confirmation of hire?

I've been employed by hospitals as an ACNP in the midwest and here in California. These are the documents I've received when I accepted a job offer and prior to starting the job:

1. A formal letter of job offer detailing salary and date of hire, status (full time), name of manager, collaborating physician and department. The process of getting on board by meeting with HR, setting a date for pre-employment physical exam, and receiving a credentialing packet is included in the letter.

2. Credentialing packet. And in California, a Standardized Procedure Document to go over and sign.

Once credentialing went through and prior to start date, these were the things I had to do:

1. Complete the pre-employment physical exam.

2. Attend a hospital or health system orientation (even though I worked in one of the hospitals as an RN). I was luckily excused from attending Nursing Orientation.

3. Fill out tax forms, employment eligibility forms, and sign up for benefits.

It's pretty similar to starting as a new RN in the hospital. There is no contract.

Just to add about credentialing...my current hospital has Credentialing Analysts, these are clerical staff who work for the Medical Staff Office and assist providers in the process of getting credentialed. One analyst was assigned to me to update me of time frames (i.e., dates when the review board meets and can discuss my case) and how well I'm meeting it in terms of documents turned in. They are great as far as communicating by email or phone but can be inefficient and unaware of technicalities in Nurse Practitioner practice so that can be frustrating at times.

Here's a few things I would suggest. One, be patient because sometimes getting providers on board is not as easy as hiring an RN to work at the bedside.

Two, if you're really worried, the best way to handle this is to talk to the physician that hired you. Make sure that this physician is still committed to bringing you over. I had the same frustrations as you when I was in the Midwest in terms of the pace in getting things started (I didn't have the same snail pace here in California because the hospital here is bigger and has a well-established NP group). I got in touch with the physician by email and on each occasion, she would tell me that she is very much anticipating my start date. There should also be a practice manager of some sort - this person is typically not a physician but a business person and should be the one handling your case. In my experience, HR is never helpful and know nothing about credentialing, all they were able to help me with were knowing about my benefits.

Three, ask for an actual letter, not one sent by email. My letter did come from HR but I think it's very unprofessional for this hospital that hired you to say they will send it by email. Mine came in the mail typed and signed on an official hospital letterhead.

Four, yes, do not resign until everything is in place.

Well then it's safe to say that you're OK. Have salary been discussed? In the midwest, salary determinations tend to be convoluted and take a while to be approved. For instance, I was told the delay in my letter when I was hired was due to the fact that new salary grades for NP's were being determined and the final numbers haven't been decided though I was given a ballpark figure which was higher than my RN pay so I took the risk. Here in CA, some hospitals are unionized (and that includes nurses and APN's). Salary is determined based on a grid that includes total experience in nursing -- makes it really easy and eliminates the haggling for the right price.