Do Nurse Practitioners Need Postgraduate Training?

Abstract

In her remarks at the 2014 conference of the National Organization of Nurse Practitioner Faculties (Journal of Nurse Practitioners, June 2015 [11(6)]), Dr. Loretta Ford reminisced how her demonstration project to train nurses in advanced clinical work was rejected by her nursing faculty colleagues. Instead, she and her physician partner, Dr. Henry Silver, relied mostly on medical school faculty and resources who, in turn, were motivated by the nurses’ great enthusiasm to learn. Nurse practitioner (NP) training has changed a lot over the years since, and nursing faculty has since come around. But it is still our enthusiasm and dedication to patient care that drive not just NP students but also our faculty and preceptors, nearly all of whom contribute to our profession far in excess of any remuneration or recognition they receive. Our patients’ needs continue to evolve, and what we need to know to care for them has grown in complexity. Is it time for postgraduate clinical training for NPs? Barbara A. ToddBarbara A. Todd, DNP, ACNP-BC, FAANP, FAAN, is a nurse practitioner and administrator at the Hospital of the University of Pennsylvania, Philadelphia, PA, specializing in cardiac surgery. Dr. Todd is also the director of the graduate nurse education demonstration project. Barbara A. Todd, DNP, ACNP-BC, FAANP, FAAN, is a nurse practitioner and administrator at the Hospital of the University of Pennsylvania, Philadelphia, PA, specializing in cardiac surgery. Dr. Todd is also the director of the graduate nurse education demonstration project. The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health recommended residency programs for nurses in the following categories: after completion of a baccalaureate, associate, or diploma program; after the completion of an advanced practice degree (ie, master’s or doctoral); and when changing clinical practice areas. We can start by declaring that this would be fellowship rather than a residency and that it would not be mandatory but optional. There is clearly a gap between education and practice that needs to be addressed. Each year, approximately 14,000 individuals graduate from NP programs across the United States. Patient care complexity has increased dramatically, and our systems of health care demand highly skilled clinicians who are ready to manage that complexity. The additional support of a postgraduate clinical training program would provide new graduates with a safe haven as they gain confidence and acclimate to their new role. Although much emphasis is placed on clinical skills, we should place equal emphasis on interprofessional competencies, working in team-based collaborative environments, and promoting patient-centered outcomes. The overwhelming response from new graduates is one of anxiety as they approach a new role and work in complex high-acuity arenas with increased autonomy. Postgraduate training programs would augment the clinical knowledge and education acquired by NPs in their academic programs, thus providing the necessary professional support for them to provide efficient, effective, and comprehensive complex health care. The drivers to date for postgraduate programs have been related to recruitment, specialty models of care, innovation, and demand by new NP graduates. Since the first primary care NP residency in 2007, there has been a proliferation of postgraduate programs in primary and specialty care across the country. This interest may continue, and a systematic approach is needed. Point/Counterpoint offers thought-provoking topics relevant to nurse practitioners in every issue of JNP. Two authors present thoughtful but opposing viewpoints on current subjects, from scope of practice and regulations to work ethics and care practices. Your opinion on these matters is also important, so go to www.npjournal.org or scan the QR code here to register your vote for either side of each topic. Comments or suggestions for future columns should be sent to Department Editor Donald Gardenier at [email protected] Erin L. DavisErin L. Davis, MSN, CRNP, is a practicing acute care NP specializing in radiation oncology at the Hospital of the University of Pennsylvania, Philadelphia, PA. She is also a graduate of the University of Pennsylvania and is active with the Pennsylvania Coalition of Nurse Practitioners. Erin L. Davis, MSN, CRNP, is a practicing acute care NP specializing in radiation oncology at the Hospital of the University of Pennsylvania, Philadelphia, PA. She is also a graduate of the University of Pennsylvania and is active with the Pennsylvania Coalition of Nurse Practitioners. NPs are increasingly seen as the solution to improving access to care in all clinical settings. The NP role today has taken us from primary care to providing care across the continuum. For 5 decades, graduates of NP programs have been prepared to competently provide safe patient care. Educational preparation is ensured via clinical and didactic course work, meeting of outlined core competencies, and certification in the area of specialty. There is an established body of literature showing that NPs have comparable or better outcomes with regard to safety, quality, cost-effectiveness, and clinical goals when compared with other providers. With the growth of NPs nationally and a trend toward clinical specialization, there has been a call for additional hands-on clinical training at the specialty and subspecialty levels, but is additional training needed? The establishment of postgraduate training programs would require significant resources including organizational support, personnel cost, and strategies to sustain funding, which would increase cost and could be a difficult argument to make given our outcomes. Current estimates place the number of new NP graduates in the United States at approximately 14,000 to 15,000 per year, which can also limit large-scale feasibility. Should the focus be placed on the standardization of onboarding, orientation, and mentorship programs for new NPs and not the creation of another expensive clinical training model? Furthermore, the consideration of unanticipated downstream effects should be closely examined before implementing postgraduate training. In particular, there is the potential that additional training requirements could lead to new NP practice restrictions or limitations in employment opportunities for NPs. As we strive to secure full practice authority for NPs nationwide, another goal in the Institute of Medicine report, we may not want to argue for training that there is no evidence that we need.