Evaluating the Impact of Nurse Practitioner Residency Programs

Background:  Nurse practitioners transitioning from education to clinical practice may face a sharp learning curve that is difficult to traverse and often times isolating. Given increasingly complex primary care patients, many health care employers require prior NP work experience as a condition for employment.  Nurse practitioner residencies function to bridge the gap during the transition to practice.  As nurse practitioner residencies continue to grow, the need to evaluate program effectiveness is critical. The Puget Sound VA Center of Excellence in Primary Care Education has established an NP residency in conjunction with interprofessional education and team-based care; one component of assessing the NP residency experience is through reflective journaling.

Purpose: The purpose of this review is to examine key themes identified during a yearlong NP residency period through reflective journaling.

Methods: The resident (N=1) was asked to maintain an electronic journal weekly archiving their residency experience. At the end of the residency period, the journals were transcribed into an electronic database and qualitatively analyzed for common themes. Using the theoretical underpinning of Meleis Transition Theory, the results were catalogued along a linear time series to reflect the transition.

Results: During the initial months of practice (month 1-3), the resident expressed greater anxiety and sense of being overwhelmed with both practice and the residency. By month 6, the resident expressed a greater sense of self and the ability to manage a patient load effectively. By the end of the residency (month 12), the resident expressed deeper awareness of clinical skills and expressed satisfaction with participating in the residency.

Conclusions: As nurse practitioner residencies continue to proliferate, it is critically important that the effectiveness of these programs is measured. Currently, no standard measure of effectiveness exists. By examining the self-reflection of the resident, this program was able to assess the direct impact on the NP as they transitioned from novice provider to proficient practitioner.