Redefining Recruitment to Retention

Transforming Recruitment and Onboarding for Ambulatory APPs – An Interview with Allison Dimsdale

Article Provided By: NPNow

After attending the AAPPR conference in Orlando last month, and a few of our NP Now representatives were very impressed with Allison Dimsdale’s discussion on the topic, “Transforming Recruitment and Onboarding for Ambulatory APPs ” We were fortunate to be able to have an interview with her in order to further learn from her expertise.

Allison Dimsdale, DNP, NP-C, AACC, FAANP is the Associate Vice President for Advanced Practice for the Private Diagnostic Clinic at Duke University Health System.  Her clinical practice is as a Board-Certified Nurse Practitioner in the Department of Medicine-Division of Cardiology, where she specializes in the treatment of heart failure, acute coronary syndromes and primary prevention of coronary heart disease.  Her third appointment is as Clinical Associate in the Duke University School of Nursing where she lectures to graduate students in the areas of professional practice and cardiology and serves as content expert on student doctoral committees.  She is an Investigator on clinical trials through the Duke Clinical Research Institute and is an active participant in nursing research initiatives through the Duke Translational Nursing Institute focusing on implementation science.  She has an interest in creative nursing education and mentorship, as well as the leadership interface between systems of care, provider utilization, access to care and excellent patient outcomes.  In her role as Associate Vice President of Advanced Practice at Duke, she is responsible for leading the effort to facilitate Nurse Practitioners and Physician Assistants to work to their full scope of practice by implementing ambulatory practice redesign with the aim to increase patient access to high quality, safe and cost-effective care.

Allison sustains active memberships in the American Association of Nurse Practitioners, American Heart Association, American College of Cardiology, American Nurses Association, and the North Carolina Nurses Association.  She is a peer reviewer for Elsevier Publishing, and has been published in several nursing and medical publications including Circulation.  She serves on a variety of community task forces and boards and was a Fellow in the 2016 AANP Leadership Program.  She holds the Associate of the American College of Cardiology recognition and is a Fellow of the American Association of Nurse Practitioners.

She earned her Doctor of Nursing Practice (DNP) and Master of Science (MSN) degrees from Duke University, and her undergraduate degree from the University of Texas.

1. Why you decided to speak on the topic, “Transforming Recruitment and Onboarding for Ambulatory APPs”?

I have 21 years of experience as both a critical care Registered Nurse, and then a Nurse Practitioner in Cardiovascular Medicine at a large academic medical center.  My doctoral work led me to a leadership role where I found myself designing and establishing best practices to design interprofessional teams to provide specialty care.  This in turn, defined the need to create a structure to recruit, hire and retain Nurse Practitioners (NP) and Physician Assistants (PA) in ambulatory specialty practice.  I am fortunate to be given abundant support and resources at Duke and was able to share my dream with Donna Ecclestone, FASPR, who quickly joined me to change our institutional culture, and to reframe how we bring Advanced Practice Providers (APPs) into our organization, and subsequently utilize their skills to provide increased patient access to high quality, high value patient care.  This was a new concept for us and then led to the need to reframe and redefine our care delivery systems.

As APPs are now being asked to work as independent providers of care, their onboarding has become far more complex and important.  As we all know, if a detail is missed around billing, or patient scheduling, or certification/credentialing – it becomes a work stoppage issue and thus a patient care issue.  Reframing the way we do things and deploy APPs was the only way to create an Advanced Practice organization that provided professionalism and attention to detail in terms of hiring the right provider for the right position at the right time to take care of the right patient.  That’s a mouthful, but it truly does define our goals.  When an excellent interprofessional team is formed intentionally, everyone wins and the entire group can look forward to a long and fruitful collaboration in order to deliver the highest quality patient-based care.

The process of creating our Advanced Practice Office (which includes professional APP recruiters, HR and onboarding or integration) is one that we have defined and created along the journey.  We saw the need as outlined above to create structure and advocacy for APPs, and to create intentional teams where APPs would be working to the top of their scope.  We started with a strategic hire program, where in a small way we brought APPs into a funded subvention program for their first year of practice.  These providers were carefully supported through the onboarding process, and gradually other practices around our enterprise started asking for our help in designing new practices as well as the recruiting and onboarding process.  In order to meet those needs, our office expanded, and Donna developed tools for onboarding (referenced online checklists).  We were able to combine with our Provider Recruitment team, which was important because in our state the nuances of NP and PA practice are unique yet important.

Today, our Advanced Practice Office offers practice consulting, recruiting, hiring, onboarding, practice metrics/data, transition to practice Fellowships, and regulatory oversight for almost 500 ambulatory specialty APPs.  We continue to learn and grow and believe that APPs and their MD colleagues and practice administrators are better prepared for practice due to the professionalism, energy and enthusiasm of our office.

2. What are your 3 biggest takeaways regarding your discussion on “Transforming Recruitment and Onboarding for Ambulatory APPs” that recruiters can easily implement? If they implement these 3 takeaways, what is the biggest benefit that they will see?

It is very important for recruiters to understand the professional landscape for Advanced Practice Providers.  Although an NP was first a Registered Nurse, as an NP they are practicing medicine from the nursing perspective.  This makes their practice wellness based and generally very holistic.  A PA has never been a nurse, and they are trained to do the same work from a biomedical perspective.  Once in practice for a few years and depending on the nuances of state laws (which are ever changing), their practices may look very similar.  APPs are in high demand all around the country, and they will be attracted to an organization that from day one treats them as a professional.  The communication, interviews, and hiring process is best done in a way that mirrors that of their physician colleagues.  This will attract highly qualified candidates who can be assured that they will be treated professionally in your organization.

The difference between administrative onboarding and clinical onboarding is important.  The introduction to the clinical practice is imperative to develop trust between the physician and the APP, and that trust must be bi-directional.  A clinical liaison or access coordinator within the practice can be very helpful in designing a practice model and a patient flow that makes sense for the patient population.  For instance, will the APP work alongside the physician and manage their non-direct patient care duties, or will they see patients independently in a proscribed visit flow (either manage their own patient panel, or see patients in combination)?  Will they augment the MD work by providing a procedure clinic, acute clinic or rounding services?  When these things are left to chance or are not well defined, misunderstandings happen easily, and practices are not well optimized.  This may lead to increased turnover and attrition, which is expensive and demoralizing for the practice.

Advanced Practice Providers should always work to the top of their scope, training and licensure.  Sometimes the answer to the need to grow a clinic is an excellent nurse rather than an APP who is trained and licensed to assess, diagnose, treat and prescribe. Avoiding competition between MD and APP for RVUs or patients, such as in the case of a productivity incentive, is imperative.  The group should function as a team without such distraction or competition – in this way they can provide the highest quality, highest value patient care.

3. What is the biggest mistake you see recruiters making within this topic?

Recruiters should be sure they are posting a specific and relevant position description.  APPs are increasingly trained as specialty providers, and don’t want to waste time applying for a position that is ill defined or lacks enough detail to determine a good fit.  APPs should be treated and deployed as providers rather than as nurses for both job satisfaction and access to care.  A good relationship with their recruiter and onboarder, and then with their clinical team can set the stage for a long and fruitful tenure in an academic medical center.

Interviewed by Dorothy Blalock, Director of Brand Management at NP Now