Acute Care NPs - To do a residency or not?

Updated | Posted
by SopranoKris SopranoKris, MSN, RN, APRN Member Expert Nurse

Specializes in ER & Critical Care. Has 7 years experience.

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I'm a dually certified ACNP/FNP. My goal is to eventually work in the ER. I have the opportunity to do a residency program at my hospital that covers multiple specialties: ER, ICU, trauma, nephrology, cardiology, orthopedics, neurology, infectious disease, endocrine, heme/onc, and palliative care. 

Pros: it's a full fellowship program with classroom instruction, rounds with teaching physicians in each specialty, exposure to all the departments in the hospital, excellent learning opportunity, chance to gain more confidence in diagnosis, procedures, etc.

Cons: the pay is "meh" compared to the workload, no time off during the program, geared for MDs/DOs (but they do take NPs/PAs), doesn't start until November (a little over 7 months from now).

For those who are current acute care (hospitalist or ER) NPs, do you think doing a fellowship as a new grad is necessary? Or do you feel that going right into the specialty I want (ER) would be a better route? I would love to hear opinions as I like to weigh all the pros and cons before making a big decision. I have until mid-April to make a decision.

Let me hear your opinions 🙂 

Bluepen

Bluepen

Specializes in Med Surg/Observation. Has 1 years experience. 17 Posts

I think you should do it. It sounds like a good opportunity. I did not know that was available to NPs . I will look for that in the future when I become an NP. My cousin had to do a 3 year residency program when she graduated from medical school. The pay was only 45,000. The experience is what matters. You will take that with you forever.

ghillbert, MSN, NP

Specializes in CTICU. Has 26 years experience. 3,792 Posts

Necessary, no. Beneficial, yes. All of the NP resident/fellows that I have experienced were far better prepared than others at the same career stage. Of course, you have to be able to afford the lower pay for a year. 

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,214 Posts

I would have jumped at the chance for such a program in a heartbeat! There are none that I could find within a possible commuting distance from my home and having kids still at home I took a hospitalist position and I'm sure I'll be happy with that. However, the opportunity to work with each specialty in more detail is one that I think will provide valuable experience for the rest of your career. For me the cons you listed are FAR outweighed by the benefits, but obviously everyone has different opinions.

That being said, I think that the translation to ER will be slightly less applicable than the hospitalist role. Developing a diagnosis in the ER, and really triaging who needs admission vs outpatient follow up vs a straight discharge- is a specialized skill set that will not really, in my opinion, be as impacted by the rounding and teaching experience in the fellowship which is more focused on the plan of care for admitted patients. Unless you do the admissions yourself, you won't be developing the full plan of care, you'll be diagnosing and handing off the admission team. While a more thorough understanding of each of the specialties will definitely make you more knowledgeable, it may not have a dramatic effect on your ability to do the ER provider role. (Which, by the way, I could never do so I'm so glad there are people that are cut out for it!)

Good luck with whatever you decide. 

socal1

socal1

50 Posts

NP schools don't prepare you for anything, they are mostly a joke especially with the diploma mills, and yes definitely would recommend a residency just to be more competent in relation to peers and patients.

ICU_05

ICU_05

28 Posts

I think this would be a great program to participate in. My hospital currently has a great program for nps/pas and it seems they come out very prepared. They perform the same work hours as the medical residents and are immersed in their teams. If I was an NP, I would absolutely want to have that structured experience. Unfortunately, it feels like the NP educational system as a whole feels disjointed

Numenor

Specializes in rounding on the floors probably. Has 10 years experience. 497 Posts

I did an IM one and worked with residents the entire time. 100% recommend. Yeah, the pay sucks but my hospital won't touch NPs anymore unless they have a ton of experience or did a residency.

db2xs

db2xs

733 Posts

If I had had the opportunity to do a residency/fellowship, I would have jumped at the chance. NP school and clinicals are weak and paltry and barely prepare you for anything. MDs have to go through their training period that pays jack as well, it's a part of the process. The learning is invaluable! I would go for it!

SopranoKris, MSN, RN, APRN

Specializes in ER & Critical Care. Has 7 years experience. 3,152 Posts

Update: the residency program was cancelled. However, I was hired on as a hospitalist NP and will start Sept. 1st. I'm so excited. I wanted either ER or hospitalist and I'm thankful I get to start out in one of my top choices. I was also able to get the salary I wanted and excellent PTO/benefits. Can't wait to start 😄

sleepwalker

sleepwalker, MSN, NP

Specializes in Occupational Health. Has 18 years experience. 331 Posts

Out of curiosity...why was the residency program cancelled?

SopranoKris, MSN, RN, APRN

Specializes in ER & Critical Care. Has 7 years experience. 3,152 Posts

On 7/26/2022 at 2:55 PM, sleepwalker said:

Out of curiosity...why was the residency program cancelled?

The 2 main instructors for the residency will both be out on maternity leave at the same time. They cancelled it for this year.

Numenor

Specializes in rounding on the floors probably. Has 10 years experience. 497 Posts

On 7/26/2022 at 10:01 AM, SopranoKris said:

Update: the residency program was cancelled. However, I was hired on as a hospitalist NP and will start Sept. 1st. I'm so excited. I wanted either ER or hospitalist and I'm thankful I get to start out in one of my top choices. I was also able to get the salary I wanted and excellent PTO/benefits. Can't wait to start 😄

I mean that's cool and all but the residency would have been very very helpful. Maybe my hospital us more free reign than most though since all APPs had done one in the group. 

Hospitalist work has a high learning curve so ask if they can take it VERY slow