Background: Nurse Practitioners (NPs) and Physician Assistants (PAs) are a vital part of a Hospital Medicine Group (HMG). Many NPs and PAs join HMGs directly after graduating and without prior experience in Hospital Medicine. The anticipation of a new position brings many emotions. There is excitement, but there is also hesitation. The introductory phase in a new position is often the most crucial because it sets a foundation for the quality of life and success in a new role.Terms such as orientation or onboarding are used to describe this process, however there is a difference in the execution of these methods. Specifically, onboarding is “process of building engagement from the first contact until the employee becomes established within the organization” (Thompson, 2014).The process of effective onboarding involves engagement and investment in an individual’s professional development. This process is best illustrated through situational exposure, relationship building, and professional education.
Purpose: NP and PA education frequently does not include the extensive clinical exposure that physician training involves. Often NPs and PAs require more specialized training to navigate the clinical and system complexities of hospital medicine in order to provide excellent patient care. The purpose of the APP onboarding process is to provide an effective and supportive environment for NPs and PAs in conjunction with positive job satisfaction and retention.
Description: The NP/PA onboarding process at the University of New Mexico Hospital Division of Hospital Medicine is a comprehensive, individualized, and structured progression to allow exposure and relationship building in the first 12-18 weeks of the NP/PA’s career. The first four weeks are spent on the NP/PA service with exposure to multiple clinical scenarios. One week is spent on a resident service with dedicated educational opportunities. One to two weeks is spent with common specialty care services such as Palliative and Nephrology. An additional two weeks is spent learning how to perform hospital admissions and provide consultation to other medical teams. During the onboarding process there is dedicated time for participation in educational activities including afternoon report, Best Practice, and Grand Rounds. The new NP/PA also has weekly to bi-weekly check ins and mentoring with a senior NP/PA.
Conclusions: At the conclusion of the onboarding process, the NP/PA has acquired adequate support and created a smooth transition into practicing as an independent Hospitalist. Several NPs/PAs who have recently completed the structured onboarding process have expressed that the individualized process has helped nurture the transition to becoming an independent hospitalist.