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?
Susan PeetrosPosted at 8:56AM, January 06 2017
Absolutely!!! In the 20 years of my NP practice I have concerns about the training of NP’s today. I became an NP after 20 years in critical care. Despite my “experience” I was well aware of what I didn’t know. I do not believe that a new grad going directly into NP training has a clue about what is involved in making key treatment decisions in complex pts especially when acting as a PCP!! Too much of the real world is nuance and not textbook. Maybe this type of program would help bridge this knowledge gap when real world experience is lacking. The medical model recognized this and developed intern/residency programs.
Claire ClousePosted at 8:56AM, January 07 2017
Definitely! My husband is a physician, and we have had this conversation multiple times. And don’t get me started on the non-clinical bogus classes required for every MSN prepared NP…theory didn’t do anything for my intubation skills. Consider how many NP programs make their students set up their own clinicals, and mediate contracts (personal and observed experience). This often results in sub par clinical experiences. You can pass a test, but are you clinically prepared? Not always. “On the job training” sounds so nice, until you can’t find a job because you have no experience and no-one wants to train you. I was fortunate, in my clinicals and job search. This is not always the case. Is it needed? YES! Is there funding OR faculty for this type of thing? Nope. Until that changes I don’t see things changing for our professions education.
Douglas PawlingPosted at 8:56AM, January 08 2017
Residency programs would be amazing. The problem with nurse practitioner education is the fact that institutions fail to admit how much variance there is with the clinical portion of the curriculum. Given that preceptors can be difficult to find and typically not compensated NP students are often forced to simply “take what they can get.” so not all training is equal. Yes, the student has the responsibility to speak up and do what he or she can to maximize the learning experience, However, time constraints and the need to finish, often lead to compromise.
Nursing leadership worked hard to justify” the NP role, and we no play an important role. However, it seems so many institutions of higher education are more interested in expanding their programs by offering an online curriculum or starting a DNP program rather than investing in their clinical curriculum. Nursing education has become a big business, It’s shameful. There is no doubt that the internet brings a lot to education, making it more accessible, but we see far fewer Physician Assistant programs available in an online only format.
So YES residency programs would be a welcomed addition to NP training but will likely never happen due to funding. Ideally, the clinical portion of a curriculum could be replaced with a residency program but then people would complaint that it’s too close the the medical model.
Dallen OrmondPosted at 8:56AM, January 08 2017
I think a residency program will bridge the gap between competent nurse and competent primary care provider. It usually takes an NP 1-2 years to feel really grounded and confident. Also residencies would open doors and hush the nay Sayers about lack of preparation.
Dallen Ormond, PhD, NP
Renee LEcuyerPosted at 8:56AM, January 08 2017
Amen! With the trend to more and more online programs, the caliber of training is just not there anymore. Residency training ground then will become a necessity. Over my years of precepting get (17+), I have had more and more students become disrespectful and act like they know it all and are ill-prepared (from online programs). Those in traditional settings are much more prepared and respectful of our time and experience.
Debbie Miller-Saultz, DNP,FNP-BCPosted at 8:56AM, January 09 2017
I agree with all of the previous comments.
Nurse Residency should be the included in the complete training of Nurse Practitioners. Healthcare has dramatically changed since the inception of the NP role. The new healthcare system demands care of patients by an Interprofessional Team and must recognize that different aspects of patient medical care is provided by team members that are not just physicians. Medical care is not the sole domain of Medicine. With the revolutionary changes in technology, increasing life exceptency allows for patients to live with complex conditions and drug therapies. The care of these patients need a different approach then the pyrimid with MD at the top and all other healthcare providers and patients at the bottom.
When federal law is updated and mirrors the reality of care, Nurse Practitioner Residency will become the norm, not the exception.
Daniel NeuspielPosted at 8:56AM, January 13 2017
We have 12 month fellowship programs for NPs and PAs at Carolinas HealthCare System in multiple specialties. For information, see: