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RN Residency vs. RN Fellowship: What’s the Difference?

Ann Feeney, CAE
Updated February 2, 2023
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What is the difference between a residency and a fellowship in nursing? This guide explains the differences and what nurses should expect during each.
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As nursing becomes more complex and demanding, many registered nurses (RNs) use residencies and fellowships to develop their experience and expertise. Hospitals value residencies and fellowships for their potential in building a specialty workforce and reducing stress and burnout.

This guide explains the differences between the two kinds of learning opportunities, how to make the RN residency vs RN fellowship decision, and how to find the right one for your goals. Learn more about how a residency or fellowship could advance your career.

RN Residency and RN Fellowship Key Similarities and Differences

What is the difference between a residency and a fellowship in nursing? Both provide additional supervised learning after you graduate. Both help you apply your learning in real-world situations and develop specialty knowledge.

The difference is experience. A residency is for new graduates or nurses with less than one year of experience, while a fellowship better suits more experienced nurses.

What is a RN Residency?

An RN residency is a combined classroom and workplace program for recent nursing school graduates, most often offered by larger academic medical centers (AMCs). These give new nurses a chance to develop entry-level experience as they transition from being a student nurse to a bedside nurse, often over 6 – 12 months.

What is a RN Fellowship?

RN fellowships are meant to transition experienced nurses to a new specialty function or higher level of care, such as the emergency department (ED), intensive care units (ICU), or labor and delivery .Again, these are most common in larger AMCs. While many RNs participate in fellowships earlier in their careers, some participants may be in the middle or even later phases of their careers. Most fellowships last a year.

Both RN residencies and RN fellowships combine classroom and real-world experience under the guidance of experienced specialists. They both consist of cohorts, and many RNs develop long-lasting professional relationships with others in their cohorts.

Both residencies and fellowships are paid positions, and you apply for them the same way that you would apply for a job.

The primary difference is the level of experience required and career stage. During a fellowship, nurses build on their basic skills learned during clinical work and school, while fellowship participants apply their nursing experience and school to a new specialty.

Advanced practice registered nurses (APRNs) may also attend NP residency and fellowship programs.

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Benefits for Nurses from Underserved Groups

A residency or fellowship can have extra value for nurses from underserved backgrounds. Nurses from underserved demographics might enjoy a residency or fellowship at a hospital full of students who share their background, especially if their previous courses lacked students similar to themselves.

The cohort structure and relationships with preceptors and other program leaders can help nurses build a network within their specialty area.

Similarly, a nurse who is moving to an area where they will be underrepresented could benefit from the structured mentoring and networking of a residency or fellowship at a hospital in that area.

What to Expect During Registered Nurse Fellowship and Residency Programs

Fellowships and residencies follow the same general structure of intensive classroom and background work, followed by placement in the specialty area. Supervised work with an increasing level of responsibility and independence follows placement.

There are two major phases: transition and integration.

Transition Phase

  • chevron-rightOrganizational onboarding
  • chevron-rightIntroduction to cohort members, staff, preceptors, and other participants
  • chevron-rightStructured learning and discussion in a classroom setting
  • chevron-rightOngoing assessment
  • chevron-rightFinal assessment, which may include certification, depending on the program and specialty

Integration Phase

  • chevron-rightAssignment to work shifts and preceptors
  • chevron-rightSupervised work with patients
  • chevron-rightOngoing assessment
  • chevron-rightJoining or observing workplace specialty groups, such as task forces or councils
  • chevron-rightFinal assessment, which may include certification, depending on the program and specialty

What Happens During a Residency?

During a nurse residency, you join a cohort of new nurses, or nurses with less than one year of experience. You will begin with intensive classroom-based instruction, then transition to working nursing shifts under close supervision. Assessment is continuous in both phases.

What Happens During a Fellowship?

Fellowship participants also start with a classroom phase and transition to the workplace. The emphasis is on learning the new specialty area rather than on expanding basic nursing skills.

Participants receive ongoing supervision and guidance. Assessment focuses on learning and skills.

RN Residency vs. RN Fellowship: Which is Right For Me?

Both residencies and fellowships provide valuable transitions into a specialty area. Both programs ensure that nurses have the knowledge they need to succeed in a specialty area, and the guidance to apply evidence-based practice.

If you are graduating from nursing school soon, or have relatively little experience and want to pursue a particular specialty area, a residency program can help you to learn and develop your network.

However, if you already have experience in one specialty and want to transition to another, a fellowship can help bring you up to speed with new research, and give you experience. Like a residency, it can also help you create a network through your cohort and the fellowship preceptors.

Frequently Asked Questions about RN Residencies and Fellowships

What does RN fellowship mean?

An RN fellowship is a program for experienced nurses to transition into a new specialty. It often lasts one year, starting with classroom learning and then working in a hospital under specialist supervision. Fellowships are paid and nurses apply for them like they apply for jobs.

What is the difference between residency and fellowship in nursing?

A residency is for new nurses and combines learning about a specialty and learning general nursing practice from experience in the workplace. A fellowship is for more experienced nurses and provides a transition into a new specialty.

What specialties are common in residency and fellowship?

Some common specialties are ICU (neonatal, adult, or pediatric), ED, psychiatry and mental health, oncology, surgery, post-anesthesia care units (PACU), infusion units, and critical care. Most hospitals advertise their residency and fellowship openings as well as listing them on their websites, so it is easy to find openings.

Do nurses do fellowships?

Fellowships are becoming more popular among nurses, advanced practice nurses, and hospitals as a way to attract and assess potential hires, reduce stress and burnout among new nurses and nurses who change specialties, address specialty shortages, and improve patient outcomes by expanding nurses’ knowledge, skills, and confidence.

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Page Last Reviewed January 28, 2023

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