MultiCare APP Fellowship Program supports new ARNPs while improving access to primary care in the community
You might be familiar with the concept of a medical residency, in which medical school graduates work in hospitals or clinics under direct supervision for several years before becoming board certified. But did you know that until 2007 nothing similar existed for Advanced Registered Nurse Practitioners (ARNPs)?
Even though ARNPs act as primary care providers within family medicine, postgraduate training programs for advanced practice nurses are still relatively rare.
Even today, only about 100 programs of this type exist across the country, with nine in Washington State. And, since 2017, MultiCare has been one of just two private organizations in the state to offer one of these valuable training programs, called Advanced Practice Primary Care (APP) Fellowships.
Designed to bridge the gap between academic licensing and workforce development, MultiCare’s APP Fellowship Program allows newly graduated MultiCare nurse practitioners (NPs) to advance their skills with support and supervision while improving access to primary care in the community.
“As a mentored program, the end goal of the APP Fellowship is to develop providers who are confident and competent, who want to practice in our community, and who hopefully want to be providers within our system for a very long time,” said APP Fellowship Program faculty member Cyd Marckmann, DNP, ARNP.
“Primary care is about building relationships and the long haul of being present in patients’ lives for years, and our fellows are passionate about that,” she said.
About the Fellowship Program
The MultiCare APP Fellowship Clinic is located at MultiCare James Center Primary Care in Tacoma, where program fellows are supervised by a team of full-time, permanent faculty members, all of whom are licensed, board-certified ARNPs.
Program fellows are also board-certified ARNPs who have recently completed a graduate-level educational program in family medicine but don’t yet have workplace experience in their new role. Like all ARNPs, MultiCare APP fellows are trained in taking primary responsibility for evaluating, diagnosing and treating patient conditions, and each has a dedicated panel of patients just as a physician does.
Many ARNPs have previously worked as registered nurses (RNs) before pursuing advanced training. But transitioning from an RN role to an ARNP role is no small feat, since ARNPs often act as primary care providers while RNs do not.
The highly competitive APP Fellowship admits two new fellows each spring and fall, out of dozens of highly qualified applicants, to create a steady cohort of four fellows throughout the year. Fellows are eased into a full patient load, starting with eight patients per day and ending with 16 per day by the end of the program.
Throughout each day, the four program fellows receive the benefit of mentored oversight by three experienced ARNPs as they care for patients, navigate Epic (MultiCare’s electronic health record system where patient records are stored), and perform coding and billing tasks.
“The APP Fellowship Program gives me the guidance and training I need to grow into my role,” said program fellow Rose Shrestha, ARNP “I’m able to talk to other fellows, discuss cases with preceptors (mentors), and explain my thought process to ensure that I’m heading in the right direction. If I were at a new job without this program, I’d be struggling a lot.”.
Becky Beal, ARNP, another program participant, agrees. “I’m so grateful to have an umbrella of support and constant feedback, and to be in a safe place to work through things and learn,” she said. My confidence has grown tremendously since starting the program.,”
Benefits to the Community
One of the main benefits of the APP Fellowship Clinic is its dedication to patient-focused care, said Marckmann.
“With health care becoming more piecemeal and episodic, sometimes the partnership piece can get lost,” she said. “At the APP Fellowship Clinic, we have a culture of attending closely to patients, taking time to get to know them, and empowering them to take an active role in their care. When they come to us, patients receive care from two providers, the fellow and the mentor, so there are always two sets of eyes looking at a problem. And our appointment times are longer than average. As a result, our providers have some of the highest scores in the system for patient satisfaction.”
Another distinguishing feature of the fellowship clinic is that it is staffed entirely by ARNPs. Because ARNPs blend clinical expertise with an added emphasis on disease prevention and health management, they are known for bringing a comprehensive and holistic perspective to health care.
“The APP Fellowship Program is a good fit for the highly reliable culture of MultiCare. It allows us to achieve excellence through mentoring and learning together, so that we can deliver the highest level of care to our community,” said Marckmann.
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