Advanced Practice Provider (App) Onboarding And Practice Guide

GlossaryAdvanced Practice Providers – Physician Assistants (PAs) and Advanced PractitionerRegistered Nurse (APRNs)Onboarding – the process through which new employees acquire the necessaryknowledge, skills, and behaviors in order to become effective organizational members;this process is critical to the successful integration of new employees into teamsOrientation – the introductory stage of onboarding that imparts the mostfundamental information the new employee needs at the initial stages ofemployment such as hours of operations, locations, staff member introductions,organizational structure, basics of compensation and benefits.Scope of Practice – the activities that an individual health care practitioner ispermitted to perform within a specific profession; defines the roles that a memberof the team may legally performCredentialing – the process used for primary source verification of academiccredentials, licensure, certification, prior work history, medical malpractice liability,national database reporting, competency assessment from previous collaboratingphysicians, and peer references.Privileging – the process of evaluating the competency, skills, certification, andexperience that support the granting of specific patient care duties and permission toperform procedures within an institution or practice.BackBack toto TopTop

ONBOARDING CHECKLISTEXAMPLESBackBack toto TopTop

Checklist Example 1Advanced Practice Provider New Employee ChecklistEMPLOYEE ManagerSignature:CompletionDate:ApprovalDate:FIRST DAYProvide employee with APP Orientation Manual.Provide employee with Department Specific Orientation Manual, if applicable.Assign preceptors and review orientation schedule.Assign HR training: HIPAA, Employment Laws and Practices, EEE, Orientation Learning Modules in the Education Center.Schedule Billing Compliance Education.Assign Instructor Led New Hire Institutional APP Orientation. Classes available in the Education Center.Assign Provider OrientationAssign Human Subject Protection TrainingPOSITIONReview Job and Position Descriptions. Obtain a signed and dated Position Description for the new employee file.Review Key Functions, Team Assignment, Work Schedule and Expectations.Review Organizational Structure: Division, Department, Section, Teams.Review Clinical Operations, Personnel, Standard Operating Procedures.INTRODUCTIONS AND TOURSGive introductions to department staff and key personnel during tour.Facilitate meeting with physicians and teams.Tour of facility, including: CafeteriaClinicCoffee/vending machinesConference SpacesCopy centersEmergency exits/suppliesFax machinesInfusion AreaInpatient UnitKitchenMail roomsMedical Library OR/Procedure AreaParkingPharmacyPrintersRestroomsSupply roomADMINISTRATIVE PROCEDURESReview general administrative Business cardsprocedures. Conference rooms Department SharePoint Site Expense reports CONCUR Keys Lab Coats/Scrubs Library and Medical Graphics Mail (incoming and outgoing) Mobile Device/PagingPlace in employee file.Page 1 Office suppliesOffice/desk/work stationPicture ID badgesPTAS ReportingPurchase requestsRemote Access ISARPTALEO Performance and LearningTelephonesTime Off Request ProcessLast Updated: 7/2019BackBack toto TopTop

EHRProvide information andensure training is completed,including: BillingClosing EncounterDocumentation/DragonIn-BasketMed ReconciliationOne Connect OverviewOrdersPhysician Attestation PrescriptionsRooming ProcessRoutingSigningCREDENTIALING AND PRIVILEGINGReview role of Medical Staff Office.Review Credentialing and Privileging.Ensure completion of Credentialing and Privileging Application.Ensure completion of Provider Enrollment Application for billing, NPI, and Medicare.Ensure completion of TMB registration for all physicians.Assist with obtaining DEA registration. (Schedule 2 – 5)Ensure CPR either BLS or ACLS is current.Review DPA Protocol and ensure new employee is added.Identify procedure training needs and follow training protocols.Identify proctor for FPPE and complete reports as required.EDUCATION CENTER TRAININGProvide information andensure training is completed,including:“A Guide to Managing Cancer Pain”“Recognition and Management of Transfusion Reactions”“Blood Component Transfusion Informed Consent and Orders”“Provider: Suicide Risk Assessment and Policy Changes”POLICIESReview key policies. APP Fair Hearing APRN/PA Policy Blood Component & TransfusionReaction Chemotherapy Confidentiality Conflict of Interest Delegated Prescriptive Authority Corrective Action Dress code E-mail and Internet use Emergency procedures Environmental Safety FMLA/leaves of absence FPPE/OPPE Grievances HolidaysMedical AbbreviationsMedical RecordMedical Staff BylawsMedication OrdersPatient Safety Event ReportingPerformance ManagementPersonal ConductSecuritySuicide Risk & IdentificationStop the LineTime and AttendanceUniversal ProtocolVacation and sick leaveVisitors APRN/PA Monthly Meeting APRN Education Meeting Departmental M&M Department Staff MeetingFellows Lecture SeriesGrand RoundsPA PACE MeetingMEETINGSReview general informationand schedules.Place in employee file.Page 2Last Updated: 7/2019BackBack toto TopTop

RESOURCES AND BENEFITSReview key resources. APP PDMAPRN WebsiteClinic PortalCompliance WebsiteEducation CenterEducation Leave – 5 daysEmployee Assistance ProgramEmployee Health 2-RING2-STOPCode Team 2-7099EC 2-3722Emergency PlanEmployee Accidents HRMedical Staff OfficeMerit Pay ProgramNCAP FundsOmbudsman OfficePA WebsiteParking OfficePRS Funds & WebsiteEMERGENCIES AND SAFETYReview key resources.Place in employee file. FacilitiesFire/SpillsInfection ControlJC ReadinessMSDS OnlineMERIT Team 6-2640Page 3 Patient/Visitor AccidentsRadiation SafetyRespiratory Fit TestingRide Out TeamsTransfer Center 3-2222UHC Safety ReportingLast Updated: 7/2019BackBack toto TopTop

Checklist Example 2PracticeEffective Date:Revised:APP Orientation ChecklistAdvanced Practice Provider Orientation ChecklistEmployeeI. ialsComments1. Introduction to office staff/co-workers and theirrole; tour of office; parking; lunch options; officeresources2. Workflow of office systems (e.g., clinic roles andresponsibilities, patient visit, infusion suite, pharmacy)3. Communication (e.g.,huddles, email, voicemail,provider/care team and patient messaging)4. APP role in collaboration with other clinical supportteams (e.g., outpatient, inpatient, emergencydepartment, radiation oncology, telehealth, laboratoryand diagnostic, tumor board)5. Documentation of patient care/billing for services(e.g., documentation methods directly in EMR anddictation; utilization of EMR system for documentation6. Demonstrates competency in EMR andchemotherapy ordering system. Demonstratesknowledge of treatment plans by diagnosis andunderstanding of role in subsequent treatmentapproval7. Information Systems log-in information8. E-Prescribe and prescription refill policy (e.g.,general refills and controlled substance prescriptionsafter hours and on weekends, if applicable)9. In-hospital laboratory services (e.g., complete bloodcounts, protime/INR, chemistries)10. Teaching materials and educational resources11. Quality and Performance Improvement (e.g. APPchart audits)12. Payer Credentialing/Hospital Privilegesadministrative support13. APP responsibilities - licensure renewal,certification renewal, SCA if applicable, prescriptive14. Resources (e.g., SHC APP group)15. Standard Care Agreement complete, if applicableBackBack toto TopTop

16. Clinical Trials APP role and responsibilities/training,if applicable17. Time off and coverage- review of guidelines (e.g.,PTO, appropriate communication, payroll systemrequest, “Out of Office Assistant” in Outlook and EMR(if applicable); notification for blocking of schedule andphysician coverage)18. APP participation in clinically relevant SHC and SCCmeetingsII. Health Promotion, Health Protection, DiseasePrevention, and sComments1. Obtains and documents a comprehensive healthhistory for patients with a past, current or potentialdiagnosis of cancer2. Uses evidence-based practice guidelines andassessment tools for evaluating patients with a past,current, or potential diagnosis of cancer3. Performs a relevant cancer risk assessment for:general populations; at-risk populations; newlydiagnosed patients with cancer; cancer survivors4. Obtains comprehensive information related to risk,diagnosis, and past experience with cancer5. Performs and documents complete, system-focused,symptom specific physical examinations for patients6. Performs a physical assessment of patients withcancer that includes a comprehensive review ofsystems and evaluation of manifestations and toxicitiesrelated to cancer and its treatment7. Assesses actual or potential late effects of cancerand its treatment (e.g. second malignant neoplasms,cardiomyopathy, pulmonary dysfunction, and othershort-term and long-term effects) in cancer survivors8. Assesses the impact of physical co morbidities oncancer symptoms and response to treatment9. Identifies the relationship between normalphysiology and specific systems alterations producedby cancer and cancer treatment10. Assesses symptoms commonly seen in patientswith cancer (e.g., fatigue, pain, GI upset, immuneresponses, etc.)11. Assesses for common signs and symptoms relatedto disease progression or recurrence12. Assesses patients who are at high risk for signs andsymptoms of oncologic emergencies13. Performs a comprehensive assessment ofnutritional status in patients with a current or pastdiagnosis of cancerBackBack toto TopTop

14. Conducts a pharmacologic assessment, includingover-the-counter medications, prescription drugs,nutritional supplements, and other complementary,alternative, and integrative therapies, to identify andcorrect any potential interactions with cancertherapeutics15. Assesses the risks of polypharmacy to the patient'shealth16. Performs a comprehensive assessment offunctional status and the impact on activities of dailyliving, including but not limited to the followingdomains: psychological; role; social; cognitive; physical17. Assesses for the presence of psychological comorbidities (e.g., anxiety/depression, substance use),past and present coping skills, and the psychosocialimpact of the cancer experience18. Assesses concerns and issues related to sexualfunction, sexual well-being, and fertility of patientswith a past, current, or potential diagnosis of cancer,including the impact on relationships19. Assesses developmental ethnic, spiritual, racial,socioeconomic, and gender variations in symptompresentation or illness experience of patients withcancer20. Assesses the roles, tasks, and stressors ofindividuals, families, and caregivers and their ability tomanage the illness experience (e.g., resources, supportservices, equipment, transportation, child care,anxiety, depression)21. Assesses patients' ability to navigate the complexhealthcare system and the barriers to continuity,coordination, and communication among multiple careproviders22. Orders screening, diagnostics, and surveillanceexaminations or tests23. Demonstrates knowledge of technical skills neededto perform diagnostic procedures to confirm or ruleout health problems (e.g., bone marrow aspirations)24. Performs an initial interpretation of laboratorystudies and diagnostic tests25. Reviews diagnostic and laboratory study results toconfirm or rule out health problems26. Demonstrates knowledge of atypical presentationsof cancer27. Demonstrates understanding of the principles ofcancer staging28. Collaborates with relevant healthcare teammembers and gathers additional information forfurther differential diagnosis and problemBackBack toto TopTop

29. Diagnoses common episodic, acute, and chronicphysical problems in patients with a past or currentdiagnosis of cancer30. Diagnoses acute and chronic conditions that mayresult in rapid physiologic deterioration or lifethreatening instability, including oncologic emergencies31. Identifies the need for screening for common lateeffects in cancer survivors (e.g., infertility,cardiomyopathy)32. Reformulates diagnoses based on new or additionalassessment data33. Determines the impact of co morbidities on theprognosis and treatment of patients with cancer34. Diagnoses acute and chronic psychologicalcomplications (e.g., anxiety, depression, substanceabuse) and their influence on the patient'spsychological state35. Documents diagnoses and problems to facilitateidentification and initiation of the treatment plan andoutcome evaluation36. Demonstrates knowledge of diagnostic andprocedural coding documentation requirements37. Collaborates with multidisciplinary team, patient,family, and caregivers to formulate a comprehensiveplan of care for patients with cancer, includingappropriate health education, health promotion andhealth maintenance, rehabilitation, and palliative care38. Plans for the management of common cancerrelated episodic, acute and chronic problems39. Plans for the management of cancer and cancertreatment-related symptoms (e.g., pain,nausea/vomiting, neuropathies, infection)40. Plans therapeutic interventions to restore ormaintain an optimal level of functioning41. Establishes a comprehensive plan of care aspatients transition from active treatment to cancersurvivorship to end-of-life care42. Plans for long-term evaluation and management oflate effects of treatment43. Coordinates care with attention to resourceavailability, accessibility, quality, and cost-effectiveness44. Coordinates care within a context of functionalstatus, cultural considerations, spiritual needs, familyor caregiver needs, and ethical principles45. Demonstrates awareness of appropriate clinicaltrials and research studies for which patients may beeligible and assists in recruiting patients as appropriateBackBack toto TopTop

46. Documents the plan of care and intendedoutcomes to ensure that interventions will beimplemented as planned47. Uses evidence-based strategies in the managementof patients across the continuum of care (i.e.,prevention, early detection, diagnosis, treatment,rehabilitation, survivorship, and end-of-life care)48. Monitors and manages the effects of cancer andcancer treatment49. Provides anticipatory guidance to assist patientsand families in coping with the illness and its potentialor expected outcomes50. Considers co-morbid conditions whenimplementing cancer treatment51. Treats episodic, acute, and chronic health problems52. Initiates appropriate treatments and referrals forpatients experiencing an oncologic emergency (e.g.,disseminated intravascular coagulation, superior venacava syndrome, spinal cord compression)53. Implements interventions to support patients whohave a rapidly deteriorating physiologic condition,including the application of basic life support54. Educates and supports patients in self-carestrategies55. Refers patients to other healthcare providers forfurther evaluation as appropriate56. Refers patients and families to appropriate supportservices57. Facilitates transitions between healthcare settingsto provide continuity of care58. Uses an ethical framework in all aspects of patientcare to assist patients, families, and other caregivers onissues related to the care and management ofsymptoms, advance directives and palliative and end-oflife care59. Coordinates palliative and end-of-life care incollaboration with patients, families, caregivers, andother members of the multidisciplinary healthcareteam60. Determines the impact of cancer treatment and itsside effects and long-term effects on patient outcomes61. Performs treatment planning and treatmentsummary visits, providing patient/family education,identifying potential needs for additional support andmaking appropriate referrals.BackBack toto TopTop

62. Observes 5 bone marrow aspirations/biopsies andindependently performs 10 bone marrowaspirations/biopsies with oversight from a physician orAPP (competency referenced)II. APP-Patient ialsComments1. Establishes caring relationship with patients,families, and other caregivers to facilitate coping withsensitive issues2. Facilitates patient and family decision makingregarding complex treatment, symptom management,and end-of-life care3. Assists patients with cancer and their families inpreparing for and coping with grief and bereavementIII. Teaching-Coaching Function1. Develops interventions with patients and familiesthat are consistent with patients' physiologic andpsychological needs and values2. Educates patients, families, caregivers, and thecommunity about cancer risk, screening, and earlydetection3. Uses evidence-based information to help patientswith cancer and their families to make informeddecisions4. Provides information to patients and families tofacilitate adherence to cancer treatment, supportivecare, and follow-up5. Educates patients and families about expected andpotential adverse effects of prescribed pharmacologicand nonpharmacologic treatments and interventions6. Educates cancer survivors regarding their risk forlong-term effects of cancer and its treatment (e.g.,second malignant neoplasm, skin cancer,cardiopulmonary complications)7. Facilitates patient decision making by explainingtreatment alternatives and potential outcomes,including the option of discontinuing active cancertreatment while optimizing supportive careIV. Professional Role1. Builds collaborative, interdisciplinary relationships toprovide optimal care to patients with cancer2. Promotes life-long learning and evidence-basedpractice while continually acquiring knowledge andskills needed to improve patient careBackBack toto TopTop

3. Recognizes the importance of participation incommunity and professional organizations thatinflue

Journal of Oncology Practice 11, no. 3 (May 01, 2015). Published online April 14, 2015. DOI: 10.1200/JOP.2014.003350 15.ASCO Journal of Oncology Practice: Special Series: NCI-ASCO Teams Journal of Oncology Practice 12, no. 11 (November 1, 2016). 16.ASCO Journal of Oncology Practice: Results of the ASCO Study of Collaborative