Date of Award

Fall 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

DNP

First Advisor

Cathleen Colleran DNP

Abstract

Background: There is a critical shortage of primary care providers (PCPs) in rural areas of the United States. Nurse Practitioners (NPs) are essential for addressing the primary care shortage especially in rural communities. However, significant barriers exist to the retention of NPs in rural communities, especially new graduate NPs in the first year of practice. Evidence in the literature suggests bolstering the focus on transition-to-practice for new graduate NPs to improve retention and turnover rates.

Purpose: The aim of this quality improvement project was to develop a structured, postgraduate, on-boarding curriculum at a rural outpatient family medicine clinic with the purpose of improving retention rates of new graduate nurse practitioners as primary care providers. The goal and expected outcomes of this project reflect the findings in literature including decreased turnover rates/intention to leave current positions, increased provider preparedness, increased job satisfaction, greater provider autonomy, and improved interprofessional collaboration.

Methods: The project was designed using the Plan Do Study Act (PDSA) model for quality improvement. The intervention was a formal, peer-mentored curriculum that was developed based on best practices from the literature. The curriculum was tailored to the needs of the participant based on a needs-assessment. Additional curriculum content was developed based on ideas obtained from DNP team members and resources like the Southern New Hampshire Area Health Education Center and a clinical nurse educator certificate course. The curriculum was evaluated using validated tools obtained from the National Organization of Nurse Practitioner Faculties (NONPF). Pre and Post curriculum data regarding clinical confidence, job satisfaction, interprofessional collaboration and intent to leave current position were collected to evaluate the effectiveness of the program.

Results: Quantitative data revealed significantly improved rates of clinical confidence in every specialty covered in the curriculum. Confidence levels were unchanged in specialty areas that were not covered in the curriculum which supported the association between improved confidence and completing the curriculum experience. The new grad NPs confidence in outpatient procedures was unchanged and independent clinical competence was unchanged. Scores for job satisfaction, confidence in clinical decision making, interprofessional collaboration, burnout and likelihood to remain in current position all improved for the new graduate NP after completion of the curriculum experience.

Conclusion: The goal of the curriculum was to reduce turnover rates by improving clinical confidence, interprofessional collaboration, job satisfaction and reducing burnout. The results of this quality improvement project were promising for achieving the intended aim, however, significant limitations in scope and design of the project were present. There were significant limitations to the scope of this quality improvement project that limit generalizability and will need to be addressed in future PDSA cycles for sustainability. Specifically, it would be vital to show data of improved “ramp up” times for new graduate providers to see a full schedule of patients in the family medicine clinic to validate the cost effectiveness of investing in the curriculum project. Analysis of retention rates over longer periods of time will also be essential for future PDSA cycles.

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