Walden University
ScholarWorks
Dissertations and Doctoral Studies
2015
A Transition-to-Practice Residency That Supports
the Nurse Practitioner in a Critical Access
Hospital
Nancy Jean Stock
Walden University
Follow this and additional works at: http://scholarworks.waldenu.edu/dissertations
Part of the Nursing Commons
This Dissertation is brought to you for free and open access by ScholarWorks. It has been accepted for inclusion in Dissertations and Doctoral Studies
by an authorized administrator of ScholarWorks.
, Walden University
College of Health Sciences
This is to certify that the doctoral study by
Nancy Stock
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Eric Anderson, Committee Chairperson, Health Services Faculty
Dr. Joan Moon, Committee Member, Health Services Faculty
Dr. Jonas Nguh, University Reviewer, Health Services Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
, Abstract
A Transition-to-Practice Residency
That Supports the Nurse Practitioner in a
Critical Access
Hospital by
Nancy J. Stock
MS, University of Minnesota, 1996
BSN, Moorhead State University, 1986
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
March 2015
, Abstract
Access to health care in rural communities is challenged by workforce shortages. Nurse
practitioners (NPs) have been filling the gap created by physician migration into specialty
areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the
emergency department with NPs or physician assistants without on-site physicians. NP
education often lacks emergency and trauma curriculum, resulting in gaps in education
and practice expectations and leading to significant role transition stress and turnover.
The purpose of this project was to construct an evidence-based transition-to-practice
residency program to support NPs providing emergency department care in the CAH.
Theoretical frameworks used to guide the project include rural health theory, novice to
expert, and from limbo to legitimacy frameworks. Global outcomes include increased
quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality
improvement initiative engaged an interprofessional team of institutional and community
stakeholders (n = 10) to develop primary products including the residency program,
curriculum modules, and the secondary products necessary to implement and evaluate the
project. Implementation will consist of a pilot followed by expansion throughout the rural
health network. Evaluation will involve the CAH dashboard to monitor patient outcomes,
Misener NP job satisfaction scale, and employee turnover rates. The project expands
understanding of the on-boarding needs of rural NPs. The results of this project will serve
as a guide to publish outcome data and collaborate with higher education to develop
programs to award academic credit for paid clinical experiences leading to academic
degrees.
ScholarWorks
Dissertations and Doctoral Studies
2015
A Transition-to-Practice Residency That Supports
the Nurse Practitioner in a Critical Access
Hospital
Nancy Jean Stock
Walden University
Follow this and additional works at: http://scholarworks.waldenu.edu/dissertations
Part of the Nursing Commons
This Dissertation is brought to you for free and open access by ScholarWorks. It has been accepted for inclusion in Dissertations and Doctoral Studies
by an authorized administrator of ScholarWorks.
, Walden University
College of Health Sciences
This is to certify that the doctoral study by
Nancy Stock
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Eric Anderson, Committee Chairperson, Health Services Faculty
Dr. Joan Moon, Committee Member, Health Services Faculty
Dr. Jonas Nguh, University Reviewer, Health Services Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2015
, Abstract
A Transition-to-Practice Residency
That Supports the Nurse Practitioner in a
Critical Access
Hospital by
Nancy J. Stock
MS, University of Minnesota, 1996
BSN, Moorhead State University, 1986
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
March 2015
, Abstract
Access to health care in rural communities is challenged by workforce shortages. Nurse
practitioners (NPs) have been filling the gap created by physician migration into specialty
areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the
emergency department with NPs or physician assistants without on-site physicians. NP
education often lacks emergency and trauma curriculum, resulting in gaps in education
and practice expectations and leading to significant role transition stress and turnover.
The purpose of this project was to construct an evidence-based transition-to-practice
residency program to support NPs providing emergency department care in the CAH.
Theoretical frameworks used to guide the project include rural health theory, novice to
expert, and from limbo to legitimacy frameworks. Global outcomes include increased
quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality
improvement initiative engaged an interprofessional team of institutional and community
stakeholders (n = 10) to develop primary products including the residency program,
curriculum modules, and the secondary products necessary to implement and evaluate the
project. Implementation will consist of a pilot followed by expansion throughout the rural
health network. Evaluation will involve the CAH dashboard to monitor patient outcomes,
Misener NP job satisfaction scale, and employee turnover rates. The project expands
understanding of the on-boarding needs of rural NPs. The results of this project will serve
as a guide to publish outcome data and collaborate with higher education to develop
programs to award academic credit for paid clinical experiences leading to academic
degrees.
