title: Driven by Ambitions: The Nurse Practitioner's Role Transition in Dutch Hospital Care.
abstract: BACKGROUND
  Insight into nurse practitioners' (NPs') role transition can help NP students and new graduates in taking on new responsibilities in a changing and demanding healthcare context. The aim of the research was to explore the role transition from nurse to NP using the components of Meleis's Framework of Transitions.
  
  
  METHODS
  A qualitative descriptive design was used. Individual interviews (n = 9) and two focus group discussions (n = 12) were held with NPs. Data were analyzed with the directed content analysis method.
  
  
  RESULTS
  The Framework component transitions' nature was characterized by changes in the healthcare system, combined with professional and educational role changes. Transition conditions showed that the respondents felt distressed after they became accountable for a patient's care and well-being. Although the respondents were authorized to do medical procedures, they initially lacked nursing role models and NP protocols. Process indicators showed ongoing transition; the respondents were still developing clinical competencies and confidence in patient care while relying on earlier acquired nursing competencies. Outcome indicators showed that the respondents found themselves successful in the medical extension of two different nursing roles: continuity of medical care for hospitalized patients in acute and intensive care settings, and being responsible for continuity of care for chronic patients in outpatient clinics.
  
  
  CONCLUSIONS
  Role transition was characterized by coping with feelings of distress at the cost of time and effort. The respondents' strategies to adapt to new expectations, combined with organizational support, determined the outcomes as well as the start of new transitions.
  
  
  CONCLUSIONS
  NPs' role transition in hospital care implies a dynamic ongoing process that needs to be supported, with the ultimate goal to improve patient outcomes.
authors.affiliation: Senior lecturer at Rotterdam University of Applied Sciences, and PhD student at Erasmus University Rotterdam, the Netherlands.
authors.forename: Ada Ter
authors.initials: AT
authors.lastname: Maten-Speksnijder
authors.affiliation: Advisor at Buurtzorg Nederland, a Dutch homecare organization, the Netherlands.
authors.forename: Aart
authors.initials: A
authors.lastname: Pool
authors.affiliation: Professor at Ghent University, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Grypdonck
authors.affiliation: Professor at Erasmus University Rotterdam, institute of Health Policy and Management, the Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Meurs
authors.affiliation: Professor at Rotterdam University of Applied Sciences, Assistant Professor at Erasmus University Rotterdam, institute of Health Policy and Management, the Netherlands.
authors.forename: AnneLoes
authors.initials: A
authors.lastname: van Staa
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D057179:Advanced Practice Nursing / Q000379:methods; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D009740:Nursing Staff / Q000600:supply & distribution; D010043:Outcome and Process Assessment, Health Care; D012107:Research Design; D000078329:Workforce
keywords: Role transition; advanced practice nursing; direct content analysis; hospital care; nurse practitioner