Length of Orientation for New NP

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Specializes in Emergency Nursing.

Hello everyone,

I'm looking to get some feedback from NPs who work in acute care settings (ED, Urgent Care, Hospitalist, ICU etc.) regarding the length of orientation that their faculty/practice group provides for brand new/new graduate NPs. I realize that their are some post-graduate residencies for NPs that are 12 months in duration and include both clinical and didatic components but the majority of new providers are not trained in that method yet. I am working with my employer to strengthen our existing training program for new advanced practice providers (NP/PA) in our emergency department and it would be helpful to see what other programs are doing. In addition to reaching out to other hospitals in the area, I am hoping to get some feedback from the AllNurses community. What I am looking to know specifically is the following:

1. What Department/Care Area do you work in?

2. What is the average length of orientation for a newly graduated NP/PA provider? Is there a minimum amount of time (shifts/hours)? Or is there a set amount of time for everyone?

3. How is it structured? What portion of time is one-on-one with a dedicated preceptor? When does the new provider come off of orientation and become formally "on the schedule" or as "a part of the complement"?

4. Do new providers have to report off any/some/all of their cases to the preceptor or attending physician? If so, for how long?

Thank you again,

!Chris :specs:

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Specializes in Nephrology, Cardiology, ER, ICU.

Hey there!

Okay, I've had two APRN jobs in my 12 years:

1. Nephrology private practice - (I was a brand new APRN with NO nephrology experience): 4-5 months of official orientation split between MD and experienced NP. This is also about the amt of time it took to get credentialed at the five hospital systems. For the hospitals, you had to do x-amt of procedures that you wanted to be credentialed for and they had to be signed off by MD or other credentialed provider. I was then on my own.

2. Heart Failure - (just started here in December) - two weeks orientation to the hospital computer system and the flow of the service. Then, I'm on my own. I couldn't start this position until I had been credentialed. Again, had to be checked off for procedures.

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Hey there!

Okay, I've had two APRN jobs in my 12 years:

1. Nephrology private practice - (I was a brand new APRN with NO nephrology experience): 4-5 months of official orientation split between MD and experienced NP. This is also about the amt of time it took to get credentialed at the five hospital systems. For the hospitals, you had to do x-amt of procedures that you wanted to be credentialed for and they had to be signed off by MD or other credentialed provider. I was then on my own.

2. Heart Failure - (just started here in December) - two weeks orientation to the hospital computer system and the flow of the service. Then, I'm on my own. I couldn't start this position until I had been credentialed. Again, had to be checked off for procedures.

Curious, what procedures do you do?

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Specializes in Nephrology, Cardiology, ER, ICU.

1. For nephrology job, it was only removing temp dialysis catheters.

2. Heart failure - not sure yet as this job is still in "pilot" stage. (I guess I should have said, "will have to be checked off on procedures.") . Sorry for misunderstanding.

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Specializes in DHSc, PA-C.

When I did acute care we had all new NP/PA providers with an experienced provider for their first month. Every patient/decision/order was reviewed. At week 3-4 we would know if the person was ready or not to be put on the schedule. Some were and others were not...at all. So, another month could be added if needed. Had one no where near comfortable into her 3rd month and she elected to leave on her own. Ran into her several months later working in the ED and she was thriving.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

1. What Department/Care Area do you work in?

Adult Critical Care

2. What is the average length of orientation for a newly graduated NP/PA provider? Is there a minimum amount of time (shifts/hours)? Or is there a set amount of time for everyone?

6 months working 3 12-hr shifts a week.

3. How is it structured? What portion of time is one-on-one with a dedicated preceptor? When does the new provider come off of orientation and become formally "on the schedule" or as "a part of the complement"?

New NP is always paired with an experienced NP for the entire 6 months. There is no dedicated preceptor as many senior NP's in the group can fill that role. The new NP is not counted in staffing as a regular NP and must work with the experienced NP while on orientation. Learing goals are discussed between new NP and preceptor and may include increasing patient load as the new NP is ready. All procedures are done with experienced NP supervising.

We have a minimum number for each type of supervised procedure prior to being allowed independence. New NP must attend all critical care didactics (daily conference, M&M, etc). As the new NP progresses, the preceptor may want to pull back on close supervision and see how the new NP handles it. We have a 6 month probationary period (per union contract) and have let go of poorly performing new NP's during this period.

4. Do new providers have to report off any/some/all of their cases to the preceptor or attending physician? If so, for how long?

The new NP presents their patients on rounds to the team (attendings, fellows, residents, students, other NP's). Early in orientation, the new NP may want to have a dry run with the preceptor as far as honing presentation skills and articulating plan of care. Experienced NP can critique new NP's notes but they are not cosigned (new NP is already fully credentialed). We've not had a new grad in a while as most of our recent hires are experienced or grads of the in-house fellowship program.

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