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  • 1.  Nurse Practitioners in Primary Care

    Posted 07-26-2023 14:30

    We have a new nurse practitioner in a one year NP residency program.  We are trying to determine what a reasonable target patient volume goal would be for her in a traditional primary care practice.  Does anyone have information or any suggestion on where I can find information?

    Thank you



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    Kimberly Von Haden, BSN, RN
    Director, Clinical Operations
    Eisenhower Health
    Rancho Mirage, CA
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  • 2.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 07:54

    I have no data to cite, but our organization has determined that an NP can co-manage ~700 patients . In our model a physician practice may add an NP when it reaches 1400 (physician panel target), then for each 700 additional patients they may add additional NPs. One our physicians has a practice with three NPs, but he works in a rural area. I'm not sure if this is the type of feedback you were looking for, but I hope it helps. 

    Toni



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    Toni Wendling MSN, RN
    Manager, Informatics
    Stormont Vail Health
    Topeka KS
    (785)354-5189
    twendlin@stormontvail.orgInformatics Manager
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  • 3.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 12:06

    Hi Toni

    Thank you for the information, this is helpful.  We are looking at the co-manage model for our busier practices.

    Have a great day

    Kim



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    Kimberly Von Haden, BSN, RN
    Director, Clinical Operations
    Eisenhower Health
    Rancho Mirage, CA
    ------------------------------



  • 4.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 08:20

    The Community Health Center and its associated Weitzman Institute may be a good contact for you, Kimberly. Here is a link to their main site and there is a tab for the NP Residency program with contact information there. https://www.chc1.com/

    The Medical Group Managers Association is another good resource for practice operations information.

    Thank you for what you are doing to help that new NP be successful. So often the experience for new APPs is more like being thrown into the deep end of the pool without any floaties.



    ------------------------------
    Leslie McDowell ANP-BC, DNP, RN
    QI Specialist / Curriculum Developer
    Northwest AHEC / Wake Forest University School of Medicine
    Winston Salem NC
    (336)972-7852
    ANP-BC, DNP, RN
    ------------------------------



  • 5.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 10:55

    Yes! I am the CNO at Community Health Center, Inc., cited above. I precept for the residency and have since the first year we had it back in 2007. 

    Here is the link to our book, which is basically a how-to in terms of post-graduate training for NPs:

    https://www.weitzmaninstitute.org/wp-content/uploads/2022/02/NPResidencyBook.pdf

    We use a progressive ramp-up throughout the first year, during their 2 precepted days, which moves to 3 precepted days by the end to make sure the model breaks even. 

    Hope this resource is helpful!

    Mary

    mary@chc1.com



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    Mary Blankson DNP APRN FNP-C FAAN
    Chief Nursing Officer
    Community Health Center, Inc.
    Middletown CT
    (860)227-5432
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  • 6.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 12:07

    Hi Mary

    Great resource, thank you for sharing with me.  

    Have a great day.

    Kim



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    Kimberly Von Haden, BSN, RN
    Director, Clinical Operations
    Eisenhower Health
    Rancho Mirage, CA
    ------------------------------



  • 7.  RE: Nurse Practitioners in Primary Care

    Posted 07-27-2023 12:04

    Hi Leslie

    This is very helpful information, thank you so much. We want our NP's be successful and not feel like they are drowning, they add so much value to our practices.

    Have a great day

    Kim



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    Kimberly Von Haden, BSN, RN
    Director, Clinical Operations
    Eisenhower Health
    Rancho Mirage, CA
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  • 8.  RE: Nurse Practitioners in Primary Care

    Posted 07-29-2023 08:28
    I cannot directly answer your question as residency programs are something I do not have direct experience with. Over many years of my own experience with new employment and watching the experience of other new NPs in the ambulatory setting (non-residency focus)  the employer expectation is for the NP to be ready to assume the role and duties of the position. With that being said ...

    Without a residency program or "adjuvant funding" for new NP hire on-boarding; 

    The scheduling is scaffolded during the onboarding during the first 90-days of employment
    Day 1-2, shadowing other providers (up to the end of the first week, (this introduces patient to the new provider and allows the provider to be aware of patient background for if and when the new provider takes over the follow up encounter(s).  
    End of week one (or start of week two): 1 to 2 patients a day while doing other educational mandates; 
    week two/three,  3 to 5 patients with ½ day shadowing and or education as needed, 
    week three/four, (repeat of week two), 3 to 5 patients with ½ day shadowing as needed or increase to 6 to 8 patients a day; 
    week five, 6 to 8 patient per day (aware that they can stop and ask other providers questions, as needed; 
    week six, 10 to 12 patients per day
    week six/seven, gradual increase to full capacity throughout weeks 8 to 12 per NP competency and departmental budget.

    Ideally, the new hire should be up to full capacity before the end of the 90-day (12 weeks) probationary period. 
    Keep in mind: ROI -- the NP success in ambulatory care is directly correlated to clinical encounter workload. 

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 


    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].





  • 9.  RE: Nurse Practitioners in Primary Care

    Posted 09-28-2023 21:50

    Within the Veteran's Health Administration we have Nurse Practitioners within Primary Care at a panel size of approximately 900 patients. We follow the Patient Centered Medial Home (PCMH) or PACT as we call it which has ancillary support staff of a RN, LPN and Medical Clerk who oversee that panel of patients collaboratively as a team. Each Nurse Practitioner has full practice authority in our system but has a collaborating MD/DO available for complex case reviews, questions and/or mentoring needs. We encourage a slow ramp up period during the first 90 days to ensure all of the onboarding training is completed.  This means starting with 1 patient in the am, 1 in the pm for the first week and then ramping up to 2 patients in the am and 2 in the pm for the next week etc until full ramp up is achieved. We do suggest checking in on progress every couple weeks to ensure questions are answered and a mentor is assisting or helping new team members. In completing a Literature Review on this topic these are some article resources I found: Nurse practitioner caseload in primary health care: Scoping review - PubMed (nih.gov), Nurse practitioner caseload in primary health care: Scoping review - ScienceDirect, Clinical productivity of primary care nurse practitioners in ambulatory settings - ScienceDirect



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    Jami Falk MS RN-BSN CNML
    VHA OPC PCMO Chief Nurse
    VHA
    Bismarck ND
    (701)367-5431
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