Nurse practitioner residencies are gaining popularity nationwide, but not much is known about them. I want to remedy that!
Elizabeth and I graduated from the same program at UIC, and I was always impressed with how talented of an NP she was. It was clear that the professors and clinical instructors thought she was fantastic as well. Elizabeth ended up going to a highly sought-after residency program in Washington and was gracious enough to share her experience with us!
Note: there is an ongoing debate of what to call these programs. Elizabeth’s was called a residency, so that is how we refer to them in this interview, but the AANP and other professional organizations do not agree with the term “residency” because it implies that the participants are not fully licensed and certified. They prefer the term “fellowship” or “post graduate training program.”
Can you describe nurse practitioner residencies as if I knew nothing about it?
NP residency is a post-graduate training program, most are 1 year. It’s an extended period of hands on learning. Ours included partner clinic (where you follow another NP), independent clinic that’s precepted (continuity clinic), didactics, and specialty rotations (ortho, spine, peds, women’s health, minor procedures, dermatology, cardiology, mental health, HIV care).
Where you did your residency and what kind of patient population did you serve?
I work at Community Health Care in Tacoma, Washington. It’s a FQHC, but it has a lot less uninsured now because of the Affordable Care Act. However we still have lots of immigrant uninsured patients. My panel included patients of all ages, a large homeless population, and many patients who are accessing the health care system for the first time in years.
Describe your residency program – how many people, what made it unique, where was it, how long was it?
There were 2 NP residents. What made it unique was that it’s integrated with DO/MD residents. There’s not a lot of these in the country. It lasted one year.
How did you decide to do a residency?
Two of my co-workers in the community health center I worked in as a RN were NP’s, one who had done a residency, and one who had not. I was able to compare them in their confidence level and efficiency level, and the one who had done the residency was a lot more confident and efficient.
How are you compensated?
On average the residency salary is 20% less than a normal first year NP. I received full benefits and vacation as well.
What would you recommend to someone who is interested in looking for an NP residency? How did you find your residency?
I found it by doing a lot of Googling, but now I think it’s a little easier. I recently went to a NP residency forum and now there are 22 programs in primary care with 11 more coming soon. There are also programs developing in specialties. Unfortunately, I cannot find a central website with information but as programs move towards accreditation, I hope a centralized system of program information will become available.
I would recommend looking into them early because they all start at different times, and the applications tend to start in February.
How did you choose the one you chose?
I interviewed at four, and was accepted at three. I chose this one because it’s integrated and I wanted to live in the Pacific Northwest.
The California one didn’t have as many specialty rotations, it seemed more like a basic precepted clinic. The one in Connecticut was the same model as the one I did, but I wanted to work with a view of Mt. Rainier from my clinic!
How has residency changed the way you practice?
I think it made me a lot more confident in presenting and asking questions, not only of my clinic’s physician colleagues, but also specialists. We didn’t really practice that in school, but you can seriously call up any specialist and do a curbside consult. It made me more confident in knowing when I needed to refer to speciality clinics. I feel that it also made me better at prioritizing. Furthermore, with the way in which clinicals were set up in grad school I felt that I did not have a good grasp on following up with lab and imaging results, the residency gave me an opportunity to learn about this in a supervised environment. I’m still working on my efficiency though!
What are some pitfalls in a residency program that are critical to avoid?
1) Getting into that mode of having the preceptor tell you what to do instead of you just making the decision. Thinking “oh I’m not gonna make the plan, someone else will make the plan.”
2) Becoming too student-like. You are a resident, you are a full provider. Just try to remember that you have some say in your schedule and your style of practice.
What are three things you told yourself that kept you going during a particularly difficult time in your first year?
I kept telling myself that when I was an ICU nurse it was really hard at first and I got through that. Also, it’s always okay when you don’t know what to do to bring someone back. Make sure they’re not immediately dying, and then look it up, discuss with colleagues, and bring them back for a better solution. And knowing that other people were going through the same thing helped. Furthermore, I was just so grateful for my post graduate training and the ability to learn from such amazing providers that the rough spots were really very few and far between.
What’s the single most important takeaway from your experience in an NP residency program?
Nurse practitioners offer a unique perspective to care for family practice than our PA or physician colleagues. Our nursing background make us empathetic and we can connect with people in a very human way. Our focus on wholeness and primary prevention really can shine through and help us when we’re dealing with acute problems or chronic illnesses.
How has being in the program differentiated you from an NP who hasn’t done a residency?
Even in the first 3 months of working independently I’m up to a full panel, which I think is different. I’m also a faculty member of our residency program, which if it wasn’t for the residency program after a year of practice I don’t think I would feel confident enough to be a faculty member. As a faculty member right now I’m doing program development – recruitment and orientation. As I get more confident in my practice I will start precepting and doing more didactic teaching.
Do you recommend any “best kept secrets” (websites, books) for new graduates?
Your local pharmacist, nutritionist and seasoned colleagues!! Also, UpToDate and Epocrates. I would recommend everyone sign up for MMWR from the CDC and Prescriber’s Letter. Some books I like Prescriber’s Guide: Stahl’s Essential Psychopharmacology and Essentials of Musculoskeletal Care by John Sarwak.
Where do you think the future of NP residency programs are going? Do you think more medical organizations will offer them?
They’re looking at accreditation as the next step, which will help to establish program requirements and lend a certain amount of legitimacy to the programs. Also there’s a debate on the name. The AANP doesn’t endorse “residencies” but they endorse “fellowships” and “post graduate training programs”. I hope that a consensus about nomenclature is reached soon within the profession.
Any tips on how to get into a residency or fellowship?
Show interest to the director early. I emailed each of the programs I was interested in December, and asked them questions. Visit if you can.
Find an area you’re interested in before you go into it – narrow down your interests before you start applying.
Anything else you want to add?
If you’re on the fence about whether to do a residency, it’s really worth taking an extra year of training. Transitioning to practice with supervision is so incredibly helpful and I feel I am a better provider for it. We all went into this profession to help our patients and I feel the small sacrifices I made to complete a residency have helped me to provide better care for each of my patients.
If you’ve done a nurse practitioner residency/fellowship we would love to hear your story as well! You can comment here, share on Facebook, or message me to do an interview. We would love to hear everyone’s individual experiences so we can learn from one another! Also, subscribe for email updates from TheRealNP!