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Implementation of a standardized transition to practice program for nurse practitioners and physician associates
1Department is UTHealth Neurosciences, The University of Texas Health Science Center at Houston, Houston, Texas.
Background:
High turnover among nurse practitioners (NPs) and physician associates (PAs) disrupts care continuity, increases costs, and strains teams, particularly in high-acuity academic settings. Structured transition to practice (TTP) programs aim to improve retention, readiness, and workforce stability.
Local Problem:
In a tertiary neuroscience department, NP and PA turnover reached 16.7% in 2023. Onboarding varied by division and relied on brief shadowing without standardized competencies, mentorship, or structured development. Early attrition within the first year reflected gaps in role clarity, confidence, and integration.
Methods:
A pre-post quality-improvement design evaluated a standardized, competency-based TTP program. Outcomes included 12-month retention, work relative value units (wRVUs), onboarding surveys, and qualitative feedback from focus groups.
Interventions:
In April 2024, a 24-week TTP program was implemented, incorporating phased clinical immersion, mentorship, biweekly didactics, and progressive competency milestones aligned with Benner Novice-to-Expert framework.
Results:
Attrition decreased from 16.7% to 6.25%, with 100% retention among TTP participants in 12 months. Productivity declined during the electronic health record go-live, then rebounded to 1,041 wRVUs by February 2025 (a 3.5-fold increase from the nadir). Surveys showed improved confidence, role clarity, and team integration, with mentorship as a key driver.
Conclusions:
A structured TTP program was associated with improved retention and productivity. Despite EHR-related disruption, recovery trends suggest enhanced clinical efficiency and role readiness. Transition to practice programs offer a scalable strategy to strengthen workforce stability in high-acuity settings.
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