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Employer Resources / Clinician Onboarding / 9 Steps to An Effective Physician Assistant and Nurse Practitioner Orientation

The secret to a good physician assistant or nurse practitioner orientation program is to intentionally create a learning environment.

These nine essential steps can help you & help your new Advanced Practice Providers.

During the first 3-6 months in their new role, new Advanced Practice Providers have a lot to learn about your work environment, the patient population, and the expectations and responsibilities of their role. An effective physician assistant or nurse practitioner orientation program supports them as they continue learning, participate in knowledge-based training, and become accustomed to your team before taking on an independent full-patient load. For the new employee, an orientation program will lead to greater job satisfaction and increased confidence. As an employer, an orientation program is essential for reaching your goals too. It will help your organization more effectively recruit and retain talented providers. It also provides a formal process for building competency and assimilating new APPs to your organizational culture. Over the tenure of their careers, this up-front investment in your new NPs and PAs will pay dividends.

A Nine-Step Checklist for an Effective PA or NP Orientation Program

If you follow these steps, your hospital will have well-identified goals and benchmarks for development, improved working relationships among APP peers and leaders, a clear picture of your educational offerings and resources, and APPs who effectively transition to practice in their new role.

  1. Assign a Mentor

Introduce your new NPs or PAs to an experienced Advanced Practice Provider or Physician who can be a sounding board and voice of experience during the orientation period. Ideally, this person should work in a different department than the new employee, so they can offer a neutral point of view.

  1. Allow for Socialization

Give new NPs and PAs opportunities to engage with their peers in a relaxed environment. Introduce them to each person on the team with whom they'll interact in their role. This builds trust and positive working relationships.

  1. Give Consistent and Routine Feedback

New employees need feedback throughout the orientation process. Establish a consistent schedule for a sit-down meeting to occur every 1 to 2 weeks during the orientation process with a preceptor. This should be a two-way conversation to open up lines of communication. Clear goals and a timeline for completing orientation including learning objectives, competencies, clinical skills, procedures, and professional skills should be identified at the beginning of orientation.  Then each week or two, the new hire and the preceptor can review progress, provide feedback, and make recommendations for completing the next steps in the orientation process.

  1. Ensure Role Clarity

It's important for every new NP and PA to have a clear and comprehensive job description. Every member of the healthcare team should understand the provider's scope of practice and hold consistent role expectations. Define, in writing, the competencies and procedures that the new NP or PA should be able to perform by the end of the orientation period.

  1. Empower the Employee with Resources

Provide an introduction to key decision-makers and help the employee access all available resources. These resources may include didactic presentations, educational offerings, and articles. If the employee is expected to be a billing provider, offer a class in coding, note writing, and a note review template.

  1. Skill Development and Procedural Training

Identify specific team members who will provide procedural and didactic training opportunities, job shadowing, and skill development for the new employee. Certainly this support team includes a preceptor, but also physicians in the department and other Advanced Practice Providers. Organizations that offer simulations to learn procedures, decision making, and communication skills not only better engage and retain their employees, they also create a more effective orientation program.

  1. Provide 10% Professional Time

Allocate 10% of the new employee's schedule for non-clinical activities. This time can be spent learning electronic health record systems, coding classes, reviewing protocol, participating in journal club, educational projects, or didactic training.

  1. Offer 3-6 Months of PA and NP Orientation

Depending on the role, an orientation program should be between three and six months in length. For primary care, we recommend about 3-4 months, acute care 4-6 months, and critical care 5-6 months for day shifts and another 3 months for night shifts. For new grad PAs who do not have prior medical work experience, we recommend doubling this time.

  1. Give a Gradual Caseload

New employees should have a gradually increasing patient load that is appropriate for the acuity of your patient population. A good rule of thumb is approximately 10-20% of a full patient load the first month, with a gradual patient load until the month before the last month of orientation.

This article was originally published on Melnic. It was recently acquired by DirectShifts.

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Post by DirectShifts
July 17, 2022


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