New graduate advanced practice registered nurses (APRNs) face multiple challenges when entering an autonomous practice, including challenges acquiring clinical competency, gaining clinical knowledge regarding their specialty area, and expanding their clinical skills to perform the new job effectively. Some of this clinical knowledge and exposure to clinical skills may not have been available to the APRN during his/her graduate education. Transitioning from a novice to an expert takes patient time, clinical exposure, experienced mentorship, and hospital finances. This lack of available mentorship and experience is especially evident in an area of an acute care specialty. At the same time, healthcare organizations are looking for talented and experienced providers while attempting to reduce cost and to improve talent recruitment. The pediatric emergency medicine fellowship for APRNs was designed to decrease the new APRN’s transition time to practice, to advance clinical competence, and to improve patient outcomes. The fellowship was designed for the pediatric emergency department at Children’s Hospitals and Clinics of Minnesota (Children’s). The 12- month fellowship was designed to serve as a link between a university education and an autonomous practice in pediatric emergency medicine, provide valuable on-the-job experience for new graduates, contribute to clinical excellence, and allow the hospital to retain experienced talent while decreasing organizational cost. The fellowship project received approval from the IRB departments of both North Dakota State University and Children’s. The project plan was presented to and endorsed by the Children’s leadership and was authorized through the department of Continuing Medical Education. A needs-assessment survey administered to nurse practitioners working in Children’s Emergency Department directed the fellowship’s curriculum development. Several unforeseen organizational changes affected the project’s implementation, including the medical fellowship director’s terminal illness, unforeseen Emergency Department APRN turnover, and APRN fellowship director staffing changes. Overall, the lessons learned from this project’s development and the networking that arose from the curriculum-development, allowed for improved orientation of the Emergency Department’s nurse practitioners, provided new opportunities for continuing medical education, pertinent to the Emergency Department staff, and improved the overall organizational support for the nurse practitioners’ clinical education at Children’s.