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Program Eases Advanced Practice Nurses into New Roles

Ensuring a consistent onboarding experience


Advanced practice registered nurses (APRNs) are at the forefront of preventive and primary care. At Cleveland Clinic and medical centers across the nation there is an influx in positions available and in new graduate APRNs ready for new work. Today, more than 1,700 APRNs care for patients across the Cleveland Clinic health system.


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As the need for APRN providers explodes, so too does the need for quality onboarding, says Anne Vanderbilt, MSN, APRN, Director of Advanced Practice Nursing at Cleveland Clinic.

“New-hire APRNs are already certified and credentialed to practice fully,” says Vanderbilt. “But a large majority of them — 65 percent of those at Cleveland Clinic — are new graduates. We want to support their transition from academia into practice and prepare them to thrive here long-term.”

To ensure the highest quality of care and maximize productivity sooner, Vanderbilt and a team have started a systemized onboarding training program called “Transition to Practice” (TTP) for new-grad APRNs. The program also includes physician assistants (PAs) who fill similar roles throughout Cleveland Clinic.

Easing into autonomy

No matter the Cleveland Clinic institute or department, all APRNs/PAs will eventually participate in a one-year TTP program. Today, caregivers in primary care departments spend four days a week alongside another provider during the first three months after hire. The provider dyad may start off by seeing patients together and gradually transition to seeing patients independently and verifying findings with each other. On the fifth day of each week, participants attend lectures, discuss case studies and have extra time to learn billing and documentation practices in a nonclinical setting.

“Our new-hire APRNs are not autonomous right away,” says Vanderbilt. “That’s a big change for some institutes. We expect everyone to front-load APRN training.”


Transition to Practice is modeled after other accreditation programming from the Accreditation Council for Graduate Medical Education and the American Nurses Credentialing Center. New hires gradually increase autonomous practice after the first three months, but continue four to eight hours of nonclinical training per week.

Throughout the program, new APRNs receive frequent and detailed evaluations so they can continue to advance their skills and knowledge. During their second six months, nonclinical training is reduced to eight hours or less per month, and participants are asked to explore a subject of interest for a professional development project, to be submitted at the end of the yearlong program.

Ensuring a consistent onboarding experience

In July 2017, Cleveland Clinic Wooster Family Health and Surgery Center was the first to launch the TTP program. The first cohort included three APRNs in a primary care clinic. They’re using a customized McGraw-Hill SmartBook® interactive learning platform to master Cleveland Clinic care paths for 47 clinical conditions in nine specialty areas.

New APRN Julie Podlogar says the TTP program is one of the main reasons she came to work at Cleveland Clinic Wooster. After 25 years as an inpatient nurse at a smaller hospital, she went back to school at Kent State University in 2014 to get her APN degree. “I learned so much in school, but when you’re clinically practicing as an APRN, it’s so different. I’m also new to outpatient nursing and the stressors are different than when you are practicing as part of a team on a hospital unit, where other providers make decisions. This program gives us good support. I really like the pace of it and getting to see different specialties.”

Additional cohorts throughout the health system began in fall 2017, including specialty tracks in general surgery and acute care. Task forces, predominantly composed of experienced advanced practice providers, are designing curriculum and guiding implementation of the program. An oncology track launched in spring 2018.

“At Cleveland Clinic, education is part of our mission, says Vanderbilt. “This curriculum is designed to help transition new APRNs into highly functional practitioners and ultimately ensure high reliability in our patient care. We believe this will also lead to more satisfied long-term employees.”

Currently, per the National Council of State Boards of Nursing, there are more than 267,000 APRNs in the United States. APRNs include:

  • Nurse practitioners
  • Clinical nurse specialists
  • Nurse anesthetists
  • Nurse midwives

Measuring care

In many research studies, patients experienced equivalent outcomes when they received primary care from APRNs, compared to physicians. And patient satisfaction scores tended to be equal or higher with APRNs. The cost of APRN care is often lower than the cost of physician care.


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