Sunday, December 5, 2010

NP Residency

The healthcare system of today is so complex yet so dysfunctional that I believe the time has come to educate and train the NP providers of tomorrow in a way that is reflective of that complexity. We have done a good job up to this point but need to bring that to the next level.

Residency.

I'm not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people's homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to handle scenarios encountered in Federally Qualified Health Centers (FQHCs). The residency lasts 1 year and appears to be a wonderfully structured program and setting.

So why are NP schools still relying on the preceptor model to train NP students? It comes down to money. The majority of medical residency's are funded by Medicare & Medicaid (I don't purport to know the full details of funding but do know that it is largely our tax money supporting physician residencies). For what I'm sure is a myriad of reasons, NP training just wasn't appropriated. Enter the Patient Protection and Affordable Care Act. Section 5316 authorizes a demonstration project to replicate the NP Residency Model. This at least is a start.

There is no doubt that the residency model in proven and tested to train professionals in the real world. In fact, a recent article in the Las Vegas Review Journal discussed residencies for new RNs working in Vegas-area hospitals.

Patient's haven't necessarily become more complex, its just that our understanding of the multidimensional aspect of them has. There are nuances in physiology, culture, health beliefs/disparities and socioeconomic standing. Taking care of disease processes is relatively easy - taking care of an individual is the real challenge. Not to mention the importance of collaborating, communicating and interacting with all the members of the multidisciplinary care team. All of our training needs to encompass and embrace these factors so that we may provide the best culturally competent and evidence based care possible to our patients. Perhaps residencies will provide us with guided real world training to take all of this complexity into account. It certainly will be interesting to follow.

20 comments:

amanda said...

Great post! As a soon-to-be new grad who is feeling *slightly* overwhelmed at the idea of independent (as in without preceptor) practice, I would LOVE to be able to ease out of the academic world via an NP residency. I am at a nursing school that is very close to the CHC's program, and the director has lectured to us on more than one occasion promoting it. Unfortunately, at this point it is only approved for FNPs (bummer!). I think that the new legislation will lead to more of these programs. The NHSC should totally jump on board and make it apart of their loan repayment program.
i enjoy your blog!
-futureWHNP/ANP : )

Stephen Ferrara, NP said...

Thanks Amanda!

Anonymous said...

I 100% agree! I've been a PNP for one year now, and I wish that I could have spent this year learning with supervision (as in a residency), rather than praying that I was making good choices. We absolutely need NP residency programs.

Cedric said...

Interesting viewpoints on this topic. As an MD I would advocate for at least some supervised training like a residency for new NPs and PAs too. One of my colleagues recently reviewed the Future of Nursing Report and of its 8 recommendations, a residency is included. http://www.policyprescriptions.org/?p=1479

Yusharnw said...

I think this is a well written blog post. I went to Washington DC In August 2010 with Dr. Jan Towers from AANP for a NP Health Policy fellowship. I learned a lot. I found out that my home Senator Daniel K. Inouye is the head person of the Appropriations and the Third in succession to the President. He also, LOVES nurses. I've spoke with Senator Inouye with the issue. He couldn't say much at the time, but many in AANP are hopeful and confident that funding will be allocated to fund NP residencies throughout the nation. How confident am I about this? I would say 8/10 confident. It's also a matter of the medical community opposing the idea in addition to "we physicians have more training" and "we're concerned about unsupervised NPs because of patient safety". It's just another method to support their argument. I am soon to graduate in August 2011 (I get to walk in Spring 2011 since I'll be doing my capstone in Summer 2011). I too feel a bit overwhelmed in the provider role. Off topic, I get a lot of: "how did you get into FNP school and how are you going to be a competent provider without RN experience?". I graduated in Spring 2009 and began FNP program in Fall 2009 and I'm full time. I know RN experience definitely helps, but it seems clinics are hiring NPs even without RN experience because they'll be doing other things? I for myself, would still want to get that RN experience to get more hands on experience with skills. All this of course, would probably require a New Grad program that costs money to train! Is it me or is the NP profession sort of fragmented? The way I see it, it should be NP degree, then after graduation specialty training, hence residency. Sorry for long post. I just saw your post when searching on Google. thanks Stephan!

Yusharnw said...

I just wanted to also say, I think if physicians and NPs work together on the same level, then patient care would be outstandingly great. With minimal fragmentation and errors or duplication! Thus, reducing unnecessary use of resources. Physicians and NPs are different careers. They're both now CRITICAL to our upcoming rising numbers of insured individuals.

Kerry Bamrick said...

Hi. I’m the program coordinator for the Nurse Practitioner Residency Program at CHC, that was referenced above. Our program is a 12 month, full time, salaried position intended for FNPs who are committed to developing careers as PCPs in the challenging setting of community health centers and other safety net systems. The program structure includes: precepted primary care sessions, specialty rotations, independent clinics and didactic sessions. We're starting to receive applications for four positions to the 2011-2012 residency class. The application deadline is April 1, 2011. If you want to know more, please drop me a note. You may also visit our website at www.npresidency.com

MarthaT said...

Hello Stephen and other fellow NPs/ soon-to-be NPs,

I am very excited to find this post! I recently graduated from a FNP program in Chicago in May 2010 and began CHC’s FNP Residency program in Connecticut (as mentioned above) this September 2010. I now have 3 months of experience in seeing patients, and I can’t imagine beginning practice in a complex community setting without this extra training. I do believe that my graduate program prepared me with a good foundation in the basics of primary care. However, rarely in a FQHC do you ever encounter a “basic” patient.

Under my preceptors’ guidance, I continue to become more comfortable managing complex disease processes that are compounded with multifaceted social and environmental situations. I am learning advanced management while simultaneously learning how to create a system that is cost effective and is able to be navigated by our patients.

My personal experience in this residency program allows me to say that this is the best way to prepare new NPs for future practice in complex FQHC environments. I am continually reminded how fortunate I am to be a part of this movement, and hope that section 5316 of the heath care bill will allow for expansion of these residency programs. Hopefully, we can all work together to get the word out there about these residency programs, and one first step in doing this is through blog conversations. Thanks for initiating this conversation!

MarthaT said...

Hello Stephen and other fellow NPs/ soon-to-be NPs,

I am very excited to find this post! I recently graduated from a FNP program in Chicago in May 2010 and began CHC’s FNP Residency program in Connecticut (as mentioned above) this September 2010. I now have 3 months of experience in seeing patients, and I can’t imagine beginning practice in a complex community setting without this extra training. I do believe that my graduate program prepared me with a good foundation in the basics of primary care. However, rarely in a FQHC do you ever encounter a “basic” patient.

Under my preceptors’ guidance, I continue to become more comfortable managing complex disease processes that are compounded with multifaceted social and environmental situations. I am learning advanced management while simultaneously learning how to create a system that is cost effective and is able to be navigated by our patients.

My personal experience in this residency program allows me to say that this is the best way to prepare new NPs for future practice in complex FQHC environments. I am continually reminded how fortunate I am to be a part of this movement, and hope that section 5316 of the heath care bill will allow for expansion of these residency programs. Hopefully, we can all work together to get the word out there about these residency programs, and one first step in doing this is through blog conversations. Thanks for initiating this conversation!

SarahNP said...

Hi NP colleagues, I was in the 3rd class of the Family practice NP residency. I found it to be an unprecedented experience! I found the precepted sessions with expert providers crucial for my growth in knowledge and confidence. Now, as an independent NP. I feel well prepared to manage diseases across the lifespan due to the equipping I was given in the residency. I believe the future for family NPs should include a 1 yr residency. I think as NPs we should advocate that the government fund a residency for us as they do for medical doctors.

Laura said...

Hi all. I will be a graduating ANP/WHNP in May 2012, and I have been very excited about the idea of finding a residency program. Imagine my disappointment! Not only has this idea not yet caught on nationally, but the two programs that I've been able to find seem to only accept FNPs and/or are connected to specific grad programs.

Has anyone heard of any other residency programs besides the CHC in CT (which sounds absolutely amazing) or the Mayo Clinic in Rochester, MN?

Thanks. I hope this conversation spreads far and wide...
L.

Anonymous said...

There is an FNP residency program starting up in Austin, Texas this year with another community clinic. I think it is based off of the same model as connecticut. In my opinion - Austin is great, great people to work with, and the pay rates are generally higher than other parts of the country.

Elaine Hitchcock Dauwalder said...

Hello -
I would like to speak to anyone concerning a nurse residency program. My institution wishes to start one for NP's. My personal e-mail is elaine@dauwalder.net.(I probably should not post my work e-mail). My phone number is 615-604-9521. I would be happy to hear from anyone who has been in a residency program, or who has developed one. Thank you!

Anonymous said...

Do you have more information about this clinic?

Erin said...

I would have loved to have an NP residency! I now have three years of NP experience and an doing just fine but I did not feel prepared for my first job as an NP. An extra year of experience would have made a big difference. I would have felt much more comfortable in my first job and would have been able to handle more complex patients.

Anonymous said...

I am so glad to read all of your postings. I will be graduating in August 2013 and also feeling nervous about independent practice. I too received an MD opinion questioning whether I was ready to practice independently as an NP. I of course do not feel I am ready to be independent, but I certainly feel that a residency program will help make the transition much smoother. After all, I'm sure that once MDs are finished with their internship/residency, they too feel overwhelmed like we do. It seems like MDs are discouraging the NP role?

Anonymous said...

I am so glad to read all of your postings. I will be graduating in August 2013 and also feeling nervous about independent practice. I too received an MD opinion questioning whether I was ready to practice independently as an NP. I of course do not feel I am ready to be independent, but I certainly feel that a residency program will help make the transition much smoother. After all, I'm sure that once MDs are finished with their internship/residency, they too feel overwhelmed like we do. It seems like MDs are discouraging the NP role?

Anonymous said...

Thank you for writing this post. I will graduate as a Family Nurse Practitioner in 2014 and I am planning to apply to a residency program. Your post and the comments are reassuring; especially when I keep being asked why I would want to spend a year earning less than what I could otherwise earn in a regular job (the residency program I'm considering pays 80% of a new grad salary). Thank you!

Anonymous said...

Thank you for writing this post. I will graduate as a Family Nurse Practitioner in 2014 and I am planning to apply to a residency program. Your post and the comments are reassuring; especially when I keep being asked why I would want to spend a year earning less than what I could otherwise earn in a regular job (the residency program I'm considering pays 80% of a new grad salary). Thank you!

Anonymous said...

Thank you for writing this post. I will graduate as a Family Nurse Practitioner in 2014 and I am planning to apply to a residency program. Your post and the comments are reassuring; especially when I keep being asked why I would want to spend a year earning less than what I could otherwise earn in a regular job (the residency program I'm considering pays 80% of a new grad salary). Thank you!