Thematic elements of the postgraduate NP residency year and transition to the primary care provider role in a Federally Qualified Health Center

Abstract

Background/Objective: Although the literature supports that nurse practitioners provide quality primary care resulting in excellent outcomes, the transition from nurse pracitioner education to practice is often difficult. Postgraduate residency programs have been suggested to help new nurse practitioners successfully transition, and studies indicate that most new nurse practitioners are interested in postgraduate residencies; however, little is known about how residencies facilitate transitioning. We sought to understand the experience of nurse practitioners in a residency program in the United States and how the program facilitated their transition to the role of primary care provider.

Methods: Reflective journals of 24 Residents who completed the first primary care nurse practitioner residency in the United States were analyzed using Content Analysis.

Results: Four to nine themes for each month and one theme for each yearly quarter were identified. Residents went from feeling shocked and overwhelmed to becoming confident, competent primary care providers, committed to underserved populations. Transitioning conditions (e.g., on-call experience) and specific facilitators (e.g., engaged preceptors) and stressors (e.g., managing chronic pain and reqests for opioids) that impacted their transition were also identified.

Conclusions: The findings are significant as the United States addresses the shortage of primary care providers and models for postgraduate residencies and fellowships for nurse practitioners and other advanced practice registerered nurses emerge. The findings also represent the first qualitative data that reflect the experience of nurse practitioner Residents and provide rich insight into the overall experience of a one year residency, as well as facilitating and stressful factors. Organizations that are developing or refining nurse practitioner residencies or fellowships should consider these findings and discuss ways to address them with both nurse practitioner Residents and preceptors, as well as program and organizational leadership.