To the Editor:
As an RN in the process of completing my last semester in the family nurse practitioner (FNP) program at the University of North Carolina, Chapel Hill, I find preparing for the adjustment of going from student to nurse practitioner to be quite exciting but also very frightening. Although I feel my educational experiences have prepared me to assume the responsibility of caring for patients, I still find myself struggling with feelings of anxiety and uncertainty when I think about entering a new profession, full of unfamiliar responsibilities and expectations. That is why I found the article by Norma R. Kelly and Maureen Mathews entitled, "The Transition to First Position as Nurse Practitioner" in the April 2001 issue of JNE (Vol. 40, No. 4, pp. 156-162) to be very comforting and informative.
According to the qualitative research study, it was discovered that initially many new nurse practitioners experienced similar feelings while going through the process of professional development in their first years out of graduate school. Some of the common feelings associated with the transitional experience included anxiety due to the loss of control over time and privacy, a sense of isolation and frustration, and feelings of inadequacy and uncertainty when tackling their new responsibilities and perceived expectations. However, with time, these individuals reported an increase in confidence and autonomy, which contributed to a feeling of overall personal satisfaction. The data from this study provided further support for the findings of an earlier longitudinal study conducted by Brown and Olshansky ( 1997), in which similar feelings were echoed by new graduate nurse practitioners.
Understanding that these feelings are part of the normal transitioning process to becoming nurse practitioners benefits new graduates by providing them with some anticipatory guidance as to what they may expect during their first years in practice (Brown & Olshansky, 1998). However, with this knowledge, it is important to identify interventions that help facilitate the transition into the nurse practitioner role. One thing that will help ease the transition of graduates into this role is to understand that many of the negative feelings described above will resolve with time. An intervention that will help new nurse practitioners cope with these feelings is to become involved in advanced practice nursing organizations and support groups (Brykczynski, 2000). Seeking support from individuals in professional organizations and support groups, as well as from former classmates, was noted to be a key coping strategy when handling the challenges encountered during the early transitional phase (Brown & Olshansky, 1998; Kelly & Mathews, 2001).
Another intervention that will help with the transition is to find a supportive mentor who will provide advice and feedback on personal performance, while also offering the support and encouragement needed to facilitate the professional development of the nurse practitioner role (Brown & Olshansky, 1998; Brykczynski, 2000; Kelly & Mathews, 2001). Having more time to see fewer patients during the early phases of transition also will help new graduates develop skills faster and more efficiently, thus enabling their patient volume to increase more quickly over time (Brown & Olshansky, 1997).
Because I will soon be a new graduate nurse practitioner, I feel the information and advice reported in the article by Kelly and Mathews (2001), as well as the other articles cited in this letter, were very informative and reassuring. I encourage all advanced practice nursing students, along with other health care professionals, to read these articles in hopes that the awareness of the transitional process provided by the findings of these studies will lead to a shorter and easier adjustment for advanced practice nurses entering their new professions. ?
Brown, M., & Olshansky, E. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing Research, 46, 46-51.
Brown, M., & Olshansky, E. (1998). Becoming a primary care nurse practitioner: Challenges of the initial year of practice. The Nurse Practitioner Journal, 23(7), 46-66.
Brykczynski, K.A. (2000). Role development of the advanced practice nurse. In A.B. Hamric, J.A. Spross, & C. M. Hanson (Eds.), Advanced nursing practice: An integrative ? approach (pp. 107-133). Philadelphia: Saunders.
Kelly, N., & Mathews, M. (2001). The transition to first position as nurse practitioner. Journal of Nursing Education, 40, 156-162.
Conduce Chitsaz, RN
Raleigh, North Carolina
We are delighted that you found our article informative and comforting. We were interested in the concept of transition and found it filled with a range of emotion with elements of loss and also feelings of confidence and personal satisfaction. * Usually, the nurse practitioner student is functioning at a level of an "expert" in nursing (as described by Benner) during the school years. It is very difficult to leave that comfort zone and now function as a novice nurse practitioner. I ask my graduate students to read this article, not only because it is an example of qualitative research, but also because of the themes that unfolded from the data. A lively discussion always ensues, which includes some fun remarks like, "Why didn't you tell me sooner?" I agree that the first step is in understanding the transition and taking control with personal interventions.
Norma R, Kelly, PhD, RN