title: Supporting primary health care nurse practitioners' transition to practice.
abstract: OBJECTIVE
  To examine role transition and support requirements for nurse practitioner (NP) graduates in their first year of practice from the perspectives of the NPs and coparticipants familiar with the NPs' practices; and to make recommendations for practice, education, and policy.
  
  
  METHODS
  Descriptive qualitative design informed by focused ethnography and narrative analysis using semistructured, in-depth, qualitative interviews.
  
  
  METHODS
  Primary health care (PHC) settings in Ontario in which NPs worked.
  
  
  METHODS
  Twenty-three NPs who had graduated from the Ontario Primary Health Care Nurse Practitioner program, and 21 coparticipants including family physicians, NPs, and managers who were familiar with the NPs' practices.
  
  
  METHODS
  Anglophone and francophone NPs in their first year of practice in PHC settings were contacted by e-mail or letter. Participating NPs nominated colleagues in the workplace who could comment on their practice. Interviews were conducted within the first 3 months, at 6 months, and at 12 months of the NPs' first year of practice and were transcribed verbatim and coded. Job descriptions and organizational charts demonstrating the NPs' organization positions were also analyzed. The researchers collaboratively analyzed the interviews using a systematic data analysis protocol.
  
  
  RESULTS
  Familiarity of colleagues and employers with the NP role and scope of practice was an important element in successful NP role transition. Lack of preparation for integrating NPs into clinical settings and lack of infrastructure, orientation, mentorship, and awareness of the NP role and needs made the transition difficult for many. One-third of the NPs had changed employment, identifying interprofessional conflict or problems with acceptance of their role in new practice environments as reasons for the change.
  
  
  CONCLUSIONS
  The transition of NP graduates in Ontario was complicated by the health care environment being ill-prepared to receive them owing to rapid changes in PHC. Strategies for mentorship and for the integration of new NPs into PHC settings are available and need to be implemented by health professionals and administrators. Recommendations for family physicians to support NP graduate transition into practice are provided.
authors.affiliation: Sullivan-Bentz Health Care Consultation Services and University of Ottawa, School of Nursing, Simulation Laboratories, 200 Lees Ave, Ottawa, ON K1S 5S9. mbentz@uottawa.ca
authors.forename: Maureen
authors.initials: M
authors.lastname: Sullivan-Bentz
authors.forename: Jennie
authors.initials: J
authors.lastname: Humbert
authors.forename: Betty
authors.initials: B
authors.lastname: Cragg
authors.forename: Frances
authors.initials: F
authors.lastname: Legault
authors.forename: Célyne
authors.initials: C
authors.lastname: Laflamme
authors.forename: P H
authors.initials: PH
authors.lastname: Bailey
authors.forename: Suzanne
authors.initials: S
authors.lastname: Doucette
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D004506:Education, Nursing / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007802:Language; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009864:Ontario; D010821:Physicians, Family / Q000523:psychology; D057184:Practice Patterns, Nurses' / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration; D012423:Rural Health; D014504:Urban Health; D000078329:Workforce