| Description |
Background: Pediatric psychiatric-mental health nurse practitioners (PMHNPs) play a critical role in addressing the increasing demand for pediatric mental health services. However, novice PMHNPs often face significant challenges in their transition to practice, including role ambiguity, limited mentorship, and inconsistent onboarding. To support workforce sustainability and improve patient care outcomes, structured transition-to-practice programs such as fellowships have gained attention as an effective solution. Local Problem: An integrated healthcare system in the Mountain West, serving both urban and rural areas, faces high turnover rates among novice PMHNPs, inadequate onboarding support, and a lack of structured mentorship as critical barriers to workforce retention. Leadership within the organization expressed a strong interest in developing a structured fellowship to address these gaps and sought accreditation through the American Nurses Credentialing Center's (ANCC) Advanced Practice Provider Fellowship Accreditation (APPFA) program. Methods: A needs assessment was conducted across three pediatric psychiatry clinics to evaluate the feasibility, usability, and acceptability of implementing a PMHNP fellowship. Data collected from surveys and semi-structured interviews with newly hired PMHNPs assessed burnout, anticipated turnover, and job satisfaction. A SWOT analysis identified organizational strengths (S), weaknesses (W), opportunities (O), and threats (T) related to the fellowship's implementation. Interventions: Key stakeholders, including nursing leadership, clinical educators, and experienced PMHNPs, were engaged throughout the needs assessment process. Data collection included demographic surveys, the Rapid Burnout Screening Tool (RBST), the Anticipated Turnover Scale (ATS), and the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). Healthcare leadership received and evaluated the synthesized findings in an executive summary document and presentation. Results: The SWOT analysis, incorporating data from survey responses (N = 5) and stakeholder discussions (N = 6), revealed significant gaps in onboarding and mentorship structures. Forty percent of novice PMHNPs demonstrated high anticipated turnover, and thematic analysis of qualitative data highlighted inconsistencies in preceptorship, unclear professional development pathways, and inadequate competency evaluation. Despite these challenges, institutional leadership strongly endorsed the feasibility and sustainability of the proposed fellowship program. Conclusion: A structured PMHNP fellowship emerged as a viable solution to address workforce retention and competency gaps within this integrated health system. Key strengths, including institutional leadership support and alignment with APPFA accreditation standards, provide a strong foundation for implementation. However, addressing mentorship deficits, developing standardized competency assessments, and ensuring long-term sustainability remain critical next steps. Ongoing collaboration with key stakeholders will be essential to the program's success and future accreditation. |
