Case for support advanced practitioner transition to practice program

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ADVANCED PRACTITIONER TRANSITION TO PRACTICE PROGRAM

ADVANCED PRACTITIONER TRANSITION TO PRACTICE PROGRAM The Advanced Practitioner Transition to Practice Program is a 12-month program designed for new nurse practitioners and physician assistants to serve as a transition into hospital-based medicine.

A truncated 6-month program is available for those who have prior experience and demonstrate competency at the time of application.

The program uses a combination of case-based, self-directed and team-based learning, one-onone mentor assignment, and didactic sessions in a step-wise approach to develop the necessary competencies, skills, and experiences for practice in hospitalist care. Students will have an assigned mentor and interact with a core group of physicians, PharmDs, and other select faculty throughout the program.

Recognizing that both nurse practitioners and physician assistants are increasingly important team members in the hospitalist model, our goal is to ensure both of these professions have the necessary competencies and skills to succeed in a hospital-based environment.

PROVIDER AVAILABILITY IN WESTERN NORTH CAROLINA A hospitalist care delivery model is a key component in the sustainability of rural healthcare. In a rural setting, recruiting and retaining primary care practitioners and specialists is often a challenge.

Nurse practitioners and physician assistants with advanced training are qualified to fill the gap in rural hospitalist care, and are crucial in establishing connections with the patient population on a local level.

The use of Advanced Clinical Practitioners (ACPs) keeps care local so long as it is safe and effective to do so. This also avoids any delay in care while awaiting transfer, which could be hours away.

Current models demonstrate outcomes equivalent to, or exceeding, physician-only care delivery models.

Western North Carolina has significantly lower availability of both physicians and Advanced Clinical Practitioners (NPs and PAs) per capita than the rest of the state.

Mission Health is experiencing the greatest shortage and need in the rural hospitalist care delivery model, with only 6.5 physicians and eight Advance Clinical Practitioners to staff five rural hospitals in the Mission Health System. This severely limits our capacity to meet acute healthcare needs in our rural communities.

The need is real. All 18 counties served by the proposed project are designated by HRSA as HPSAs (Health Professional Shortage Areas). Six of the 18 counties are designated “Medically Underserved Areas� (MUAs).

ABOUT THE PROGRAM

The Advanced Practitioner Transition to Practice Program seeks to better equip nurse practitioners and physician assistants with the necessary skills to serve as part of a tertiary care or rural hospitalist team. Unlike physician post-graduate residency programs, no such formal residency program structure exists for APCs. There are a few academic medicine centers that offer a program, but these opportunities are extremely limited.

The need is real. In a 2007 survey of 562 NPs, only 10% of new graduates reported being “very well prepared” for clinical practice. In fact, half of the surveyed sample believed that they were only “somewhat” or “minimally” prepared to enter practice as an NP. 87% percent of the respondents expressed an interest in pursuing a “residency program of supervised clinical training” had one been available to them after their NP training.

The expressed interest of NP graduates in additional training, the necessary growth of the hospitalist model, and the need for additional inpatient care providers create the ideal environment to foster NP hospital medicine training programs.

The Mission Center for Innovation formed the Mission Center for Advanced Practice and developed an APC-specific curriculum, which was piloted in early 2015 with tremendous success. To build on this success, funding is needed to fully implement a long-term residency program. Unlike physician residency programs, absolutely no governmental funding is available for a Advanced Practitioner Transition to Practice Program Ideal candidates should be a newly graduating nurse practitioner or physician assistant interested in becoming a general hospitalist provider or working primarily in a hospital-based specialty. This program is designed to meet the immediate need of advanced practitioners who require more acute inpatient skills. Additionally, the program has the flexibility to graduate mid-career clinicians who do not have prior acute inpatient management skills, but are able to demonstrate competency early.

The majority of the program’s clinical rotations will occur in collaboration with Asheville Hospitalist Group of Mission Medical Associates, a Mission Health practice. Founded in 1999 with four fulltime, board-certified internal medicine physicians, the hospitalist practice has since grown to more than 50 board-certified, full-time providers providing over 25,000 patient encounters per year.

The Advanced Practitioner Transition to Practice Program is funded by Mission Health, and APC Residents are committed to a Mission Health member organization for two years following the residency.

ADVANCED PRACTITIONER: READINESS TO PRACTICE “Being able to spend one-on-one time with a preceptor is imperative to success as an Advanced Practitioner. The first year is so critical to establishing good practices to build your practice upon. Any new graduate that does not start their first year(s) with proper precepting risks building a career on less-than-solid ground.�

- MMA Advanced Practitioner Forty percent of Advanced Practitioners reported having no precepting experience upon being hired and having to act as an independent provider. Of those who had precepting experience, 48% reported that adequate time was not given during orientation to allow for optimal effectiveness.

The Advanced Practitioner Transition to Practice Program will provide the experience needed to enter hospital-based care.

HOW CAN YOU HELP?

The cost for each Advanced Clinical Practitioner resident to go through the Advanced Practitioner Transition to Practice Program is $104,000. This covers the cost of faculty, resident salary, education, materials, and recruitment of residents. The program will enroll 8 residents each year.