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.
Comments
i enjoy your blog!
-futureWHNP/ANP : )
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!
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!
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.
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!