How are NP Residencies and Fellowships Structured?

If you’re interested in applying to a nurse practitioner residency program, it’s important to understand what you’re signing up for on the front-end. How will completing a residency be different than traditional entry into practice?

Overall, residency and fellowship programs allow a more gradual, supported entry into independent patient care than the typical employment setting. If you’re a new grad and jump right in to employment, you’ll be expected to treat high volumes of patients, up to several patients per hour, and may treat very complex health scenarios. Post-graduate programs are designed to build on the clinical foundation you’ve built in school while recognizing that your practice level may not be such that you’re quite prepared to treat the most complex of patients at a rapid clip. How is this level of independence and efficiency accomplished in a primary care nurse practitioner residency?

Most primary care or family nurse practitioner residencies and fellowships consist of the following components:


If you’re a nurse practitioner student or recent NP grad, you’re familiar with the concept of preceptorship. As you grow your patient panel in a residency, you’ll also have some time each week where you practice alongside a preceptor who gives close oversight and observation over the care you provide your patients. Unlike in NP school, however, preceptorship as part of your NP residency won’t be 100% of the time you’re in clinic. This usually occurs during specified sessions each week. For example, many residency programs state they have “2 precepted sessions per resident each week”.


NP residencies and fellowships define mentorship a bit differently than preceptorship. Mentorship is access to an experienced provider during patient care as opposed to active oversight. For example, the NP may be seeing patients independently but be assigned a designated mentor in case a question arises. As opposed to preceptorship, the experienced provider would not be co-managing the patient, but rather serving as a resource for questions and concerns about patient care.

Specialty Rotations

Most, but not all, primary care nurse practitioner residencies and fellowships offer specialty rotations. These allow NPs more focused experience in areas like women’s health, psychiatry, pediatrics and other specialties. The majority of primary care NP residencies focus on these broader specialties. There are a few opportunities out there with more in-depth specialty experience such as rotations in gastroenterology, hepatitis, or addiction medicine. Specialty offerings depend on the services provided at the facility where the residency occurs as well as the facility’s relationships with outside organizations. A hospital-owned primary care clinic, for example, is more likely to offer in-depth specialty rotations given access to these types of specialty clinics.

Didactic Sessions

Didactic sessions may be offered to NP residents alone or in conjunction with family medicine residents (if the facility has a family medicine residency program). Some primary care clinics have their own didactic curriculum while others outsource this portion of the residency. For example, rather than classroom education taking place in the clinic, NP residents may attend didactic courses at an affiliated university, hospital (ex. Grand Rounds), or medical/nursing school. Some programs opt to partner with other residency programs or education companies so NP residents complete didactic coursework with a group of nurse practitioners on a similar career path but that do not necessarily work in their same practice.

Quality Improvement

So called ‘Quality Improvement’ coursework and projects seem to be popular among primary care NP residencies and fellowships. Quality Improvement involves topics like healthcare systems and leadership. NPs, for example, may be asked to evaluate a certain system or patient care delivery method and make recommendations as part of a project. Or, they simply may have some leadership and healthcare systems content included as part of the didactic curriculum.

Full-Time Employment

Nurse practitioner residents are formally employed by the facility where they complete the residency. They must be certified and licensed to see patients as they now practicing in the capacity of a provider rather than as a student. Most programs are about one-year, or a few months more. Many facilities offering residencies require that participating NPs also commit to at least one-year of traditional employment with the facility after the residency is complete.

While all primary care residency programs vary somewhat given the differences among clinics, these components are generally what NP residents and fellows can expect. As the residency progresses, expectations of the NP gradually increase. Nurse practitioners will be asked to work on an increasingly independent basis and to see increasingly higher patient volumes throughout the program preparing them to work in a traditional capacity by the time the program is complete.

Did you miss out on a NP residency? Check out ThriveAP. The program delivers a didactic component similar to a residency for early career primary care nurse practitioners.