Journal of Pediatric Care

Description

Adult advanced practice nursing residencies and fellowships have increased as a result of recent calls for more nursing postgraduate residencies, whereas pediatric advanced practice nursing fellowships remain limited. A postgraduate pediatric primary care advanced practice nursing fellowship and its beneficial effect on a children's health care system are described.

Independent Practice

There are many ways Advanced Practice Registered Nurses (APRNs) move into clinical positions. In order to make the transition from formal training programs to independent practice, an increasing number of APRNs are enrolling in postgraduate fellowships. There are 162 advanced practice residencies and fellowships in 37 states, according to the Association of Post Graduate APRN Programs (2022). These postgraduate programs focus heavily on adult and family care, with a population focus of 6.7% (n=11). Nursing faculty, health care administrators and advanced practice leaders recognize the significance of the APRN-to-RN transition. Urbanowicz (2019) examines this transition and highlights key themes, such as novice Nurse Practitioners (NPs) lacking self-confidence. A pro forma for a 12-month primary care PNP fellowship was presented in 2017 and approved by senior leadership in a Delaware health system. Brown and Olshansky studied the transition of the primary care NP and described the evolution of confidence and the diminishing perception of distress. Fellowship opportunities were provided in the Mid-Atlantic region of the United States by a 200-bed level-one trauma center and a pediatric tertiary and quaternary referral hospital with a network of primary and specialty care practices. The fellowship was created by the advanced practice director, who also directed the program. Counsel Colleagues are assessed by their essential consideration congruity facility guide at 1, 6 and a year utilizing the veterans undertakings focus of greatness in essential consideration training skill assessment changed for pediatric capabilities. Pediatric competencies were developed in collaboration with pediatric advanced practice nursing faculty and the national organization of nurse practitioner faculties. Pediatric NPs are poised to contribute to advancements in population health initiatives and the transition to value-based care and provides an illustration of this. Pediatric NPs are key players in advancing safe and quality care. Within this health system, the primary care APRN fellowship has contributed to strategic initiatives that promote value and recruit a workforce that is highly skilled and diverse. The success of the primary care fellowship raises concerns about the need to establish additional pediatric subspecialty fellowship programs.

Nurse Practitioner

The establishment of residency programs for advanced practice nursing graduates has been suggested by the Institute of Medicine. There is currently a lack of evidence regarding the effectiveness of programs. To explain how the VA Centers of Excellence in Primary Care Education (VA CoEPCE) determined the outcomes of Nurse Practitioner (NP) residents on seven competency domains. Over the course of the 12-month program, we looked at the mean self-ratings of NP resident competency and the mean ratings given by mentors in five different NP residency programs. The items with the highest and lowest ratings, as well as differences between mentor ratings and self-ratings of NP residents, were analyzed. All domains showed statistically significant improvement in the mean mentor and self-ratings of NP residents. Mentors assessed NP residents' ability to practice without supervision in all competency domains at one year. At one and one year, the lowest-scored domains were clinical, leadership and quality improvement/population management, while the highest-scored competencies were patient-centered care, inter-professional team collaboration, shared decision-making and sustained relationships. The Institute of Medicine's (IOM) report, "The Future of Nursing:" Highlights areas for improvement as well as preliminary evidence of the effectiveness of VA CoEPCE NP residency programs. Leading change, advancing health recommended the establishment of residency programs and identified the need for transition-to-practice programs for advanced practice nursing graduates (IOM, 2010). Since the publication of the report, the number of Nurse Practitioner (NP) post-graduate residency or fellowship training programs has skyrocketed, with over 90 programs in the United States in a variety of specialty areas and clinical settings. 16 NP residency programs in primary care, acute care and psychiatry/mental health are supported by the Veterans Affairs (VA). New graduate NPs are in high demand for all of these training programs. The Carolinas Health System's NP and physician assistant fellowship programs in acute care, primary care and mental health received 823 applications for 158 positions across seven cohorts. There are at least five applicants for each NP residency position across all sites in the competitive VA Centers of Excellence in Primary Care Education (CoEPCE) cohort from 2017 to 2018.

The following accreditation organizations were recently established in order to guarantee the quality of the education provided by NP post-graduate training programs: The National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), which can be found at http://www.nppostgradtraining.com/ and the American Nurse Credential Center (ANCC). Program leadership, organizational enculturation, development and design, practice-based learning, professional development, and quality outcomes are all emphasized by the ANCC standards. Curriculum, evaluation, program eligibility, administration, operations, staff and trainee services are all included in the NNPRFTC standards. The effectiveness of NP post-graduate residency programs on trainee outcomes is poorly documented in the available literature. For instance, NP post-graduate training programs were discussed in a number of articles; However, only seven articles dealt with the results. Four of these were qualitative reports with small sample sizes and they examined the following topics: (a) The reasons why individuals sought out a post-graduate NP training program, (b) the stakeholder perspective's feasibility of establishing a postgraduate NP program, (c) the strengths of a postgraduate NP training program from the NPs' and preceptors' perspective and (d) reflective journaling analysis to comprehend how the residency facilitated practice transition.