Advanced Practice Provider Orientation
Monroe Carell Jr.
Children’s Hospital at Vanderbilt
Ambulatory Care
NEW ADVANCED PRACTICE PROVIDER NAME:
FIRST DAY OF EMPLOYMENT:
Checklist for Advanced Practice Provider Orientation
General Objectives Date/ NotesDAY 1:
Attend You Make a Difference orientation from Human Resources (alternating locations listed on website) - http://hr.vanderbilt.edu/training/newstafforientation.htm
Documents to bring to Orientation: http://hr.vanderbilt.edu/training/newstafforientation.htm (includes orientation parking details); documents to bring on first day: IDs for I-9 form (one document from List A or a document from List B and a document from List C, provided at http://hr.vanderbilt.edu/i9/documents/
AuthorizationDocuments.pdf); direct deposit materials (voided check for a checking account, deposit slip for a savings account); copies of immunization records (information provided at http://occupationalhealth.vanderbilt.edu/occupational-health-clinic/article/new-employee-evaluation)
Benefits: http://hr.vanderbilt.edu/forms/documents/AAG-Staff.2009-FormsDocs.pdf (requires VUnetID to access, can be saved or printed)
Complete employment paperwork (I-9, W-4, New Employee Information, Direct Deposit) – may be completed at You Make a Difference
Obtain ID card from Medical Center Card Office in D-2107 MCN (requires signed ID Card Authorization form) - http://hr.vanderbilt.edu/hrdepts/vumccardoffice.htm Your initial ID badge will be an RN badge or equivalent, as you are in provisional status until credentialed as an advanced practice provider.
Sign up for parking permit at Parking Facilities Office in East Garage – information for new staff at http://www.mc.vanderbilt.edu/root/vumc.php?
site=medcenterparking&doc=20074
DAY 2:
Attend Hearts and Minds VUMC orientation from the Learning Center (S-2435 MCN, Round Wing ground floor) - http://www.vanderbiltlearningcenter.org/?id=96
Complete Conflict of Interest disclosure (either at orientation or online) - https://webapp-a.mis.vanderbilt.edu/coi
DAYS 3-5:
Attend APN Orientation: Occurs monthly following You Make a Difference and Hearts and Minds
2011 dates: March 9-11; April 6-8; May 4-6; June 8-10; July 13-15; August 10-12; Sept. 14-16; Oct 12-14; Nov 9-11; Dec 14-16
Become familiar with phone system, voicemail, - http://its.vanderbilt.edu/voice
Become familiar with how to resolve computer issues through the Help Desk www.mc.vanderbilt.edu/infocntr/helpdesk/
Activate VUnetID - www.vanderbilt.edu/epassword
Review shuttle map and boarding locations - www.mc.vanderbilt.edu/root/pdfs/vumctraffic/SHUTTLEMAP.pdf
Locate Connect to Human Resources (C2HR) website to review demographics, pay info, etc. – https://webapp-a.mis.vanderbilt.edu/c2hr
Become familiar with Vanderbilt’s faculty/staff discount program – http://hr.vanderbilt.edu/benefits/perqs.htm
Learn about payroll and the payroll schedule – http://hr.vanderbilt.edu/
compensation/VanderbiltUniversityHumanResources.htm
Learn about Interpreter Services – http://www.vanderbilthealth.com/main/14548
Meet with Employee Relations Representative for area about:
HR policies
FMLA and other types of leave
Grievance process
Performance Improvement Counseling
HIPAA and privacy compliance
Webinservice: http://www.webinservice.com/vanderbilt/login50
Privacy Office: www.mc.vanderbilt.edu/root/vumc.php?site=hipaaprivacy
Meet with Health and Wellness about available services
Work/Life Connections-EAP: Drug-free and violence-free workplace policy, crisis intervention, wellness programs
Schedule systems training classes:
http://www.etraining.mc.vanderbilt.edu
StarPanel
HEO/WIZ
Learn about online training resources
Review key HR policies: http://hr.vanderbilt.edu/policies
Online safety training: www.vandysafe.com
Online compliance training: www.webinservice.com/vanderbilt/login50
Learning Center: www.vanderbiltlearningcenter.org
Human Resources: http://hr.vanderbilt.edu/training/workshoplist.htm
Identify clinical leaders and administrators within VCH and Department
Review AIDET, HEART and credo behaviors
Review SBAR communication
Schedule MCJCHV FOCUS training http://www.childrenshospital.vanderbilt.org/interior.php?mid=7761
2011 dates: March 17, June 16, Sept 15, Dec 15th; 1-4pm in VCH Theater
Advanced Practice Provider Objectives
Find out who the nursing managers are in your area and introduce yourself. Developing a strong working relationship with nursing management and the nurses in your area is vital to patient care and successful outcomes. If you ever have nursing questions or concerns, please communicate with the nursing management directly.
Complete and Submit the “One Packet” – Initial Credentialing Application. This information provides the basis which Provider Support Services begins the verification process which takes approximately 90 days. The One Packet is issued by Provider Support Services only upon request of the Assistant Director with the receipt of a One Packet (initial) Request Form. Administrators/Assistant Directors can contact PSS directly for a One Packet Request Form (to be available electronically in the future). A supervising physician must be identified prior to issuing a One Packet. Protocols and Delineation of Privileges must be near completion prior to release of the One Packet. The One Packet must be completed by the provider and returned to Provider Support Services together with the following supporting documents:
· Copy of Master’s Level Diploma
· Copy of original and current RN and APN license
· Copy of Board Certification
· Copy of Advance Practice Training Certificates
· Curriculum Vitae
· Copy of US Govt photo ID (driver’s license)
· Copy of Social Security Card
· Copy of ACLS, BLS cards
· Copy of DEA certificate-- http://www.deadiversion.usdoj.gov/drugreg/reg_apps/onlineforms_new.htm
· Copy of Notice and Formulary signed by Supervising MD -- http://www2.state.tn.us/health/Downloads/g6014278.pdf
· Copy of letter assigning NPI - https://nppes.cms.hhs.gov/
· Completed Protocol Signature Sheet
· Copies of 3 professional peer references
Schedule One Packet Appointment/Overview – The APP must schedule a meeting with Assistant Director of Advanced Practice or CAPNAH Administrator to review the delineation of privileges, notice and formulary, rules and regulations, the development of protocols and the credentialing/One Packet process.
FOR BILLING PROVIDERS:
Faculty Offer Letter– This letter outlines your terms and agreement of employment. Please sign and return the signed offer letter within 14 days of receipt.
Faculty Appointment Letter– A Faculty Appointment letter is generated by the School of Nursing or School of Medicine (based on your department) upon receipt of your signed offer letter. A Faculty Appointment for Advanced Practice Providers is mandatory for all billing providers as set forth in the Medical Center By-Laws.
· When you require a faculty appointment letter from the School of Medicine, you will need to submit an updated CV and 3 reference letters, along with your offer letter. Your Assistant Director/Administrator will also submit an Affirmative Action Form.
· When you require a faculty appointment letter from the School of Nursing an email needs to be sent by your Administrator/Asst. Director to Dr. Bonnie Pilon and copy Carolyn Arakelian with the following information:
• the APN’s name as it appears on licensure
• start/end* date *if applicable
• Salary source
•FTE information
• Attach an electronic copy of the APN’s CV
Send Carolyn the following back up documents:
• RN/APN license
• DEA certificate
• Board Certification
• Copies of educational certificates
• Original nursing academic transcripts that correspond to educational certificates
• CPR certification
Submit Billing Application. The Assistant Director or Finance Officer is to complete a Billing Application. The billing application must include the following: specific salary source information, job code, cost center numbers. It must be signed by the Department Chair. The completed billing application form is then forwarded to CAPNAH for approval. The billing application form MUST be accompanied by a copy of the Faculty Appointment Letter. Forms may be emailed to: or faxed to 615-343-8646.
Receive Billing Approval. CAPNAH is obligated to confirm the salary source cost center numbers. The billing application is sent for vote to the Billing Committee. Once voted upon and approved by the Committee, the information is then forwarded to Provider Support Services, Epic and Payer Enrollment.
Review the Center for Advanced Practice Nursing and Allied Health website. Here you will find important information for Advanced Practice Providers, resource links, educational events, samples of credentialing forms including the “One Packet” and further orientation information -- http://www.mc.vanderbilt.edu/root/vumc.php?site=CAPNAH
Review the Tennessee Board of Nursing Rules and Regulations for Advanced Practice Nursing. The BON rules are more specific to prescriptive prerequisites and the management of pain.
http://www.state.tn.us/sos/rules/1000/1000-04.20100620.pdf
Review the Tennessee Board of Medical Examiners Rules and Regulations for Advanced Practice Providers. The BME rules mandate a supervising physician and the use of written guidelines for patient management. They stipulate a minimum of 20% chart review by the supervising physician. http://tennessee.gov/sos/rules/0880/0880-06.pdf
Review the VUMC Medical Staff Bylaws, Rules and Regulations, Policies and Procedures, and Nursing Bylaws paying particular attention to Advanced Practice Provider guidelines. -- https://mcapps.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/F5A41DF5B2744EC5862577A4005FB159
Review and/or develop your clinical practice protocols –
· Protocols are mandated by the Tennessee Board of Medical Examiners (Chapter 0880-6.02, Tennessee Board of Medical Examiners Rules and Regulations)
· A protocol is defined as a written guideline for the medical management of a patient’s condition.
· Protocols should be jointly developed and approved by the supervising physician and advanced practice provider.
· Protocols should account for all protocol drugs by appropriate formulary.
· Protocols should be dated and signed.
· Copies of approved protocols must be maintained at the practice site and available for inspection.
· Protocols must be reviewed and/or revised every two years.
· If developing new protocols, you may utilize the protocol development template located on CAPNAH website.
· Protocols can be submitted electronically to CAPNAH for approval.
· Ideally, electronic copies are maintained by Provider Support Services.
It is acceptable to adopt existing protocols within the same department or division
Review your Delineation of Privileges, the list of Domains and Core Competencies for Nurse Practitioners
Discuss and review with your preceptor and supervising MD the Advanced Practice Procedures which you will be performing in your area.
· Each procedure must have an approved protocol and checklist for performance.
· The advanced practice provider must request specific privileges to perform advanced procedures independently. The applicant is required to maintain a procedural log as evidence of performance.
· The supervising MD and preceptor observing the applicant performing the procedure must attest that the applicant is competent to perform the procedure independently.
· Once an applicant has successfully performed the required amount of procedures under supervision, the application for Advanced Practice Procedures is completed and submitted to Provider Support Services for review.
· Refer to the CAPNAH website to view a sample Application for Special Privileges with the list of approved advanced practice procedures, number required to apply for initial privileging and number of procedures required annually to maintain competency. -- http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Advanced%20Procedures_VUH_2010-07-09-SAMPLE.pdf
· You will receive a letter of confirmation of privileges once been approved
Presentation of your file at Joint Practice Credentialing Committee. This peer review committee reviews all completed credentials files for advanced practice providers and makes recommendations for approval. The Committee meets monthly.
Presentation of your file at MCJCHV Credentialing Committee. This peer review committee of physicians and APRNs reviews all completed credentials files for providers at VCH and makes recommendations for approval. The Committee meets monthly.
Presentation of your file at Medical Center Medical Credentialing Committee. Recommendations for the Joint Practice Committee are taken to the Children’s Hospital Credentials Committee if applicable and then to the Medical Center Credentialing Committee. The Committee meets monthly.
Receive Letter of Notice. Once all committees and the Board of Trust have approved the requested privileges, a letter of Notice is sent to the advanced practice provider applicant.
REMEMBER: AP Providers must be directly supervised until credentialed
Obtain your Advanced Practice Provider ID Badge. Credentialed advanced practice nurses must obtain a navy blue identification card from the ID card office. Format hint: First line: Name, highest degree followed by board certification; Second line: Title (i.e. Assistant in … or Nurse Practitioner) Third line: Division/Department
Review the Advanced Practice Provider Professional Performance Evaluation Process / Policy:
· Ongoing Evaluation (OPPE)– Continuous monitoring of maintenance of licensure/certification, compliance with VUMC training modules, charting, productivity, outcome measures and 6-8 month evaluation of competency in the seven core competency domains of APRN practice. The process will involve electronic review, 360 review from advanced practice and physician colleagues, nursing and other team members and administrative personnel. .
· Focused Evaluation (FPPE) – Completed initially during the providers “orientation” period (first 6 months of employment) and at future times when a period of evaluation is needed to confirm or improve competence in specific areas. Always completed 6 months after new hire and when applying for new privileges. Can be triggered from an ongoing evaluation or if other concerns arise regarding practitioner’s competence. The process can involve electronic review, simulation, monitoring of clinical practice patterns, discussion with any or all of the following: supervising MD, consulting MDs, administrative personnel, nursing and peers.
Obtain a list of regularly occurring educational opportunities within department (i.e. grand rounds, M&Ms, lectures, etc.)
Practice utilization of EMR (Star Panel): Finding labs, reports, note templates, saving documents to a file, amending notes, accessing sign out tool/team summary, etc. Sign up for additional training if needed.
*Reminder that while in provisional status, all orientee notes must be reviewed by the preceptor and a statement must be made on the document that the preceptor has reviewed and approved the document.
Practice utilization of other electronic software applicable to your practice area (i.e. IMPAX, KM Portfolio, Quill, etc.). Seek additional training if needed.
Review your area’s requirements for and method of documentation (i.e. History and Physical, Progress Note, Discharge Summary)
Review your area’s admission and discharge process. Reminder that all admission and discharge documentation notes must be countersigned by the supervising physician or physician designee within 24 hours.
Review your department orientation manual and checklist. Review any unit specific orientation items and attend orientation classes as applicable.
Review the Orientation Evaluation tool, as applicable to your area – Ambulatory, Acute or Critical Care. This tool is completed both midway and at the end of orientation to customize your orientation to your learning needs ; It also serves as the initial portion of FPPE here at MCJCHV and VUMC.
Other Contact Information:
Name / Phone / EmailCenter for Advanced Practice Nursing and Allied Health -- CAPNAH / 322-4664
Provider Support Services / 322-3573
Suzanne Staebler, Asst Director Adv Practice / 875-1103 (office) /
Suz Kaprich, Director of Nursing, CHOC
Nursing Leadership:
Part 2 of Orientation – Evaluation
VCH Advanced Practice Ambulatory Care – FPPE Evaluation Tool
Definition of Ratings
N/A: Not applicable. No opportunity or insufficient experience for evaluation.
(1): Below expected skill level: Consistently requires substantial assistance or supervision to perform task adequately.