Imagine you’ve just graduated from medical school and are working as a physician in your community. The waiting room in your office is packed with patients, many of whom have complex chronic conditions. Suddenly, a nurse informs you that three patients are presenting with severe stomach pain and require immediate attention. Could one of the cases require a hospital visit? You’ll have to delay the other waiting patients in order to thoroughly examine each stomach case.
This scenario plays out on a daily basis for many physicians. The number of patients seeking primary care has increased drastically due to the introduction of the Affordable Care Act, Medicaid expansion, and an aging population.1
This is especially evident in community health centers where, by 2015, patient volume was expected to hit 40 million — nearly double the volume in 20102. In Pennsylvania, the number of patients in community health centers increased by 13 percent between 2010 and 2016. Increased demand for primary care requires more care givers; in fact, it’s estimated that we’ll need an additional 52,000 physicians by 20253.
Nurse practitioners (NPs) are uniquely positioned to help physicians provide high quality care to the population and improve population health outcomes. NPs have graduate-level education, advanced clinical training in specialized fields, and a scope of practice that encompasses evaluating, diagnosing, prescribing, and managing patient care.
There are 222,000 licensed4 NPs in the United States health care workforce to fill the gaps, and their numbers are expected to grow in the next decade.
Preparing Nurse Practitioners through Supervised Clinical Experience
NPs do not receive the same opportunities for supervised clinical experience that physicians do, and when they enter the workforce, they risk becoming overwhelmed by the high patient counts and wide range of complex and critical health needs that occur in the community health setting.
Understandably, this contributes to high rates of NP burnout and turnover. A 2007 study found that 51 percent of NPs felt they were only minimally or somewhat prepared for practice after completing their education.5
Partnering with Puentes de Salud to Offer a Pioneering Nurse Practitioner Residency Program
To address this issue, the Independence Blue Cross Foundation partnered with Puentes de Salud (Puentes), a community health center in Philadelphia, and the University of Pennsylvania to launch the nation’s third Nurse Practitioner Residency Program in 2016.
The program was designed and proposed by Dr. Steve Larson, co-founder and executive director of Puentes, who strongly believes that the one-year, supervised rotation through the Emergency Departments at both the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia, as well as a community health center like Puentes, provides the NP resident with the equivalent of three years of unsupervised clinical experience. According to Dr. Larson, “Discerning an acute abdomen from a benign process, or sorting through the patient with chest pain can be stressful and challenging clinically. It often relies on subtle pattern recognition that can’t be read in a textbook or taught in a classroom; it only comes with ‘hands-on’ experience.”
The clinical experience is supplemented by inter-professional instructive sessions with medical residents at the University of Pennsylvania. Dr. Larson emphasizes the importance of NP clinical experience, stating, “Through mentored patient contact in the emergency department and busy community health centers, our program is structured to assist our NP residents in establishing the confidence and clinical experience needed to identify and manage these patients successfully.”
The Pilot Year of the Nurse Practitioner Residency Program
The Nurse Practitioner Residency Program went through a pilot year prior to its official launch. Adriane Tuttle, a family nurse practitioner who received her graduate degree from the University of Pennsylvania, was the inaugural NP resident. “[Dr. Larson] conceived the residency as a way to enhance the preparation of nurse practitioners, while promoting interdisciplinary collaboration between nurses and physicians [hence] strengthening the training of providers who wish to work with under-served communities,” she said.
Throughout Adriane’s year in the program, in addition to her shifts at the aforementioned organizations, she was able to provide care to patients at the Jonathan Lax Center for HIV primary care; a rural health center, La Comunidad Hispana, a refugee clinic at the Children’s Hospital of Philadelphia; and the Philadelphia Department of Public Health.
She saw first-hand the demands for clinical services grow along with the need for care management. When reflecting on her experience, Adriane observed that, “the diversity of my clinical sites provided for a spectacular learning curve and while stressful at first, I eventually thrived on the variety that each week provided. In the end, this made me a better and more flexible primary care practitioner.”
The first Independence Blue Cross Foundation NP Resident will begin a one-year rotation in early 2017.