November 23, 2018/Nursing/Nursing Operations

APRN/PA Transition to Practice Program Expands

Onboarding initiative continues to add specialty tracks


Just one year after Cleveland Clinic launched its new streamlined Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) onboarding program, known as ‘Transition to Practice,’ leaders have doubled the number of onboarding specialties.


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In addition to the original primary care track, which launched in July 2017, and newer critical care and general surgery tracks, the onboarding program now includes oncology, connected care and hospitalist. In this Q&A, Meredith Lahl Foxx, MSN, MBA, APRN, Associate Chief Nursing Officer (ACNO) of Advanced Practice Nursing, shares more about the program and its need to expand.

Q: What is the Transition to Practice program?

A: Transition to Practice offers standardized system-wide onboarding for all new graduate APRN and PA hires. The systemized onboarding training runs for one year and is designed to ease an advanced practice provider from academia to patient care.

It is modeled after ACGME, ANCC and ARC-PA accreditation programming. New hires gradually increase autonomous practice after the first three months, but continue nonclinical training as a group. During their second six months, nonclinical training is reduced. In the primary care track, for example, program participants spend the first three months alongside another provider four days a week, with four additional hours spent in lectures.

Q: Why did the Transition to Practice leadership team decide to expand the program?

A: When the program launched, we had an immediate need to focus on primary care in the outpatient medical setting. Our organization was (and still is) heavily focused on population health and at the time, we were preparing to launch our new population health unit. Also known as Cleveland Clinic Community Care, the unit focuses specifically on population health management, primarily in Cleveland Clinic outpatient ambulatory settings. Advanced practice providers are vital to the success of the unit and we wanted to ensure new APRNs and PAs were as prepared as possible for their roles.


Since then, however, we have been finding a greater need for APRNs in inpatient settings, such as internal medicine. As nurses continue to be recognized as important members of the healthcare team, we are seeing significant growth in the inpatient care environment. Strategically, we will continue expanding the onboarding program and developing curriculum based on identified areas of need or hire.

Q: Are the new tracks different than the current tracks?

A: Yes, each track is moderately customized to the specialty area. New tracks all feature separate curricula, but share similar content. For example, there are roughly 10 APRNs/PAs in the new hospitalist track, and they follow a schedule that has them participating in didactic and shadowing experiences, which is a slightly different approach than some of our other tracks.

Cleveland Clinic’s APRN Director Anne Vanderbilt, MSN, RN, CNS, ANP-BC, co-leads the program with Debra Kangisser, PA-C. Together, Vanderbilt and Kangisser build and develop all onboarding curricula and handle the day-to-day program operations. Their roles are instrumental to the program’s success.

Q: What differentiates Cleveland Clinic’s APRN/PA onboarding program from other similar programs?

A: The biggest differentiator is that our program is not a true fellowship. Cleveland Clinic’s Transition to Practice participants are Cleveland Clinic caregivers who have already been hired into their positions. With many of the other APRN/PA onboarding programs we’ve seen, participants aren’t actually employees of the organization, but rather “fellows” or trainees.

Q: What is one of the greatest benefits you’ve seen with Cleveland Clinic’s Transition to Practice program?

A: One of the most significant benefits or advantages I’ve noticed is that the program is fostering improved communication between advanced practice providers and physicians. Not only does this positively impact team care models, the frequent and meaningful feedback our new graduate APRNs and PAs receive from physician colleagues is invaluable to their professional growth and confidence.

Have questions or comments? Feel free to contact Foxx for more information or insight on Cleveland Clinic’s Transition to Practice onboarding program or watch the below video:

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