WelcomeImplementing Post-Graduate

Nurse Practitioner and Clinical Psychology Residencies

February 10, 2016

WEBINAR 2: From Recruitment to Graduation: The Structure, Design and Content

Of the 12-month Nurse Practitioner Residency Program

Community Health Center, Inc.

Foundational Pillars1. Clinical Excellence- Fully Integrated teams,

Fully integrated EMR, PCMH Level 3

2. Research & Development- The Weitzman Institute is the home of formal research, quality improvement, and R&D 3. Training the Next Generation: Post Graduate Training Programs for nurse practitioners, postdoctoral clinical psychologists, and students of the health professions

CHC Profile:•Founding Year - 1972•200+ delivery sites•130k patients

The Community Health Center, Inc. and its Weitzman Institute will provide education, information, and training

to interested health centers in: Transforming Teams• National Webinars on the team based care model• Invited participation in Learning Collaboratives to launch team

based care at your health center

Training the Next Generation• Two National Webinar series on developing Nurse Practitioner

and Clinical Psychology residency programs and successfully hosting health professions students within health centers

• Invited participation in Learning Collaboratives to implement these programs at your health center

Email your contact information to nca@chc1.com and visit www.chc1.com/NCA.

From Recruitment to Graduation: The Structure, Design and Contentof the 12-month Nurse Practitioner

Residency ProgramToday’s Objectives:1. Participants will describe the key components of the process of

implementing nurse practitioner residency training programs at their health centers.

2. Participants will identify the necessary structure, design, and content of the 12- month nurse practitioner residency program.

Get the Most Out of Your Zoom Experience• Send in your questions using Q&A function in Zoom• Look out for our polling questions• Live tweet us at @CHCworkforceNCA and #StartingResidencies and

#HRSAnca • Presentation and slides will be available after on our website• CME approved activity – please complete survey • Upcoming webinars: Register at www.chc1.com/nca

Deciding to Start a Postgraduate NP Residency Program

Before You Begin:

• Identify your drivers and need

• Understand the program content and structure

• Gain Board and Leadership buy-in

• Assess Your Resources – financial, physical, human

Questions to Ask Before You Begin

• Who will lead the program implementation and operations?

• Who will provide clinical leadership to the program?

• What other staff will be involved?

• Where will your residents work?

• How many residents will your organization hire?

• Will you engage any external partners?

Overview of Program Planning and Implementation Steps

1. Pre-program Planning2. Recruitment3. Orientation 4. Program Content and Curriculum 5. Evaluation 6. Anticipating the End 7. Accreditation

Pre-Program Planning • Develop an implementation plan

• Educate your organization and staff

• Train key staff members on roles and responsibilities

• Register for our Webinar on March 23rd – Precepting, Supervision, Leadership, Logistics

• Identify resources at designated site(s) for trainees

• Physical• Technology• Human

• Design schedule for the program year

Elements of a Successful Recruitment Plan

• Marketing Plan• Advertising

• Selection Process• Selection Committee• Review Applicants • Conduct Interviews • Make offers

• Formal Agreement or Contract

Orientation • Program

•History of your program •Program structure and expectations •Key clinical trainings

• Organization•Employee orientation•Site orientation •Training in technology

• Community•Meeting with community leaders• Community health data • Community Immersion Excursion

Core Elements of NP Residency Program • 12 months, full time employment

• Continuous training to clinical complexity and a high performance model of care

Ongoing multi-input evaluation component using qualitative and quantitative measures

Training to a high performance QI model, including clinical microsystems approach to improvement at the front lines, data driven QI, and leadership development

40%

20%

30%

10%

Core Program Components

Precepted Continu-ity Clinic

Specialty Rotations

Mentored Clinic

Didactics

The Details Matter • Designated staff and processes to coordinate all aspects of the

program is key to making a program run effectively and for a positive resident experience

Evaluating your Program • Real-time, on-going, bi-directional evaluations of both

qualitative and quantitative measures for all program components

• Recommend use of online technology to collect evaluation data • Recommended program evaluations:

Register for our Webinar April 13th – Measuring the Outcomes: Research and Evaluation

• Celebrating your residents

achievements • Final debrief - lessons

learned and future program improvements

• Final evaluation report

• Employment post residency

• Keeping in touch with your alumni

Anticipating the End of Your Program

Family Health Center of Worcester Post-Graduate Nurse Practitioner Residency in Community Health and Family

Medicine

Overview of Program

Inaugural class in 2009 with one resident, increased to two in 2012, considering increase to four in 2017-18.

12 month program with an additional 12 months as full-time FNP and the possibility of staying beyond if desired.

Retention/Attrition: 11 accepted, 9 graduated, 2 early leave, 7 still in community health, 2 currently in training, 5 still F/T at FHCW.

Key Components of Our Program Each week includes 6 key elements:

Seven precepted clinic sessions (including Team Precepting)

Mentored Clinic session(s) with another NP provider Specialty clinic session (i.e. Women’s clinic, skin, newborn,

sports medicine, school based health, ADHD, infectious disease, Centering Pregnancy)

Administrative time Didactic at UMass Medical School (i.e Alcohol Misuse,

Procedures, End of Life/Palliative Care, Abortion Options & Counseling, Child Development, Motivational Interviewing)

Rounds: Grand Rounds, Chart Rounds, Learning Lunch Participation in a Quality Improvement Project Monthly and quarterly meetings with advisor, collaborating

physician and residency team

Hallmarks of Residency

Interprofessional education (IPE) Interprofessional education occurs when two or more

professions (clinical and non-clinical) learn about, from and with each other to enable effective collaboration and improve health outcomes – physical, mental and social. Precept aside UMMS FM Residents Study in same resident workspace Didactics and rounds with FM Residents Chart and Grand Rounds Quality Improvement Project Providers As Leaders (PALs) rotation Annual Retreat Graduation Source: Health Professions Networks Nursing & Midwifery Human Resources for Health

(2010). Framework for Action on Interprofessional Education & Collaborative Practice. World Health Organization, Department of Human Resources for Health. http://www.who.int/hrh/nursing_midwifery/en/

Support Roles & Responsibilities

Director: Manages recruitment process, selection of candidates, orientation, scheduling, budgeting, funding, relationship between UMass Medical School & FHCW, evaluations, retention

Human Resources: Recruitment, onboarding, salary and benefits

Development: Assistance with locating funding opportunities and grant writing

Scheduling: Works with change of templates and clinic scheduling

Former residents: Act as mentors and advisors

Faculty: Precept and provide consistent feedback about resident progress

Measurement & Evaluation

• Hart, A. M., & Macnee, C. L. (2007). How well are nurse practitioners prepared for practice: Results of 2004 questionnaire study. Journal of American Academy of Nurse Practitioners, 35-46. – Likert-type scale assessing perceived competence in specific clinical areas.

• McKay, P. S. (1983), Interdependent decision making: Redefining professional autonomy. Nursing Administration Quarterly, 7(4), 21-30. – Subjective essay assessing perceived autonomy in NP role.

Thank You!Questions?

International Community

Health ServicesARNP Residency

Program

DoQuyen Huynh, DNP, FNP - Program Director

ICHS at a Glance – 2014 Data

Patient Income Levels◦ 55% below 100% FPL◦ 75% below 200% FPL◦ 22% unknown

Payer Mix◦ 10% uninsured◦ 14% homeless◦ 55% publicly covered◦ 17% privately insured

60 - 70 % of patients historically have language barriers

7 locations: medical, dental, pharmacy, labs, BH, OB/GYN, school services, community advocacy

Earned accreditation from Accreditation Association for Ambulatory Health Care (AAAHC) in 2014

The only CHC in western WA named “National Quality Leader” by the US Department of Health & Human Services

21,426 unduplicated patients in 2014

88,672 FQHC visits

128,075 health encounters

Why Do New Grads Need A Residency?

ARNP RESIDENCY MISSION

To educate and retain well-rounded, highly autonomous, effective, and culturally-

competent Family Nurse Practitioners (FNPs) who will serve as primary care providers in

community health settings.

What is an ARNP Residency Program?

1 year salaried intensive post-graduate training Participants are fully licensed & credentialed nurse practitioners

Training curriculum includes 5 main components:◦ Continuity Clinic at ICHS 3 days/week◦ Partnered Clinic at ICHS 1 day/week the first 3 months◦ Specialty Rotations 1 day/week◦ Didactics half day/week◦ Special Population Project with leadership emphasis

weaved in throughout the year

CurriculumPrecepted Continuity Clinic

Three Days Per Week

Develop their own patient panel with dedicated preceptors

Specialty Rotations

One Day Per Week

Up to eleven rotation in areas of high-volume/high burden/high-risk situation most commonly encountered in the community health center setting.- Cardiology, GI, Pulmonology, Endocrinology, Neurology, Obstetrics, Women’s Health, Pediatrics, Geriatrics, Newborn Care, Behavioral Health, ER, and community health with special populations

Partnered Clinics

One Day Per Week

See patients at the delegation of the primary care providers.

Didactic Education

Half Day Per Week

Formal learning sessions on a variety of complex clinical challenges most commonly encountered in community health centers. The content of the presentations is designed to correspond to the residents’ current clinical experiences.

Special Population Project

Throughout Year

Research and develop a project of interest, which will meet the needs of ICHS and the communities we serve.

ICHS ARNP Residency Program

Recruitment for 3rd class• Application Cycle Opens January 1st – March 25th • Interview candidates April and May• Decisions in May/June

Curriculum development & assessment• ICHS preceptors (minimum 2 year clinical experience, knowledgeable in patient

population, clinically competent) • Community partners ( careful selection of didactic and specialty rotations)• Quarterly evaluation

ICHS Residency Data - Applications

◦ First year: 23 applicants, 8 interviewed, 3 accepted◦ Second Year: 30 applications, 8 interviewed, 3 accepted

- First year Accomplishments:◦ ~ 1,700 patient encounters per resident (exclude specialty rotations)◦ ~ 1,500 clinical hours per resident (exclude project)◦ Special Population Project: created successful roadmap to launch an

after-hour youth clinic and mentorship program◦ All 3 residents signed contracts to continue as ICHS providers post

residency◦ Didactic offered to current NPs and PAs who are new to practice at ICHS.

Inter-Professional Collaboration

INFRASTRUCTURE DEVELOPMENT

Ancillary staff:

- Medical Assistants

- Interpreters/Health Assistants

- Health Education

- RN/OB

- WIC/Nutrition

- PSR/Referral

TEAMS

- Medical (preceptors, didactic)

- Pharmacy (pharmacist consultation, didactic)

- Psych/Behavioral Health (didactic & consultation)

- Traditional Medicine/Acupuncture (didactic)

- Dental (didactic)

- Multi residencies and internships collaboration

ICHS ARNP Residency: Looking Forward Accreditation by summer 2016

◦ Curriculum support◦ Uniformed quality

Multi-track residency – 5 year goals◦ Geriatrics◦ OB/Midwifery

Ongoing research to show:◦ Improved clinical outcomes◦ Increased provider competence & confidence◦ Increased patient access◦ Decreased healthcare costs

Paradigm shift:◦ National recognition ◦ Federal funding

THANK-YOU

Click icon to add picture

Source: National NP Residency & Fellowship Training Consortium

APPLICATION www.ichs.com

arnpresidency@ichs.com

206-788-3788

Accreditation

• Accreditation is necessary next step. It provides external validation of rigor, quality, and high standards; it supports model replication, and it positions programs for future federal funding that may require accreditation

• Applying for accreditation for your program • Explore options for accreditation for your program• Complete self study guide• Site Visits

Register for our Webinar April 27th – Accreditation for Postgraduate Residency Programs

Open Space for Discussion

RemindersSign up for our next webinar in this series:

From Recruitment to Graduation: The Structure, Design, and Content of the 12-month Postdoctoral

Clinical Psychology Residency ProgramWed., February 24th 3–4 p.m. EST

First “Transforming Teams” webinar begins:Building Your Primary Care Team to Transform Your

PracticeThurs., February 18th 2–3 p.m. EST

Sign up at www.chc1.com/NCA

SpeakersFrom Community Health Center, Inc.Margaret Flinter, APRN, PhD, Senior Vice President & Clinical Director Kerry Bamrick, MBA, Senior Program Manager Charise Corsino, MA, Program Manager

From International Community Health ServicesDoQuyen Huynh, DNP, FNP - Program Director

From Worcester Family Health Center Shelby Lee Freed, FNP-BC, Program Director