New Nurse Practitioner Fellowship Will 'Train Our Own'

A new fellowship program at UNC Hospitals will offer two years of advanced training to nurse practitioners interested in pursuing a clinical specialty in orthopaedics. These “transition-to-practice” fellowships have become popular nationally, but this is the first at UNC and the nation’s first orthopaedics-specific program. The first fellow, Ryan Rauch, NP-C, arrived in Chapel Hill from Pittsburgh in September.

New Nurse Practitioner Fellowship Will 'Train Our Own' click to enlarge Ryan Rauch, NP-C
New Nurse Practitioner Fellowship Will 'Train Our Own' click to enlarge Tom Bush, DNP, FNP-BC, FAANP, clinical associate professor, Department of Orthopaedics

By Jamie Williams,

Throughout the two-year fellowship, Rauch will receive advanced training in the treatment of musculoskeletal conditions with clinical rotations in multiple orthopaedic subspecialties. As his skill and experience grow, he will begin seeing patients in UNC’s OrthoNow Clinic and work to highlight the value of the NP profession within the health care system.

Rauch is already fully credentialed at UNC.

Tom Bush, DNP, FNP-BC, FAANP, clinical associate professor, Department of Orthopaedics, is the program director. He says these fellowship opportunities are a win-win for fellows who receive advanced training and medical centers who achieve cost savings attributable to higher retention and providers practicing at the top of their license.

“People are hungry for this experience,” Bush said. “Even though the fellow receives a training salary during the fellowship, they recognize that this is an investment in their future.”

This program is internally funded at UNC through the Department of Orthopaedics, a signal that UNC sees the value in investing in Rauch and future fellows.

“This sort of program can help us attract the brightest clinicians to our health system and during the two year fellowship, they get advanced training, become familiar with our institution and – assuming there is mutual interest at the end of the fellowship – they will stay on and we will benefit from an incredibly skilled clinician,” Bush said.

Graduate nursing education incorporates competency-based standards and national program accreditation to prepare NPs to complete national certification exams and deliver high-quality patient care upon graduation. Supplemental postgraduate education is not required or necessary for entry into practice, but, added support and mentoring after graduation is fundamental to an effective transition from new graduate NP to expert clinician. Formalizing this support helps NPs adjust to their new roles, promotes their autonomy and supports productivity within the medical center.

“In many cases, people either get the experience on their feet in practice or they don’t,” Bush said. “We developed this program to train our own.”

That type of focused training was one of the factors that appealed to Rauch.

“There is so much on-the-job training in the profession and so obviously experiences will vary based on who is training you,” Rauch said. “This is an opportunity to really focus and standardize that training in a way that will be most beneficial to both myself as a care provider and patients.”

Rauch said he will soon begin seeing patients, but is already becoming accustomed to the non-medical intricacies of working in a large medical center.

“There are so many intricacies and I’ve been getting used to the system and the flow of the place,” Rauch said. “Getting a chance to interact with the staff, do rotations and see how to best serve our patients has been key.”

Bush said that Rauch and future fellows will see patients in the OrthoNow urgent care clinic – currently staffed entirely by NPs.

“At the OrthoNow clinic, we see a broad range of patients. Many are within our scope and those that aren’t are referred to the appropriate physicians for surgical services,” Bush said. “I think our surgeons value this model because they have the opportunity to treat the most complex and challenging cases while NPs are taking care of patients with more common orthopaedic conditions. It’s important to organize the culture in a way that ensures we are not limiting ourselves with self-imposed barriers and everyone is practicing at the top of their license.”

In addition to seeing patients, Bush said Rauch and future fellows will work to continue to foster the growth of their profession and further support other Advanced Practice Providers.

“Ortho NPs are among the most autonomous APPs at UNC. We all see our own patients and bill for our services,” Bush said. “It’s important to continue to document both the value that all APPs bring to the health system and the quality care that we provide.”

Bush said there has been broad, national interest in the fellowship and hopes that the program can serve as a model for other departments at UNC.

“From a workforce perspective, this program will help us to recruit and retain the best clinicians and is certainly worthy of the internal investment,” Bush said.

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