To develop a comprehensive onboarding platform for neurocritical APPs to achieve our goal of expanding APP knowledge and autonomy, reducing APP turnover, and improving quality of patient care.

Advanced Practice Providers (APPs) are vital members of modern neuro critical care units (NCCUs). However, Physician Assistant (PA) and Nurse Practitioner (NP) education seldom includes an in-depth teaching of neurology and critical care. 

New APPs hired to our NCCU underwent 6 months of comprehensive onboarding. APPs were required to complete NIHSS and ENLS certifications within the first two weeks of training and the Neurocritical Care Society APP onboarding platform within 6 months of employment. Intubation and procedural competency was provided by our facilities anesthesiologists and Neurocritical care APPs, respectively. Patient and procedural logs were utilized and reviewed throughout. APPs underwent competency evaluations at the end of their onboarding period. APP retention was defined by at least one year of employment following orientation. Job satisfaction was measured by Glint survey scores. Quality of care was assessed by Get with The Guidelines awards.

A total of 4 APPs underwent this orientation between 2019 to 2021. 1 APP was a Physician Assistant and 3 were Nurse practitioners. All newly hired APPs had experience ranging from newly graduated to 5 years working as an APP. All APPs were retained. We achieved and maintained Get with the Guidelines Gold Plus Advanced Therapy Elite Honor Role status during the two years of this review. Our team’s Glint survey eSAT scores were over 80% for 2 consecutive years and ranked consistently higher than other departments within our organization.

A rigorous onboarding platform is essential for developing autonomous NCCU APPs and serves to optimize APP retention and job satisfaction. Furthermore, ensuring adequate APP onboarding translates to a high level of patient care provided by these APPs.