Marilyn Douglas DNP, MSN, RN, FNP-BC, OCN

Abstract:

Background: There is a critical shortage of medical providers in the United States (U.S), and over the next ten years, the Association of American Medical Colleges estimates there will be a shortfall of more than 122,000 physicians nationally, which will impact healthcare access and equity. However, the supply of nurse practitioners (NPs) is projected to increase significantly during the same period. In addition, the state of California passed AB890 in 2023, which offers a path for NPs to practice within the full scope of their license. Supporting the transition of new NPs into new clinical roles while ensuring safe, effective care requires both adequate orientation and mentoring. Effective mentorship has been shown to promote retention, job satisfaction and professional socialization during the role transition of the first year of practice. Objective: The purpose of this project was to assess the impact of a structured peer mentoring program on perceived competence and self-confidence and role transition for NPs with less than a year in practice. Methods: An interventional, quality improvement (QI) project was used. Eligible NPs volunteered to receive eight one-on-one weekly mentoring sessions over two months with an experienced advanced practice nurse. The Novice Nurse Practitioner Role Transition Tool (NNPRT), a questionnaire that assesses role transition for novice NPs, was administered to the participants before and after the mentoring intervention. Overall NNPRT scores, perceived competence and self-confidence sub scores, and mentorship scores were calculated and analyzed using paired t-tests to compare mean scores. Results: Nine NPs volunteered for participation with an attrition of 1 NP, resulting in a completion rate of 89%. When pre-and post-intervention were compared using a paired t test, no statistical difference was observed (p=.35). The questions evaluating the mentorship subdomain were all positive on the post-intervention survey. The questions evaluating mentorship were all positive with respondents rating at least “agree” on the post-intervention survey, however, these results may not support that the eight sessions of mentoring contributed to an improvement in role transition. Limitations: The small sample size and convenience sampling threaten external validity, decreasing generalizability of the results beyond the context of the project. The variability in the quality of the orientations and mentoring sessions is a confounding factor that may have influenced responses, resulting in higher pre-mentoring scores. The eight mentoring sessions were completed over two months which may not have been enough time for the mentees to use the tools provided in the sessions. Lastly, the NNPRT tool does not specifically measure aspects of role transition that may be important, such as role identity or sense of belonging. Conclusion: Despite many limitations that may have influenced the results of the project, much can be learned. The project did not demonstrate statistical significance but did highlight the potential challenges of NP structured mentoring programs. Structured mentoring formats with more sessions over longer time periods warrant further investigation and may enhance feasibility for busy clinicians. Additional research is needed to support the recommendation of structured mentoring to improve role transition for novice NPs during the first year of practice.

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