Published in the November 2017 issue of Today’s Hospitalist
IN REFERENCE to your September story (“Building your team with NPs/PAs“), we have taken this a step further. All new PAs/NPs are included in a fellowship for 18 months; after completion, they are integrated into our program. Typically, we include weekly didactics, ultrasound training, procedural care and critical care skills.
We take people straight out of school before they get misinformed—in our opinion—and trained to do things in a manner that would not support our model. It is expensive, but turnover is close to 0%, which pays for itself. The APPs are happier, and so are the physicians.
Robert Fields, MD
Howell Township, Mich.
In the first facility I worked at as a hospitalist NP, they used the NPs to do H&Ps all day long. While this was great experience for a new provider, at times it could be rather stressful admitting for 12 different doctors with different personalities and preferences in how they wanted their H&Ps dictated. The NPs in that position had high turnover, including myself.
I took my current job because I would be able to work with one physician, carry a census and round on patients each day. As your article pointed out, one successful method of utilizing NPs is to work, as I do, with one physician. We work the same schedule and carry between 24 and 26 patients depending on the census, usually eight to 10 more patients than the rest of the physicians. I also split admissions with the physician throughout the day.
While the physician usually sees ICU patients, I follow ICU patients if they were originally mine on the floor. Sometimes, if it is a very interesting case that I can learn from, I will manage an ICU case with the doctor’s close help.
While your article was well-written, I wish it had addressed the fact that nurse practitioners have the option of going through either a family nurse-practitioner program or an acute-care nurse-practitioner program. The acute-care program is geared more specifically toward the inpatient clinical environment. Most acute-care nurse practitioners also have an extensive ICU nursing background that better prepares them for the hospitalist role.
Debbie Fine, MSN, AGACNP-BC
We have a very large hospitalist program with 30 physicians and 38 NPs/PAs. Together, we see between 190 and 220 patients per day.
We have had much success due to comprehensive onboarding, bylaws that incorporate the NPs/PAs as full voting members of the medical staff , the ability to work to the top of our license and education so physicians understand NP/ PA scope of practice. Effective leadership is also key.
Tonya Appleby, DNP, ACNP-BC, GNP-BC
Bel Air, Md.
You cannot run a competitive hospital medicine program without APPs, but the model must be tailored to local needs. No one-size-fits-all approach will work.
Alexandre Andrianov, MD
Coaching physicians to work effectively with NPs/PAs is extremely difficult.
K. Brown, MD