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History of the Postgraduate NP Residency and Fellowship Training Movement

In the fifty-year history of the nurse practitioner role in the United States, there have been many creative and successful strategies adopted by innovative organizations to help support the transition of new nurse practitioners into practice following their excellent educational preparation. The NNPRFTC extends its deep appreciation of their work. On a policy level, the absence of funding postgraduate training for NPs under federal graduate medical education training funds, which supports physicians and dentists in their postgraduate training, has been considered a primary barrier to widespread development of formal residency and fellowship programs for NPs. Despite this, it is estimated that there are 220,000 practicing NPs in the United States.

CHCI recognized the acute need for formally developing and expanding access to programs that could support the brilliant, highly committed new NPs who were joining FQHCs and experiencing a very difficult transition from new NP to primary care provider. From the beginning, CHCI understood that this difficult transition was not due to any shortcoming on the part of the new NPs or their educational preparation, but rather a logical consequence of the enormous gap between meeting the standards for safe entry to practice, and managing the challenges of practice as a primary care provider in the nation’s safety net settings.

CHCI asked the question: How can we support new NPs who seek the opportunity to fully embrace full scope primary care in the safety net setting? CHCI and its Board recognizes that the long-term success of primary care depends on ensuring that new primary care providers have the additional support, training, and education that would lead to the confidence, competence, and mastery associated with professional satisfaction and success. The Board of Directors approved the creation of what is believed to be the first formal, primary care postgraduate NP residency training program in 2007 and has since expanded the program significantly.

Other programs soon followed at the Family Health Center of Worcester, MA, in the Veterans Affairs (VA), in nurse managed health centers, and in other community health centers. Equally important, development of postgraduate residency and fellowship training in specialty areas and the acute care setting emerged, particularly in North Carolina and Georgia, and are growing rapidly across the country. Other primary care residency and fellowship programs have developed their own unique approaches in order to meet their goals and the vision of its leaders.  It is estimated that there are approximately 45 primary care NP postgraduate training programs in the US.

In the past decade, NP specialty care postgraduate, 12-month training programs have also blossomed.  A partial listing of current programs has nearly 70 training programs in existence in the US including: critical care, emergency care, surgical care and women's health.

The original CHCI primary care NP residency program model includes:

  • An initial 4-week intensive population-focused orientation to the community, its residents, leaders, and institutions as well as the model of care and technology of its host organization.
  • The curriculum is built on four key components: precepted clinics (with the exclusive attention of a preceptor to the learning needs of the NP Residents); specialty rotations in areas of high importance to primary care, particularly of vulnerable populations; didactic educational sessions; and independent or "mentored" clinics in which an experienced preceptor is available to the Resident, but not exclusively assigned to them.Throughout it all, NP Residents participate fully in the life of the organization and its activities, events, and initiatives

For an example of a list of didactic presentation topics from the CHCI NP Residency program, click here. 

For an example of a list of specialty rotations from the CHCI NP Residency program, click here. The chosen topics and rotations will differ by program based on the focus and objectives of the program.

The model of postgraduate NP residency and fellowship training in specialty and sub-specialty care has been developed to meet the learning and  training needs of NPs who will practice in those settings. We look forward to adding more material about these programs soon to this website.

Updated 2/15/17

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