Improving pediatric acute-care NP retention rates

Achieving better retention and improving the acute-care pediatric NP (ACPNP) experience will be key in sustaining NP growth in this setting.

Surveys of NP job satisfaction show high marks for NP autonomy and feeling challenged by the profession, but rank lower in terms of satisfaction with professional growth and intra-professional collegial relationships. 

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Although data on NPs is limited, better job satisfaction has been associated with more positive patient outcomes in RN studies, according to Trimarchi.

She also had several recommendations to encourage smoother transitions from RN roles to NP roles in acute-care settings:

  • Creating clearer job descriptions for ACPNPs
  • Conducting competency-based orientation to match job requirements
  • Establishing mentorship programs with experienced NPs
  • Implementing formal transition-to-practice programs to better introduce NPs to the organizations in which they work

A more detailed description of the transition-to-practice model at CHOP, “The Care Model of the Future: Supporting APRNs Through an Innovative Transition to Practice Program,” is available in the Journal of Pediatric Healthcare for those interested in learning more.

In addition to better transition programs, implementing step-wise career development ladders that recognize and reward NPs for their expertise, years of service, and doctoral degrees is another strategy Trimarchi recommends for improving ACPNP retention rates.

Encouraging NPs to pursue leadership roles is also important.

“Leaders must understand the process by which Medical Staff Affairs grants practice privileges and credentials within the context of state and federal requirements for NP certification and within the boundaries of NP scope of practice,” Trimarchi said.

“Leaders dedicated to advance practice nursing are also better able to design educational and career development opportunities specifically targeted to NPs.”

What’s next?

Currently, there is great variation in NP requirements for practice among state boards of nursing and within healthcare systems.

More efforts are needed to develop leadership and infrastructure to support acute-care pediatric nurse practitioners, and to pass legislation that removes barriers to practice at the state and federal levels.

Advocating for NP full-practice authority in all states is a top priority, according to Trimarchi. More standardized requirements for higher education and specialty certification are also needed.

“The Consensus Model for APRN Regulation should drive the requirements for NP certification and type of certification should drive the hiring decisions of hospitals, but that isn’t happening consistently,” Trimarchi said.

“If both nurses and health-care leaders better understood the importance of aligning education with practice, then alignment would be consistently required, and the requirement of acute-care certification in order to care for complex, acute and critically ill children, would drive the demand for more acute care PNP programs.”


  1. Trimarchi T. #106. “Managing NP Teams in High Acuity Settings: Unique Leadership Challenges.”
  2. Trimarchi T. #117. “Performance of a NP-Driven Front-Line Care Model in a PICU.”
  3. Both presented at: NAPNAP 2015. March 11-14, 2015; Las Vegas.