Background: The use of advanced practice providers (APPs) is increasingly prevalent throughout all levels of healthcare. However, there is no standard of practice regarding onboarding these providers to their new positions. This is in part due to the vast range of roles and responsibilities that APPs can contribute to the workforce. Although methods for initiating APPs vary, data demonstrating the importance of effective onboarding is consistent. Structured onboarding is associated with increased APP satisfaction and retention (Barnes, 2015).
Purpose: Our hospitalist program is part of a quaternary acute care academic hospital with over six hundred beds. We sought to expand overnight cross-coverage through the addition of nocturnist nurse practitioners (NPs). Due to the focused scope of practice, a condensed onboarding curriculum was created with the goal of increasing NP orientee knowledge of and comfort with common cross-cover scenarios management.
Description: Our NP orientation program consists of two components (1) shadowing hospitalists, intensive care unit APPs and the rapid response team and (2) half-day boot camp program. The bootcamp is split into general educational material for all and five clinical scenarios reviewed in a one-on-one setting. The general educational section covers billing, clinical management for common overnight calls (e.g. recommendations for breakthrough pain overnight), and electronic medical record (EMR) tips to improve efficiency. The clinical scenarios covered the following topics in more detail: acute chest pain, gastrointestinal (GI) bleeding, respiratory distress, sepsis, and atrial fibrillation with rapid ventricular response (RVR). The boot camp participants completed a pre-and post-boot camp survey to assess their general comfort with transition into this role, familiarity with management of the above five topics, and multiple-choice questions to assess knowledge on the clinical vignettes. The addition of APPs to our hospitalist group first started in March 2024 with three NPs. To date, six NPs have completed the onboarding process. Although we have only had a limited number of participants, feedback for our NP onboarding program has been consistently positive. Survey responses demonstrate improvement in NP comfort managing acute care scenarios and when to escalate patient care . The NP participants had greater perceived expertise with acute GI bleeding, chest pain, respiratory distress, sepsis, and atrial fibrillation with RVR and a correlating improvement in scores on the multiple-choice clinical vignette questions. Although increases were seen across all categories, only improvement in perceived expertise with GI bleed management was statistically significant (p 0.04).
Conclusions: Preliminary data demonstrate that a condensed NP orientation structure can be used to effectively onboard APPs for a nocturnist cross-cover role. Further assessment will be needed to evaluate retention rates, long-term provider satisfaction compared to other onboarding programs, and actual clinical performance.