Stacey Lombardo, DNP, APRN, AGPCNP-C

Danbury Hospital

Bio

Stacey Lombardo, DNP, APRN, AGPCNP-C is a board certified, doctorally-prepared, adult-gerontology nurse practitioner at Nuvance Health. She has grown personally and professionally as a long-time staff member of this network. She is passionate about her work and she continues to strive for success. Stacey started her career at Danbury Hospital, in 2005 as a food service aide. Upon completion of her Bachelor’s of Science in Nursing degree from Western Connecticut State University in 2008, she started working as a registered nurse in the operating room at Danbury Hospital. She later went on to pursue a Doctor of Nursing Practice degree in 2016 from Quinnipiac University. Upon completion, Stacey continued to grow within this network as she accepted a primary care practitioner role at Danbury Primary Care. Since starting at Danbury Primary Care, she has continued to develop into an expert clinician, often serving as a mentor and preceptor to new NPs. She has also been nominated as a “superuser” to act as a resource for other clinicians as Nuvance converted to a new electronic medical record system. Stacey was nominated for and she has completed the basic and advanced leadership courses of Nuvance’s Leadership Academy. In addition, she has worked as a preceptor and/or clinical instructor for various universities over the past five years, including Western Connecticut State University, Quinnipiac University, Massachusetts College of Pharmacy and Health, among others. Stacey finds her work, caring for patients while teaching her students, incredibly rewarding. She is currently working with leadership at Nuvance to bring to life a standardized new-graduate nurse practitioner orientation and residency program.

Scholarly Project

Nurse Practitioner Efficacy and the Need for Residency Programs

SCHOLARLY PROJECT

Nurse Practitioner Efficacy and the Need for Residency Programs

Stacey Lombardo, DNP, APRN, AGPCNP-C

Patricia A. Tietjen, MD
Teaching Academy, Nuvance Health

PROJECT ABSTRACT

Nurse Practitioner Efficacy and the Need for Residency Programs

The purpose of this project was to evaluate the need for a new-graduate nurse practitioner residency program, with an emphasis on self-efficacy of the novice primary care clinician. A literature review was performed by searching for keywords of “nurse practitioner residency,” “novice nurse practitioner” and “nurse practitioner self-efficacy” in CINAHL, PubMed and Google Scholar databases. An additional method was performed by collecting surveys of nurse practitioners regarding their reports of self-efficacy within their first several months of practice. An electronic survey was sent to a convenient sample of local primary care nurse practitioners across Nuvance Health. The survey measured, using a Likert scale, how confident nurse practitioners felt to practice independently in their first 3-6 months of practice. Respondents were also asked to describe their biggest challenges in their first 3-6 months of practice. Results of the literature review revealed common themes of feeling underprepared for independent practice immediately after graduation. Lack of a standardized orientation program and insufficient time to assimilate where major factors that were identified as challenges to successful integration of the novice NP. The survey results mirrored the literature review results. 100% of respondents indicated feeling underprepared within the first 3 months of graduation. On a scale of 1-5 (5 meaning fully confident and 1 not confident at all), the average response was a 1.6 out of 5. The average amount of on-the-job training after graduation in those surveyed varied greatly from a few days to 3-4 months. Top challenges identified in the first year as APRN in those surveyed include: role transition, time management, clinical decision making and billing. The Institute of Medicine has not only recommended NPs to help close the current care gap in primary care, but they highly support the initiation of NP residency programs across the country. While nurse practitioners have a solid foundation as registered nurses, the expectation for new graduate nurse practitioners to jump immediately into independent practice is unrealistic. Literature review and data collected indicate self confidence levels are low and one solution would be a formal residency program. Even after completion of medical school, new graduate physicians often complete several years of residency. So why shouldn’t a new graduate NP complete some type of formal residency during on-the-job training? Next steps would be creating a pilot group with the goal of increased confidence to address the challenges identified. This would be a great benefit to the network and make this network a more competitive choice for advanced practice clinicians. Existing nurse-practitioner residency programs in New Haven County can provide an excellent example and may provide guidance on how to set up and structure this new curriculum going forward.