Advanced nurse practitioners (ANPs) often have limited or no mentorship opportunities, despite those training in the role saying this is the most important part of moving into advanced practice, new research has found.
According to a review of 11 existing studies by researchers at Royal Derby Hospital, the quality of mentorship programmes for ANPs – also referred to as advanced clinical practitioners (ACPs) – was “patchy at best”.
“Many of the advanced clinical practitioners interviewed seriously underestimated the level of difficulty involved”
It also found when trainee ANPs were not provided with six key areas of support – including quality mentorship, job orientation, clinical skills development, clinical supervision and education at master’s level – they may drop out of their courses.
The researchers said they wanted to look at the transition from a registered nurse or midwife into becoming an advanced clinical practitioner to find out what could be done to improve the process.
Analysis of the 11 international studies from 1997 to 2016, which included four from England, found that many of the advanced nurses did not anticipate how difficult the change would be.
“Many of the ACPs interviewed seriously underestimated the level of difficulty involved in transition and the range of problems experienced that they felt unprepared for,” said the study paper – titled How does role transition affect the experience of trainee Advanced Clinical Practitioners: Qualitative evidence synthesis.
“Where these six key areas are not taken seriously or ignored, the transition process is prolonged and the trainee experiences unnecessary stress”
The paper, published in the Journal of Advanced Nursing this month and based on interviews with 733 participants across all of the studies, found there were six key requirements for a “timely and effective transition from novice to expert”.
Mentoring was the most important, though in one of the UK studies – focussed on neonatal nursing – over half the trainees said that they only received mentor support “sometimes” or “occasionally”. A further UK study on critical care nursing also had participants that reported limited or no mentorship.
Clinical supervision was another of the six key requirements, but there was “widespread evidence that there were problems with the introduction and development of clinical supervision for ACPs”.
Two US studies highlighted that in cases where trainee advanced nurses had tried to form collaborative relationships with supervisors – who either did not understand or refused to accept the ANP role – several considering leaving their employer or reverting to their previous post.
In terms of learning skills, which was another core requirement, advanced nurses said that if their clinical experience was inadequate then this had a negative effect on the development of their technical abilities.
“There was widespread evidence that there were problems with the introduction and development of clinical supervision”
In some of the studies, the trainees were the first ACPs to be employed, often with no formal structure in place to support them. The review found job orientation was important but that more research was needed to understand the key components.
Meanwhile, the review concluded that while master’s level education was an “important part of ACP training as a means of professionalising the role… the empirical evidence concerning evaluation of this is still in the early stages of development and further research is required”.
Employers must provide a comprehensive orientation and education programme to be certain that their qualified ACPs are suitably prepared for their role in health care, said the researchers.
“Where these six key areas are not taken seriously or ignored, the transition process is prolonged and the trainee ACP experiences unnecessary stress leading to unhappiness in the role and either a failure to reach expected goals or resignation from the role,” warned the study paper.