Navigating the pathway to advanced practice: A grounded theory of nurse practitioner role transition in a fellowship

Abstract

Background: Greater attention to the transitional period for advanced practice nurses has urged health care organizations and employers to implement fellowships. Currently, the theoretical process of nurse practitioner (NP) role transition from the essential perspectives of NP fellows does not exist. Purpose: The purpose of this study was to construct a middle-range theory grounded in reality of an NP fellowship environment that explains how NPs transition to their new role. Methodology: Following Charmaz's constructivist methodology, 11 NPs who transitioned to practice in a fellowship were interviewed. Results: “Navigating the Pathway to Advanced Practice: A Grounded Theory of Nurse Practitioner Role Transition in a Fellowship” emerged from the data and is composed of through five phases: (1) mapping a path, (2) stepping onto the trailhead, (3) navigating the trailway, (4) gaining traction, and (5) summiting. Conclusions: The resulting middle-range theory is the first in the nursing literature that conceptualizes meaning about NP role transition in a fellowship. This process occurs in the contextual factor of a realm of support that includes growth, value, lifelong learning, and readiness. Throughout this process, NPs build competence and confidence that advances them to summit, or transition, to their NP role at the completion of an NP fellowship. Implications: This discovery will fill the research gap pertaining to best practice interventions in support of NPs during role transition in fellowships. Understanding how NPs transition to their new advanced practice roles may inform organizations on how to structure fellowships that support learning, encourage confidence, and enhance competence.