Background: It is typical for new advanced practice providers (APPs) to onboard within our hospital medicine division for at least six months. With the arrival of the first Covid-19 surge in Spring 2020, we onboarded a dozen off-service APPs on a much shorter timeline, typically one week. This required intensive precepting and teaching. As the second wave arrived in Fall 2020, we realized a different approach was needed to successfully onboard and support an additional 30 APPs.
Purpose: Rapidly training non-hospitalist APPs was a challenge for existing APP staff. Extensive instruction regarding chart navigation, workflow, care plans, and oxygen delivery systems was required. Our APP hospitalists were enthusiastic and dedicated, but as months wore on became weary. We built and piloted an intervention to streamline the orientation of 30 outpatient APPs to the Zinc/Covid-19 service.
Description: Step 1: APPs completed a survey describing their credentials and experience. On a 5-point Likert scale, they reported their comfort level with the management of hospitalized adults with Covid-19, sepsis, oxygen delivery systems, encrypted communication mobile application, and seeking assistance. After the survey, an individual response was sent to each APP addressing any areas marked as “uncomfortable” or “very uncomfortable.” Step 2: APPs independently reviewed short instructional videos and checklists for pre-orientation, orientation, and daily workflow. Additional links for common hospital medicine topics such as sepsis, pneumonia, and anticoagulation were included. After working through the materials, there was a second short survey confirming the completion of pre-orientation day tasks. If they were unable to complete any of the tasks, we reached out to them to resolve prior to orientation.Step 3: The APPs received a 1-day orientation with an APP hospitalist preceptor, who completed a final survey at the end of the day to report whether the APP was safe to practice within the supervised structure of the Covid surge service. We also had weekly video conferences, with the first 10 minutes devoted to answering questions and collecting feedback, and the last 10 minutes focused on the dissemination of information. The remainder of the hour focused on a theme and occurred in a “talking circle” format. APPs reported the meeting increased camaraderie with hospitalists and concerns and emotions were validated and recognized by their leadership.
Conclusions: Covid-19 care involves working outside our comfort zones, especially for non-hospitalist clinicians. Our hospital medicine division prioritized the creation of an orientation and supervision structure that addressed our off-service colleagues’ psychological safety. Our goal is to emerge on the other side of this pandemic with clinicians reporting they were well supported and cared for during this unprecedented year.