Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Joan Kearney

Abstract

Most Advanced Practice Provider (APP) turnover occurs within the first year of practice. It is often linked to feelings of inadequacy caused by limited professional instruction and immediate expectations of full practice integration. These challenges are compounded further in systems with inconsistent onboarding processes and underprepared trainers, further exacerbating turnover rates. At East Carolina University (ECU) Health System, turnover rates for Physician Assistants and Nurse Practitioners reached 20% and 12%, respectively, surpassing national averages (ECU Health, 2024), highlighting the urgent need for a structured onboarding approach.A system-based Train-the-Trainer (TTT) program was developed to address these issues, focusing on essential areas of APP professional development: billing and coding, licensure and credentialing, team dynamics, and personal wellness. Trainers completed online learning modules supplemented with additional resources designed for knowledge reinforcement. Following the modules, trainers mentored newly hired APP orientees through a newly structured three-month orientation. Evaluation of the program included pre- and post-intervention surveys measuring self-efficacy in professional development topics of both Trainers and Orientees. Statistical analysis, conducted using paired T-tests and Wilcoxon Signed-Rank Tests, demonstrated significant increases in self-efficacy scores for both trainers (p < 0.001) and orientees (p = 0.002). These findings suggest that structured professional role development education enhances trainer confidence and effectively promotes second-generation learning through the TTT model. The implemented model provides a scalable, cost-effective solution to mitigate turnover, enhance readiness to practice, and address evolving demands in healthcare delivery.

Comments

This is an Open Access Thesis.

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