How to Start a Nurse Practitioner Residency at Your Clinic

An increasing number of clinics are offering residency and fellowship programs to nurse practitioners. While advanced practice providers are not required to complete such programs, many providers experience what we’ll call a “skills gap” once they finish their graduate programs causing problems for employers unprepared to help with this transition. While the provider has laid a solid foundation for their clinical career, they still have a ways to go to develop the proficiency and efficiency demanded in many employment settings. Busy primary care and urgent care clinics, for example, may require that nurse practitioners see 3+ patients per hour but new graduates struggle to keep up with these volumes.

Rather than forgo hiring less experienced providers in your facility, implementing programs for green nurse practitioners can be a great way to attract motivated, enthusiastic providers to your clinic and teach them to practice in a way that works best with your facility’s culture and patient population. Residencies can facilitate retention and higher levels of job satisfaction among your provider team. And, there are ways to make such programs a low time and even a neutral cost investment for your practice.

If you’re looking for an innovative way to employ less experienced advanced practice providers, here’s how you can create a residency/fellowship program, or a residency-like experience in your clinic.

1. Think Through Logistics and Finances 

Just like hiring another provider in the typical sense requires logistic and financial planning, you’ll need to think ahead if you want to start a residency program for NPs. Does your clinic have space for another provider (ex. are there enough exam rooms)? Do you have the patient volume to support adding another (albeit lower volume) provider? Does your current or proposed staffing model allow a more experienced provider to take some time away from his/her current responsibilities to assist residents?

As far as finances are concerned, you will need to pay the NP resident a salary and provide benefits. While this salary is lower than that offered to experienced providers, the nurse practitioner resident also won’t be generating as much revenue since they see lower patient volumes. Do some number crunching to figure out where your expectations below need to fall in order for the cost of adding a resident to make sense for your facility. Unlike residencies for physicians, there is not current federal finding for advanced practice residencies so financial management is your responsibility. The upside? You have the opportunity to develop a highly productive provider team member.

2. Name a Coordinator

While there are opportunities to outsource some aspects of your nurse practitioner residency program (discussed below), depending on how the program is administered, there will be some associated legwork. Interviewing applicants, approving or developing a curriculum, and organizing the typical employment logistics are just a few of the things that come to mind. It’s helpful to have a point person responsible for coordinating the residency program, developing the various aspects of the program, facilitating the application process and responding to questions that come up along the way.

3. Get Buy-In from Experienced Providers

A critical piece of offering a nurse practitioner residency or similar at your facility is providing day-to-day support and mentorship for these new grad providers. They will have a number of questions about patient care and you’ll need an experienced provider on site to help out. While this veteran provider can certainly still handle some level of a patient caseload of his or her own (depending on the number of residents), helping out does take some time out of the work day. Not to mention, you’ll want to make sure this is a responsibility that other providers in your practice are interested in. Some facilities delegate this responsibility to an a member of the admin team like the CMO, others to a purely clinical team member like another nurse practitioner or a physician.

4. Plan a Curriculum

Residency and fellowship programs also offer regular, formal classroom-style or lecture-type content to enhance the nurse practitioner’s learning experience. Some facilities create this content on their own while others outsource to a third party specializing in these programs. One example of outsourcing would be ThriveAP’s ThriveAP program. This program offers weekly primary care lectures for less experienced NPs that integrate with the workday as well as facilitates a 2-day hands-on skills and procedures session for residents. We have a number of NP residency programs across the country that take care of on-site mentorship and support on their own, but outsource the classroom aspect of education to us.

If you want to create your own curriculum, it’s essential to think through the time and energy this takes. It may even be a full-time job for one of your providers. Preparing lecture content, recruiting additional speakers and experts, lining up technology delivery platforms and purchasing resources are just a few of the things you can expect to take on in planning a customized curriculum.

5. Draft Job Responsibilities and Expectations

Creating expectations for your new providers is important, even though they are new graduates. The goal here is to grow new nurse practitioners’ skills. At what level do you expect these NPs to start when it comes to patient volume? Will they see all types of patients or only those who are lower acuity/complexity? What are expectations around timeliness of documentation? How long will the onboarding period last? At what point will patient volume be expected to increase? Get a plan in place for the course of the year-long residency as far as how these skills will progress and at what rate. This will give your nurse practitioner residents goals to work toward throughout the program.

6. Finalize the Application Process

You’ll want to have some criteria by which you vet potential residents. Typically, this involves looking at graduate school transcripts/GPA, references, resumes and an application essay or two for each applicant. Most programs then interview qualified applicants over the phone, Skype and/or in person. Depending on the number of applications you receive, vetting applicants can involve a lot of legwork. If you aren’t receiving enough applicants to your program, or want to increase the number of qualified applicants, your coordinator will need to take measures to get the word out about your program. If you’re having trouble getting applicants or want to outsource the application process, ThriveAP’s residency-like program, ThriveAP+, accepts NP applicants from across the country and can help identify and narrow down the applicant pool for your new program.

Are you considering starting a nurse practitioner residency at your facility? Start with a formal onboarding process. Download our free Physician Assistant and Nurse Practitioner Onboarding Checklist. The checklist contains guidance and step by step suggestions to ensure your onboarding process is as efficient as possible.