The lived experience of nurse practitioners practicing within a professional practice model: A phenomenological study

Professional Practice Models (PPMs) are the gold standard for nursing practice in organizations committed to nursing excellence and quality patient outcomes. The framework for guiding nurses in their practice consists of a system of structure and processes supporting the environment of care. PPMs originated in 1983 and are a required element for all Magnet designated hospitals. This study describes the lived experiences of nurse practitioners (NP) practicing within the Transformational Advanced Professional Practice (TAPP) Model. While Magnet designated hospitals require PPMs that are reflective of all levels of nursing, a gap exists in supporting nurse practitioners (NP) within a specifically designed registered nurse (RN) PPM. NP professional practice is different in education and training and also different in required competencies. In addition to nursing care, NPs also deliver medical aspects of care guided by their state boards of nursing regulatory requirements. PPMs should reflect the level of professional practice accomplished by NPs. The TAPP Model is an evidence based specific NP PPM that supports a patient care domain and professional development domains of practice. This phenomenological study describes the lived experience of NPs practicing within the TAPP Model. Interviews were conducted with concurrent data analysis utilized Colaizzi’s Methodology and a Mind Mapping Technique resulting in three major themes: 1) transforming professional practice; 2) cultivating the inner self; and, 3) mentoring professional transitions. Transforming professional practice reflected NPs’ concept of expanded practice and support needed to effectively interface with the healthcare team. Cultivating the inner self revealed how NPs grew into role expectations and the embodiment of professional practice roles within their human experience. Mentoring professional transitions spoke to how PPMs were useful devices to guide new NPs in their role development. Findings identified that elements of the TAPP Model are inextricably interwoven with NP professional practice and development. Implications for NP practice include informing hospital organizations, leaders, and NPs about the importance of transitioning RN roles to NP roles through the development and implementation of specific NP PPMs. Research implications include additional studies measuring the impact of NP-specific PPMs on role and job satisfaction, retention, and patient outcomes. Methods: A descriptive phenomenological analysis using semi-structured interviews of eleven NPs across multiple inpatient and outpatient clinical areas at Texas Children's Hospital. Member checking and theming data occurred using the mind mapping technique.

Results: Main themes included: (1) transforming professional practice; (3) cultivating the inner self; and, (3) mentoring professional transitions. Conclusions: The findings of this study provide qualitative evidence that the TAPP Model influences role transition and professional development. Transforming NP practice within organizations and within the nursing profession itself will take mindfulness with an intentional approach to design PPMs specifically for NPs.