Transition to Practice for New Grad CRNAs, PAs, NPs, and CNS

Transition to Practice for New Grad- APPs Including CRNAs, PAs, NPs, and CNS

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New Graduate Advanced Practice Providers (APPs, including CNS, CRNAs, NPs, PAs and other APRNs) require a transitional orientation into practice upon graduation. Careful planning by the employer before a new graduate APP begins can help ensure a successful transition. Those who do not have a formal orientation often report feeling unsafe or not properly trained for their role. As a result, many opt to return to their RN role while searching for a new APP role that will appropriately support them in the transition to practice process. Across the board, APPs report that a transition to practice orientation is the most important aspect of a new graduate role. Through our experience working with APP new graduates, we have established few key components of a transition to practice model for new graduates.

Key Components of a Transition to Practice for New Grad APPs Orientation:

Set expectations for how new hires need to prepare for each session. Similar to medical residents, it is likely that every day the new grad will need to spend time reviewing, studying, researching, and reading up on new diagnoses and identified gaps in knowledge from that day's patients.
Clearly layout what the new hire APP can expect from preceptors and the orientation process.
Create a Skills and Competencies checklist of practice areas to be proficient in by the end of orientation.
Provide on-the-job training in how to create a plan of care:
Provide a framework for developing a plan of care.
Articulate the role of the new hire to develop the plan of care for each patient and ensure the preceptor knows that it is the new hire's job to come up with the plan, not to be told the plan.
Allot time for the APP to shadow other providers if the practice or inpatient unit. This gives the new graduate APP a well-rounded experience of the day to day flow, administrative duties, and patient experience and care needs.
Develop a check list of communication and professional development strategies:
Use the principles of bullying and incivility developed by Professor Beth Nachtsheim Bolick, DNP APRN PPCNP-BC CPNP-AC FAAN, Director of Acute Care Pediatric Nurse Practitioner Program, Rush University College of Nursing, and Robert Wood Johnson Foundation Executive Nurse Fellow Alumna. These principles can help new hires learn to effectively communicate with peers, families, nurses, and other patients or team members.
Use a communication training program geared toward healthcare providers.
Use simulations to practice communication skills with a focus on conflict resolution and difficult conversations.
Discuss the team based care delivery model including a definition of the role of the APP as well as the other providers. Introduce the APP to the team, create a badge identifying their role, and reiterate responsibilities.
Develop a checklist of patient management processes and skills, i.e. vent management, suturing, etc.
Lay out ongoing learning opportunities, such as didactic content and resources:
Literature reviews
CME opportunities
Webinars and trainings
Any other didactic resources
Provide patient simulation training in a lab. Provide a list of modules to be completed and schedule the lab to complete these training sessions, if possible at your institution..
Create a timeline for reviews with new hires to review their progress. Design a framework for meetings with new hire APPs. Include a review of how training is going pertaining to #1-10 above, set short and long term goals, and provide, as well as accept, feedback from the new hires about how orientation is going.

Successful APP transition to practice requires a prepared hiring manager who sets a clear timeline for the orientation process. APP orientation length may vary by practice settings, with a general rule of thumb as 4 months for primary care, 5 months for acute and specialty care, and 6 months for ICU and surgery, with an often additional 3 months for night shifts. We also recommends a year long orientation or residency process for new graduates with more minimal healthcare provider background. Flexibility is also key! Be willing to let the new grad CRNAs, PAs, NPs, and CNS have additional time based on their progress, as long as they are making a reasonable amount of progress. Occasionally, the new hire is not a fit for the role and cannot achieve the orientation goals, but typically with the right support, they will be independent in no time! Be prepared to provide a gradual patient load for new grad CRNAs, PAs, NPs, and CNS of approximately 10% of a full patient load to begin with and then adding patients at a regular cadence until full productivity is met.

New graduate CRNAs, PAs, NPs, and CNS are well trained in their programs. They also need support for the first year to become proficient in their role and in the specialty. The cost of not providing a transition to practice program is approximately 2.5 times their annual compensation (salary, plus benefits). It pays to build a training program and invest in new graduate hires. If hiring managers are not in a position to train new graduates then they should focus on hiring experienced candidates.