From RN to Nurse Practitioner: Career Transition Guide

Introduction

This paper examines the process of transitioning from the status of Registered Nurse (RN) to Nurse Practitioner (NP). In doing so, the researcher defines and describes the duties, obligations, and educational requirements of both positions. The primary questions addressed include: (1) what factors influence a nurse's decision to transfer from one position to the next; (2) does transferring from RN to Nurse Practitioner pose specific advantages or disadvantages to the nurse in question; and (3) what gaps in the literature currently exist regarding research in this area?

The answers to these questions will assess whether further study of this phenomenon is necessary or prudent in evaluating the career goals and motivations of nurses in the field of medicine. The researcher hypothesizes that as a continuing decline in the supply of practicing nurses becomes evident, fewer RNs may decide to transfer to the role of Nurse Practitioner — partly because of elevated responsibilities, and partly due to a lack of communication, proper training, and support, as the literature review evidence will show.

At present, there is a national crisis within the nursing industry. More and more people are interested in becoming nurses, who work in many capacities in clinics, community centers, hospitals, and private practice. However, for some, there is no clear distinction between an RN and a Nurse Practitioner. Furthermore, there is little data exploring the mechanisms through which a nurse may decide to pursue an advancing career, and what support, if any, he or she may receive in doing so. The purpose of this paper is to clarify the roles of these two positions and assess which is most needed given the current status of nursing and healthcare in the United States.

By identifying the differences between, and the need for, both RNs and Nurse Practitioners — and the ease with which one may transfer from one role to another — those interested in pursuing nursing are better prepared to make sound judgments about their careers, their livelihoods, and the well-being of their communities. A nurse's role in the community dramatically affects patient quality of life, patient outcomes, and organizational management. One's choice of position may also carry financial implications, both personally and for the employing organization, and may affect overall productivity. This researcher addresses all of these concerns through a comprehensive review of the current literature on the profession.

Theoretical Framework and Problem Statement

The theoretical framework for this research is drawn from Hackman and Oldham's job characteristics theory (Blossom et al., 2007; Fisher & Ashkanasy, 2000), which suggests that the characteristics of a given job have multiple effects on job outcomes and on the choices made by those holding that position. Using this theory, the demands that certain jobs place on their incumbents can significantly influence a person's desire to change positions — such as switching from a Registered Nurse to a Nurse Practitioner. Hackman and Oldham's model examines job satisfaction and motivation, among other characteristics, and their implications for one's likelihood of transferring from one position to another — a useful lens for understanding why nurses move between roles.

Riley (2000) supports this theoretical framework by confirming that multiple job characteristics — chief among them communication — influence a nurse's desire to transfer from one nursing position to another. Riley suggests that nurses make "intimate journeys with clients and families" throughout their careers and provide patients with multiple forms of support, including education that may affect patient outcomes and futures (p. 2). A nurse's role and title can affect their ability to communicate and, in turn, their ability to deliver quality healthcare (Riley, 2000). It is therefore important to examine the implications of a nurse's role for their ability to communicate effectively and to develop those communication skills as part of their professional purpose.

A nurse's actions vary according to job responsibility. A nurse may promote, maintain, or restore a patient's health or well-being depending on their role. For example, professional nurse practitioners may "bear primary responsibility for the nursing care clients and patients receive" (Riley, 2000, p. 25; Congress for Nursing Practice, American Nurses Association, 1973). This means that nurses in the Nurse Practitioner role carry greater responsibility and, according to Riley (2000), greater ability to communicate with patients from an empowered position.

Role Distinctions: Nurse Practitioner vs. Registered Nurse

To understand why a nurse might transfer from one role to the next, one must first distinguish between the levels of service a Nurse Practitioner offers compared with a Registered Nurse. There is considerably more status associated with the role of Nurse Practitioner than with that of a traditional RN (Sobralske & Naegele, 2001; Shi & Samuels, 1997). The practice environment for Nurse Practitioners closely resembles that of a physician's assistant: the nurse is granted authority to communicate directly with patients, assess them, and provide treatment recommendations in many of the same ways a PA or physician would, under the oversight of the primary care physician (Sobralske & Naegele, 2001, p. 544). For many nurses, this environment — and the employment characteristics it entails — is idealized, because Nurse Practitioners are more empowered to make decisions and take an active role as members of the healthcare team (Shi & Samuels, 1997).

This does not diminish the role of the RN, however. An RN is a critical provider in any healthcare facility, but often must manage some of the more routine tasks associated with nursing, and may be overburdened with job characteristics perceived as less favorable — including lower pay for greater workload, or frequent requests for overtime without adequate recognition of the time and commitment they give to their patients (Sekcenski et al., 1994).

Applying the same theoretical framework, one may also suggest that the limited supply of qualified Nurse Practitioners — combined with state-level rules and regulations governing advancement to NP status — may itself be a barrier. These requirements may impose too great an economic or personal hardship for RNs to realistically pursue such advancement (Sekcenski et al., 1994, p. 1268). The role of the Nurse Practitioner thus represents both an aspirational goal and a structurally challenging transition for many working RNs.

When deciding whether to transfer from one nursing role to another, Riley (2000) recommends the use of a self-assessment tool — one that allows nurses to evaluate not only "their skills, but also use the self-assessment as a tool to teach tenets of customer service" and communication (p. 439). Using this instrument, nurses answer 25 questions on a Likert-type scale from 1 (not skilled) to 4 (very skilled). Questions assess their ability to communicate, interact with clients, take responsibility for patient care, encourage client feedback, offer help, and respect confidentiality, among other competencies (p. 440). Nurses with high scores — those in the range of 77 to 100 — are more likely to have a clear awareness of their abilities and to make informed decisions about whether to transfer to a new role or remain satisfied in their current position within the nursing profession (Riley, 2000, p. 440).