puzzle of transformation: Becoming a nurse practitioner

The purpose of this study was to provide introductory knowledge about the value of narrative methods of teaching nurse practitioners and their transition to advanced practice. According to this study, becoming a nurse practitioner requires a paradigm shift. It demands that nurse practitioners remain grounded in nursing and yet, integrate enhanced critical thinking, diagnostic reasoning, and holistic humanistic caring. It was determined that the transition to the nurse practitioner role begins during the formal learning program and continues for several years after graduation. There is a learning curve involved in the transformation. Creating a new identity occurred slowly and incrementally over time as a result of continuous learning. Students and graduates often felt frightened and alone in their new role. According to the findings of this study, becoming a nurse practitioner requires a transformation. The following four processes or meta-themes describe the transformation: (1) A learning process: Continuous learning; (2) A problem solving process: Putting the pieces together; (3) A challenging process: A time of transition; and (4) A socialization process: Expanding one's identity. Participants identified the metaphor of a puzzle to symbolize the transformation they experienced. The puzzle represents the challenge of putting together the pieces of learning and the change involved in the transformation from registered nurse to nurse practitioner. The conclusions suggest that learning the diagnostic reasoning skills required in primary care practice is enhanced by using narratives. The conclusions indicate that stories and case studies are useful methods for teaching the process of assessment, diagnosis, and treatment needed by nurse practitioners. Case studies improve critical thinking and problem solving skills. Stories help nurse practitioners remain grounded in humanistic nursing practice and focused on the therapeutic relationship. This study determined that the essential quality that makes both of these methods valuable for learning is the ability to encourage critical thinking through dialogue and discussion.