Nurse Practitioner Orientation and Mentorship: Perceived Competence by Melissa F Coble A scholarly project submitted to the faculty of East Carolina University College of Nursing in partial fulfillment of the requirements for the degree of Doctorate of Nursing Practice Greenville 2014 Abstract Every year thousands of Nurse Practitioners (NPs) graduate and accept positions in hospital based settings Transitioning into these roles is typically perceived as stressful for the novice Nurse Practitioner NPs that complete an orientation program and are supported by mentors are typically happier in their role, continue employment for a longer time period, which then improves patient outcomes Although developing and maintaining such a program is a financial investment for the healthcare organization, the positive impacts such as increased NP job satisfaction, decreased NP turnover will result in cost savings for the institution There are many studies regarding Registered Nurse orientation, but little has been written about NP orientation programs and what is currently being developed in this area This paper will discuss the differences in Nurse Practitioner perceived competence with and without an orientation and mentorship program in critical care areas Also addressed with be comparing the perceived competence and longevity of NPs in various stages of their NP careers Keywords: Nurse Practitioner Orientation, Mentor, Mentorship Acknowledgements I would like to express my special appreciation and thanks to my chair Professor Dr Michelle Skipper, you have been a tremendous mentor for me I would like to thank you for encouraging me through the DNP project process I would also like to thank my committee members, Professor Dr Connie Mullinix, Professor Dr Cheryl Duke, Alisa L Starbuck, MSN, NNP-BC, NEA-BC for serving as my committee members I also want to thank you for your brilliant comments and suggestions Thanks also to Dr Sally Bulla for your assistance during my scholarly project A special thanks goes to my family Words cannot express how grateful I am to my children, my mother and mother-in-law for all you have done to support me through my doctoral program A special thank you goes to my friend and colleague, Andrea Sessoms MSN, CNM, I could not have made it through without your encouragement and just being there for me when I needed someone to talk to I would also like to say a special thank you to my husband, Doug who has given me many pep talks and just made me laugh when I felt like crying instead Thanks so much! Melissa F Coble © Table of Contents CHAPTER I: INTRODUCTION Problem Statement Justification of Project Purpose Project Hypothesis Definition of Terms Nature of the Problem Summary CHAPTER II: RESEARCH BASED EVIDENCE Introduction Review of Literature Available Tools for Mentor Assessment Available Tools for Nurse Competence Theoretical Framework Summary CHAPTER III: PROJECT DESCRIPTION Project Implementation Protection of Human Subjects Setting Instrument Project Design Methods Limitations Timeline and Budget Summary CHAPTER IV: RESULTS Introduction Project Participants Summary CHAPTER V: DISCUSSION Introduction Implications of Findings Application to Theoretical/Conceptual Framework Limitations Delimitations Implications for Nursing Recommendations Conclusion REFERENCES APPENDICES FIGURES Appendices Appendix A- Permission to use Mentor Role Instrument Appendix B- Link to NP Survey Appendix C- Permission to use Nurse Competence Scale Appendix D - IRB Approval from Wake Forest Baptist Health Appendix E – IRB Approval from East Carolina University Appendix F- Email to Nurse Practitioners List of Figures Figure 1: Nurse Practitioners by Unit Figure 2: Nurse Practitioners by Years of Service at the Academic Medical Center Figure 3: Nurse Practitioners by Years Practicing as a NP Figure 4: Utilizes Information Technology Figure 5: Working in Multidisciplinary Groups Figure 6: My Mentor Serves as a Sounding Board for Me Figure 7: My Mentor is Someone I Can Trust Figure 8: My Mentor is Someone I Can Confide In Figure 9: My Mentor Shields Me Figure 10: My Mentor Thinks Highly of Me References American Association of Colleges of Nursing (2004) AACN position statement on the practice doctorate in nursing Available at http://www.aacn.nche.edu/dnp/dnppositionstatement.htm APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee (2008) Consensus model for APRN regulation: Licensure, accreditation, certification & education Retrieved from http://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Auerbach, D (2012) Will the NP workforce grow in the future?: New forecasts and implications for healthcare delivery Medical Care, 50(7), 606 Bahouth, M N., Ackerman, M., Ellis, E F., Fuchs, J., McComiskey, C., Stewart, E S., & Thomson-Smith, C (2013) Centralized resources for nurse practitioners: Common early experiences among leaders of six large health systems Journal of the American Academy of Nurse Practitioners, 25(4), 203-212 doi:10.1111/j.1745-7599.2012.00793.x Bahouth, M N., Bahouth, M N., & Esposito-Herr, M B (2009) Orientation program for hospital-based nurse practitioners AACN Advanced Critical Care, 20(1), 82; 82-90; 90 Bailey, P., Jones, L & Way, D (2006) Family physician/nurse practitioners: stories of collaboration Journal of Advanced Nursing 53, 381-391 Benner, P E (2001) From novice to expert: Excellence and power in clinical nursing practice Upper Saddle River, N.J: Prentice Hall Brown, A., Christie, L M., Higgerson, R A., Mikhailov, T A., Stojadinovic, B J., & Forbes, M L (2012) A national survey of PICU nurse practitioners - opportunities to standardize practices and optimize service delivery.Pediatric Nursing, 38(5), 249250,277 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/1173239306? accountid=10639 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 Dilmore, T C., Rubio, D M., Cohen, E., Seltzer, D., Switzer, G E., Bryce, C., & Kapoor, W N (2010) Psychometric properties of the mentor role instrument when used in an academic medicine setting Clinical and Translational Science, 3(3), 104-108 doi:10.1111/j.1752-8062.2010.00196.x Donald, F., Mohide, E.A., DiCenso, A., Brazil, K., Stephenson, M., & Akhtar-Danesh, N (2009) Nurse practitioner and physician collaboration in long-term care homes: Survey results Canadian Journal of Aging, 28, 77-87 Donner, G & Wheeler, M (2009) Innovative approaches are needed to support practitioners The Canadian Nurse, 105, 2, 8-9 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/232037009?accountid=10639 Duke, C (2010) The lived experience of nurse practitioner graduates’ transition to hospital-based practice ProQuest (UMI Dissertation Publishing No 34119121) Gehart, L (2012) A new strategy to invest in the capital of novice nurse practitioners Nurse Leader, 10, 3, 51-53 Gibson, T., & Heartfield, M (2005) Mentoring for nurses in general practice: An Australian study Journal of Interprofessional Care, 19, 50-62 Gray, M., & Smith, L (2000) The qualities of an effective mentor from the student nurse’s perspective: Finding from a longitudinal qualitative study Journal of Advanced Nursing, 32, 1542- 1549 Greene, M., & Puetzer, M (2002) The value of mentoring: A strategic approach to retention and recruitment Journal of Nursing Care Quality, 17, 67-74 Halfer, D., Graf, E., & Sullivan, C (2008) The organizational impact of a new graduate pediatric nurse mentoring program Nursing Economics 26, 243- 249 Harrington, S.(2011) Mentoring new nurse practitioners to accelerate their development as primary care providers: A literature review Journal of the American Academy of Nurse Practitioner, 23, 168-174 Hill, L A., & Sawatzky, J V (2011) Transitioning into the nurse practitioner role through mentorship Journal of Professional Nursing, 27(3), 161-167 Hayes, E (1999) Athena found or lost: The precepting experiences of mentored and non-mentored nurse practitioner students Journal of the American Academy of Nurse Practitioners, 11, 335-342 Hayes, E (2005) Approaches to mentoring: How to mentor and be mentored Journal of the American Academy of Nurse Practitioners 17, 442-445 Hittle, K., & Tilford, A K (2010) Pediatric nurse practitioners as hospitalists Journal of Pediatric Health Care, 24(5), 347-350 doi:http://dx.doi.org.jproxy.lib.ecu.edu/10.1016/j.pedhc.2010.06.009 Institutes of Healthcare Improvement (n.d.) Retrieved October 13, 2014 from http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx Ivey, J (2012) Transition from student to nurse: The orientation process (Order No 1520129, Gardner-Webb University) ProQuest Dissertations and Theses., 50 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/1114560375? accountid=10639 (1114560375) Kelly, N & Mathews, M (2001) The transition to first position as nurse practitioner Journal of Nursing Education, 40(4), 156-62 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/203975982? accountid=10639 doi:http://dx.doi.org.jproxy.lib.ecu.edu/10.1016/j.profnurs.2011.02.004 Meretoja, R., Isoaho, H., & Leino-Kilpi, H (2004) Nurse competence scale: Development and psychometric testing Journal of Advanced Nursing, 47(2), 124133 doi:10.1111/j.1365-2648.2004.03071.x Mckay, H (2006) Trauma nurse practitioners-baptism by fire! variations in role orientation Journal of Trauma Nursing, 13(3), 102-4 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/194451627?accountid=10639 Myall, M., Levett-Jones, T., & Lathlean, J (2008) Mentorship in contemporary practice: The experiences of nursing students and practice mentors Journal of Clinical Nursing, 17, 1834- 1842 Nuckols, T K, & Escarce, J J (2005) Residency work-hours reform Journal of General Internal Medicine, 20(10), 873-878 doi:http://dx.doi.org/10.1111/j.15251497.2005.0133.x Pasaron, R (2013) Nurse practitioner job satisfaction: looking for successful outcomes Journal of Clinical Nursing 22, 2293 – 2604 http://doi: 10.1111/j.13652702.2012.04331.x Phillips C., Esterman A., Smith C & Kenny A (2013) Predictors of successful transition to Registered Nurse Journal of Advanced Nursing 69(6), 1314–1322 doi: 10.1111/j.1365-2648.2012.06123.x Ragins, B., & McFarlin, D (1990) Perceptions of mentor roles in cross-gender mentoring relationships Journal of Vocational Behavior, 37, 321–339 Sheahan, S., Simpson, C., & Rayens, M (2001) Nurse practitioner peer review: Process and evaluation Journal of the American Academy of Nurse Practitioners, 13, 140-145 Tourigny, L., & Pulich, M (2005) A critical examination of formal and informal mentoring among nurses Health Care Manager, 24, 68-76 Woolforde, L (2012) Onboarding nurse practitioners: A healthcare system approach to interprofessional education Nurse Leader, 10, (5), 1-3 Yeager, S (2010) Detraumatizing nurse practitioner orientation Journal of Trauma Nursing, 17(2), 85-101 Retrieved from http://search.proquest.com.jproxy.lib.ecu.edu/docview/595206620?accountid=10639 Appendix A Permission for Use of Mentor Role Instrument Dear Dr Ragins, Greetings! I am a nurse practitioner in rural North Carolina, and in the preparation stages of my doctoral project at East Carolina University I am writing to ask permission to use your Mentor Role Instrument in my capstone work The tool would be administered to nurse practitioners within a large academic medical center in North Carolina This tool would be used to evaluate nurse practitioner mentoring following orientation to the neonatal and critical care intensive care units I am so grateful that you have dedicated your career to better understanding mentoring and its importance to business and health care My work will also focus on application of Patricia Benner’s Novice to Expert Nursing theory to the orientation and mentor process In my literature review, I have struggled to find useful tools that would help bring some objective data to such a subjective issue Could you please provide a complete copy of the Mentor Role Instrument? Of course, if permission is granted, I would be most willing to share results with you from the work Sincerely, Melissa Coble MSN, NNP-BC November 12, 2013 @ 10:47 am East Carolina DNP student Dear Melissa Thanks so much for your interest in our work! I've attached two articles which have the items, likert scales, instructions etc for the mentor role instrument and also the mentor satisfaction scale (see appendix) I've also attached a book chapter that has another scale which may be of interest to you - it captures high quality mentoring (see table in chapter) Of course you can use all of these measures I published them so that people can use them for their research Good luck with your research! Belle November 12, 2013 @ 11:31 am Dr Belle Rose Ragins Associate Editor, Academy of Management Review Professor of Human Resource Management Sheldon B Lubar School of Business University of Wisconsin-Milwaukee 3202 N Maryland Avenue Milwaukee, Wisconsin 53211 e-mail: Ragins@uwm.edu Home Office: (414) 332-5134 Work Office: (414) 229-6823 Work Fax: (414) 229-5999 http://www4.uwm.edu/business/faculty/busfaculty/ragins.cfm Appendix B Link to NP Survey https://www.surveymonkey.com/s/7DG3FDX Appendix C Permission to Use Nurse Competence Scale Dear Dr Meretoja, Greetings! I am a nurse practitioner in rural North Carolina, and in the preparation stages of my doctoral project at East Carolina University I am writing to ask permission to use your Nurse Competence Scale in my capstone work The tool would be administered to nurse practitioners within a large academic medical center in North Carolina This tool would be used to evaluate nurse practitioner competence following orientation to the neonatal and critical care intensive care units I am so grateful that you have dedicated your career to better understanding nursing competence and its importance to patient care My work will also focus on application of Patricia Benner’s Novice to Expert Nursing theory to the orientation process In my literature review, I have struggled to find useful tools that would help bring some objective data to such a subjective issue Could you also provide a full copy of the tool to use in my capstone work? Of course, if permission is granted, I would be most willing to share results with you from the work Sincerely, Melissa Coble MSN, NNP-BC East Carolina DNP student November 12, 2013 @ 10:32 am Dear Melissa, thank you for your interest in the Nurse Competence Scale I am pleased if you find the Nurse Competence Scale useful for your study You must ask the official permission to use the NCS from Wiley - Blackwell who holds the copyright for the English version There are no costs associated to the use The NCS should only be used in its original form The whole instrument, the 73-item Nurse Competence Scale as well as the scoring methodology is published in that article (Meretoja et al Nurse Competence Scale: development and psychometric testing JAN 47(2), 124-133) The validity and reliability of NCS is reported in that publication as well the assessment scales for evaluation of competence levels and frequency of using competencies in actual clinical practice Do not hesitate to contact me again if you have some questions to discuss Good luck for your very important study and keep me posted ! Riitta Meretoja, Adjunct Professor, PhD, RN November 18, 2013 @ 5:25 am Appendix D Appendix E Appendix F Email to Nurse Practitioners ... III: PROJECT DESCRIPTION Project Implementation Protection of Human Subjects Setting Instrument Project Design Methods Limitations Timeline and Budget Summary CHAPTER IV: RESULTS Introduction Project. .. like crying instead Thanks so much! Melissa F Coble © Table of Contents CHAPTER I: INTRODUCTION Problem Statement Justification of Project Purpose Project Hypothesis Definition of Terms Nature... to assess the effectiveness of the mentor process CHAPTER III: PROJECT DESCRIPTION Project Implementation The purpose of this project was to examine the differences in perceived competence between