REPLY to this discussion:

Hello, classmates! I’m Danielle Bergman, residing in sunny and hot Orlando, FL. My nursing background primarily centers around critical care, with a specialization in heart and lung transplants, as well as post-operative CABGs/VADs. Additionally, I’ve had experience in the medical device industry as a clinical educator, focusing on urinary catheters and rectal tubes throughout Florida. Currently, I am a Senior Director of Clinical Development at a healthcare technology company. My company’s goal is to provide Accountable Care Organizations (ACOs) and other healthcare organizations with predictive analytics to proactively prevent adverse health outcomes in the ambulatory setting. I’m excited to be nearing the end of our Master’s program and on the path to officially becoming a Family Nurse Practitioner (FNP). After several years away from direct patient care, I’m looking forward to taking this step back into clinical practice.

Transitioning from a nurse to a nurse practitioner in the outpatient setting presents its share of challenges. Faraz (2019) highlights that many nurse practitioners (NPs) experience a lack of confidence during their first year of practice, often leading to feelings of discontentment, lower job satisfaction, and increased turnover. This struggle is exacerbated when NPs enter employment without additional residency or training programs. They can face heightened stress, making the transition even more demanding. Other significant challenges include a lack of respect from fellow clinicians, inadequate support from superiors or colleagues, and overwhelming workloads, including managing complex cases. Research emphasizes the importance of mentorship, social support from peers, and deriving meaning from one’s work in facilitating a smoother transition into practice (Faraz, 2019). Park et al. found that postgraduate training programs significantly boost NP confidence and mastery in their roles as independent primary care providers. Moreover, jobs offering these residency programs often foster a team-based approach to care, resulting in higher job satisfaction (Park et al., 2022; Speight et al., 2019). When seeking future employment opportunities as an NP, it’s essential to inquire about mentorship, fellowship programs, and other training resources to support novice NPs during their transition to practice (Speight et al., 2019).

In addition to the personal challenges faced by NPs, there are also practice barriers related to the healthcare reform. In the United States, some states have transition-to-practice requirements that dictate the level of practice authority for NPs. Seven states, including Arizona, California, Florida, Illinois, New York, Virginia, and West Virginia, have transition-to-practice requirements with reduced practice authority. Meanwhile, ten states, such as Colorado, Connecticut, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, South Dakota, and Vermont, have granted NPs full practice authority with transition-to-practice requirements. States with restricted practice authority limit NPs from providing certain services, such as lacking hospital privileges, encountering issues with provider credentialing, restricted clinical admitting, limited staff privileges, and reimbursement challenges. These limitations impede NPs from delivering comprehensive patient care, restrict patient choice of providers, and diminish the visibility of NPs in the healthcare system. Research demonstrates that these regulations and barriers prevent NPs from practicing to the full extent of their education and licensure, thus reducing the availability of healthcare services to the population they serve (Kleinpell et al., 2023).

In 2020, the legislative House Bill 607, known as the Direct Care Workers bill, was passed, allowing NPs practicing in specific areas of primary care to operate autonomously. However, in Florida, we are still operating under a collaborative practice agreement until specific criteria are met to permit autonomous practice. These criteria encompass 3,000 practice hours with a physician under protocol during the five years preceding, 3 credit hours or 45 continuing education units (CEUs) in differential diagnosis and advanced pharmacology, malpractice insurance, an unencumbered license, and no licensure discipline within the past 5 years. The author of this publication emphasizes that the fight continues in Florida, aiming to allow every Advanced Practice Registered Nurse (APRN) to practice to the fullest extent of their education and training with full practice authority (Stone-Gale, 2023).

References:

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 (6), 364-370. doi: 10.1097/JXX.0000000000000158.

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of nursing regulation, 14(1), 13–20. https://doi.org/10.1016/S2155-8256(23)00064-9

Park, J., Faraz Covelli, A. & Pittman, P. (2022). Effects of completing a postgraduate residency or fellowship program on primary care nurse practitioners’ transition to practice. Journal of the American Association of Nurse Practitioners, 34 (1), 32-41. doi: 10.1097/JXX.0000000000000563.

Speight, C., Firnhaber, G., Scott, E. S., & Wei, H. (2019). Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review. Nursing Forum, 54(4), 557–564. https://doi-org.libauth.purdueglobal.edu/10.1111/nuf.12370

Stone-Gale, V. (2023). Blessings and barriers: Achieving autonomous practice in Florida. Journal of the American Association of Nurse Practitioners, 35(6), 332–333. https://doi.org/10.1097/jxx.0000000000000889