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CHAS Health Nurse Practitioner Residency Program

Monday, April 15, 2019   (0 Comments)
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Todd Smith, ARNP
Nurse Practitioner Program Clinical Director, CHAS Health



Three years ago, a group of forward thinking individuals at CHAS Health, an FQHC in Spokane, WA, recognized the need for well-trained ARNPs (Advanced Registered Nurse Practitioners) capable of managing complex medical patients, many of whom also have mental health issues or lack the basics of enough food or permanent housing.  However, many new graduate NPs (Nurse Practitioners) can be overwhelmed by the intensity and responsibility of the work and the stress it brings.  Sustained stress often leads to burnout and the loss of well-intentioned providers, thus worsening the shortage of primary care providers and limiting patient access.  Furthermore, the cost to recruit and onboard a new practitioner can be up to $20,000, creating a financial burden for many community medical clinics that exist as part of a last line of defense in the healthcare system .


CHAS Health opened the first and only NP residency in Eastern Washington in September 2017.  Unlike most other NP residencies around the country, we are housed in our own clinical space, the Nurse Practitioner Residency Clinic (or NPRC as we call it), on the ground floor of the same building as our Spokane Valley Clinic.  This model is more akin to a medical residency and creates a culture of learning that is shared by all staff, not just the providers.  Clinical days for the residents are on Monday, Tuesday, Thursday, and Friday.  Wednesdays are dedicated to time spent working on a quality improvement project, participating in case discussions, leading oral case presentations and attending didactic sessions.  Didactic sessions are held most every Wednesday afternoon.  Topics cover issues like chronic liver disease, heart disease, musculoskeletal complaints and common eye problems in primary care.  We also hold multiple skill days and cover topics such as topical anesthesia administration, abscess drainage, suturing, skin biopsy and more.  For this year, I constructed some abscess models made from foam blocks hollowed out, water balloons filled with simulated pus and fake skin ordered from Amazon to cover the block.  In the end, they were quite life-like and gave everyone the opportunity to get comfortable with the technique.  Because many patients of CHAS Health have resource issues around food and housing, we train residents to incorporate these considerations into their management plans.  For example, a patient struggling with depression might disclose that they had to quit their job because of the severity of their symptoms.  In turn, this has forced them to choose between either enough food or heat during the cold winter.  Once identified, we can link them with our Patient Services Coordinator and refer them to our community mental health partners. 


Clinical days are broken out into continuity clinic, which are typically three days per week, and specialty clinic one day per week.  During continuity clinic days at the NPRC, residents work with clinical preceptors either individually or in small groups.  Preceptors support and guide the new providers as they adapt to their role.  Unlike their physician counterparts, Nurse Practitioners do not need to complete post-graduate education, commonly known as residency, to obtain final licensure and begin working.  Instead, they arrive at CHAS Health as fully licensed providers capable of providing safe and competent care who are looking to take their skill set to a higher level much more quickly and in a structured manner that supports their transition from RN to Advanced PracticeProvider.  Their experience as nurses before returning to graduate school has already given them a good foundation of clinical knowledge, the ability to manage complex psychosocial and family situations, as well as empathy and a respect for patient dignity.  From there, we continue to build and advance their knowledge and skill set.  


Each month brings a new specialty rotation.  These occur at either CHAS Health or with our partner Multicare Rockwood Clinic.  We currently require rotations in Pediatrics, Behavioral Health, Women’s Health, Urgent Care, Orthopedics, Cardiology, Gastroenterology and Pulmonology.  Some specialty rotations offer more hands on experiences than others do, but they all afford the residents a great opportunity to work alongside and learn from skilled Advanced Practice Providers, as well as Physicians.  We intend to offer elective specialty rotations near the conclusion of the program that could include additional time spent working in one of the aforementioned specialties or in areas such as Rheumatology, Hepatitis C, HIV or rural medicine.


Constant evaluation of program components such as didactic offerings, specialty rotations, and preceptor performance helps us improve the program and ensure we are providing the best experience possible for residents.  Ongoing evaluation is also a requirement of accreditation.  The CHAS Health Nurse Practitioner Residency received full accreditation through the National Nurse Practitioner Residency & Fellowship Training Consortium, simply referred to as the consortium, in January 2019.  Achieving this status was not easy and there are less than 10 programs nationally that have achieved this status; though I would anticipate many more to come as the value of both NP Residencies and accreditation are recognized.  As the consortium website states: “Accreditation connotes rigor and quality in the program itself, and the likelihood of success of its graduates.”  


The Nurse Practitioner residents are subject to ongoing evaluation by the preceptors they work with on a regular basis.  There are weekly chart reviews, shadowing of office visits and collection of patient feedback following office visits.  While this can be stress inducing for residents, it ensures all patients receive safe and appropriate care and better prepares residents to manage the complex medical problems they will encounter with underserved populations.  People who are considering applying should recognize that this is a challenging program and requires some personal sacrifice during the year.  However, I would argue the value of a residency for a new graduate NP far outweighs the sacrifice, as so many skills are gained in the first year to set graduates up for success in their future professional endeavors.   


For questions and/or more information, please contact: communications@chas.org





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