The purpose of this study was to explore the differences in how advanced beginners, competent, and expert nurses prioritize and reprioritize patient care. This qualitative study had a purposive sample of 23 nurses on cardiac/ telemetry units at five hospitals. Four themes emerged from the data: cognitive strategies, communication, integration of roles, and response to the work environment. As the nurses progressed in expertise, they were better able to organize, more effectively deal with interruptions, anticipate patient needs, integrate varied nursing roles into their work, and communicate effectively. The significance of this study is the identification of factors that affect the nurse's ability to work productively in today's care environment. It increases understanding of the graduate nurses' perception and response to the complexity and work of nursing. An understanding of these factors provides the basis for further research to understand and promote transition of nurses from advanced beginner to expert.

The Institute of Medicine's The Future of Nursing report recommended the extension of nurse practitioner (NP) fellowship programs to highlight and assess competencies after completion of licensure. The initiative, “Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention as nurse practitioners promptly transition from novice to expert clinician,” evaluated NP satisfaction between NPs who had not completed a fellowship versus NPs who had participated in a fellowship. Transition of an NP was evaluated through the Misener Nurse Practitioner Job Satisfaction Scale via 258 NPs through Emory Healthcare, MD Anderson, DNP discussion groups, and Show Me Your Stethoscope from social media. A series of independent t-tests were performed to determine statistical significance. The results of the analyses found that individuals who had participated in an NP fellowship had significantly higher scores on a sense of value for “what you do,” monetary bonuses, and compensation for services outside of normal duties and obtained statistical significance. Owing to the positive trends of the surveys, continuation of NP fellowships is recommended for a successful NP role transition to develop clinical growth, retention, leadership skills, and ultimately an expert clinician.

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