This in turn may lead to job dissatisfaction later down the line and ultimately limit ones ability to succeed in their chosen field. Presently there is not enough research provided to provide conclusive evidence one way or another as to the extent to which problems or gaps in teaching may influence one's decision to move from one career to the next. More information could be collected in the form of self-report surveys as mentioned previous that would assess whether nurses felt they were prepared educationally to take on the challenges of the role they currently held or aspired to (Evans, n.d.; Dumas, Villeneuve, & Chevrier, 2000). There are others however, that believe that in some cases the RN aspiring to the role of nurse practitioner or even that of physician assistant is adequately prepared to define the scope of their practice, and prepared for rotations in education, however, surveys do reveal a need for greater education of the ways to "best teach adult clinical students how to learn most productively and effectively" suggesting possible opportunities for follow-up research within this area (Mitchell, 2004: 1).

Strengths & Weaknesses of the Concept

Whether one should examine the current state of nursing comes to question when evaluating the role of nurse and the relative ease with which a nurse may transfer to the role of Nurse Practitioner, and his or her reasons for doing so. Despite questions as to the legitimacy of such research, there is ample evidence suggesting a need for both R.N.s and more Nurse Practitioners (Mitchell, 2004) exists, especially with an aging population and more and more patients requiring primary and secondary care. Nurses engaged in the role of Nurse Practitioner may more readily follow up with patients having the skills and training necessary to take on advanced roles and responsibilities in the clinical care setting.

The idea of cross training or holding dual-positions is not discussed in this research review, but it another idea or concept for consideration in future studies. The implications of this study suggest a need may exist for further research exploring the extent to which an intermediary position may be available, allowing nurses to engage in training that allows them to practice in limited capacity as a Nurse Practitioner for minor complaints while retaining the title of R.N. And the relative freedoms it affords where appropriate. There is certainly a wealth of job opportunities available to both parties regardless of their choice of position.

Summary of Overall State of Knowledge of the Concept & Related Problem

There is common knowledge today that nurse practitioners hold an elevated role over RNs, one closer to the role of a physician assistant (Mitchell, 2004). This statement is not made to denigrate the role or the importance of the role a traditional registered nurse has with any healthcare agency. Part of the purpose of this research was to assess factors contributing to one's desires to transfer to the position of a Nurse Practitioner, as well as one's desires to remain in their current stature. The theoretical framework used to assess this role and the motivations for such changes included exploration of characteristics of the job involved.

Important to one's satisfaction in any job, especially in the healthcare setting, is the ability of a person to have mobility in their job, or to move upward in their job if the so desire. Decision-making authority may be another important factor, as well as one's ability to communicate equitably with members of the staff. Those holding the title of nurse practitioner may have greater "power" at a subconscious but also very realistic level, in such a way that may encourage nurses to aspire to this role. More and more Nurse Practitioners and fulfilling the duties many physician's assistants would, aid with diagnosis and treatment of patients. If an RN's motives include desiring greater job satisfaction resulting from the ability to be more empowered at work, they may decide to transfer to the next level of authority. The decision to transfer from one role to another must allow for one to assess how much they wish to become involved in the care of their patients. There is adequate evidence suggesting that the "clinical training backgrounds" of roles differ significantly, and more attention need be paid to standardization of these roles before an RN can choose willingly to participate in one program vs. another (Mitchell, 2004).

The decision to transfer must also involve one's willingness to take greater responsibility for their education, as at present there seems a large gap in communication on the workforce leading to problems for many. Some nurses may not want to feel bothered by the increased duties associated with becoming a practicing nurse rather than a nurse...

Regardless, there is ample evidence suggesting additional research in this area would prove beneficial in understanding the roles nurses play in healthcare today.
Discussions & Summary Conclusions

There is much research currently in the field of nursing, much of it focusing on the advancing roles of nurses. Relatively little attention has been paid the ease of which a nurse may transfer from the role of an R.N. To a Nurse Practitioners. Questions that remain unanswered include whether there exists ample educational opportunities for nurses wishing to transfer to this role, and whether education is suitable or addressing the communication and skills training needs of nurses aspiring to the role of Nurse Practitioner.

Given the data provided from the literature review, one must also question whether there is evidence of clarity between the true differences between the role of a Nurse Practitioner and a Physician's Assistant, as pointed out in much of the literature including studies provided by (Buppert, 1999; Dumas, Villeneuve & Chevrier, 2000; Evans, n.d.; Mitchell, 2004). What is apparent is there is little clarity about the need for greater movement in the industry. The only facts that are clear is that there is a shortage or nurses in the field (Blossom, Ying-Chen & Wen-Hung, 2007) and this has largely to due with the influence of job characteristics and the perceived outcomes of nurses in the clinical care as well as the private practice setting (p. 225).

The implications for this study suggest more in depth analysis is necessary to assess nurse's motivation for expressing interest if any in transferring to the role of nurse practitioner, and whether such a transfer will bring greater job satisfaction and motivation than if the nurse were to remain as a R.N. There is little in the way of evidence at this point clearly defining whether there is a significant trend one way or the other. Another fact clearly identified by this research is the need for more education among nurses aspiring to the role of Nurse Practitioner. This education need be centered on the art of communication, because nurses taking on the role of a NP will by nature have to communicate more directly with patients and supervisory staff, including the physicians with which they work (Mitchell, 2004).

A future study analyzing the satisfaction levels of nurses in the R.N. role and among nurses who decide to pursue other career opportunities including that of Physician Assistant or the Nurse Practitioner would help shed more light on this subject. Such studies should incorporate self-assessment of job characteristics and outcomes as suggested by the theoretical model used for this analysis. However, to provide more empirical data studies should also consist of statistical analysis measuring the turnover rate of nurses transferring to different roles. In addition, studies on how job outcomes and satisfaction reports vary from those practicing in various environments would help. For example, R.N.s practicing in private practice may report much greater satisfaction than those practicing in a clinical setting or an emergent care setting, where the workload and caseload may induce more stress and necessitate more training.

The researcher recommends an additional, more comprehensive review of the research in the form of a meta-analysis of incumbent self-report questionnaires combined with statistical data gathered from major hospital centers, community outreach programs and those engaged in private practice. This research could then be combined to ascertain the advantages and disadvantages, as well as the true motivations and implications of nurses transferring from the role of R.N. To that of Nurse Practitioner or Physician Assistant. One may also ask whether a distinction is needed between the role of Nurse Practitioner and Physician Assistant (Mitchell, 2004).