The impact of a structured onboarding program for newly hired nurse practitioners and physician assistants.

BACKGROUND: The return on investment for onboarding programs and their effect on attrition and engagement within health systems across the United States are unclear. LOCAL PROBLEM: The existing onboarding program for nurse practitioners (NPs) and physician assistants (PAs) at a hospital on the west coast was varied and lacked a clinician focus. A structured onboarding program was created to standardize their entry to our workforce. METHODS: A needs assessment was completed with a stakeholder focus group, for which an onboarding curriculum was then created. Participants completed presurveys/postsurveys during the data collection period as the primary outcome. A Plan-Do-Study-Act approach was used to revise session content and improve participant experience. Onboarding costs and attrition were tracked as secondary outcomes. INTERVENTIONS: From July 2017 through June 2019, newly hired NPs and PAs were invited to participate in the program. Six quarterly cohorts attended five in-person 2-hour onboarding sessions over 12 months. RESULTS: One hundred twenty-nine eligible NPs and PAs completed an anonymous pre/post Qualtrics survey. The aggregate responses were significantly improved using Fisher exact test. Measured onboarding value was not significantly changed. Mean pre-onboarding attrition was 10.3% compared with 4.5% for onboarding participants. The annual cost for onboarding participants was $63,470 versus $256,826 as the estimated mean cost of one separation within their first year. CONCLUSIONS: Workforce engagement, standardized knowledge, and participant attrition revealed an improving trend with this structured onboarding program. The investment to formalize onboarding newly hired NPs and PAs was modest, and the findings suggest that an onboarding program has financial and engagement merit.

Solid pseudopapillary neoplasm of the pancreas head in a pregnant woman: safe pancreaticoduodenectomy postpartum.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare and typically arise in young women. The optimal management of a pregnant woman suspected of having an SPN of the pancreas head is unclear. We report such a case where close monitoring for tumor growth was done during pregnancy and a successful pancreaticoduodenectomy was performed after term delivery.

What patients with abdominal pain expect about pain relief in the emergency department.

INTRODUCTION: Abdominal pain is the leading cause of patient visits to the emergency department. Although patients present to the emergency department in search of relief from pain, few experience complete pain relief. The purpose of this study was to describe patients' expectations for pain relief and how communication of their pain to nurses and physicians affected their overall pain relief. METHODS: Questionnaires were completed by patients who reported abdominal pain and by their primary nurse and physician. Numeric rating scales were used to rate pain intensity from 0 (no pain) to 10 (worst possible pain) and actual and expected pain relief (0 = no pain relief, 10 = complete relief). RESULTS: Forty-four percent of patients reported that they expected complete relief of their abdominal pain. Over 98% of the patients told a provider that they were in pain, but only 33.3% asked for pain medication. No significant differences were found between the patients who asked for pain medication and those who did not in patients' expectation scores or relief scores. DISCUSSION: The results of this study showed that patients with abdominal pain have high expectations for pain relief; however, their expectations were not associated with their tendency to ask for pain medication or report actual relief of pain.