2020 in Review: NW-CAPE's Impact on Healthcare and Workforce

Northwest Consortium of Advanced Practice and Education (NW-CAPE) 2020 Brief

First Author: DoQuyen Huynh, DNP, FNP, ARNP

Second Author: Anne Hirsch, PhD, ARNP, FAANP, FAAN

Nurse Practitioner postgraduate clinical education programs, also known as nurse practitioner residencies and fellowships, have provided a crucial solution for healthcare workforce development in Washington State over the past eight years. These programs are optional postgraduate learning opportunities, typically 12 months or longer and aim to bridge the gap between graduate education and clinical practice through intensive clinical training, supported by a rigorous curriculum. Residents and fellows are licensed and credentialed nurse practitioners who choose to enter into an additional rigorous education program post-graduation.

History and statistics: The US continues to have a severe shortage of healthcare providers, which disproportionately affects patients from disadvantaged backgrounds. Nurse practitioner residencies and fellowships are strategic initiatives aimed at addressing this shortage. The first program in WA started in 2012 at Community Health Center, a Federally Qualified Health Center in Tacoma. Between 2012 and 2020, 9 family practice programs and 7 specialty programs were created, offered at a total of 20 sites. Two of these programs have since closed. The organizations hosting postgraduate clinical education programs are often community health centers or healthcare facilities serving diverse, complex and/or disenfranchised patients. In 2014, these programs came together for collaboration and support, creating the Northwest Consortium of Advanced Practice and Education (NW-CAPE), affiliated with the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC).

Annually, approximately 80 nurse practitioners participate in these programs. Eight of the 16 programs responded to the recent NW-CAPE survey*. Results of this survey indicated that 89% of graduates from these programs were retained to work with the underserved patient populations they were trained for, and 48% of the graduates come from Black Indigenous or People Of Color (BIPOC) backgrounds. 100% of graduates remained in the field as nurse practitioners after the completion of their residency.

Impact:

Workforce Development: Residencies and fellowships provide a stable pipeline of qualified, highly competent advanced practice providers who are taught and mentored to serve targeted patient populations, and thus are more likely to remain in these communities. For example, International Community Health Services in Seattle, hosting its 7th class of residents, reported that the organization rarely needs to recruit outside of their established pipeline for committed, competent and confident nurse practitioners. Organizations hosting NP postgraduate clinical education programs have reported an increase in clinical and academic excellence, a paradigm shift in the organization’s culture, and an increase in professional development and job satisfaction for all levels of staff involved. All of these factors further strengthen the workforce and increase patients’ access to high quality care.

Interprofessional Education: All programs designed their curricula with a focus on interprofessional practice, and often inter-organizational training, while some included leadership and quality improvement skill development. This is attained through interprofessional didactic sessions, clinical rotations, and community projects. One of the successful pillars in the curriculum is the special population and quality improvement project where trainees perform a needs assessment to address gaps in service, and to create a solution that meets the needs of their patient populations. Examples of projects include the creation of a young adult clinic to provide the much needed confidential reproductive and mental health to adolescent youth in Shoreline City, and the creation of a confidential trauma informed care clinic for sex workers and trafficked victims in south Seattle. These projects require residents to collaborate and learn with multiple disciplines in and outside of healthcare professions, and across multiple organizations, ultimately benefiting the surrounding community.

Diversity: Most organizations hosting NP residencies and fellowships serve very diverse and disenfranchised patient populations; one organization has patients and staff that speak over fifty languages. Studies have shown that clinicians who were trained in, or came from these communities tend to stay and seek opportunities to continue to serve these populations. As such, most of the residency and fellowship programs target new graduate NPs who reflect the patients they serve. For example, five programs explicitly state a preference for diverse applicants in their application process. As a result, 48% of all trainees in these programs are BIPOC.

A national movement:

Nurse practitioner postgraduate clinical education has been a movement that is sweeping the country since 2007. Currently, there are over 240 programs across 45 states, with more than 130 programs in family practice. At the end of 2018, the Health Resources and Services Administration (HRSA) announced its inaugural grant dedicated to advancing NP residencies, with $20 million in funding. In 2019, another $5 million was released in the 2nd wave of HRSA grant opportunities. International Community Health Services and Sea Mar are recipients of these grants; both are Federally Qualified Health Centers. At the NNPRFTC 3rd annual conference, Dr. Luis Padilla, the associate administrator for health workforce at HRSA and director of the National Health Service Corps announced an ongoing commitment to NP postgraduate clinical education as a major strategy for growing the healthcare workforce.

Conclusion:

Nurse Practitioner postgraduate clinical education is a successful healthcare workforce strategy that builds on a foundation of graduate education and further fosters interprofessional education and clinical excellence.  As of today, Washington State has the most number of programs compared to other states in the country, with the expectation of explosive growth in the coming years. Washington will continue to lead the way in expanding and strengthening this strategic initiative that aims to improve the overall health of all patients in the Pacific Northwest.

*NW-CAPE programs that participated in the survey: CHAS, Community Health Care of Tacoma, International Community Health Services, Multicare Health Systems, Sea Mar, Seattle Children’s, Virginia Mason, Yakima Valley Farm Workers.