Advance Practice Provider Transformational Leadership Structure: A Model for Change

Advanced Practice Registered Nurse Burnout in Magnet Hospitals: Opportunities for Organizational Intervention

OBJECTIVE

To determine modifiable organizational factors associated with advanced practice RN (APRN) burnout in Magnet ® -designated hospitals to guide organizational interventions to improve APRN well-being and retention.

METHODS

Cross-sectional study of work environments of 50 US Magnet hospitals and the associated well-being of 21 855 of their clinicians (APRNs, physician assistants, physicians [MDs], RNs).

RESULTS

Overall, 37% of APRNs experienced high burnout compared with 34% of MDs ( P < 0.05) and 49% of RNs ( P < 0.001); additionally, 32% of APRNs intended to leave their jobs. APRN burnout was significantly lower in organizations that minimized chaotic working conditions, provided APRNs more control over their workloads, involved APRNs in shared governance, improved clinician and management relations, and improved interprofessional teamwork.

CONCLUSIONS

Well-being and retention of APRNs in Magnet hospitals require their greater engagement in organization processes and systems that improve work environments.

PA leadership: Implementation, structure, and sustainability

ABSTRACT

Physician associate/assistant (PA) leaders are essential to healthcare and critical to a healthcare organization's success. In this article, the second of a two-part series on PA leadership, we summarize methods for implementing and sustaining PA leadership opportunities and organizational structures.

The importance, benefits, and contributions of PAs in healthcare leadership

ABSTRACT

Physician associate/assistant (PA) leaders are essential to healthcare and are critical to a healthcare organization's success. This article, the first of a two-part series on PA leadership, summarizes the importance of PA leaders and the benefits of PAs serving in administrative and leadership roles.

Integration of a nurse practitioner and physician associate leadership structure within an academic cancer center

BACKGROUND

Nurse practitioners and physician associates are an essential part of the multidisciplinary cancer care team with expanding and evolving roles within cancer specialties.

LOCAL PROBLEM

As these clinicians flourish, a parallel need for leadership rises to optimize scope of practice, mentor, and retain this crucial workforce. The purpose of this quality improvement project was to development a nurse practitioner and physician associate leadership structure within an academic cancer center.

METHODS

Development of this nurse practitioner and physician associate leadership structure was guided by transformational leadership theory. In collaboration with nursing, business, and physician leadership, a quad structure was supported.

INTERVENTIONS

Implementation of a leadership structure included the establishment of eight team leaders and two managers. These leaders identified multiple opportunities for improvement including improved communications, offload of nonbillable work, development of incentive programs, provision of equipment, specialty practice alignment, hematology/oncology fellowship, and professional development.

RESULTS

Overall, a nurse practitioner and physician associate leadership structure allowed for representation across the cancer center. Such inclusion supported multiple quality improvement projects developed in partnership with nursing, business, and physician leaders. Cumulatively, these interventions yielded efficient workflows and expansion of services. Consistent with reported evidence, these efforts contributed to nurse practitioner and physician associate retention as well as improved job satisfaction.

CONCLUSIONS

Advanced practice leadership is essential to recruiting, developing, supporting, and retaining nurse practitioner and physician assistant colleagues in cancer care.

Stronger together: PA and APRN shared governance council drives transformational change

ABSTRACT

Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction.

Highlighting an Advanced Practice Fellowship for Leadership Transition

As the advanced practice provider (APP) workforce continues to rapidly grow in healthcare, there is a greater need for APP leadership positions. Often, these positions are organically designated to the best clinicians on the team, who may not have leadership experience. Stanford Health Care Center for Advanced Practice embarked on formalized leadership training using a newly developed administration specialty within the APP Fellowship Program to support new leader transition.

Shared governance council to engage advanced practice registered nurses in a hospital setting

BACKGROUND

Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs.

LOCAL PROBLEM

The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk.

METHODS

Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions.

INTERVENTION

Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues.

RESULTS

Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement.

CONCLUSION

Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.