What does the 12-month Nurse Practitioner Residency program look like? This webinar will delve into the details of the structure, design, and content of a 12-month, Federally Qualified Health Center (FQHC) based, postgraduate nurse practitioner residency program. Topics such as recruitment, screening and selection of candidates, core programmatic and curricula elements, and the essential contributions of other staff will be discussed. This webinar will feature speakers from the Community Health Center, Inc.’s first-in-the-nation nurse practitioner residency program and guests from other exemplary programs around the country.

1. Welcome
Implementing 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

2. Community Health Center, Inc.
Foundational Pillars
1. 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

3. 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.

4. From Recruitment to Graduation:
The Structure, Design and Content
of the 12-month Nurse Practitioner Residency Program
Today’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.

5. 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

6. 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

7. 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?

8. Overview of Program Planning and Implementation Steps
1. Pre-program Planning
2. Recruitment
3. Orientation
4. Program Content and Curriculum
5. Evaluation
6. Anticipating the End
7. Accreditation

9. 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

10. Elements of a Successful Recruitment Plan
• Marketing Plan
• Advertising
• Selection Process
• Selection Committee
• Review Applicants
• Conduct Interviews
• Make offers
• Formal Agreement or Contract

11. 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

12. 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
Continuity Clinic
Specialty Rotations
Mentored Clinic
Didactics

13. 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

14. 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

15. • 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

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

17. 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.

18. 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

19. 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/

20. 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

21. 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.

22. Thank You!
Questions?

23. International
Community Health
Services
ARNP Residency
Program
DoQuyen Huynh, DNP, FNP -
Program Director

24. 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

25. Why Do New Grads Need A
Residency?

26. 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.

27. 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

28. Curriculum
Precepted
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.

29. 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

30. 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.

31. 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

32. 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

33. THANK-YOU
Source: National NP Residency & Fellowship Training
Consortium
APPLICATION
www.ichs.com
arnpresidency@ichs.com
206-788-3788

34. 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

35. Open Space for Discussion

36. Reminders
Sign 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 Program
Wed., February 24th 3–4 p.m. EST
First “Transforming Teams” webinar begins:
Building Your Primary Care Team to Transform Your Practice
Thurs., February 18th 2–3 p.m. EST
Sign up at www.chc1.com/NCA

37. Speakers
From 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 Services
DoQuyen Huynh, DNP, FNP - Program Director
From Worcester Family Health Center
Shelby Lee Freed, FNP-BC, Program Director