1. Abel, Lisa DNP, MSN, ARNP

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"It's hard being an NP." This is a quote from a former student of mine. She has been in practice for about 2 years and was expressing her frustration with making the transition from being an RN to an advanced practice registered nurse (APRN) with a Doctor of Nursing Practice (DNP) degree. Role transition is an experience that each of us can relate to, and the associated stress caused by this transition may have us doubting our preparedness and skill level.


I remember feeling doubt as a new APRN graduate. I carried around a small notebook with a list of medications and practice protocols to refer to just in case. I knew the right course of action, but I needed that added security. The pocket-sized notebook, of course, is my generation of NPs. Today's new graduates can access this information using smartphones.


The master's degree: Honing our abilities

After talking with my former student, it was clear that those of us who completed our master's degrees before advancing to the DNP degree may have an advantage over today's NPs who graduate directly with a DNP. The master's degree offered us a stepping stone, giving us time to refine our newly acquired skills and adjust to our new roles. Future NPs will not have this gradual transition. In addition to functioning in an advanced role, the DNP graduate is expected to have advanced leadership skills.


I am concerned about this added expectation along with the heavy work burden that future APRNs will experience, which includes the healthcare provider demands that the Patient Protection and Affordable Care Act has brought to our profession.1-3 How will APRNs become comfortable with their new skills and be expert leaders? We need to maintain the quality of care that NPs have always provided. Will our burden be too great and affect quality? These are valid questions and concerns that many of us have. The time is now for APRNs to stick together and lean on each other.


We who have been in practice for years need to provide support and encouragement to our newer colleagues. The Institute of Medicine proposed a nurse residency to assist new graduate RNs and APRNs transitioning into the work environment.2 These programs have been slow to come into fruition. Role transition theories also may guide us.4,5 Based on my experience as a clinical preceptor, I propose a few interventions for helping new graduates transition.


First, share your transition experiences and talk about what it was like when you were a new NP. Emphasize that it is normal to feel anxious in a new situation.


Second, acknowledge that you are still learning. Students often ask, "How long will it take to learn everything?" The APRN certainly needs to be well trained to practice safely, but we all should be continually learning in our area of specialty.


Lastly, if you are a clinical preceptor, touch base with your students after graduation to see how they are doing in their new positions. This is especially important for graduates who do not work with other APRNs. If you have a new APRN in your practice, be available for questions, consults, and support.


As APRNs, we must stand united, supporting and helping each other professionally. We must also take the time to assist new APRNs in their role transition. This support will ultimately keep our profession strong and well qualified to care for our patients.




1. U.S. Department of Health and Human Services. About the Affordable Care Act. 2017. [Context Link]


2. The future of nursing: leadership change, advancing health. 2010. [Context Link]


3. Poghosyan L, Lucero R, Rauch L, Berkowitz B. Nurse practitioner workforce: a substantial supply of primary care providers. Nurs Econ. 2012;30(5):268-274, 294. [Context Link]


4. Duchscher JE. Transition shock: the initial stage of role adaptation for newly graduated registered nurses. J Adv Nurs. 2009;65(5):1103-1113. [Context Link]


5. Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-407. [Context Link]