request from the authors.

Using the set of 54 items, an EFA was performed to examine the internal factor structure of the NNPRT Scale. The KMO test was 0.80, which suggested the data adequate for conducting an EFA ( Kline, 1994 ). Kaiser's criteria (eigenvalues >1) revealed 11 factors. The scree plot, parallel analysis, and MAP suggested extracting five factors. Based on the results of these factor extraction approaches, we decided to extract five factors, which agreed with our knowledge of the conceptual underpinnings of NNPRT. Using the five-factor structure, we ran the oblique rotation (promax) and removed items based on the factor loading criteria discussed above. We iterated this process four times until no items were identified for removal. In total, we removed 14 items leaving 40 items across five factors.

The reliability of the final 40-item NNPRT Scale was 0.96. The KMO test increased to 0.85, again supporting adequate data with the smaller set of items. Kaiser's criterion suggested seven factors. The scree plot and parallel analysis again identified five factors (Figure ​ (Figure2), 2 ), and the MAP also suggested a five-factor structure. The final set of items, pattern coefficients, and factors can be seen in Table ​ Table2. 2 . Correlations between the five factors ranged from 0.18 to 0.65, suggesting the rotation technique was appropriate ( McCoach et al., 2013 ).

Novice NP role transition scale EFA scree plot and parallel analysis. EFA = exploratory factor analysis; NP = nurse practitioner.

Factor structure of the NNPRT scale

Note: Exploratory factor analysis rotated pattern matrix; NP = nurse practitioner.

The final NNPRT scale

On average, the novice NPs in our sample reported moderate role transition experiences; the mean 40-item NNPRT Scale total score was 4.45 (SD: 0.64; range: 2.38–5.60). The five factors extracted from the data included (Figure ​ (Figure3): 3 ): 1) organizational alignment (14 items); 2) mentorship (four items); 3) sense of purpose (12 items); 4) perceived competence and self-confidence (eight items); and 5) compensation (four items). Of the five factors that emerged from the data, two of the factors measure intrinsic concepts (sense of purpose; perceived competence and self-confidence) and three measure extrinsic concepts (organizational alignment, mentorship, and compensation).

Factor structure of the NNPRT Scale. NNPRT = novice nurse practitioner role transition.

Organizational alignment

Factor 1 measures the fit of the NP with their employment setting. Many of the items included in this factor measure organizational structures, such as professional autonomy, quality of relationships, feeling respected by others, and those structures that contribute to work–life balance. One item (“I belong in my practice setting”) was originally developed under the domain role acquisition (Figure ​ (Figure1). 1 ). However, the item loaded with other items focused on the organization in which the NP works, suggesting that the factor is not just about job satisfaction, but more about how well the NP feels welcome and integrated into the organization.

Factor 2 measures the availability and perceived quality of mentorship in the first NP position. Mentorship is a critical aspect and is cited as a facilitator of NNPRT ( Faraz, 2019 ; Sargent & Olmedo, 2013 ; Zapatka et al., 2014 ). It has been theorized that mentorship of novice NPs may lead to increased self-efficacy, improved job satisfaction, and retention ( Barnes, 2015 ; Harrington, 2011 ; Hill & Sawatzky, 2011 ). Mentorship has been described as an environmental factor or form of extrinsic support ( Barnes, 2015 ); however, the emergence of mentorship as a factor separate from measures of the NP's organizational fit demonstrates its importance to the larger concept of NNPRT. It may also reflect that mentorship does not need to come from the organization, and NPs may find mentorship outside of their practice settings.

Sense of purpose

Factor 3 measures the NP's internal feelings about caring for patients and reflected engagement within the NP role ( Barnes, 2015 ). This concept was originally included as a subdomain under job satisfaction (referred to in Figure ​ Figure1 1 as sense of meaning ) as a concept related to the NP position. Having a sense of purpose and finding meaning in their work by helping patients and making a difference in their communities has been cited by novice NPs as positive factors ( De Milt et al., 2011 ; Faraz, 2019 ; Kelly & Mathews, 2001 ).

Perceived competence and self-confidence

Similar to factor 3, factor 4 measures intrinsic concepts related to NNPRT. Factor 4 measures the NP's feelings surrounding their ability to meet the demands of the position and the needs of their patients, as well as feelings that they are performing well in their job. This is a well-established concept, beginning with the seminal “From Limbo to Legitimacy” framework ( Brown & Olshansky, 1997 ) and confirmed by other researchers ( Kelly & Mathews, 2001 ; Faraz, 2016 , 2017 ).

Compensation

The final factor 5 measures the NP's satisfaction with their financial compensation. Low wages and a lack of benefits compared with colleagues and prior RN compensation have been cited as negative factors for novice NPs ( Faraz, 2019 ). It is important to distinguish that NPs have reported dissatisfaction with a lack of parity in compensation as compared with their peers for similar work and are more interested in fair rather than high salaries ( Faraz, 2019 ).

We developed the NNRPT Scale to measure the concept of novice NP role transition. The NNPRT conceptual framework, informed by our combined programs of research, guided initial item development. Face and content validity were established from panels of NP role transition experts and recent NP graduates. Using data from a pilot sample of novice NPs ( N = 89), we conducted initial psychometric testing to obtain evidence of reliability and examine the internal factor structure of the instrument. The results of the pilot EFA revealed five factors: 1) organizational alignment; 2) mentorship; 3) sense of purpose; 4) perceived competence and self-confidence; and 5) compensation (Figure ​ (Figure2). 2 ). The final NNPRT Scale includes 40 items that measure an individual's perception of the role transition experience.

The United States health care system is challenged with ensuring the delivery of safe, effective, and efficient patient care. Over the next 10 years, empirical evidence will be required by administrators, clinicians, and researchers to optimize preparedness and performance of the NP workforce to improve access to care, patient outcomes, and costs ( Buerhaus et al., 2019 ). Optimizing care delivery and efficiency, however, can only be achieved if provider well-being is also addressed ( Perlo et al., 2017 ; Sikka et al., 2015 ). Additionally, the forthcoming Future of Nursing 2020–2030 committee identifies nurses' well-being as important to the delivery of high-quality patient care ( National Academy of Medicine, 2020 ). Thus, there is a critical need to understand novice NP transition to practice. Without an instrument with evidence of validity and reliability, conducting large-scale examinations of NNPRT to identify interventions or approaches that can support successful development of novice NPs is limited.

Future research includes collecting data with a different sample of novice NPs for further psychometric testing. The current five-factor structure will provide the theoretical structure for additional testing and an a priori hypothesis of the factor structure for use in a confirmatory factor analysis ( Cabrera-Nguyen, 2010 ; McCoach et al., 2013 ). Additionally, we encourage the use of the NNPRT Scale in future studies and practice change projects aimed at increasing our collective understanding of NNPRT, as well as developing and testing interventions that will support NPs' entry into the workforce.

Limitations

The study is not without limitations. As with any self-report survey, there is the potential for sampling error or bias ( Polit & Beck, 2017 ). For the pilot study, we did not achieve the recommended minimum sample size of 5–10 participants per item ( Cabrera-Nguyen, 2010 ; McCoach et al., 2013 ). However, our data were considered adequate for an EFA via the KMO test. Collecting data from novice NPs is challenging and researchers have used indirect methods (i.e., snowballing) to augment participant recruitment ( Faraz, 2017 ; Faraz & Salsberg, 2019 ). Our data collection relied on both direct recruitment (i.e., emails to AANP members) and snowballing methods. Additionally, we were unable to target the AANP email blasts to NPs who met our inclusion criteria. Thus, we were unable to calculate a response rate because we cannot confirm how many NPs meeting the inclusion criteria received a link to the study.

Conclusions

Studying NNPRT in today's health care environment is critical as the number of NP graduates has increased by over 200% since 2008 ( Salsberg, 2018 ), and NP employment across settings is growing ( Barnes et al., 2018 ; Martsolf et al., 2018 ). Additionally, the current global COVID-19 pandemic, coupled with an already increasingly complex health care system, is underscoring the importance of rapid and successful transition during this critical time in NPs' professional role development ( Wolfe, 2020 ). We anticipate the NNPRT Scale will be useful to organizations, employers, and educators needing evidence to guide development of interventions to support novice NPs. Ensuring that researchers, educators, and administrators have an instrument with strong psychometric properties to measure NNPRT will improve examination of the concept across practice settings, educational experiences, and regulatory environments.

Acknowledgments

Acknowledgements: The authors would like to thank Drs. Regina Cusson, Margaret Flinter, Ann Marie Hart, and Rachael Crowe for their expert feedback during the early stages of item development. The authors would also like to specifically thank Dr. Regina Cusson for permission to adopt selected items for the NNPRT Scale. The authors also thank the American Association of Nurse Practitioners (AANP) and the AANP Research Committee for their assistance with data collection. This study was funded by pilot grants from Sigma Phi Epsilon Chapter and The George Washington University School of Nursing.

Competing interests: The authors report no conflicts of interest.

Authors' contributions: H. Barnes and A. Faraz Covelli conceptualized the study, generated scale items, collected the data, and interpreted the results. H. Barnes performed the data analyses and was primarily responsible for writing the manuscript. A. Faraz Covelli contributed substantially to the intellectual content of early drafts of the manuscript. J. D. Rubright guided the processes of instrument development, data analysis, and results interpretation. All authors read and revised the manuscript.

• American Association of Nurse Practitioners. (2020). Career starter membership . https://www.aanp.org/membership/career-starter-membership . [ Google Scholar ]
• Barnes H. (2015). Nurse practitioner role transition: A concept analysis . Nursing Forum , 50 , 137–146. [ PubMed ] [ Google Scholar ]
• Barnes H. Richards M. R. McHugh M. D., & Martsolf G. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners . Health Affairs , 37 , 908–914. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Briggs N. E., & MacCallum R. C. (2003). Recovery of weak common factors by maximum likelihood and ordinary least squares estimation . Multivariate Behavioral Research , 38 , 25–56. [ PubMed ] [ Google Scholar ]
• Brown M. A., & Olshansky E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role . Nursing Research , 46 , 46–51. [ PubMed ] [ Google Scholar ]
• Browne M. W. (2001). An overview of analytic rotation in exploratory factor analysis . Multivariate Behavioral Research , 36 , 111–150. [ Google Scholar ]
• Buerhaus P. (2018). Nurse practitioners: A solution to America's primary care crisis . American Enterprise Institute. https://www.aei.org/research-products/report/nurse-practitioners-a-solution-to-americas-primary-care-crisis/ . [ Google Scholar ]
• Buerhaus P. Martsolf G. Donelan K. Clarke S. Barnes H. Cohen C., & Tubbs Cooley H. (2019, November). Nursing health services research agenda for the 2020s . Montana State University College of Nursing. https://sites.udel.edu/nursing/files/2020/01/NHSR_Agenda2020s_Nov2019.pdf . [ Google Scholar ]
• Cabrera-Nguyen P. (2010). Author guidelines for reporting scale development and validation results in the Journal of the Society for Social Work and Research . Journal of the Society for Social Work and Research , 1 , 99–103. [ Google Scholar ]
• Cattell R. B. (1966). The scree test for the number of factors . Multivariate Behavioral Research , 1 , 245–276. [ PubMed ] [ Google Scholar ]
• Chanfreau-Coffinier C. Washington D. L. Chuang E. Brunner J. Darling J. E. Canelo I., & Yano E. M. (2019). Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women veterans' experience with VA care . Health Services Research , 54 , 816–826. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cronbach L. J. (1951). Coefficient alpha and the internal structure of tests . Psychometrika , 16 , 297–334. [ Google Scholar ]
• Cudeck R. (2000). Exploratory factor analysis . In Tinsley H. & Brown S. (Eds.), Handbook of applied multivariate statistics and mathematical modeling (pp. 265–296). Academic Press. [ Google Scholar ]
• Cusson R. M., & Strange S. N. (2008). Neonatal nurse practitioner role transition: The process of reattaining expert status . The Journal of Perinatal and Neonatal Nursing , 22 , 329–337. [ PubMed ] [ Google Scholar ]
• De Milt D. G. Fitzpatrick J. J., & McNulty S. R. (2011). Nurse practitioners' job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider . Journal of the American Association of Nurse Practitioners , 23 , 42–50. [ PubMed ] [ Google Scholar ]
• Fabrigar L. R. Wegener D. T. MacCallum R. C., & Strahan E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research . Psychological Methods , 4 , 272–299. [ Google Scholar ]
• Faraz A. (2016). Novice nurse practitioner workforce transition into primary care: A literature review . Western Journal of Nursing Research , 38 , 1531–1545. [ PubMed ] [ Google Scholar ]
• Faraz A. (2017). Novice nurse practitioner workforce transition and turnover intention in primary care . Journal of the American Association of Nurse Practitioners , 29 , 26–34. [ PubMed ] [ Google Scholar ]
• Faraz A. (2019). Facilitators and barriers to the novice nurse practitioner workforce transition in primary care . Journal of the American Association of Nurse Practitioners , 31 , 364–370. [ PubMed ] [ Google Scholar ]
• Faraz A., & Salsberg E. (2019). From education to practice: What we can learn about the workforce from a survey of new nurse practitioners . Journal of the American Association of Nurse Practitioners , 31 , 454–461. [ PubMed ] [ Google Scholar ]
• Gorsuch R. (1983). Factor analysis . Lawrence Erlbaum Associates, Inc. [ Google Scholar ]
• Harrington S. (2011). Mentoring new nurse practitioners to accelerate their development as primary care providers: A literature review . Journal of the American Association of Nurse Practitioners , 23 , 168–174. [ PubMed ] [ Google Scholar ]
• Hill L. A., & Sawatzky J. A. (2011). Transitioning into the nurse practitioner role through mentorship . Journal of Professional Nursing , 27 , 161–167. [ PubMed ] [ Google Scholar ]
• Horn J. (1965). A rationale and test for the number of factors in factor analysis . Psychometrika , 30 , 179–185. [ PubMed ] [ Google Scholar ]
• Kaiser H. F. (1960). The application of electronic computers to factor analysis . Educational and Psychological Measurement , 20 , 141–151. [ Google Scholar ]
• Katz D. A. McCoy K. D., & Vaughan-Sarrazin M. S. (2015). Does greater continuity of Veterans Administration primary care reduce emergency department visits and hospitalization in older veterans? Journal of the American Geriatrics Society , 63 , 2510–2518. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kelly N. R., & Mathews M. (2001). The transition to first position as nurse practitioner . Journal of Nursing Education , 40 , 156–162. [ PubMed ] [ Google Scholar ]
• Klein C. J. Weinzimmer L. G. Cooling M. Lizer S. Pierce L., & Dalstrom M. (2019). Exploring burnout and job stressors among advanced practice providers . Nursing Outlook , 68 , 145–154. [ PubMed ] [ Google Scholar ]
• Kline P. (1994). An easy guide to factor analysis . Routledge. [ Google Scholar ]
• Lam K. Arnold C. G. Savage R. D. Stall N. M. Zhu L. Wu W. Piggott K. Bronskills S. E., & Rochon P. A. (2020). Does physician retirement affect patients? A systematic review . Journal of the American Geriatrics Society , 68 , 641–649. [ PubMed ] [ Google Scholar ]
• Martsolf G. R. Barnes H. Richards M. R. Ray K. N. Brom H. M., & McHugh M. D. (2018). Employment of advanced practice clinicians in physician practices . JAMA Internal Medicine , 178 , 988–990. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• McCoach D. B. Gable R. K., & Madura J. P. (2013). Instrument development in the affective domain: School and corporate applications (3rd ed.). Springer. [ Google Scholar ]
• McHugh M. D. Kutney-Lee A. M. Cimiotti J. P. Sloane D. M., & Aiken L. H. (2011). Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care . Health Affairs , 30 , 202–210. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Moran G. M., & Nairn S. (2018). How does role transition affect the experience of trainee advanced clinical practitioners: Qualitative evidence synthesis . Journal of Advanced Nursing , 74 , 251–262. [ PubMed ] [ Google Scholar ]
• National Academy of Medicine. (2020). The future of nursing 2020–2030 . https://nam.edu/publications/the-future-of-nursing-2020-2030/ . [ Google Scholar ]
• Perlo J. Balik B. M. Swensen S. Kabcenell A. Landsman J., & Feely D. (2017). IHI framework for improving joy in work . Institute for Healthcare Improvement. http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx . [ Google Scholar ]
• Polit D. F., Beck C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Wolters Kluwer. [ Google Scholar ]
• Salsberg E. (2018). Changes in the pipeline of new NPs and RNs: Implications for health care delivery and educational capacity . Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20180524.993081/full/ . [ Google Scholar ]
• Sargent L., & Olmedo M. (2013). Meeting the needs of new-graduate nurse practitioners: A model to support transition . Journal of Nursing Administration , 43 , 603–610. [ PubMed ] [ Google Scholar ]
• Sikka R. Morath J. M., & Leape L. (2015). The Quadruple Aim: Care, health, cost and meaning in work . BMJ Quality and Safety , 24 , 608–610. [ PubMed ] [ Google Scholar ]
• Strange S. N. (2015). The development and psychometric testing of the Nurse Practitioner Role Transition Scale (661) [Doctoral dissertation, University of Connecticut] . https://opencommons.uconn.edu/dissertations/661 . [ Google Scholar ]
• Swan M. Ferguson S. Chang A. Larson E., & Smaldone A. (2015). Quality of primary care by advanced practice nurses: A systematic review . International Journal for Quality in Health Care , 27 , 396–404. [ PubMed ] [ Google Scholar ]
• Velicer W. F. (1976). Determining the number of components from the matrix of partial correlations . Psychometrika , 41 , 321–327. [ Google Scholar ]
• Wolfe B. (2020). Postgraduate inpatient training in the time COVID . Journal for Nurse Practitioners , 16 , 478. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Zapatka S. A. Conelius J. Edwards J. Meyer E., & Brienza R. (2014). Pioneering a primary care adult nurse practitioner interprofessional fellowship . The Journal for Nurse Practitioners , 10 , 378–386. [ Google Scholar ]

The transition to advanced practice nursing: A systematic review of qualitative studies

Affiliations.

• 1 Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
• 2 Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China. Electronic address: [email protected].
• PMID: 37263057
• DOI: 10.1016/j.ijnurstu.2023.104525

Background: Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes.

Aim: To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role.

Design: A systematic review of qualitative studies.

Data sources: Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL.

Review methods: This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis.

Findings: A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition.

Conclusions: Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.

Keywords: Advanced practice nursing; Nurse's role; Role transition; Systematic review; Thematic synthesis.

Copyright © 2023 Elsevier Ltd. All rights reserved.

Publication types

• Systematic Review
• Advanced Practice Nursing*
• Nurse's Role
• Qualitative Research