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Where I am in the transition
After 11 years as an emergency department nurse, I'm in my final practicum before practicing as a family nurse practitioner. In the emergency department I was the person new nurses came to. In clinic, I sometimes freeze when a patient asks a question I should be able to answer, and I double-check everything. I feel like a beginner again.
Making sense of it with transitions theory
Meleis et al. (2000) describe a middle-range theory of transitions, developed from five research studies, that includes types and patterns of transitions, properties of the transition experience, facilitating and inhibiting conditions, process and outcome indicators, and nursing therapeutics.
Type of transition. Mine is an organizational and professional transition, overlapping with personal changes: I've moved to a part-time job to finish school.
Properties of my experience:
- Awareness: I know I'm in transition, which helps; I'm not pretending I'm still an expert.
- Engagement: I'm actively preparing by reviewing guidelines every evening and asking my preceptor to talk through her reasoning.
- Change and difference: The biggest difference is responsibility. As an RN, I assessed and escalated; now I make the diagnosis and the plan.
- Critical points: My first patient with chest pain in clinic was a turning point. I recognized that my emergency experience helped me triage, but the decision about follow-up was mine alone.
Conditions. My emergency nursing experience is a facilitator for assessment and acute problems, but it can be an inhibitor when I approach chronic disease the way I would in the emergency department.
What the research says about support
In a study of 352 nurse practitioners, only a formal orientation was significantly related to a positive role transition; prior RN experience was not (Barnes, 2015). This surprised me. I assumed my years of experience would carry me. It suggests that how I'm supported in my first NP job matters more than what I bring from before.
Process indicators I notice in myself
Meleis et al. (2000) describe process indicators such as feeling connected, interacting, and developing confidence and coping. I feel connected to my preceptor, and my confidence is growing for common problems like hypertension and urinary tract infections, but not yet for complex patients with several conditions.
My plan for the first year of practice
- Ask any employer about their formal orientation for new nurse practitioners, and choose a position that offers one.
- Find a mentor outside my practice through my professional organization.
- Keep a weekly reflective log of difficult cases and what I learned.
- Accept that feeling like a novice is part of the process, and measure progress by the problems I can now handle on my own.
References
Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178–183. https://doi.org/10.1016/j.nurpra.2014.11.004
Meleis, A. I., Sawyer, L. M., Im, E.-O., Hilfinger Messias, D. K., & Schumacher, K. (2000). Experiencing transitions: An emerging middle-range theory. Advances in Nursing Science, 23(1), 12–28. https://doi.org/10.1097/00012272-200009000-00006
