Postgraduate Nurse Practitioner Critical Care Fellowship: Design, Implementation, and Outcomes at a Tertiary Medical Center

• We support the need for postgraduate advanced practice education via the literature.
• We outline a theoretical model for the design and implementation of a postgraduate advanced practice nurse fellowship.
• We describe the considerations for the design and implementation of a postgraduate advanced practice nurse fellowship.
• We outline the positive outcomes and challenges of implementing a postgraduate advance nurse practice fellowship.
• We describe the full design and implementation of a simulation-based program and its use of failure to rescue scenarios.
• We describe an interdisciplinary process of collaboration via the advanced nurse practice fellowship design and implementation.

Nurse practitioners (NPs) have demonstrated competent and efficient patterns of care and are in great demand in United States hospitals. The transition from the novice to expert provider role is challenging for many reasons. Moved by the Institute of Medicine recommendations, NP leaders in an academic quaternary care medical center proposed and developed a postgraduate critical care fellowship to ensure competency and readiness to practice in highly specialized critical care units. A comprehensive postgraduate critical care fellowship program was developed to support both new graduate and experienced NPs who expressed an interest in developing this expertise. The fellowship includes a 9-month, immersive, structured clinical and didactic program directed by an interprofessional team of experienced critical care nurse practitioners and physicians. Early evaluations show improved perception about readiness to practice, improved performance, improved decision making, improved medical doctor and NP satisfaction, decreased role confusion, and improved transition to independence.