Neuro 101 Toolkit-Onboarding and Orientation APP

Onboarding and Orientation APP

Pdf Summary

The article describes a structured onboarding program developed in 2014 for advanced practice providers (APPs) entering a neurocritical care service. The program aims to prepare APPs for complex ICU care while supporting retention and consists of five elements: careful candidate selection, assignment of an experienced proctor, a three-phase orientation, remediation when needed, and mentorship.<br /><br />Candidates are assessed for critical care experience, clinical judgment, and willingness to undertake substantial ongoing study. Each new APP is paired with a proctor who provides consistent supervision and feedback.<br /><br />Orientation typically takes about six months. Phase I focuses on observing care and learning to assess and triage critically ill patients. In Phase II, trainees gradually manage patients under supervision, develop procedural skills, and complete written and oral examinations. Phase III builds neurocritical-care expertise while APPs practice independently, with further study and final assessments. Each phase includes assigned readings and measurable goals; unsuccessful exam attempts lead to targeted remediation and retesting.<br /><br />Before the program began, two of four APPs left, with insufficient training or clinical knowledge cited as contributing factors. Since implementation, 12 APPs have completed the program, and 10 remain in the division—an 83% retention rate. All trainees who required examination retakes passed after remediation.<br /><br />The authors report that the program appears to strengthen clinical knowledge and support APP retention. However, they note that larger-scale research is needed to establish its effectiveness, including its impact on patient safety and clinical outcomes.

Keywords

advanced practice providers

neurocritical care

onboarding program

ICU care

retention

proctor supervision

three-phase orientation

remediation

mentorship

clinical training