Effects of completing a postgraduate residency or fellowship program on primary care nurse practitioners' transition to practice

Background: To prepare new graduate nurse practitioners (NPs) for transition to practice, postgraduate residency or fellowship programs have been spreading across the nation in the past decade. Purpose: We examined the effects of completing a postgraduate residency or fellowship program on role perception, practice autonomy, team collaboration, job satisfaction, and intent to leave among primary care NPs (PCNPs). Methods: We analyzed 8,400 PCNP respondents, representing a total of 75,963 PCNPs nationwide, to the 2018 National Sample Survey of Registered Nurses. We conducted multivariate logistic regression analyses to examine whether completing a postgraduate training program was associated with increased role perception, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave in their work, controlling for NP personal and practice characteristics. Results: About 10% of PCNPs completed some form of postgraduate training. Primary care NPs who had completed a residency or fellowship program were more likely to have a minority background (e.g., non-White and male) and also see more underserved populations (e.g., minority background, with limited English proficiency) than those without residency training. We found that PCNPs with residency training were more likely to report enhanced confidence in independent roles, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave than those without residency training. Implications for Practice: This study supports further expansion of such programs, which would have positive effects for NPs, health care organizations, and patients, necessitating a long-overdue conversation about real public funding for primary care graduate nursing education.