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14 Articles in Volume 18, Issue #9
Assessing Arthralgia in Children
Children, Opioids, and Pain: The Stats & Clinical Guidelines
How to Fit into a New Practice
How to Talk to Your Chronic Pain Patients
How to Treat Opioid Use Disorder in Pregnant Women
Intranasal Ketamine for Acute Pain in Children
Medication Selection for Comorbid Pain Management (Part 3)
MR Neurography: Using Peripheral Nerve Imaging as a Pain Diagnostic
Naloxone in Schools; Buprenorphine Conversions; OUD Management
Opioid Conversion Calculations and Changes
Pes Anserine Tendino-Bursitis as Primary Cause of Knee Pain in Overweight Women
Self-Management of Chronic Pain in Primary Care
The Homebound Adolescent: Managing Chronic Pain Conditions in the Pediatric Population
The Opioid Band-Aid: The State of Pain Pills, Congressional Bills, and Healthcare in the US

How to Fit into a New Practice

Now that I have the job, what is the best way to fit into a new practice? Our resident APP responds.
Pages 16-17

Joining a new practice or taking over the care of patients established in an existing practice may be challenging, especially when the treatment strategies and/or culture may differ from what you are used to. Of course, no matter your status in a practice, your main goal should always be to provide a high level of care. Here are a few basic principles that may help to defuse any conflicts as you try to fit in with your new team:

  • Take time getting to know the practice styles of your colleagues by asking non-threatening questions and observing. There is much to be learned by understanding how others manage their patients.
  • Be up front and clear with your learning needs, level of clinical competency, and comfort level with the management of complex pain patients, especially when it comes to medication prescribing.
  • Support your individual decision-making with evidence-based practice standards and consensus guidelines. Official guidelines will provide you with a convincing argument to stand by your clinical decisions.

These tips may sound simple and logical in theory, but in day-to-day practice, especially for a new practitioner, may be difficult to implement. The rest of this article focuses on the how.

New PracticeFitting into a new practice may be tough, but there are several measures you can take to ensure a smooth transition. (Source: 123RF)

Stay Positive

Every career change comes with a variety of emotions. While you may be thrilled to take the next step in your journey, transitioning into a new practice is bound to come with a few challenges. Whatever the case may be, it is important to maintain your optimism and endure the change positively. This may be especially important when taking over the care of patients established within the practice, who may be reluctant to transition care to a new provider. In fact, fear of the unknown, disguised as aggression, is not uncommon in a population of vulnerable patients dealing with chronic pain. They will be looking to you for a positive attitude, professionalism, and kindness. Patient opposition tied to a transition of care may even begin before you meet the patient. It will take time for them to trust and warm up to this new relationship.

Yet, if the professional handoff is managed well—including actions by the transiting clinician to endorse confidence in your skills and abilities—the change is likely to be more effortless. Additional things that you can do early in the treating relationship is to acknowledge the patient’s frustration with the situation, look at the perceived loss (ie, end of a previous treating relationship) from the patient’s perspective, and allow him or her to tell their story.1 Active and mindful engagement and showing empathy, while compassionately setting boundaries, can establish a therapeutic milieu quickly.

In addition, showcasing your enthusiasm can go a long way toward engaging your co-workers and making initial interactions smoother. Understand that while most of your co-workers will do their best to help you fit in, be mindful of those within the organization that may breed toxic feelings. It is not uncommon for a practice to employ an individual or two who tends to lead with negativity, but by being respectful, you can avoid potential confrontation. One way to deal with genuinely negative colleagues is to spend as little time with them as possible. If you are forced, through your role in the practice, to work with a negatively minded person, try to set limits and get your manager involved as soon as possible.2

Find Your Routine

Variables related to your transition – whether this is your first job, a new specialty, or if you have been out of work for a while – will all play a role in how long it takes to establish a routine. Preparatory activities can greatly help you assimilate into your new environment and ease the process of developing a functional schedule. Take time during the interview process and in your first days at the practice to understand and articulate expectations. Communicating on the points below, for instance, will help you establish a comfortable working routine early on:

  • How many patients are you expected to see (including follow-up)? What is the practice’s level of patient complexity?
  • What is the clinic’s structure, including individual roles and time devoted to administration versus clinical activities? What are the support staff responsibilities?

Onboarding can also be valuable to clarify organizational and clerical questions and to establish routine.3 If the new practice does not have a formal onboarding process, try to arrange for shadowing and orientation during your first few weeks, and do not hesitate to ask for additional support if you need it.4

Set Goals

Make a point to establish some beneficial goals, including professional, personal, and financial objectives. Ask yourself what you would like to accomplish in your first three months, and in the future, and how you plan to continually improve your efficiency. Goal-setting is particularly important to have in place for pain management clinicians, as much of our patient care outcomes are linked to realistic goal-setting.4

Seek Out Mentorship

The value of a mentorship program, as part of the formal orientation process, or in addition to, is immense. Mentorship is valuable to the new as well as experienced clinician in terms of building trust, confidence, respect, and teamwork.5 The value to the group practice includes employee satisfaction, engagement, and retention. If your new practice does not have a formal mentorship program, request to establish one for yourself. After observing daily operations for a while, reach out to someone you admire within the practice.

Fitting in with the Practice Culture

Fitting in at a new job often means observing the overall culture of the practice and then adapting. Simple as it sounds, this aspect can be the most important factor to maintain your new employment and potentially can be met with the most conflict. Since you were hired for the position, you probably expressed a variety of values that made you a good match for the company.6 The work environment affects the satisfaction of the professional and support staff, and is reflected in how patients are cared for as well as the overall function or dysfunction of a practice.

Even before you consider interviewing for a new job, it is advised to take a cultural assessment. Consider how the practice matches up to what is important to you, such as practice size, setting, mission, and technology use. How are Advanced Practice Providers (APPs) utilized – as independent clinicians or to support physician practice – and is that acceptable to you? It may be very difficult to change practice culture, but not impossible. It is, therefore, vital that you accept the existing culture as a new clinician to the practice. Enthusiasm and motivation are great attributes, but pause before rushing to make suggestions or recommendations, such as advocating for practice changes. Instead, spend time observing operations and learning how the staff interacts with one another.

As advanced practice registered nurses and physician assistants continue to find employment opportunities within specialty practices, there is a growing opportunity for APPs to show colleagues the skill sets they bring to a practice. With this responsibility comes the task of educating physician colleagues about how your training and experience may have differed from medical school. Believe it or not, most physicians have little idea about the training, education, supervisory responsibility or skills sets of their APP colleagues. Before you can educate your new practice colleagues and staff about your role, you must first understand the practice parameters within your state and institution.

For example, some institutions regulate the level of APP practice to be more restrictive than what their state license allows. Specific restrictions may be related to: prescription privileges, supervisory requirements, billing parameters, liability, and requirements for performing “medical” procedures.7-10 If you are joining a hospital, many will have a medical staffing department that credentials APPs; this may be the best place to check on approved privileges and institutional requirements. It is also important to bone up on current clinical practice guidelines and standards of care. This will give you a sense of security, direction, and confidence as you grow in your new role and show your colleagues that you are engaged and proactive.11-13


All jobs come with joys and challenges. The biggest mistake that an employee can make is leaving a job because of pent-up frustration, assuming that the “grass must be greener” elsewhere. Taking time before accepting and starting a new position to self-assess needs, strengths, weaknesses, and priorities will smooth the transition. Once on board, set expectations and establish clear communication with your new colleagues, be transparent about your learning needs and comfort level with managing complex pain conditions, and support your decision-making with evidence-based standards and consensus guidelines.

Last updated on: April 12, 2019
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Managing a New High-Dose Opioid Patient
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