Elsevier

Nursing Outlook

Volume 65, Issue 1, January–February 2017, Pages 50-57
Nursing Outlook

Article
Practice
Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation?

https://doi.org/10.1016/j.outlook.2016.08.004Get rights and content

Highlights

  • The DNP degree puts APRNs on par with other health care providers with doctorates.

  • NP residency models strengthening Essential VIII specialty competencies are described.

  • Policies related to DNP nurse practitioner residencies are recommended.

Abstract

Background

The Doctor of Nursing Practice (DNP) degree positions nurse practitioners (NPs) and other advanced practice registered nurses, with clinical competencies similar to other disciplines requiring doctoral education (medicine, physical therapy, psychology, and pharmacy). In addition, all these disciplines also offer residencies. However, nursing is the only discipline that does not require a doctoral degree and/or have a systematic approach to residency training for advanced practice roles. The authors posit that there are critical policy issues to resolve within the nursing profession to clarify the role that clinical residencies should play in transition to DNP practice specifically related to NPs.

Purpose

The purpose of this article was to (a) describe the context of NP residency models within NP curricula that strengthen the DNP Essentials with an emphasis on Essential VIII and a focus on distinctive clinical specialization, (b) describe the history and policy implications of NP residency programs as well as existing programs that assist transition to practice, and (c) recommend policies for consideration related to DNP NP residencies.

Methods

Literature on nurse practitioner residencies was reviewed.

Discussion

While nurse practitioner residencies continue to grow, research is needed regarding outcomes of job satisfaction, clinical competencies, and patient satisfaction.

Conclusion

The first year of practice for nurse practitioners is a critical period of professional development. It is important to further clarify the need, direction, and program standards. Academically affiliated residencies will facilitate the development and standardization of curricula and competencies to enhance clinical rigor. The partnership between academic units and clinical agencies will pool resources and strengthen nursing in both settings.

Section snippets

Policies and Recommendations Related to Residency Training

In 2004, the American Association of Colleges of Nursing (AACN) published a position paper proposing that entry into advanced practice nursing become the DNP (American Association of Colleges of Nursing, 2004). This doctoral-prepared clinician would enhance quality of care via improvement science, increase safety and care coordination, and control costs as well as extend access to clinical care. Indeed, ensuring access to high-quality, effective expert care is the defining competency of the DNP.

Residency Programs

Although residency models now exist for NPs, physician assistants, dentists, and other health disciplines, the roots of residency education reside with medicine. The first formal residency programs for medicine were established more than 125 years ago, laying the foundation for the modern formal system of Graduate Medical Education (GME) for specialties. The historical foundation of funding for residency training in Medicine began after World War II. The GI Bill supported an increased number of

Nurse Practitioner Residencies

Even with the challenges inherent in developing residency programs, there are currently about three-dozen NP residencies in operation throughout the United States (Brown, Poppe, Kaminetzky, Wipf, & Woods, 2016). The first formal, postgraduate residency training for NPs was piloted in 2007 (Flinter, 2011). Based in Federally Qualified Health Clinics in Connecticut, the Weitzman Center of Connecticut's Community Health Center system developed a 1-year, full-time program whereby four family NPs

Benefits of NP Residencies

While large outcome studies regarding NP residencies have not been completed, there is support from graduates of NP residencies that attest to their importance. In a qualitative study based on reflective journals from 28 graduates of a primary care NP residency over the course of 8 years, graduates reported greater clinical proficiency (Hart & Flinter, 2015). In addition, they reported superior skill in interprofessional teamwork, an increased understanding of community health, and improved

Future of NP Residencies

This review of NP residency programs demonstrates that there is interest and movement toward NP residencies based on recognition of the benefits of having a structured experience as NPs transition to practice. The current policy environment supporting DNP education for NP practice and the recognition of the importance and usefulness of residency programs provide an excellent platform for stakeholders to grapple with critical issues related to residency programs and DNP NP preparation.

Several

Conclusion

The first year of practice as a novice NP is a critical period of professional development. The most challenging policy issues that must be resolved are whether NP residencies should be required for all DNP students or the BSN-NPs and whether the residency should be integrated into the DNP program or postprogram completion. It is important to raise questions related to residency programs to further clarify the need, direction, and program standards. NP residencies should be supported by

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