Onboarding for PAs and NPs

Quick Takes

  • One or more trained preceptors should work closely with a newly hired PA or NP to assist in transitioning to the new practice setting.
  • Develop a skills checklist for system competencies that each new hire should be expected to achieve, such as physical layout, electronic health record, compliance and billing, scheduling, requesting a consultation, preparing for discharge, and transitions of care.
  • For each individual new hire, identify deficits of medical knowledge or practice and develop a systematic program to address these. The program might include didactic learning, clinical rotations, or participation in rapid response or code blue teams.

Study Questions:

What onboarding strategies will effectively prepare newly hired PAs and NPs for their careers in the hospital setting?


To improve the onboarding process for new PA and NP hires in a large academic, urban, quaternary referral hospital, an onboarding task force was created. The ideal onboarding process included several elements: 1) onboarding preceptors were trained; 2) an initial 30-day time window was allotted for acquiring system competencies based on a structured checklist along with planned shadowing and/or preceptorship; 3) a subsequent 60-day time window was allotted for identifying and strengthening individual medical knowledge and transition to full patient care responsibilities; 4) at 90 days, a 360-degree review would be completed; and 5) additional steps might be implemented based on results of the 360-degree review. Primary outcome measure was knowledge acquisition, which was assessed quantitatively by the percentage of structured checklist competencies achieved by day 30, with a goal of 80% completion. Throughout the process, the quality improvement framework of Plan, Do, Study, Act (PDSA) was utilized in addition to assessment surveys to facilitate continuous improvement.


Over 2 years and three cycles of PDSA, a novel approach to PA and NP onboarding was developed. A checklist for system knowledge of departmental core competencies was developed, and preceptors were trained to guide the new hire through development of these competencies in the first 30 days of their orientation. Competencies included tasks such as requesting a consultation, planning and executing a patient discharge, transitions of care, accessing and requesting changes to the provider schedule, and placing a page. Implementation of the checklist received high satisfaction marks from recent hires. In the second PDSA cycle, specific medical knowledge deficits of individuals were identified, and an individualized plan for development between days 30 and 60 was instituted, which included participation in clinical rotations, rapid response teams, and code blue teams. Feedback regarding this intervention was positive. At 60 days after hire, a need for continued support of new hires during their first year became apparent. In PDSA cycle three, new hires underwent a 360-degree review process at 90 days after credentialing. Based on outcomes of the review, a plan for continued competency development of the new PA or NP was designed and implemented for ongoing use through the first year of employment. This final aspect of the new onboarding process also received positive reviews from most participants.


This structured approach to onboarding of hospital PAs and NPs incorporated objective competency checklists for departmental/hospital system knowledge, individualized plans for overcoming medical knowledge deficits, a standardized review tool based on professional competencies, a plan for ongoing development through the first year of employment, and robust longitudinal mentorship by the hospitalist director. A successful onboarding strategy may facilitate broad career development for PAs and NPs in the hospital setting.


Although this onboarding strategy was designed for hospitalist PAs and NPs, its principles might be applicable to any hospital-oriented specialty. The ACC Cardiovascular Team Member Section has developed a set of core competencies that could be used to develop check lists for medical knowledge.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Nursing, Team, Care Team, Patient Care Team, Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiac Surgical Procedures, Heart Failure, Angiography, Quality Improvement, Professional Competence

< Back to Listings