Document Type


Publication Date

Spring 2024

Date of Final Presentation


Committee Chair

Amber Gentry, DNP, RNC-OB, IBCLC, CNE

Committee Member

April Howell, DNP, RN

Coordinator/ Chair of DNP Program

April Howell, DNP, RN

Abstract/ Executive Summary


Retention of advanced practice providers (APPs) is needed for ongoing high quality comprehensive care. Administrators at a large urban pediatric institute in the Midwest identified turnover and retention as an issue for APPs in the first one to two years of service. Even in years when turnover rates were not as high, the greatest number of APPs leaving the institution where those in their first five years of tenure. Without strategies aimed at improving transition to practice, new hire APPs will continue to be unprepared for their new role, therefore endangering job satisfaction, leading to continued turnover, and threatening quality of and access to care.


The setting of implementation was a large urban free standing pediatric institution in the Midwest.


Brown and Olshansky’s (1997) model titled From Limbo to Legitimacy provided the theoretical guidance for this project.

Specific Aim

The aim of the Doctor of Nursing Practice (DNP) scholarly project was to implement a formal APP transition to practice fellowship. This fellowship includes didactic sessions, preceptor guided practice-based learning and mentorship.

Project Outcomes

There were nine outcomes of the DNP scholarly project. Outcomes were both process and change outcomes. These included participation in the fellowship, attendance of the didactic session, increase in self-efficacy, engagement with mentor and creation of SMART goals with mentor, and tracking of competencies by new hire APP and APP preceptors.

Implementation and Evaluation

Eight new hire APPs were enrolled into the APP transition to practice fellowship during the project implementation timeframe of May 2023-July 2023. APPs were notified of enrollment by the APP educator and didactic day dates were provided. The APP educator administered the pretest General Self Efficacy Scale (GSES) at this time. The APPs were introduced to their mentor via email. The email outlined the expectations of the mentor and new hire relationship. The APP educator met with the preceptors to educate them on the tracking of competencies in the Kahuna platform. The posttest GSES was administered by the DNP student and APP educator during the didactic day.


The primary aim of the project was to create a formal APP transition to practice fellowship. This was achieved with 100% participation of the new hire APPs in fellowship. The didactic session was attended by 88% of the new hire APPs. 87% were paired with a mentor within two weeks of hire. 100% of the new hire and mentor pairs created SMART goals. 50% of preceptors tracked the competencies of the new hires in the Kahuna platform. The one outcome that was not achieved was the goal of a 5% increase in self-efficacy based on the GSES pre and post implementation.


The implementation of the APP transition to practice fellowship was successful with eight out of nine outcomes achieved. This program has the potential to engage and provide support for new hire APPs.


APPs have a significant role in healthcare delivery and recruitment and retention efforts are necessary to maintain this workforce. The first year of practice for new graduate APPs is a time of uncertainty and rapid growth. This transition to practice fellowship supported new APPS and was impactful. The outcomes and evaluation plan for this implementation can be used for ongoing iterations of the APP transition to practice fellowship.