8 Key Elements to Advanced Practice Provider Retention

Recommendations for Retention Strategies for Advanced Practice Providers (APPs = Nurse Practitioners and Physician Assistants)

1. Set up a strong orientation program including the following:

• Begin the program 4-6 months before full patient load days, add another 2-3 months for nights for NPs(Nurse Practitioners), and 12 months for PAs (Physician Assistants).
• Assign a preceptor-best to have a physician either as a resource, preceptor or mentor.
• Assign a mentor, a trusted confidant who will hear some of the fears and concerns, give constructive advice and direct the new hire on solving the problems.
• Give time and training on the EMR system.
• Give 10% administrative time, initially for studying and didactic learning. Going forward, they would use that time for professional development, research, working on quality or nurse education projects.
• Have the APP shadow in related units and services. For example, when training a CVICU APP have them shadow in the cath lab, with anesthesia in OR (learning to do procedures while shadowing anesthesia is very beneficial to their role in the CVICU), radiology, and other related units.
• Allow the APP to practice within the full scope of their role and do procedures.
• Establish a clear role definition and communicate this role to the multidisciplinary team members. (Each member should be clear on their role on the team.)
• Use simulation for competency and skill building (ongoing).
• Work together to build “Multidisciplinary Teamwork” into the environment with a focus on education, training, leadership, and communication strategies

2. Competitive salary: $90,000 - $95,000 (locally); $100,000 nationally (specifically Dallas, Texas and Houston, Texas).

3. Competitive relocation package: $3500 - $5000; includes area tour, dinner the night before with APP(s), shadow during interview.

4. Unit APP Manager support for orientation program development, relationship support and role definition for physician and fellows, as a continuous process of growing a mutually respectful and supportive multidisciplinary team.

5. Development and addition of a Director of Advanced Practice who has a seat at the medical group leadership table, works with the C-level leadership to capture APP billing opportunities, and develops productivity measurements for APPs.

6. Acknowledge and address the transition process and its challenges (possibly monthly or quarterly discussion topics) for new grads as they transition from RN to PNP.

7. Pay licensing fees, CEUs, conferences.

8. Encourage professional development, presentations, talks, papers both individually and with the  multidisciplinary team.


To inquire about these jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Advanced Practice Provider Scope of Practice in the Emergency Department

Advanced Practice Provider (APP) Scope of Practice in the Emergency Department

With the changing climate of health care in the U.S., advanced practice providers are assuming more responsibility for the direct care and clinical management of acutely ill or injured infants, children, teens and young adults in the emergency setting than ever before.  These providers are experienced in urgent/acute care medicine and many are nationally certified nurse practitioners or clinical nurse specialists who practice in hospital clinic emergency departments.  They evaluate, stabilize, treat and care for pediatric trauma patients through histories, assessments, physical examinations, ordering and performing diagnostic tests and procedures, prescribing medications and developing treatment plans.

Collaborating with the attending physician, the Advanced Practice Provider in the ED, manages the entire Emergency course of treatment and provides comprehensive time sensitive, family-centered care for these critically ill or injured children.  The advanced practice provider is a nurse leader whose role includes consulting, educating, administration and research in addition to the clinical component in the Emergency Department.  For more information on pediatric emergency care and advanced practice nursing roles in emergency medicine, utilize the following resources from the Emergency Nurses Association:

• Advanced Practice Nurses in Emergency Care
• Emergency Nurses Association White Paper Advanced Practice in Emergency Nursing 

Looking for a new advanced practice job in the Emergency Department?  Explore these exceptional opportunities at leading children's hospitals:  

Dallas Physician Assistant - Emergency Department - Dallas, TX
Pediatric Nurse Practitioner - Emergency Department - Dallas, TX
Pediatric Nurse Practitioner Fast Track Urgent Care - Dallas, TX

To inquire about these jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

ARNP Scope of Practice - Iowa Supreme Court Makes Landmark Decision

Iowa Nursing practice recently achieved a “big win” as the Iowa Supreme Court issued a landmark decision ruling that the Iowa Board of Nursing maintains authority to define the scope of Nursing Practice in Iowa, not medical organizations.  The American Nurses Association issued a news release explaining that the appeal by three nursing organizations was prompted by an Iowa District Court judge’s ruling that supervision of fluoroscopy was not “recognized by the medical…profession as proper to be performed by the registered nurse,” as required by Iowa Nursing Law.  The ANA news release quoted ANA President, Karen A. Daley, PhD, RN, RAAN, “In today’s high-demand health care environment, we need nurses and all other health care professionals working to the top level of their capabilities and licenses  The court’s decision will help Iowans get the health care services they need in a timely, efficient, and effective way."      


In an article written by Lynn Boes - INA Legal Counsel, posted on the Future of Nursing: Campaign for Action website, Boes’ included the following noted by the Iowa Supreme Court: “if the District Court’s ruling were to be upheld, it would fundamentally alter the nursing profession, as well as healthcare within Iowa, by allowing physician associations to have absolute veto power over any proposed new nursing rule, regardless of the actual opinions of Iowa physicians and of the actions of Iowa physicians in their privileging of nurses to perform various practices.”

Boes wrote, “this is a win for Iowa patients and Iowa healthcare in general and Iowa nursing practice specifically!” 

Melnic Consulting Group supports the Campaign for Action, and is a strong advocate for Advanced Practice Nurses and the nursing community. 

To inquire about PNP jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Nurse Practitioners Practicing Without Physician Oversight

 

Should Nurse Practitioners be able to treat patients without Physician oversight?
In over one-third of the states, this question has already been answered. In those states, Nurse Practitioners have Full Practice Authority. Nurse practitioners with Full Practice Authority provide patients with direct access to the full services in which they are equipped to provide.  The “full service” or scope of practice of nurse practitioners is different from that of doctors.  Nurse Practitioners are not competing with physicians; they are providers that work in similar roles and many times on the same team. 
American Association of Nurse Practitioners Full Practice Authority Definition 

According to a research article, called “Recommendations for Matching Pediatric Nurse Practitioner Education and Certification to the Pediatric Acute Care Population”, the scope of practice for nurse practitioners has been carefully defined.

A study by ANA, showed that  Nurse Practitioners were more likely to practice in rural areas in states with greater practice autonomy (states with Full Practice Authority), with borderline statistical significance. In addition, male NPs were more likely than females to work in rural locations. These findings imply that practice autonomy should be considered as a state-level strategy to encourage rural practice by Nurse Practitioners.  This study found 152,185 APRNs with National Provider Identifiers-NPIs in the United States, of which 106,113 were Nurse Practitioners. Overall, there were 3.6 urban and 2.8 rural Nurse Practitioners per 10,000 people.
This report of rural health providers was funded by the American Nurses Association. 

According to Dr. Howard Rabinowitz, a professor of family and community medicine at Thomas Jefferson University's Medical College,  “The shortage of rural physicians is a "huge problem."   "About 20% of the population lives in rural areas but only 9% of physicians practice there," said Rabinowitz who has studied the issue for more than 30 years.

With this information, there is one clear conclusion, Nurse Practitioners, who in all research findings practice safely, deliver high quality of care, and receive high patient satisfaction scores, should be able to practice with full practice authority to help provide access for patients to healthcare. 

To inquire about advanced practice nursing jobs visit Melnic Consulting Group or contact: Jill Gilliland 800-886-7906 jill@melnic.com

Importance of a PNP Orientation Program



New Pediatric Nurse Practitioners are transitioning from an RN role to a PNP role that involves a whole new level of decision making and responsibilities.  With this transition, new PNPs very often experience feelings of decreased confidence, anxiety and frustration.  To help the PNP through this critical transition it is extremely important for the PNP to go through an orientation program that will guide them through the process and offer support during this time of uncertainty.  The program should offer new PNPs time to do outside learning and knowledge based training before transitioning to an independent full patient load.  It takes 4-12 months for this transition for specialty care PNPs.

As a new PNP, a clearly defined and structured orientation program is something you should look for when considering a new pediatric nurse practitioner job and a new pediatric healthcare facility.  Be sure to ask extensive questions about the PNP orientation process when interviewing with a potential new employer.  Some questions to ask include: 

• Is there a PNP Orientation Coordinator?
• Do you assign new PNPs a mentor?  (Ideally a PNP or physician from a different department)
• Do you provide coaching and support?
• Is there a clear understanding of the PNP scope of practice and role across all team members?
• Do you provide procedural and didactic guidance?
• Are there job-shadowing and training opportunities? 

These are valid and appropriate questions to ask a potential employer.  A PNP orientation program is extremely important to your success, confidence, and comfort in your new role.  If an employer does not currently have an orientation program, but recognizes the importance of instating a new process, do not write them off.  If they are open to developing a program, this may be your big chance to be on the founding team of their new PNP orientation process.  There is an industry wide recognition for the need of PNP orientation programs, and assisting in the development and implementation of a new program could be a huge resume booster.   

To learn more about PNP Orientation Programs contact Melnic Consulting Group's President, Jill Gilliland 800-886-7906 jill@melnic.com.  

Visit our website for Pediatric Advanced Practice Nursing Jobs Melnic Consulting Group

Pediatric Nurse Practitioners Scope of Practice Increase

Pediatric Nurse Practitioners Scope of Practice Increase


According to Kaiser Health News,"A report released Tuesday may give nurses with advanced degrees a potent weapon in their perennial battle to get the authority to practice without a doctor's oversight.

The report, released by the Institute of Medicine and sponsored by the Robert Wood Johnson Foundation, says nurses should take on a larger and more independent role in providing health care in America, something many doctors have repeatedly opposed, citing potential safety concerns. It calls for states and the federal government to remove barriers that restrict what care advanced practice nurses - those with a master's degree - provide.

The report calls for elimination of "regulatory and institutional obstacles" including limits on nurses "scope of practice" - which are state rules about what care people who are not physicians can provide." more ...



To inquire about PNP jobs visit Melnic Consulting Group or contact:Jill Gilliland800-886-7906jill@melnic.com