Training Plan for New ICu app's

For the next 6 months you will be trained to work in ICU as an advanced practice provider. The following is a list of expectations and objectives with a time frame to help focus your training. 

Month 1

Begin working with an assigned preceptor in ICU and focus on the following

- A common ICU diagnosis check list will be provided along with learning references for each diagnosis. Begin to understand the pathophysiology, guidelines, and treatment of the diagnoses listed. 

- Begin to learn our charting system. For the first month, 2-3 patients will be assigned to you daily. Your preceptor will assist you with charting, management, and decision making for these patients. Orders will be discussed together, but should be entered by the orientee.

- You may watch procedures as they take place and attempt them with close assistance as time allows. For the first month especially, procedures should be a low priority as time may be better spent becoming familiar with the disease processes you are being exposed to.

Procedures can be practiced with open kits, use of US on IV gel pad. 

- You are expected to attend rounds, but participation is not expected for the first month. 

- Questions from staff and communicating with other providers will be completed by the preceptor at this point. 

Month 2 

- You should start to slowly check diagnoses off of your ICU check list as you become comfortable with each diagnosis. Checking off should include a discussion with your preceptor and only be completed after learning materials have been completed. 

- Continue to start the day with 2-3 patients and complete charting with your preceptor's assistance. Decision making will continue to be shared, but as you become more comfortable with the issues encountered, your preceptor will be asking your opinion prior to coming up with solutions. You will also start admitting patients as time allows, generally 1 new patient daily. 

- Start to participate in procedures with guidance from your preceptor. All procedures should be logged for credentialing purposes. 

- Continue to attend rounds and, if able, start to participate (but not lead) rounds on the 2-3 patients you are assigned to in the morning. Ask questions during rounds and continue to get preceptor and physician guidance. 

- Communication with staff and other providers will mostly be provided by your preceptor. You may be asked to come up with your own solutions to questions, but the communication component and final decision is still the preceptor's responsibility. 

- You will undergo a 2 month review of your progress.  This will be scheduled at least a week ahead of time and will include feedback from your preceptors and attending physicians. 

Month 3

- Continue to check diagnoses off your check list. You should have at least 1/4 of your list checked off by the end of month 3. Again, checking off completed work should be discussed with your preceptor. 

- Start the day with 3-4 assigned patients and expect to be admitting at least 1 new patient daily. Decision making is still shared at this point, but the initial plan should start to be generated by the orientee. 

- Orientee will be expected to do any procedures available with preceptor assistance. Please continue to log these for credentialing purposes. 

- Plan to lead rounds on at least one of your patients each morning. 

- Start answering questions from staff with preceptor approval for your plan of action. Communication with other providers should be happening by the end of month 3, but will continue to be your preceptor's responsibility. 

- You will undergo a 3 month review of your progress.  This will be scheduled at least a week ahead of time and will include feedback from your preceptors and attending physicians. 

Month 4

- Continue to check diagnoses off of your check list. You should have at least 1/2 of your list checked off by the end of month 4. Checking off completed work should be discussed with your preceptor. 

- Start the day with 4-5 patients and expect to admit at least 1 new patient daily. Decision making should be developed by the orientee with fine tuning completed by the preceptor. This month, the expectation is that more than half of the management for simple ICU patients is completed by the orientee. As always, your preceptor is still there to help and fine tune patient care management. 

- Orientee will continue to be expected to do any procedures available with preceptor assistance. Please continue to log these for credentialing purposes. 

- You will be leading rounds on your patients this month. Charting does not need to be completed prior to rounds, but a thought out plan should be in place and voiced during rounds. 

- You are expected to answer any questions from staff. You should still get preceptor approval for your plan of action. Communication with other providers should start to take place by the end of the month. This includes communicating with other specialties and calling report to providers outside of the ICU. 

- You will undergo a 4 month review of your progress.  This will be scheduled at least a week ahead of time and will include feedback from your preceptors and attending physicians. 

Month 5

- Continue to check diagnoses off of your check list. You should have at least 3/4 of your list checked off by the end of month 5. Checking off completed work should be discussed with your preceptor. 

- Start the day with 4-5 patients and expect to admit at 1-2 new patient daily. Decision making should be developed by the orientee with fine tuning completed by the preceptor. Your preceptor will continue to be available for questions and to ensure there is an appropriate plan of care, but the orientee should be making more decisions by the end of this month and confident in their plan choices. 

- Orientee will continue to be expected to do any procedures available with preceptor standby assistance. Depending on the amount of procedures completed to this point, the hope is that the preceptor will be present, but not actively participating in every procedure. Please continue to log these for credentialing purposes. 

- You will be leading rounds on your patients. Try to have 1-2 charts completed prior to rounds and be ready to lead rounds on all of your patients by the end of the month. 

- By the end of the month, all communication with nursing staff and other providers should be completed by the orientee with preceptor present. 

- You will undergo a 5 month review of your progress.  This will be scheduled at least a week ahead of time and will include feedback from your preceptors and attending physicians. 

- You will be updating family members and participating in family meetings and goals of care discussion by the end of this month. 

Month 6

- By the end of the month, your check list should be completed. Checking off completed work should be discussed with your preceptor. 

- Start the day with 4-6 patients and expect to admit at 1-2 new patient daily. Decision making should be developed by the orientee with minimal preceptor guidance. Your preceptor will continue to be available for questions and to ensure there is an appropriate plan of care, but the orientee should be making most to all  decisions by the end of this month and confident in their plan choices. 

- Orientee will continue to be expected to do any procedures available with preceptor standby assistance only. For procedures that have had multiple repetitions, preceptor assistance should only be used for complications or difficult procedures. Central line and arterial line placement should be completed with no assistance from your preceptor at this point. Please continue to log these for credentialing purposes. 

- You will be leading rounds on your patients. Try to have 2-3 charts completed prior to rounds and be ready to lead rounds on all of your patients by the end of the month. 

- All communication with nursing staff and other providers should be completed by the orientee with preceptor in agreement with the plan, but not necessarily present. 

- You will undergo a Final review of your progress.  This will be scheduled at least a week ahead of time and will include feedback from your preceptors and attending physicians. 

- Family meetings, pending your comfort level, and goals of care discussions should be run by the orientee at this point. 

Month 7

You survived! You should be on your way at this point, but keep in mind that you are never alone in this and will always have an attending physician and other APP's to help you develop your skills an an MCC ICU APP.