Do New Nurse Practitioners Support a Post-Graduate Residency for the Transition to Practice?

Saturday, 29 July 2017

Julie C. Stuckey, DNP, MSN
Division of Student Life, Our Lady of the Lake University, San Antonio, TX, USA


 The purpose of this DNP project was to describe the Nurse Practitioners (NP) perceptions of the Nurse Practitioner Residency (NPR) Programs effectiveness and impact on their transition to practice. The project was designed to determine the following questions related to the post-graduate Nurse Practitioner Resident (NPR); what were their perceptions of the residency program, determining the effectiveness of the program, and what impact the program provided towards the transition into primary care practice. The project also included the opportunity to identify any additional themes that could assist in further development of the NPs transition to primary care practice through the residency experience.


This was a pilot study that utilized a quantitative descriptive survey, with a nonprobability purposeful sample of Nurse Practitioner post-residency graduates from Community Health Clinics Inc. A Qualtrics survey was sent to fifty-six possible survey participants via email. Fifty-four emails were successfully delivered to the sample subjects. Nineteen completed the Qualtrics survey, with ten partially completing the survey. Twelve surveys were deemed valid. The participants answered a total of 145 questions on their perceived preparation for practice and the importance of that preparation in five different clinical areas: the specialty area of practice, specific disorders seen in practice, procedural skills, clinical skills preparation, and other elements of NP Residency training.


The Pearson Correlation (2–tailed) and the Nonparametric Correlations using the Spearman’s rho measured perceived preparation for practice and the importance of that preparation (n =12, r = 0.245,) showed that there was no relationship between the perceived preparation for practice and the importance of that preparation. The Nonparametric Correlations measuring skill preparation and the importance of the skills the Kendall’s tau b (Tau-b = 0.453; 0.238) and Spearman’s rho (rs = 0.393; 0.383) show a possible low relationship but data still supports non-relationship. The survey reliability showed a Cronbach's Alpha of (N = 81, 0.990), ANOVA with Friedman’s Test with a mean of (3.21), and Kendall Coefficient of (W = 0.362) providing a reliable and valid survey instrument for this pilot study.


The DNP project determined that NP Residences do not perceive a relationship between preparation for practice and the importance of that training post residency in the five areas surveyed. The sample was from a single residency program. From the potential sample size of 54 and the actual sample size (N=12) the survey participants may be exhibiting survey fatigue. This study did not compare post-graduate NP’s who did not attend the additional year of residency to those who did. This study does not support the literature review.

New graduate NP’s describe themselves as “ill-prepared for the expectations of their new role and lack of support to assume responsibilities in the high-acuity setting of primary-care” (Sargent & Olmedo, 2013, p. 604). They lacked the confidence, competence and mastery of the provider role to adequately fulfill the expectations of the primary care provider in a Federally Qualified Health Center (FQHC) (Flinter, 2005). Compounding this “only about one-quarter of frontline nurse leaders are fully satisfied with the new graduates’ performance” (Advisory Board, p.3). Confident experienced primary care providers are difficult to find and expensive to replace, turnover in health care settings also disrupts continuity of care (De Milt, Fitzpatrick, & McNulty, 2009).

With the implementation of the Affordable Health Care Act (AHCA) (AHCA, 2010), the 2025 predicted physician primary care shortages are greater than 130,000 (Iglehart, 2014). Nurse Practitioners are slotted to fill these gaps in primary care (Green et al., 2013). In the Institute of Medicine report, “State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas” (IOM, 2003, Joint Commission [JC], 2010). The ACA includes grants for nurse-managed clinics and significant financial support for NP training (Iglehart, 2014). The National League of Nursing reported on March the 1st that the 2017 Federal budget proposes 229.472 million for nursing workforce development programs through Health Resources and services Administration (HRSA).

New healthcare environments demand “safe, timely, efficient, equitable, and patient-centered care in complex environments, with healthcare professionals functioning as highly collaborative teams” (AACN, 2004: IOM, 2010; Iglehart, 2014). Bush (2014) states, “nurse executives have the opportunity to champion postgraduate NP training programs. Designing programs for recent NP graduates and experienced NPs transitioning to new practice settings can help ensure adequate retention and job satisfaction of a rapidly growing and important segment of the clinical workforce.”

Nurse Practitioner Residency programs continue to grow and further research of the NPR and the residency programs will need to be conducted. Longitudinal studies of the NPR who attend accredited residency programs will need to be assessed through the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC).