It is known across industries, and particularly in healthcare, that quality onboarding of new hires is a job satisfier and creates dedicated employees that are more likely to stay with a company long term.1,2,3,4,5 “The strongest evidence consistently showed new graduate nurse programs enhanced critical thinking, competency and retention.”2 “Interviews with PAs and NPs reveal that onboarding programs can reduce turnover and improve productivity.”4 “New NPs report experiencing anxiety, isolation, and a lack of confidence in their new roles, despite often having experience as an RN.”4 New Advanced Practice Provider (APP) graduates are seeking employment where there is a more structured onboarding process.4 With Emergency Medicine (EM) groups looking to recruit experienced APPs, these PAs and NPs often change jobs seeking better opportunities. The loss of experienced APPs is costly for organizations, and the “cost” of having poorly onboarded APPs working in EM is not just the med mal risk and potential harm to patients, it is the uneasy feeling the PAs and NPs experience when working in an environment that they feel vulnerable.
Additionally, a high-quality onboarding educational program can save money to an organization by reducing the time for providers to work safely and effectively. The actual financial cost of not having a good onboarding program is real. APP employers have calculated that the loss of productivity from poor onboarding is typically about $40,000.4 Not only will the productivity of the APP be worse, but the increased time that a supervising physician needs to spend with a new APP cuts into that physician’s productivity as well. “PA graduates report requiring an average of 6 – 8 months to feel proficient in their first jobs.”5 Physician groups and health systems have recognized that there is a particularly huge financial burden when the APP quits early in their employment: “if that PA or [advanced practice] RN leaves within that first year, we know that number is around $250,000 non-tangible or tangible expense to the organization.”5
Scope of practice and independent practice of PAs and NPs has clearly expanded in the past two decades. Health systems and other employers of APPs “might begin to view PAs and NPs as more autonomous than they were in the past, and hasten to reduce support and increase productivity expectations.”4 A recent article in the Journal of Nursing Regulation acknowledged that NP certification alone does not provide sufficient training for the practice of emergency medicine.6 The American Academy of Emergency Nurse Practitioners (AAENP) and The Society of Emergency Medicine Physician Assistants (SEMPA) both advocate for extensive additional training for all providers planning to practice in the ED. These organizations have a clear understanding of the importance of a quality onboarding program for fellow NPs and PAs transitioning to the practice of EM.
So, what are the benefits of creating a high-quality onboarding educational process? A 2007 study from the Wynhurst Group found that newly hired employees are 58 percent more likely to still be at the company three years later if they had completed a structured onboarding process, and an Aberdeen survey showed that 83 percent of the highest performing organizations began onboarding prior to the new hire’s first day on the job.6 New providers want the confidence to do their job well and employers want providers that are safe and productive. All of these expectations can be met by creating a highly structured onboarding process and the best first step is establishing solid foundational training with the most comprehensive emergency medicine program available: Emergency Medicine Core Training (EMCT). The 10 online systems based and 4 specialty modules of EMCT, with its 156 hours of AMA PRA Category 1 AACME and ACEP approved CME, is the only program that brings trainees to the bedside with actual patient encounters and procedures performed on real patients, not manikins. Supervising physicians and APPs can follow progress with a unique “group” functionality, an assurance of academic integrity. If you need help putting together a 5-step program for onboarding your APPs in the emergency department or urgent care center, please reach out to us at firstname.lastname@example.org.
- Bauer TN, Bodner T, Erdogan B, Truxillo DM, Tucker JS. Newcomer adjustment during organizational socialization: a meta-analytic review of antecedents, outcomes, and methods. J Appl Psychol. 2007 May;92(3):707-21. doi: 10.1037/0021-9010.92.3.707. PMID: 17484552.
- Rush KL, Janke R, Duchscher JE, Phillips R, Kaur S. Best practices of formal new graduate transition programs: An integrative review. Int J Nurs Stud. 2019 Jun;94:139-158. doi: 10.1016/j.ijnurstu.2019.02.010. Epub 2019 Feb 26. PMID: 30965203.
- Apollo Technical, “Why Onboarding is Important and a Key to Success.” https://www.apollotechnical.com/why-onboarding-is-important/
- Morgan P, Sanchez M, Anglin L, Rana R, Butterfield R, Everett CM. Emerging practices in onboarding programs for PAs and NPs. JAAPA. 2020 Mar;33(3):40-46. doi: 10.1097/01.JAA.0000654016.94204.2e. PMID: 32097215.
- Maurer, R., “Onboarding Key to Retaining, Engaging Talent.” April 16, 2015
- Lavin, Roberta ProffittVeenema, Tener GoodwinSasnett, LesleySchneider-Firestone, SarahThornton, Clifton P.Saenz, DeniseCobb, SandyShahid, MuhammadPeacock, MichelleCouig, Mary Pat et al.. “Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments.” Journal of Nursing Regulation , Volume 12, Issue 4, 50 – 62.