Nurse Practitioner Residency & Fellowship Emergence Remains Sluggish

Post-graduate nurse practitioners continue to search for more advanced knowledge and skills following graduation. The availability of both residencies and fellowships has remained stagnant over the past 10 years. The first documented Nurse Practitioner Residency was introduced in 2007 by Community Health Centers, Inc. in Connecticut. Since then a sluggish emergence of similar programs continued there are just under 20 clinical residencies or fellowships across the country. The majority offer twelve months of intense training and mentorship, without the pressures of independently navigating the ropes of competent practice. Graduates of residencies note more confidence, increased marketability and a firm foundation to carry out the specialty of their calling. As the need for primary care continues to rapidly expand, the need for Primary Care Residencies so to shall remain.

The Critical Post-Graduate Year 1

As a professor and educator with over 25 years of experience, I have noted the frustration and stress among many of my post-graduates as they enter the job market. Even the brightest and most skilled providers struggle with finding their role. The world of medicine, the vast knowledge of required to practice and simply the lack of experience as a provider, leaves many new nurse practitioners with discouragement and doubt about their competency.

We often have discussions centered around the "first job may not be your dream job". Confounding this issue is the observance of disengaged mentors or colleagues that are paired with new graduates in the work place. Mentors are typically not "mentors". The pressures of managing a practice or simply juggling a large patient load, leave little room for new graduates to gently enter into the workplace without a safe and support environment. The expectations of physician collaborators is for providers to "hit the ground running" as new hires enter the medicine world. These pressures, coupled with need to learn the specifics relating to the specialty can often lead to disappointment and discouragement among new graduates. Many experienced nurse practitioners, who are honest, will share their first few years as a provider were quite difficult. Navigating the first year can be challenging and frightening. However, there IS hope as leaders are recognizing the void that exists between graduation and competent practice.

Financial Realities

A nurse practitioner resident can plan to earn a stipend of about $40,000. Forgoing residency and moving straight into practice a new NP would make about double this amount. While this may leave a $40,000 deficit, a residency may allow a higher paying job more quickly offsetting lost income. Becoming proficient in practice also holds significant non-financial value. If graduating this spring or summer, new nurse practitioners must consider the financial implication of NP Residency.

Residencies Currently Available as of January 2013:

American Association for the Study of Liver Diseases NP/PA Clinical Hepatology Fellowship Program

Boston Children’s Hospital (Massachusetts) Pediatric NP Fellowship

Capital Health (New Jersey) Neurosciences NP Fellowship

Carilion Clinic (Virginia) Emergency Medicine NP and PA Fellowship

Columbia University Medical Center (New York) Critical Care NP/PA Program

Community Health Care (Washington) Family NP Residency

Community Health Centers (Connecticut) NP Residency in Family Practice and Community Health

Emory Center for Critical Care (Georgia) Critical Care Residency

Family Health Center of Worcester (Massachusetts) Family NP Residency

HealthPartners Institute for Education and Research (Minnesota) Psychiatry PA/NP Fellowship Program

John Hopkins (Maryland) NP Fellowship in Gastroenterology & Hepatology

Lahey Clinic (Massachusetts) NP Fellowship in Dermatology

Massachusetts General Hospital NP Fellowship in Palliative Care

Mayo Clinic (Minnesota) NP Clinical Residency Program (other Mayo Clinic NP programs are in Arizona and Florida)

MD Anderson Cancer Center (Texas) Post Graduate Fellowship in Oncology Nursing for Advanced Practice Nurses

Memorial Sloan-Kettering Cancer Center (New York) NP Fellowship in Pain and Palliative Care

Methodist Hospital System (Texas) NP Program Fellowship in Transplant or in Neurosciences

Penobscot Community Health Care (Maine) Primary Care NP Residency Program

St. Luke’s University Health Network (Pennsylvania) NP Residency in Trauma and Surgical Critical Care

UCLA/UCSF/Glide/Union Rescue Mission (California) Primary Care NP Residency

University of Maryland Medical Center Critical Care/Shock Trauma Center Residency Program

University of Miami Hospital and Jackson Health Systems (Florida) Acute Care/Adult NP Residency Program

I highly recommend to new graduates who are concerned about their ability to enter real-world practice, look into NP residencies. With this additional year of hands-on practice experience coupled with an engaged mentor, most new nurse practitioners will come away well-prepared to enter the nurse practitioner role. The first year as a nurse practitioner will be rough. A residency program promises to facilitate the transition from education to practice saving you endless anxiety. For those unable to attend a residency, the struggle continues to bear the stress of the critical 1st year of post graduate residency.

Dr. Powe is an acute care nurse practitioner and clinical researcher. With over 26 years of experience in critical care and emergency medicine, including combat experience in the USAF. He currently owns Global Training Institute, LLC, a simulation and training laboratory for healthcare providers including advanced practice providers. E-mail: chrispowe@globaltraining.insitute / Web: www.globaltraining.institute