Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Laura Kuensting


Dr. Patty Hendrickson

Dr. Tonya Haynes


Problem: Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning from a traditional nursing role to advanced practice. The Veteran’s Health Administration (VHA) utilizes a NP primary care fellowship program. An acute care fellowship may assist with role transition, confidence and competence for acute care NPs. The purpose of this evidence-based pilot project was to develop a transition to practice acute care fellowship program at a Midwestern VHA hospital.

Methods: A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures included evaluation of skills interpreting electrocardiograms (ECG), chest x-rays (CXR), and self-reported confidence in performing these skills over the initial six-week period of the 12-month program.

Results: There were three participants (N=3, 100%). There was a 33% increase in self-reported confidence of readiness to practice at completion of the pilot. However, ECG scores decreased 66% and CXR interpretation scores decreased 33%. In reference to ECG, there were two (n=2) participants who met the expected level of correct interpretations at 50%, but one (n=1) did not. Regarding CXR, all participants met the expected level of correct interpretations at 50%.

Implications: Despite training and targeted clinical experiences in ECG and CXR interpretations during an acute care fellowship, competence in these skills decreased while self-reported confidence increased at the end of six-weeks. Continued education and training throughout the 12-month program is recommended to increase the novice NP’s competence in these skills while transitioning to their new role.

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