Role Transition From RN to ACNP

From Experienced RN to Novice ACNP

The role transition process is a significant professional change for a nurse. The transition period from registered nurse (RN) to acute care nurse practitioner (ACNP) is a milestone filled with enthusiasm and excitement, but also much uncertainty. It can be a moment of vulnerability and self-doubt. One of the challenges of ACNP role transition is imposter syndrome, which can have a negative effect on self-confidence, attitude and performance. Imposter syndrome can be a result of stressful situations, such as a role transition. It results from a high-paced, performance-driven, stressful environment, which most critical care units have. In 2010, the Institute of Medicine recognized the need to address such role transition problems by recommending residency programs designed for new graduates of APRN programs. The American Association of Nurse Practitioners and other APRN organizations support this approach. However, as detailed in this article by Urbanowicz, there’s been minimal progress in implementing residency programs for new graduate NPs nationwide.

Preceptorship and Mentorship

Learning to adapt to a new role relies heavily on a preceptorship, which promotes professional development and helps ensure safe and effective patient care. A preceptor uses specific strategies, such as role modeling, in which novice NPs observe their preceptor. Mentorship is vital for NPs’ transition to practice. Organizations implementing residency programs leverage the benefits of formal mentoring approaches that include training for both mentor and mentee, setting goals and schedules, and providing evaluations. The goal of mentoring is for the mentee to feel emotionally safe, learn new skills and strengthen their current skill set; the mentor’s role includes coaching and role modeling. Role development includes presenting the mentee with opportunities for professional growth and a caring relationship in which the mentor has the mentee’s best interest at heart. The mentor-mentee relationship is based on trust and means devoting the time to helping the mentee grow professionally. For the mentorship to occur successfully, there must be a caring and open relationship between mentor and mentee; both must be committed to devoting time to this relationship. Unfortunately, such mentoring is rarely available to novice NPs.

My Story

Becoming an NP in the cardiothoracic ICU (CT ICU) with eight years of experience as a CT ICU RN seemed like it would be a smooth transition. Having successfully graduated from a top ACNP program, I was confident in my knowledge base and even felt overly confident. My NP career began at one of the largest heart centers in the country and during one of the more challenging times one can endure, the COVID-19 pandemic. Moving to a new city and starting a new role was very empowering. COVID-19 also brought a new set of challenges for me, including an emotional burden due to isolation, being away from home, low confidence, low self-efficacy and lack of social interaction, which negatively impacted my role transition. I began my role transition in a COVID-19 ICU as well as a CT ICU, both with high acuity and volume. Not being able to balance clinical knowledge and emotional strength left me overwhelmed with feelings of inadequacy, causing poor assimilation to my new role. Constantly comparing myself to others in my cohort made me feel isolated. I had a sense of not belonging, which ultimately had a negative effect on my performance.

The Solution: A Great Mentor

I was fortunate enough to be part of a team that believed in me, who saw the potential I didn’t see in myself, and who were dedicated to my success. My former preceptor and I bonded over our common interests: extracorporeal membrane oxygenation (ECMO) and cardiac surgery. This helped create camaraderie between us. She soon became my mentor. She embraced my weaknesses and provided the support I needed to be the best ACNP in the CT ICU I could be. Together, we created a mentorship approach to help with my transition.

A Mentor-guided Transition Plan

1. My mentor developed an individual plan to meet my needs.
2. Using resources, written material, online learning modules and podcasts, she provided opportunities for us to bond over specific interests in the CT ICU specialty.
3. My mentor made individual adjustments to the schedule and to the preceptors I was assigned to work with to ensure a comfortable, optimized learning environment.
4. During the mentorship, I became more involved in the unit. I embraced the feedback and constructive criticism and used them for growth.
5. My mentor helped me use my knowledge base and skill set to build my confidence. This reflected greatly on my performance, not only with patient management but also with strengthening my abilities to collaborate and communicate with the rest of the multidisciplinary team.
6. Being fully supported by a mentor who recognized my imposter syndrome, and understood it, was the key that enabled me to flourish as an ACNP.

Pearls of Wisdom on Role Transitioning

• Be kind to yourself. Show yourself compassion, patience and love. You are braver than you think.
• Do not compare your journey to someone else’s. Focus on how far you have come and where you are willing to go.
• Use your resources. Do not be afraid to ask for help. You are your biggest advocate.
• Have humility. Acknowledge the fact that you don’t know it all, you’ll never know it all, and there’s always something new to learn. We owe it to our patients to be open minded, learn from others and recognize our own shortcomings.
• Always celebrate your achievements. It doesn’t matter what they are. Anytime we grow professionally it calls for a celebration. Be your own biggest cheerleader.

Create a Successful Role Transition

To become an expert at anything we must invest time and effort. Role transition for ACNPs is challenging, and imposter syndrome among new NPs is more common than we think. If you are feeling signs of imposter syndrome, talk to someone. Usually, someone else is feeling the same way or perhaps felt the same way early in their career. We owe it to ourselves and our patients to use our fear and self-doubt as an opportunity to grow.

Special Acknowledgement

I acknowledge and thank my co-author, Mary Sullivan, MSN, RN, AGACNP-BC, CCRN, a cardiac surgery nurse practitioner specializing in ECLS and heart failure, for contributing to the development of this blog.

If you are transitioning from an RN to an ACNP/NP or mentoring an RN transition to an ACNP/NP, what are your challenges and how did you overcome them?