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J Neurosci Nurs. 2018 Jun;50(3):157-160. doi: 10.1097/JNN.0000000000000359.

A Comprehensive Onboarding and Orientation Plan for Neurocritical Care Advanced Practice Providers.

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Questions or comments about this article may be directed to Tamra M. Langley, MSN AGACNP-BC, at She is an Instructor, University of Kentucky College of Nursing, and Division of Critical Care Medicine, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY. Jeremy Dority, MD, is Associate Clinical Director for Advanced Practice Providers, Department of Anesthesiology, and Division Chief, Neuroanesthesia, College of Medicine, University of Kentucky, Lexington, KY. Justin F. Fraser, MD, Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, College of Medicine, University of Kentucky, Lexington, KY. Kevin W. Hatton, MD, is Division Chief, Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, KY.



As the role of advanced practice providers (APPs) expands to include increasingly complex patient care within the intensive care unit, the educational needs of these providers must also be expanded. An onboarding process was designed for APPs in the neurocritical care service line.


Onboarding for new APPs revolved around 5 specific areas: candidate selection, proctor assignment, 3-phased orientation process, remediation, and mentorship. To ensure effective training for APPs, using the most time-conscious approach, the backbone of the process is a structured curriculum. This was developed and integrated within the standard orientation and onboarding process. The curriculum design incorporated measurable learning goals, objective assessments of phased goal achievements, and opportunities for remediation.


The neurocritical care service implemented an onboarding process in 2014. Four APPs (3 nurse practitioners and 1 physician assistant) were employed by the department before the implementation of the orientation program. The length of employment ranged from 1 to 4 years. Lack of clinical knowledge and/or sufficient training was cited as reasons for departure from the position in 2 of the 4 APPs, as either self-expression or peer evaluation. Since implementation of this program, 12 APPs have completed the program, of which 10 remain within the division, creating an 83% retention rate.


The onboarding process, including a 3-phased, structured orientation plan for neurocritical care, has increased APP retention since its implementation. The educational model, along with proctoring and mentorship, has improved clinical knowledge and increased nurse practitioner retention. A larger-scale study would help to support the validity of this onboarding process.

[Indexed for MEDLINE]

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