Is a Nurse Practitioner Residency Program for You?

Is a Nurse Practitioner Residency Program for You? Weighing the Odds and the Need for Programs in Every State

Posted on August 27, 2020 | by Whitney Weingarten, FNP-C | Leave a Comment

When a nurse practitioner (NP) graduates from an accredited program, they are ripe with a combination of masters prepared knowledge and registered nursing experience. Many new graduates are eager to start a position in their new role as a healthcare provider but can feel equally as anxious about the new amount of autonomy and responsibility expected from them. Although accredited nurse practitioner programs require a minimum of 500 supervised direct patient care clinical hours, many employers remain hesitant to hire new graduate NPs due to the lack of experience as a provider in the field. Additionally, there is an employee turnover rate twice the amount of physicians with advanced practice providers, and it is hypothesized that the two factors to blame are experience and receiving a formal orientation. There is, however, a potential solution to creating a comfort zone for both employers and NPs through the use of nurse practitioner residency programs.

What Is a Nurse Practitioner Residency Program?

A nurse practitioner residency program is a voluntary post-graduate position through which advanced practice nurses shadow other healthcare providers in order to earn critical, on-the-job experience. Most are familiar with physician residency programs, which are required for licensure by their profession. Residents obtain a plethora of hands-on experience that can be more beneficial, in terms of growth of one's professional character, than didactic lessons themselves.
These programs can emphasize gaining skills from numerous different specialties, ranging from primary care, oncology, cardiology, and more.
A typical program lasts one year and is usually hosted by, but not limited to, teaching hospital facilities.
The first nurse practitioner residency program was established in 2007 in Connecticut.
The largest fellowship to date is housed at the Center for Advanced Practice at Carolinas Healthcare System in North Carolina, which accommodates 68 fellows at any given time.

What Are the Positives of Nurse Practitioner Residency Programs?

Hands-on experience. While shadowing experts in the field, the resident is able to practice first-hand with mentors readily available for review. Since it is established that the resident is technically in training, they may receive more of a grace period for questioning and errors. Residency programs can be viewed as "training wheels," and at the completion of the program, the candidate should feel comfortable removing them.
Networking. By working alongside experts, one is able to establish relationships directly with professionals in the field. Many new graduates have stated that they found their first positions solely through networking; by attending a residency, future employers may be able to put a face to the name.
Job satisfaction. According to a survey conducted in 2016 involving nurse practitioners who participated in a post-graduate program, job satisfaction was higher amongst these individuals. This makes sense when relaying back to the previous exponential turnover rate in comparison with physicians. The study concluded that NPs who had formal orientation were less likely to resign. Consequently, the preparedness of the nurse practitioner is directly related to job satisfaction. This factor may be appealing for employers as well, since hiring a nurse practitioner is an investment for the company, and many are wary of hiring candidates with a sporadic work history.

What Are the Negatives of Nurse Practitioner Residency Programs?

Salary. Most residency programs will only pay the participant approximately 60% of a typical nurse practitioner salary, which may be conflicting for the new graduate who has many student loans to repay. This factor may make candidates who have multiple years of registered nursing experience hesitant, since 60% of the NP salary may be comparable to a veteran registered nurse's salary. Therefore, residency programs could be a very appealing option for a new graduate with minimal prior nursing experience. Additionally, a graduate who has completed an accelerated RN to MSN program with no acting experience in the hospital setting could potentially benefit as well.

Relocation. Since the concept of residency programs is not yet widely implemented, one may have to move to a different state for a full year in order to complete a program that is aligned to their specialty of choice. This may not be an option for a graduate who has a family rooted in their current location.

Why Aren't There More Nurse Practitioner Residency Programs?

Ultimately, it boils down to funding. Most programs are internally funded, which in return benefits the same hospital system by producing advanced practice providers who can contribute back with readiness and preparedness. In order to increase the number of programs, federal funding must be increased. One may help increase the demand for residency programs by advocating through the legislature. Contact local representatives and propose why adding an NP residency program may help with the increased demand for healthcare providers. There is a dire need for competent advanced practice providers in the field, as the shortage of primary care physicians continues to increase.

Is a Nurse Practitioner Residency Program Right For You?

Is the market in your location saturated with new graduates? If so, what are your cohorts saying about the likelihood of new graduate nurse practitioners actively being hired in the field? Completion of a residency program may highlight you from a sea of applicants. This is especially applicable if one is wanting to work within a specific hospital system. Many applicants can search for as long as six months to find a new graduate position. If the market is saturated and the probability of finding a job is low, consider applying to a residency program to expand your network and add another strong bullet point to your resume. If your state is one of the twenty without programs, consider writing a letter to your legislature to introduce the topic.

5 Must-Have Apps & Tools for Nurse Practitioners in the Clinical Setting

Posted on August 25, 2020 | by Amy Quynh L.N. Tran, FNP-C | Leave a Comment

Prior to becoming a nurse practitioner (NP), you gain experience administering and educating patients about medications and medical conditions as a registered nurse (RN). Now, as an NP trainee or practicing NP, your tool kit is enhanced with an extra layer of complexity due to the responsibility of accurately diagnosing patients presenting clinical symptoms, prescribing the right medications, and managing conditions successfully.

The more practice you have under your belt, the more confident and knowledgeable you will be regarding the process of diagnosing, utilizing diagnostic tools, and selecting the right medical regimens for your patients. Your nurse practitioner education should effectively prepare you for this advanced practice role. It is important to have tools ready at your fingertips to quickly double-check any clinical suspicions or simply look up the right medication for the medical condition you are treating.

While technology makes looking things up much faster and easier than ever before, keep in mind that these tools are for reference only. Make sure to also use your critical thinking and clinical judgment before implementing any recommendations. If you are still unsure, it's recommended that you check with a more experienced clinician and additional trustworthy print or online resources.

1. Medication Look-Up Tool

In cases when the NP is seeing patients back to back, he or she might need to quickly double-check the indications or contraindications, dosing, and adverse effects of a particular medication before prescribing it to a patient.

The Epocrates app serves as a go-to app for many clinicians, offering a free way to lookup medications. It also allows you to check interactions with other drugs by inputting all medications that a patient is taking into the app. Remember to always check for contraindications, interactions, and the patient's history of medication allergies before you prescribe. Additional features such as information on diseases are also available for an additional fee. Find out more at www.epocrates.com.

2. Medical Calculator Tool

There are many algorithms, calculators, equations, and guidelines that help the NP with quantitatively measuring his or her clinical suspicion of a presenting symptom, or determining whether it is justifiable to prescribe a medication for a patient. Luckily, most of these are readily available.

The MDCalc app is an excellent tool with many guidelines and calculators that you can utilize in clinical settings. It has all of the common guidelines such as the Ottawa Ankle Rule to reduce unnecessary X-ray ordering and the ASCVD risk algorithm for the NP to determine when to start a patient on anti-cholesterol medications, such as statins meds. It is available both as a smartphone app and online at www.mdcalc.com.

3. Medical Management Tool

In clinical settings, the NP may have a long list of patients to take care of. Therefore, it's important to have a concise tool to efficiently look up the most relevant management for a particular medical condition.

The FPNotebook app is a straightforward and user-friendly app that helps the NP formulate differentials and review common management. You can look up information by diagnoses or symptoms. It is available both as a smartphone app and online at fpnotebook.com. Again, remember to use your clinical judgment in every patient encounter.

4. Pediatrics Dosage Tool

The NP is required to dose prescriptions based on the pediatric patient's weight and/or age. For every medication, there is a recommended dosage per kilogram. For example, the recommended dosage for Acetaminophen for children is 10-15mg/kg/dose. So how much should you give a child of 60lbs?

The PediQuikCalc app is an especially convenient tool. All you need to do is enter the patient's weight. The app will then generate the suggested dose, maximum dose, recommended drug strength, adverse effects, dose frequency, and dispense amount per prescription. Of course, these are only recommendations. Find out more at www.pediquikcalc.com.

Learn more about nurse practitioner practice authority.

5. Antimicrobial Tool

Antibiotics misuse is on the rise, which means that the NP needs to be judicious when prescribing them. Other antimicrobials such as antivirals or antifungals require sensible use as well. So how do you choose the right antimicrobial?

The Sanford Antimicrobial Therapy app has been a long-standing trustworthy authority in the antimicrobials world. You can look up which antimicrobial is recommended based on the particular medical conditions. You can also enter the medication name and retrieve a thorough review on the usage, dosage, pharmacology, and major drug interactions. Although the price is steep for the app at $29.99/year, you can also buy a paperback version and keep it in your lab coat pocket. For more info, visit www.sanfordguide.com.

While there are endless tools that you can keep at your fingertips to enhance your clinical performance, these options are especially ideal if you're in a time crunch and need to retrieve concise information efficiently.

Public Health Simulations: How I Learned What I Thought I Knew

Posted on August 11, 2020 | by Michelle Woo, MPH, MS, BSN, RN | Leave a Comment

"Health happens outside of a medical office."

This is a common saying in healthcare. It means that beyond a standard 15-30 minute clinical appointment, a person's health occurs in their daily lives. This includes where they live, work, and play, as well as what they eat, their transportation, and more. We may think that we understand these factors, but do we truly understand how it all works?

In nursing school (pre-licensure and beyond), simulations provide an insightful experience that helps students prepare for both inpatient and outpatient situations in the clinical setting. Simulations can range from a medical emergency in a primary care office to a pregnant woman with undiagnosed eclampsia. Simulations have personally taught me how to function in a team setting, work under pressure, and learn from my mistakes without harming anyone. These lessons are all highly valuable.

The public health simulation that I participated in during my baccalaureate pre-licensure program was my favorite. This simulation showed me that I didn't understand what Americans struggle with as much as I thought I did. If there is one critical simulation for nurse practitioner (NP) students to experience, it's a public health simulation.

What Is a Public Health Simulation?

A public or community health simulation is a non-threatening activity that nursing students participate in. The activities involved in this simulation vary from school to school. While these simulations are not as popular as a traditional simulation in an acute care setting, they are critical in helping students understand disease prevention, population health, and social determinants of health. In the article "Preparing Today's Nurses: Social Determinants of Health and Nursing Education," Thornton and Persaud discuss how simulations can help students understand the health inequities that exist today. Such simulations offer incredible insight into why health disparities exist, as well as provide reflective and thought-provoking moments for nursing students that can help improve their practice as a nurse or advanced practice provider.

At my baccalaureate program, I participated in an activity with a group of student colleagues where we each played a community member with very limited resources. This particular group was a family unit, and mine included a single parent, a child under 5, a teenager, and a live-in grandparent. Our family had no car and the single parent worked two jobs. Scenarios ranged from needing to visit the county building to renew services to taking the children or grandparent to see a doctor. Our family even had our "money" stolen during one event. The experience was incredibly eye-opening. I experienced stress, despair, anger, and hopelessness throughout the simulation. I also felt frustrated with the system. How can somebody who works two jobs make it to the county office to sign for continued services for food or other resources? While I understood that life was difficult for many families in America, I did not fully grasp the extent of it until participating in this four-hour simulation. It truly humbled me. I recognized where I've placed judgment and identified implicit biases that I hadn't previously noticed. That experience made an impression that lasted all the way through my NP program, in both didactic and clinical settings.

Incorporating Community Simulation Programs for NP Students

As I look back on my time as a graduate student, the one simulation that I believe every NP program should invest in is a community/public health simulation. As NPs, we provide disease prevention and management. Therefore, we must go beyond understanding our patients and see the perspective of patients who may not have access to necessary resources. A community or public health simulation provides students with a realistic example of the challenges that many Americans face today. From learning empathy to understanding humility, this type of simulation is critical for future nurses and nurse practitioners to care for patients to the best of their abilities.

Conquer Uniqueness: 5 Novel Ways to Educate Yourself and Expand Your Advanced Practice Nursing Career

Posted on August 10, 2020 | by Fran Fasching, DNP, RN, FNP-BC | Leave a Comment

You're an experienced nurse practitioner (NP) who meets all the standards: inquisitive, analytical, compassionate, communicative, and a strong leader. You're the NP whom others look to for clinical advice, and have autonomy and respect in your field. However, you know that there is more to your advanced practice role than this and you just can't shake that nagging feeling that you haven't mastered it all. Does this sound familiar? Explore the following opportunities to find additional value in your NP role.

1. Explore New Areas of Expertise

Have you ever dabbled in areas outside of the traditional NP practice? Here are some new areas of expertise that can broaden your scope and give you the opportunity to leverage valuable skills:

Do you love travel and adventure? Consider a career as a foreign affairs NP. These federal government positions care for United States citizens and their families serving abroad – typically in remote countries. Foreign affairs NPs relocate every two to four years. After all, there's no better education than real-world experience!

Explore medical writing as a potential career. Medical writers prepare continuing education, contribute to professional articles, and provide health literacy content throughout the industry. You can learn more about medical writing (and editing) here.

Are you the nurse practitioner who answers clinical questions for staff and orients all of the new practitioners? Harness that valuable skill set and pursue a nurse practitioner educator role. These highly communicative nurse practitioners are often sought after to educate future nurses and nurse practitioners within universities, hospitals, and medical device/pharmaceutical companies.

Like flexibility and no commute? Try telemedicine. Serving as a significant growth area during the past 10 years, telemedicine is now more popular than ever! Telemedicine connects remote patients and providers through the use of medical electronics and video or telephone communication. If you don't have access to telemedicine in your practice, consider becoming the telemedicine point person and start offering increased flexibility for patients and bringing more creative revenue to the practice.

Advanced nurse practitioner education and experience is a solid foundation for legal nurse consulting. Legal nurse consultants (LNC) require strong knowledge about the legal system, as the role involves reviewing medical records, health care timelines, and organizational policies and procedures. The LNC is a valuable team member in hospitals, law firms, and court systems.

2. Become a Political Advocate for Nurse Practitioners and Nursing

Nurse practitioners are crucial to transforming health policies and creating an environment for independent practice and professional advocacy. Despite having the trust of the public, advanced education, and professional standing, nurse practitioners often underestimate their political power. Ryan & Rosenberg (2015) explain how nurse practitioners can maximize their political influence and be a voice for change. Visit the advocacy pages of state nursing and nurse practitioner associations such as the American Association of Nurse Practitioner (AANP) advocacy page to learn about the latest political goals and how you can help advance both the NP practice and your leadership career.

3. Obtain Additional Certifications in Your Field

Nurse practitioners can obtain specialty certifications outside of their population focus to advance their practice in specialized areas. There are specialty certifications in emergency medicine, orthopedics, palliative care, oncology, dermatology, nephrology, and cardiology. Many certifications require a certain number of clinical hours, in addition to continuing education and testing.

4. Pursue an Additional Post-Master's Certificate

To maximize your career variability, consider an additional post masters certificate outside of your population focus. You can choose to cross over to a different specialty or add to your population focus. For instance, family NPs may consider the psychiatric nurse practitioner realm, or acute care NPs might want to add a pediatric NP role to their resume. If you are interested in health care business management, a Master's in Business Administration (MBA) or Master's in Health Administration (MHA) are good options. A newly popular choice, the health informatics master's program, focuses on nursing electronic systems support, management, and data monitoring.

5. Participate in Continuing Education in a New Way

While on-site conferences are a traditional way to learn new skills and collaborate with colleagues, they are also expensive and the associated travel is typically not conducive to the busy lives of NPs. Luckily, there are many online webinars and conferences available to NPs for continuing education credit.

Other alternative ways to participate in continuing education include:

Podcasts offer continuing education credits
Portable education
Searchable subjects of interest
Doximity– read peer-reviewed articles and your continuing education credits are tracked and easily uploaded
Publish articles
Present at web conferences

Innovative NP education provides unique clinical experiences, fosters leadership, and expands our world view. Combining traditional education with unique clinical experiences expands an individual's NP career, and provides an upstream view of health care and the world. Contribute, be creative, and continuously meet your personal and professional goals!

New Graduate Nurse Practitioners: Keep Learning to Build Confidence

Posted on July 24, 2020 | by Kelly Coloff, FNP | Leave a Comment

As a new graduate nurse practitioner, you're equipped with all of the latest information and guidelines to inform your practice. You demonstrate enthusiasm and compassion, and offer a fresh set of eyes in the medical field. However, you can't help but feel nervous, uneasy, and overwhelmed by the sheer volume of knowledge required to provide safe and effective care for a wide variety of patients. Understanding the important ways to support and advocate for yourself as a new grad is essential to your long-term success in this demanding field.

Build Confidence With a Fellowship Program

With varying credentials among nurse practitioners including MSN and DNP, formal education and hands-on clinic experience can vary at the time of graduation. Some universities and healthcare facilities are expanding post-graduate training to include NP residency and fellowship programs. These programs may focus on a particular specialty, or offer further training in the broad field of primary care. These programs offer support for new NPs in developing assertiveness, long-term patient planning, and critical thinking skills. According to JoAnne Saxe from the UCSF School of Nursing, "The community setting is demanding – even for those who are excellently prepared. The extra in-the-trenches learning of a residency not only solidifies skills, but also acts as a testing ground for future work experience."

Focus Your Skills With Specialty Training

Nurse practitioners are employed in nearly every medical specialty. Specialty training is critical for success in these focused fields. Specialty training may include:

On-the job training
Course work for specialty certifications
Conference training sessions

Many healthcare facilities and clinics offer specialty training after employment begins. This is a simple way to obtain extra training and gain invaluable experience while working as an independent provider. Attending specialty professional conferences that offer clinical training sessions is another skill-building technique. These hands-on training sessions are particularly effective for NPs moving into fields such as dermatology, cardiology, neurology, or orthopedics. Attending conferences is also beneficial for building a network of colleagues. Maintaining collaborative relationships with other providers both locally and remotely is a great confidence builder. Specialty professional organizations, such as the Orthopedic Nurses Certification Board or Dermatology Nurse Practitioner Certification Board, also offer coursework for certifications in these fields. Reviewing test-prep materials and educational resources for specialty certifications offer a deep understanding of current evaluations, diagnoses, and treatments for NPs who are motivated to pursue specialty practices.

Collaborate With a Mentor

As noted in a 2018 review in The Clinical Teacher, "the practice of mentorship may help to foster an understanding of the enduring elements of practice within these organizations. Mentoring involves both a coaching and an educational role, requiring a generosity of time, empathy, a willingness to share knowledge and skills, and an enthusiasm for teaching and the success of others. Being mentored is believed to have an important influence on personal development, career guidance and career choice."

Finding a mentor may be your most important task as a new grad NP. A good mentor is invaluable in any career setting, but it's particularly essential in the healthcare field. In addition to helping build confidence and skills among new grad NPs, mentors also offer the moral and emotional support that's critical to practitioners' success in today's demanding environment. A mentor-mentee relationship does not end when you become a seasoned practitioner. Mentorship is an important part of a career-long support chain that will eventually lead to you serving as a mentor. Healthcare providers must hold each other up, challenge each other to provide the best patient care possible, and protect each other during challenges to effectively maintain a passionate and progressive standard of care. A mentor may be:

An experienced physician in your clinic
An experienced NP in your clinic
Another new grad NP
A clinical professor
A previous clinic preceptor

As long as a colleague supports your ongoing learning, offers helpful and timely advice, and lends an open ear for any challenges you may have, you can consider them a mentor.

Get Comfortable With a Learning Mindset

Scientific studies, evidence-based practice guidelines, and treatment updates are constantly evolving. Therefore, it is critical to find resources that support your ongoing learning. Having a go-to toolbox is helpful for day-to-day learning during clinical practice. Programs such as UpToDate, 5-Minute Consult, and National Clinician and Consultation Center offer quick, concise, evidence-based guidelines for treating a wide variety of conditions. Finding a program that works for you is key. A pharmaceutical reference such as Epocrates, Physicians' Desk Reference, or Lexicomp is also useful for safely prescribing medications. Specialty organizations and the USPSTF offer convenient access to the guidelines for a variety of common health treatments and screening procedures. Additionally, learning continues outside of clinical practice. The variety of online and in-person CME products and online and print professional journals allows NPs to choose the format and topics they wish to study.

Ultimately, succeeding as a new grad NP requires a growth mindset of constantly gaining knowledge and adapting. Whether we are calling on a colleague, reading a journal article, or completing a hands-on clinical session, we are never done learning.

Is Full Practice Authority Here to Stay? How COVID-19 is Advancing the Future of Nurse Practitioner Practice

Posted on July 16, 2020 | by Antonette Montalvo, MSN, PNP-BC, BSN, RN | Leave a Comment

In 2011, the Robert Wood Johnson Foundation Initiative on the Future of Nursing released The Future of Nursing: Leading Change, Advancing Health. This compelling report called for the "transformation" of health care delivery by allowing nurses – especially APRNs – to "practice to the full extent of their education and training" as an opportunity to address the challenges involved in primary care and our healthcare system. Nearly 10 years later and amid a global pandemic, we are seeing some of the fruition of this report come to life. With concerns regarding obtaining access to care in rural populations, creating equitable systems for racial and ethnic minorities, and maintaining care for an aging population, our profession and society is facing a sudden shift to address the drastic impact that COVID-19 has created.

Varying Guidelines on Nurse Practitioner Full Practice Authority

Although there is growing evidence linking nurse practitioners to higher quality of care and safety for patients, shortages of care remains a long-standing discussion in healthcare – particularly for APRNs. Additionally, varying guidelines on nurse practitioner full practice authority continues to be an ongoing conversation. In fact, it's often a "regulatory barrier" for the profession and our ability to deliver care at our highest abilities for the communities we serve. This is primarily due to the fact that our licensure has been heavily regulated on the state level, as opposed to a federal level. This legislative regulation often makes it difficult to consistently ensure that nurse practitioners are able to deliver care without the challenge of legal and geographical boundaries that can leave some states far more restrictive in practice than others. While small advances have occurred over the years, they have been slow-coming up until now.

NP Practice Authority During a State of Emergency

Since the onset of COVID-19, we have seen an immediate shift in the various legislative barriers and regulatory practices that have served as a major obstacle for nurse practitioners. Governing bodies, both within the healthcare industry and on a national level, have also embraced the urgent need to reevaluate the traditional restrictions that have been in place since the profession began in the 1960s. One visible shift in this understanding has been made public in an evolving statement from the American Association of Nurse Practitioners, which details the various ongoing changes occurring on a policy level to temporarily suspend and waive practice agreement requirements. These waivers have been the solution to the growing need for competent health care providers to address the exponential necessity of access to care. This refers to cases that relate to the global pandemic of COVID-19, as well as primary care and population health needs that have been present all along. In the midst of social distancing guidelines and state lockdowns, one major tool that has helped drive this accessibility is telehealth.

The Rise and Impact of Telehealth on NP Practice

The presence of telehealth, or telemedicine, is not a new topic or concept. However, with the rise of technological innovations and societal changes that have occurred due to the global pandemic, the conversation surrounding telehealth has become the topic of our times. According to a 2018 article, Telehealth and Legal Implications for Nurse Practitioners, the most basic definition of telehealth is the "use of…telecommunication technologies to support and promote long distance…health care." The article further explains that telehealth's original goal was to meet the needs of underserved and rural patients. However, much like what has been seen in traditional primary care practices, there are regulatory barriers to telehealth as well. Requirements have often varied from state to state, which has ultimately led to confusion for NPs involved in the practice. Regardless of these obstacles, we have recently seen a drastic transformation in the extended permission of this valuable and urgently necessary tool for the practice of all healthcare providers. This change has truly represented a shift toward practice transformation, as hoped for in the 2011 Future of Nursing Report.

Approaching NP Practice in a Post-Pandemic Society

The major question on everyone's minds is, what's next? How do we approach NP practice in a post-pandemic society, assuming how quickly our trajectory changes? Even more importantly, how do we adequately equip future and new-to-practice nurse practitioners to be well-prepared to handle shifting policies, requirements, and ongoing credentialing needs? The need to implement unique ways to fulfill clinical requirements is now more important than ever. On a positive note, with the ongoing need for social distancing guidelines, future nurse practitioners are being strategically prepared to thrive in telehealth and technology-heavy health care systems. Nurse practitioner students, faculty, and (most importantly) policy-makers must continue to consider all of the possibilities in this "new normal." So, is full practice authority here to stay? If we truly hope to see a transformation in practice, we must aim to follow the pivotal 2011 report: be the future of nursing by leading change and advancing healthcare.