Clinical Residency for Family Nurse Practitioner Programs

Introduction

Despite the growing demand for family nurse practitioners today, there is no clinical practicum component offered as a standard part of that degree. Therefore, this study seeks to identify what is required in order to create a clinical component — in the form of a clinical residency with specialty rotation within the clinic setting — for a family nurse practitioner program. The Doctor of Nursing Practice (DNP) clinical residency is a key component that would ideally integrate a clinical practicum with an immersion experience, demonstrating at program completion the competencies required by relevant accrediting healthcare organizations. To this end, this study proposes to develop a clinical residency program for family nurse practitioners in the United States in order to facilitate the delivery of care to a panel of patients across a clinical setting that is becoming increasingly multicultural and older in demographic composition.

According to McCabe and Burman (2006), "Advanced practice nurses (APNs) have become increasingly visible and important providers in America's changing and often unpredictable healthcare system. Evidence exists establishing both the quality and cost-effectiveness of the APN role in meeting the needs of patients" (p. 3). Despite their growing importance to the healthcare needs of an increasingly aging and multicultural society, there remains a fundamental need to improve the curricular offerings required to attain a Doctor of Nursing Practice today, particularly as they pertain to a clinical residency component. As Ebersole and Hess (1998) emphasize, "There seem to be no specialized training programs in schools of nursing that have formal coursework and clinical residency" (p. 1031). In this environment, identifying opportunities for improving the manner in which advanced practice nurses in general — and family nurse practitioners in particular — are educated and provided with hands-on experience has assumed new importance and relevance.

Background and Rationale for a Clinical Residency

Although there remains a paucity of relevant studies concerning the need for a pre-doctoral clinical residency for advanced practice nurses in general and family nurse practitioners in particular, some valuable insights can be gained from similar studies conducted in other professions. For example, a survey of 410 members of the American Mental Health Counselors Association conducted by Scovel, Christensen, and England (2002) found that 41.5% of respondents believed that at least one year (2,000 hours) of pre-doctoral clinical residency should be completed before their members were authorized independent prescription privilege. A similar proportion (40%) believed that more than one year (3,000 hours) should be required, while slightly fewer — though still a significant share — 9.5% believed that less than one year (1,000 hours) should suffice (9% did not respond).

For the purposes of this study, independent prescriptive privilege was defined as a type of privilege in which the healthcare provider is authorized to prescribe psychotropic medications without physician oversight. Dependent prescriptive privilege was defined as a type of prescriptive privilege in which the healthcare provider has authority to prescribe psychotropic medications under the oversight of a physician (Scovel et al., 2002).

Review of the Relevant Literature

Likewise, a majority of respondents in the Scovel et al. study favored requiring one or more years of supervised post-doctoral clinical residency for members to attain their dependent prescriptive privileges (Scovel et al., 2002). In addition, Scovel and her associates found that slightly more than three-quarters (75.6%) of respondents felt that more than 2,000 hours of supervised post-doctoral clinical residency was needed in order for their members to be sufficiently prepared to exercise dependent prescriptive privilege. Regarding independent prescriptive privilege, the survey showed that fully 84% of respondents believed that between one and five years of training was necessary, and nearly 82% believed that a post-doctoral clinical residency in excess of 2,000 hours was required in order to be sufficiently prepared to exercise independent prescription privilege (Scovel et al., 2002).

Following the publication of the AACN's guidelines in the Essentials of Master's Education for Advanced Practice Nursing (1996) and the development of the initial set of monitors used to assess the quality of doctoral nursing education in 1986, a number of changes in healthcare education and delivery have taken place that have required a reevaluation of previous requirements for advanced practice nurses. In fact, the past several decades have witnessed a significant expansion in the number of graduate programs in nursing. For instance, in 1980, just 220 institutions provided 39 doctoral programs and 180 master's programs; by sharp contrast, by 2006, there were 518 institutions offering 101 doctoral programs as well as 417 master's programs (AACN, Essentials of Master's Education, 2006). According to the guidelines published by the AACN, "Increasing numbers of these programs offer preparation for certification in advanced practice specialty roles such as nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists. Specialization is also a trend in other health professional education" (p. 6).

From 1980 to 2006, there has also been an enormous increase in innovations in technology and a growing body of scientific evidence used to guide nursing practice in ways that have made nursing educational programs longer and more comprehensive (AACN, Essentials of Master's Education, 2006). The AACN points out that, "In response to these trends, several other health professions such as pharmacy, physical therapy, occupational therapy, and audiology have moved to the professional or practice doctorate for entry into these respective professions" (AACN, Essentials of Doctoral Education for Advanced Nursing Practice, 2006, p. 6).

Clearly, there is an increasing trend toward doctorate-level educational requirements for advanced practice nurses, a trend that will be fully realized when all nurse practitioners are required to hold a doctorate. While the need for additional training and hands-on experience is acute, there remains a lack of a clinical residency component across colleges of nursing — a gap that adversely affects the ability of aspiring family nurse practitioners to enter the field sufficiently prepared for the rigors they will inevitably encounter on a day-to-day basis.