Abstract and Introduction
Abstract
Community Health Center, Inc. (CHCI), a multi-site, federally qualified, health center (FQHC) in Connecticut, implemented a one-year-residency program for new nurse practitioners (NPs) in 2007. This residency program is specifically designed for family nurse practitioners intending to practice as primary care providers in federally qualified health centers. These centers comprise the nation's largest safety net setting; they are commonly referred to as community health centers. Supported in part by the Health Resources Service Administration, health centers are private nonprofit or public organizations serving populations with limited access to healthcare. They are located in designated, high need communities; governed by patient-majority boards of directors; and provide comprehensive, primary healthcare services. The author begins by reviewing the background and context for a nurse practitioner residency program, the importance of NP residency programs, and the recruitment and selection of NP residents. She explains how the residents are trained to a model of care and the content of care. She furthers the discussion by addressing program evaluation and outcomes and costs. Implications for national health policy, clinical practice, and nursing and areas for further research are presented. This article is timely in light of recent recommendations in the Institute of Medicine's 2010 report on the future of nursing recommending the development of residency programs for new, advanced practice registered nurses.
Introduction
The United States (US) today faces a crisis in access to primary healthcare. Millions of newly insured people will soon seek additional healthcare. They will confront the current and projected shortfall of primary care providers to deliver that care. This shortage is most apparent in the nation's largest primary care system, the network of more than 1,100 federally qualified health centers (FQHCs), also known as community health centers, or simply health centers. These centers are currently serving 18 million people in medically underserved and health-professional-shortage areas across the US. These numbers are expected to double by 2040.
I will begin by reviewing the background and context for a nurse practitioner residency program, the importance of NP residency programs, and the recruitment and selection of NP residents. Next, I will explain how the residents are trained to a model of care and to the content of care. I will conclude by discussing the program evaluation and outcomes to date; implications for national health policy, clinical practice, and nursing; and areas for further research.
In this article, I will focus on a particular FQHC, Connecticut's Community Health Center, Inc. (CHCI), a comprehensive, statewide, primary care system with 130,000 patients. Established in 1972 with a mission of healthcare as a right, not a privilege, the center focuses on improving health outcomes of special populations and building healthy communities. CHCI has three central drivers: clinical excellence; research and innovation; and training the next generation of healthcare providers. CHCI's Weitzman Center is its research, development, and innovation arm. In 2007 the Weitzman Center piloted the country's first formal, post-graduate residency training program for new family nurse practitioners. CHCI took this step after years of observing the difficult transition experience of new nurse practitioners (NPs). Their challenges included caring for a totally new panel of patients representing an enormous range of health conditions and needs that often included problems of behavioral health, substance abuse, low health literacy, and lack of access to specialists. These observations are supported in the literature (Bosch, 2000; Brown & Olshansky, 1997, 1998; Hart & Macnee, 2007; Huffstutler & Varnell, 2006; Kelly & Mathews, 2001). The NP residency program accepts four residents annually for the one-year, full-time program. As the Senior Vice President and Clinical Director of CHCI, and the Director of the Weitzman Center, the NP Residency is under my organizational leadership but has the strong, collaborative support of the entire executive team. CHCI anticipates that the NP residency graduates will develop careers as primary care providers in community health centers across the country; we have no implicit or explicit expectation that they will remain at CHCI.