Navigating the Debate: Nurse Practitioner (NP) Residency Programs
The topic of NP residency programs is layered and complex, with advocates and opponents voicing strong opinions. As the number of NP residency programs increases, it’s essential to understand the nuances of this issue and find a balanced approach that supports the professional transition of nurse practitioners.
Advocating for NP Residency Programs
Advocates of NP residency programs cite the National Academy of Medicine’s recommendation for these programs, new graduate NPs’ interest in these programs, and increasing patient complexity as reasons to support them. The argument is that additional training after graduation from an MSN program is needed to hone skills, as new graduates may not have the knowledge required to provide safe patient care.
Opposing NP Residency Programs
The most outspoken opponents of NP residency programs include the NP Roundtable, a collaborative of various national NP organizations representing nearly 300,000 NPs in the U.S. The NP Roundtable expressed that NPs are competent providers at graduation and do not require additional training. They are concerned that mandatory residencies could create financial barriers, limit access to healthcare in underserved areas, and suggest to the public that new NP graduates lack competency, which is not supported by current research.
Evaluating the Evidence
Systematic reviews and meta-analyses show that NPs provide safe, effective patient care with outcomes comparable to those produced by physicians (Martinez-Gonzalez et al., 2014; Stanik-Hutt et al., 2013; Horrocks et al.,2002). A 2002 study found no differences in prescriptions, return consultations, or referrals between NPs and physicians, and in some cases, patients rated the quality of care provided by NPs as better than that of physicians (Horrocks et al., 2002). These findings suggest that gaining competency is not a valid reason for mandating NP residencies.
Finding a Balanced Approach
The right answer to NP postgraduate education lies somewhere in between the advocates for NP residencies and opponents of it. While NPs do not require more training from a competency-perspective, they may benefit from support in the transition to practice, honing their clinical skills, and building confidence.
The focus should be on supporting new NP graduates as they transition into practice, rather than concerns about “losing value” or limiting access to healthcare. This can be achieved through contract negotiation, where new NPs secure a slow “ramp up” period and opportunities to meet with a collaborating provider (MD, APRN) weekly, as well as seeking private supervision with an experienced clinician for case reviews and medication management.
By addressing the subjective feelings of support, diminishing doubt, and increasing confidence, new NP graduates can be empowered to provide safe, high-quality patient care without the need for mandatory residency programs.
References:
Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. Br Med J, 819-823. DOI: 10.1136/bmj.324.7341.819
Martinez-Gonzalez, N., Djalali S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing, M., & Rosemann R. (2014). Substitution of physicians by nurses in primary care: A systematic review and meta-analysis. BMC Health Services Research. DOI: 10.1186/1472-6963-14-214
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L. & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners. DOI:https://doi.org/10.1016/j.nurpra.2013.07.004
