The transition from school to being an APP in inpatient medicine is not an easy one; the learning curve can be steep as research shows many education programs have limited clinical rotations and varying levels of mentorship. An APP from a medical subspecialty can take 12 months to learn the basic skill set to function in the hospitalist service line.
To help with this adjustment, Carle launched the Acute Care APP Fellowship, which gives two new acute care nurse practitioners (APRNs) or physician assistants (PA-Cs) an opportunity to expand upon their education with a year of advanced training to prepare them for long-term success.
The program provides instruction and clinical practice via hospitalist and specialty rotations to increase consistency of base knowledge and experience in the new graduates.
Lauren Johnson, PA-C, found the fellowship to be an excellent bridge into inpatient medicine.
“This allowed me to build on what I learned from graduate school and continue to develop my skills in acute care. I continued to be mentored and taught, while creating a safe and productive space to learn the details of inpatient medicine,” Johnson said. “Without the fellowship, the road to the destination I’m at now would likely still have been possible, but it would’ve been more uncomfortable, anxiety inducing and arduous.”
The fellows’ rotations with various medical specialties give the APPs a broader perspective of the system and the patient experience in the hospital. From the patient’s initial experience in the Emergency Department to hearing how providers discuss end of life decisions in Palliative Care to seeing a test flow from Cardiology – these rotations give APPs a macro view of the system.
“They’re gaining knowledge from that consulting service to be able to set their patient and the consulting service up for success,” said Emergency Medicine/Hospitalist APP Lead Amanda Steffen, APRN. “This gives them the skill set to know what an appropriate consult is, what in our culture can be done successfully in the outpatient world for patients and what that connection looks like.”
That broad exposure helps the fellows to better understand the interconnected systems that affect patient care.
“I loved that we got to work with the medical specialties as well as others like physical therapy, utilization review, case management, social work and extended care facilities. We truly got a rounded experience that helped us appreciate the entire system that plays into the patient experience,” Johnson said.
Hong Yang, APRN, ACNPC-AG, also found the experience rewarding.
“It’s the best professional decision I have made. I’ve been given an opportunity to be exposed to different sides of healthcare I might not have seen otherwise,” Yang said. “Through my rotations in so many different specialties, I’ve been inspired seeing how the whole Carle healthcare team comes together to provide the best possible care for our patients, even during challenging times.”
The fellows appreciated being in a learning setting, especially considering that from the start, they were given a large amount of information to absorb.
“The first few months were difficult because there was so much to take in and it all felt so overwhelming initially. With some time, and seeing situations repeatedly, it became more comfortable and I was able to solidify the knowledge better,” Johnson said.
Yang expressed a similar sentiment.
“I felt unprepared, overwhelmed and intimidated. I found myself wishing I had two brains so I could learn twice as fast. But this is because I care about this fellowship and want to be a good provider. This motivates me to keep learning. I remind myself of what I have conquered and continue to learn every day,” Yang said. “And I’ve learned that I have a huge APP network supporting me. They’re welcoming, supportive and knowledgeable. As a new APP at Carle, I know the people here are always willing to help.”
As one-up for Johnson and Yang, Steffen sees feedback as a key part of the program.
“They’re going into this learning opportunity that is an extension from their school baseline. They chose to take this next step. So that weighs heavily on my role with them. I’m reiterating that I care about their long-term success.”
Offering feedback on note writing, confidence in talking with patients, how to validate that you’re making best practice decisions, and creating a personalized plan for a patient – such input is a cornerstone of the program to facilitate the fellows’ success at Carle.
Though both fellows have already shown they’re well prepared.
“By the four-month mark, I could already see their success clearly,” said Steffen. “Their confidence, demonstration of flexibility and their understanding of an appropriate consult is evident. Watching them talk to patients and seeing how comfortable they are, they’ll be very highly functioning providers.”
While the program is an investment in the fellows, and requires engagement and involvement across multiple teams in the organization, it doesn’t just benefit the fellows themselves. This effort helps ensure patients are getting high-quality care and it strengthens relationships across specialties.
“This is helping us build so many bridges for more collaborative working relationships with so many different groups that I think that we’re not even able to tangibly see all of the ripple effect of the good that this is going to do,” Steffen said.
Further, the program is intended to facilitate a pipeline for new grads who are successful in their roles throughout Carle Health as it also supports retention and recruitment efforts.
“When I’m interviewing for permanent positions with experienced APPs, it speaks volumes about our organization that we’re willing to financially invest in a new grad,” Steffen said. “It makes them realize how successful they’d be as an APP in this organization. This tells them we’re a company they want to work for, thinking, ‘If they’re putting that investment into new grads, this is a place that would invest in me a lot.’”
Categories: Culture of Quality