The Debate On Residency Programs For Nurse Practitioners

A residency is a postgraduate training program which allows the resident to perform as a licensed practitioner while under the supervision of an experienced teacher. Usually thought of as the domain of physicians and pharmacists, residencies for nurse practitioners are starting to trend. Although they are few and far between, there is debate about whether or not NP residency programs are necessary, and if they should be made mandatory.

History of the nurse practitioner

Nurse practitioners first arrived on the scene around 1965 when Loretta Ford and Henry Silver created the first nurse practitioner program. After a decade with a shortage of physicians due to more physicians specializing and the advent of Medicare and Medicaid programs, medical professionals agreed nurses were experienced and knowledgeable enough to care for children and families (which they had been doing already). This led to an expansion of their roles to mirror the roles and responsibilities of primary care physicians, hence the invention of a nurse practitioner program.

However, in recent years, nurse practitioners are starting to encounter more complex cases due to changes in our healthcare system, and the hospitals and clinics that hire nurse practitioners are struggling to keep them in their scope of primary care. A report published in 2010 from The Institute of Medicine recommended the development, funding, and evaluation of post-graduate “transition-to-practice” training programs for nurse practitioners. But it also stated that safety and quality of care data across multiple settings offered little evidence for mandating such programs.

The small amount of qualitative data available suggests nurse practitioners would benefit from residency programs. A 2004 survey found that 87% of nurse practitioners said they would be interested in post-graduate training if it were available. Only 10% of the sample felt they were well prepared for practice and 51% said they were “somewhat” or “minimally” prepared.

“The amount of clinical experience and training that one has in that context…is insufficient for people to enter practice particularly in the very challenging environment of the role of primary care provider and the setting of community health centers,” says Margaret Flinter, APRN, Ph.D., creator of the 1st nurse practitioner residency and senior vice president and clinical director of the Community Health Center in Middletown, Conn.

Despite the evidence that nurse practitioners are seeking out and would benefit from a residency, there are many hurdles to jump over.

First and foremost is the lack of funding. Physician residencies are subsidized by Medicare and Medicaid, but nurse practitioner residencies are internally funded. Although Flinter and other nurse practitioners have spent many years lobbying the government for more funding, nothing yet has been passed.

Another concern is attracting participants. Because nurse practitioner residencies are not mandatory and not funded, a residency would require practitioners to do the same amount of work as they would if they got a job, but with a lot less pay.

Lastly, there is no clear evidence to show a nurse practitioner residency would create better care or better nurse practitioners. The debate still rages about whether or not nurse practitioner residencies should be mandatory. The American Nurses Association website states, “Nurse practitioners are prepared to be fully licensed providers at graduation.  No added academic clinical or supervisory hours are necessary for safe patient care.”

Flinter states she isn’t seeking for residency to be mandatory. “What I would like to see is that every new nurse practitioner who wants to be a primary care provider and feels like to be the best primary care provider they can be in the setting they’d like to be in [and] would like to do a residency, I would like for there to be the capacity for each of them to find a residency,” she said.

If you are a nurse practitioner, what do you think? Do you feel you would benefit/have benefitted from a residency?