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Tipping Point

Taking Off

Candice Rettie, PhD 0 509

Nearly two decades ago, the Canadian journalist Malcolm Gladwell popularized the concept of “tipping point,” in his bestselling book of the same name. According to Gladwell, the tipping point is the notion of being “in a place where the unexpected becomes expected, where radical change is more than a possibility.  It is – contrary to all our expectations – a certainty.”

I see indicators of radical change regarding NP postgraduate training at every level: individual, organizational, and, perhaps most importantly, national.

NPs Lighting the Way

Shooting Stars

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It is midnight dark. Streaks of light race across the sky.  In mid-August, despite being a buffet for mosquitoes, I love to watch the Perseid meteor showers.  The first time I experienced the magic of a “falling star” I was 5 or 6.  I’ve been hooked ever since.

It’s not too much of a stretch to say that’s also my experience with nurse practitioners. I’m hooked on NPs.  Although by education, training and experience, I am an educator and psychologist, it’s now my profound pleasure to be a part of the NP world.  I see NPs wherever I look.  Part of that is because of my position with the Consortium, of course, but it is much, much more. 

North Star: Leading the Way Forward

Nurse Practitioners as Leaders in Interprofessional Practice

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Nurse practitioners and other health care professionals navigate the implementation of healthcare by adhering to the North Star of interprofessionalism.  As with the North Star, Nurse Practitioners may not be the biggest or most noticeable “star in the night sky”, but Nurse Practitioners are anchors in delivering interprofessional, evidence-based and high-quality care that is culturally sensitive.  Interprofessional care is a hallmark of their practice.  It’s a mandate to offer patient-centered, comprehensive care to the most vulnerable among us.  Read more about the intersection of musings on the North Star as an essential navigational tool, how Nurse Practitioners serve as the North Star for interprofessional practice, individually and collectively, and the implications for accreditation.

Two Roads Diverged in a Yellow Wood

Accreditation Provides a Quality Anchor in Disruptive Innovation

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A wonderful synchronicity occurred recently when I attended the APGAP (Association of Postgraduate APRN Programs) workshop in Phoenix.  I’d written this post the evening before the conference.  The next morning, we were greeted by the conference’s opening with exactly this picture and Robert Frost’s poem.  The idea of making choices and the impact of those choices regarding training program design, delivery, and accreditation on outcomes resonated deeply.  It was especially apt since I’d also been inspired by Robert Frost and had just finished writing this blog which focuses on choices, transitions, and creating the future.

Making choices necessitates a transition.  Staying on the same path is choosing to make a commitment to pursue familiarity and continuity; the likelihood of predictable change that occurs with a known situation – and perhaps a transition to stability.  Electing a different path is choosing a transition to new opportunities and the possibly disruptive innovation that generates new knowledge, new practice, new policies. Those choices determine how the training programs function, subsequently shaping the future of the profession.

Accreditation translates excellence in practice and awareness of emerging practice trends into salient benchmarks for quality training experiences. 

Success and Professional Identity

Understanding How Postgraduate Training Influences Novice NPs

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If you have read other blogs in this series, you know that I am frequently inspired by nature. The harvest moon was in full glory this past week, signaling farmers that it is time for harvest.  Birds and butterflies are migrating south, individually and in sky-darkening flocks. Hurricanes are rampaging through warm waters. Each day the hours of darkness increase.  All are signs of nature’s seasonal transition. 


Piaget and Kuhn each conceptualized transitions as essential steps in forward progress.  Beginning with Piaget's notion of transition -- successful transitions are characterized by 'important changes in how the [novice NP] thinks’.  Then layering on Kuhn's notion of a paradigmatic shift -- [earlier ways of practice] are 'replaced by new and different’ ways of functioning as a [confident and experienced healthcare professional.] Let’s explore how transitions occur in nurse practitioner postgraduate training programs.  These programs provide deliberate, structured opportunities for navigating the novice practitioners’ transition from newly minted to seasoned practitioner through opportunities designed to develop relevant “attitudes, beliefs and standards” that correspond with  a “clear understanding of the responsibilities of being a health care provider.” A useful nursing skill acquisition model is provided by  Patricia Benner’s stage theory of clinical competency that describes RNs' progression from novice to expert nurse. The concept of novice NPs moving through five levels of proficiency is applicable to the evolution of a novice NP’s professional identity.  Read more to learn about two recent studies that describe this developmental progression from novice NP to confident practitioner.