FY23 Annual Report: Transition to Practice Program
JHCP’s Transition to Practice Program Sets Up New NPs and PAs for Success
By: Michael Keating
Shalini Balram started her nursing career in 2015 as a clinical technician at the bedside in the Department of Neurology, and continued in the same unit after graduating from nursing school as a registered nurse. “I loved my job, but I wanted to do more,” she says.
In October of 2022, as she prepared to take the board exams for her nurse practitioner license, Balram surveyed the mid-Atlantic market to determine her best employment opportunity. That’s when a job recruiter for Johns Hopkins Community Physicians (JHCP) piqued her interest with information about the organization’s new Transition to Practice (TTP) program.
TTP pairs advanced practice providers (APPs) who are nurse practitioners (NPs) and physician assistants (PAs) with fewer than three years’ experience with a seasoned JHCP mentor for a one-year period.
“This was definitely the type of program that I personally was looking for,” says Balram, who began working at JHCP’s Urbana location in July. “You hear so many stories of new graduates being thrust into the role, and it’s a little overwhelming. I wanted to be part of a program where I felt that I would get support from upper management in becoming a successful advanced practice provider. Not many places offer that, but once I knew Hopkins did, I researched the program and I applied.”
In an interview in August, after just one month on the job, Balram says the program is everything she hoped for — and needed.
“I’m currently seeing only one patient an hour, so they’re really easing me into it,” she says. “As for now, I’ve primarily been focusing on urgent visits, compared to an annual appointment where they might have more chronic conditions to take into consideration. Instead, I see patients who are clinically presenting with an acute concern and work on addressing that. I always have my superior physician or physician assistant available, who I can speak to and do curbside consults with. That way I get immediate feedback on whether I’m tailoring my treatment plan appropriately in the way that they would agree with as well.”
Balram is one of eight NPs and PAs hired since the program launched in January of 2023 under the direction of Elisabeth Stephens, a PA at JHCP’s location in Urbana and the recently appointed director of advanced practice providers for JHCP.
“We are setting up these new APPs for success,” says Stephens, noting that JHCP, like most health organizations, has experienced high turnover among new advanced practice providers due to burnout and lack of support.
“This helps them get an understanding of the JHCP culture and how we do things. They are teamed with a mentor from the get-go and start with a reduced schedule of patients. We then steadily bump that number up over the course of the year so that they develop enough confidence clinically, as well as a good sense of their own personal workflow, so they can function fully as a solo primary care provider.”
The advantages of mentorship work both ways, says Stephens. Mentees get structured goal-setting, planned patient chart reviews, tips on role socialization, and advice or confirmation of medical decisions when needed. Mentors get a structured relationship that allows them to influence the next generation of the profession, as well as the professional enhancement of the JHCP practice. Mentors also receive an annual stipend.
Unique Assessment Guides and Tools for Support of ‘The Whole Person'
At the start of the program, new nurse practitioners complete a self-assessment of their clinical acumen during the first month, then again at six months, and again at the end of the program (one year). This allows both the mentor and mentee to identify areas of strength and opportunity when it comes to didactic instruction.
Stephens developed a guide she describes as “an incredibly complex spreadsheet that documents all the required steps over the course of the year,” with everything from daily and weekly tasks, requirements and goals, to key transition points at certain weeks, addresses the ramp-up schedule, and embeds a high level of oversight and observation by requiring reviews and sign-offs from the mentor, department chiefs of service, the practice administrator and the office medical director.
A Readiness to Practice tool was also created that includes a final self-assessment of the mentee, as well as an evaluation from the mentor, practice administrator, office medical director and the chief of service. The tool also tracks and includes quality metrics and patient satisfaction scores, as well as observational notes such as whether the person arrives to work on time and acts as a team player.
“To the best of my knowledge, JHCP is the only organization to create and utilize these types of guides and tools,” says Stephens. “Our aim is to hire and support the whole person throughout their career and to be the premier employer for advanced practice providers.”
Expanded Training and Career Path Opportunities
Long term, the goal of the program is to integrate formal mentor-to-mentee didactic training with evidence-based instruction that includes topics in cardiology, endocrinology, pediatrics, neurology, orthopaedics, gynecology/urology, pulmonology, dermatology and hematology, says Stephens. This training will help meet the CME requirements of the mentees in the Transition to Practice program while also being available for those wanting to “tune up” their clinical acumen at any time during their work at JHCP.
“Many new grads and current practicing NPs and PAs are also looking for professional development and a career ladder,” says Stephens. “There are many gifted clinicians looking for ways to share their expertise or hone their skills to expert level. My hope is that we will see such opportunities be realized as the role of the APP director expands.”
For Balram, the Transition to Practice program makes JHCP an ideal choice as her place to work. “From what I can see and what I know and what I’ve experienced, I would highly recommend the program to other new grads like myself,” she says. “I feel very much supported. It’s a great program.”