Advancing the Practice of Nursing Through Specialty Fellowship Development

In the United States, Advanced Practice Nurses (APNs) include nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists. This presentation will focus primarily on nurse practitioner APNs. Upon graduation from a master’s or doctoral program in nursing, APNs are eligible for national certification and state licensure in one of six population foci. APNs are fully prepared to practice in a variety of inpatient and ambulatory settings upon graduation; however, for APNs who choose to further specialize their practice within one of these population foci, options for post-graduate training are limited. Historically, fellowship training has been utilized by physicians to further develop clinical acumen and skills as well as promote research within a specialized population. Previous research on APN “transition to practice” indicates that formal orientation programs are desired by APNs (Hart & Bowen, 2016) and positively correlated with successful role transition (Barnes, 2015). Additionally, mentorship by APNs and physicians within the context of an inter-professional fellowship increases provider confidence and development of clinical skills (Zapatka et al, 2014). This presentation describes the design, development, implementation, and outcomes of the first year of an APN Fellowship in Developmental-Behavior Pediatrics (DBP).

The APN Fellowship in DBP was designed to provide advanced didactic education, focused clinical experience, and professional mentoring to prepare APNs to provide optimal care to children with developmental needs. This particular specialty was selected for a fellowship to meet the growing national need for providers trained in this specialty. In the United States, the field of DBP currently has the second highest shortage of pediatric providers and wait-times for appointments that are seven times the national benchmark (Children’s Hospital Association, 2012). The host organization is a national leader in the care of children with developmental disorders, particularly Autism Spectrum Disorder (ASD), and this data was integral in establishing need and financial feasibility of an APN fellowship program. In this organization, APNs are highly valued as evidenced by their status as members of the medical staff, ability to practice in a collaborative yet autonomous environment, and senior leadership support for innovative approaches to improving APN transition into practice and quality of care.

The APN Fellowship in DBP was implemented as an intensive 12-month program integrated with curriculum from the Accreditation Council for Graduate Medical Education (ACGME) Fellowship program in DBP. The APN fellow received comparable training and experience as the physician fellow in DBP in the first year. Didactic education included weekly lectures, completion of an online mental health fellowship (KYSS, Ohio State University), and attendance at an annual DBP conference. Clinical experience included hands on training under the supervision of experienced DBP physicians and APNs, formal training on the use of standardized DBP screening and diagnostic tools, and observation of other specialties and disciplines. APN role development including advocacy, research, professional growth and development was promoted by yearlong mentorship by an experienced APN. Finally, a research component included participation in an interdisciplinary research project related to the health care transition of adolescents & young adults with ASD.

Evaluation of the APN fellow occurred throughout the year on an ongoing basis. The fellow was expected to be deemed competent in all core competencies required for APN practice in the US based on the National Organization of Nurse Practitioner Faculties (NONPF, 2014), which included competencies in Scientific Inquiry, Practice & Policy, Leadership, Autonomous Practice, Ethics, Healthcare Delivery Systems, Quality, Practice Inquiry, and Technology & Information Literacy. Furthermore, the fellow was given DBP-specific competencies that required completion prior to the culmination of the fellowship. The fellow had the opportunity to self-assess as well as be evaluated by each preceptor at least three times throughout the year.

The first year of the APN Fellowship in DBP will conclude in January 2017 and the outcomes of the first year of the APN Fellowship in DBP will be reported. The anticipated outcomes include successful completion of all core and specialty competencies, review of pre and post capstone assignment as developed by Ohio State KYSS fellowship, survey feedback from fellow and preceptors, timely transition into full time role and retention of fellow as full time medical staff member. Future outcomes to be assessed include time to transition to full time practice compared to non-fellow prepared new graduate APNs, time to meeting productivity measures, retention, customer satisfaction and APN satisfaction. The anticipated success of this program has led to continuation of the fellowship for a second year as well as development of an APN Fellowship in Physiatry.