A survey of nurse practitioner (NP) residency/fellowship program directors found that the vast majority of respondents identified benefits of these programs, and <50%  identified barriers  to support the creation of more programs in the United States, according to a study published in the Journal of the American Association of Nurse Practitioners.

Of the 88 NP residency/fellowship programs in the United States, 41 program directors completed the survey which was administered from November 2018 to February 2019. A survey tool was developed to obtain information about benefits and barriers of program development and implementation as well as funding. Four colleagues familiar with NP residency/fellowship programs reviewed the survey for validity and divided the survey into 4 categories: program demographics, facilitators and barriers to program implementation, benefits of the programs, and sources of funding.

The majority of respondents referred to their program as NP Residency (44%) or NP Fellowship (51%); only 5% used an alternate title such as postgraduate NP or Advanced Practice Nursing training. The majority of the programs (85.4%) indicated that they were 12 to 18 months in length; however, the typical length was 12 months. The programs were relatively small in size (maximum cohort size=20) and the mean length of existence was 4.8 years.

Program directors cited numerous facilitators to implement NP residency programs ranging from physician and administrative support to a demand by NPs for programs and competitive compensation programs. Benefits of NP resident/fellowship programs include salary, insurance, vacation, and tuition benefits. Salary for resident/fellows ranged from $50,000 to $98,000/year, with the mean salary of $69,301/year.

A total of 78% of NP program directors indicated that they did not require contract time after program completion, but 67% hired their NP resident/fellow graduates and 80% assisted them with job placement. Newly graduated NPs found evaluation feedback from the preceptor/mentor to be beneficial as they transition to practice; however, lack of incentives for preceptors appeared to be of moderate concern.

Less than 50% of respondents identified barriers including increased burden and workload of the preceptor and cost of program implementation. Only 11% of program directors stated lack of qualified preceptors was a barrier to program implementation.

Almost half of the programs (46%) received no source of funding and only 10% of programs received 2 sources of funding. Major sources of reportable funding were from organization billing (15%), Veterans Administration Centers of Excellence in Primary Care Ed (10%), and Medicare/Medicaid (4.9%).

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“Overwhelmingly, the program directors indicated that NP recruitment and retention were benefits to organizations implementing NP residency/fellowship programs,” the authors concluded. “The vast majority indicated that physician support and administrative support were facilitators to program implementation. Less than half of program directors were able to identify barriers to implementation.”


Kesten KS, El-Banna MM. Facilitators, barriers, benefits, and funding to implement postgraduate nurse practitioner residency/fellowship programs [published online April 8, 2020]. J Am Assoc Nurse Pract. doi:10.1097/JXX.0000000000000412.