Date of Conferral



Doctor of Nursing Practice (DNP)




Andrea Jennings-Sanders


Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in practice expectations and significant role transition stress and turnover. The purpose of this project was to construct from the scholarly literature a transition-to-practice residency program to support NP's in providing emergency department care in the CAH. The limbo to legitimacy theory guided the design and implementation of this project. Expected outcomes from this project include increased quality of care, increased patient safety, increased NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of 8 institutional leaders who designed the residency program and curriculum modules and the secondary products necessary to implement and evaluate the project. The project expands the understanding of the on-boarding needs of rural NPs and produces outcome data to evaluate results. Recommendations include collaboration between health care organizations and institutions of higher learning to promote postgraduate emergency care education leading to post-masters certificate or Doctor of Nursing Practice with emergency care subspecialization.