By Janelle Tipton, APRN-CNS, AOCN®
Contributing to the orientation and onboarding of new advanced practice RN (APRN) providers supports optimal patient outcomes, professional satisfaction, and nurse retention. Orientation involves working through the hospital’s training program, policies and procedures, organizational structures, and mission or vision statements, whereas onboarding builds engagement and relationships in the organization over many weeks to months. Some institutions have formalized, detailed processes for orientation and onboarding, but others may offer very little structure and support.
Example Oncology APRN Onboarding Schedule and Activities
Note. Based on information from Robeano et al.
Experience Influences the Onboarding Timeline
Each employee can have a slightly different onboarding process depending on their past experience as an RN and APRN and in oncology. Today, nursing has multiple career paths. An increasing number are returning to school to become an APRN with only a few years of RN experience. Others may have several years of nursing experience but are novice in the APRN role. Some may have many years of APRN experience and are changing institutions.
Experience in the clinical area also affects the onboarding timeline and learning curve. Novice nurse practitioners may enter oncology roles without previous experience in the specialty, and larger centers are offering oncology advanced practice provider (APP) fellowships to meet the growing need for APPs. Orientation and onboarding processes can also vary if an APRN is hired from within the health system and has an established understanding of its processes and procedures or if the APRN is new to the environment and technology, such as the electronic health record.
Follow These Phases for Successful Onboarding
Some onboarding models have defined phases and activities that are critical to successful transitioning to a new APRN role. See the timeline in the sidebar for an example of onboarding process and activities and when they would typically occur.
In the prearrival period, an administrative navigator guides the credentialing process and prepares for the nurse’s arrival on the first day. In some cases, this may be someone with a more clerical role, but they serve as the primary communication and connection to the new department. This is also the time to have a new APRN perform a needs assessment with professional goals, which will help the APRN providing the orientation to offer more specific activities and competency checklists.
During the first 30 days in the role, a new APRN is completing EHR training, working with the APRN preceptor, shadowing key stakeholders, and developing priorities with collaborating physicians. Larger institutions and practices may have many APRN preceptors; however, options may be more limited for relatively new roles or small institutions or practices, and the preceptor may be a physician or other clinician. APRNs should receive role-specific training if possible.
Beyond 30 days, identify key areas of focus, additional didactic education and training, and quality and productivity expectations. Review performance evaluations, patient satisfaction scores, and documentation audits at one year or in earlier intervals.
As APRNs progress beyond the novice stage, include discussions about specialty certification, such as the advanced oncology nurse practitioner (AOCNP®) certification through the Oncology Nursing Certification Corporation, as part of their professional development plan.
Focus on Emotional Support
The transition to a new APRN role with high expectations can be stressful and challenging for both novice and experienced APRNs, and a positive well-being is an integral part of engagement and transition into practice. Mentorship with APRN preceptors and other APRN peers can boost on-the-job productivity and professional development.
Provide Professional Resources
ONS has several resources for APRNs for clinical practice and professional development, including practice competencies, continuing education courses, certification study prep, journal articles, and specific content tracks at national conferences.
On a local level, ONS chapters often have networking and educational activities to connect APRNs with others in the community.