Neonatal nurse practitioner role transition: the process of reattaining expert status

Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs. The data consisted of participants' written responses to open-ended questions. Four themes emerged that depicted a linear progression of the transition process from school preparation to beginning feelings in the new role and then development into a more confident practice. Theme 1: First impressions emphasized the ambivalence novice NNPs experienced regarding their preparedness for the role during a stressful and exciting adjustment period. Theme 2: The transition demonstrated the overwhelmingly similar feelings of anxiety, insecurity, exhaustion, and lack of confidence that plagued decision making. Theme 3: Making it as a real NNP indicated that the 1-year mark was a consistent, significant timeframe for feeling like a real NNP. Theme 4: The helpers and hinderers revealed the vulnerability of the novice NNPs to harsh criticism as well as the importance of support, especially from nurse colleagues. NNPs are a valuable resource; thus, enhancing transition is a worthy goal.