Developing and Expanding APRN and PA Teams

Ruth M. Kleinpell, PhD, APRN-BC, FAAN; April N. Kapu, DNP, ACNP-BC, FAAN; Susan Stempek, MMSc, PA-C, FCCP; Corinna Sicoutris, MSN, CRNP, FCCM; Britney S. Broyhill, DNP, ACNP-BC; Rhonda D'Agostino, MSN, ACNP-BC, FCCP, FCCM


Am Nurs Journal. 2020;15(12) 

In This Article

Abstract and Introduction


As hospital executives work to establish optimal staffing models to address hospitalized patients' complex needs, increased intensive care unit (ICU) bed capacity, physician trainee work-hour restrictions, workforce shortages, and safety and quality mandates, advanced practice registered nurses (APRNs) and physician assistants (PAs) are being integrated to work in collaboration with healthcare teams, particularly in large academic medical centers. (See APRN and PA roles.)

Several studies have demonstrated the impact of APRN and PA care, including promoting care continuity, decreasing ICU length of stay, increasing adherence to clinical practice guidelines, and enhancing resident physician and critical care fellow training. In addition, a recent workforce analysis from the U.S. Department of Health and Human Services that addresses how the COVID-19 pandemic has impacted healthcare cites the role of APRNs, who are uniquely positioned to lead and support epidemic and pandemic response strategies. In response to the pandemic, several states issued executive orders, including temporary suspension of all APRN practice requirements in five states and waiving select practice agreement requirements in 16. Evaluating the impact of these measures on APRN practice and subsequent outcomes of care is ongoing.

Although APRN and PA roles are being established at academic medical centers, community hospital settings, clinics, telehealth centers, long-term care, and other settings, uncertainty continues to exist among hospital administrators, physician collaborators, nursing leaders, and others as to how to best develop and expand this care model.

As part of a think tank of APRN and PA leaders attending a national leadership workshop, directors of advanced practice clinicians identified key considerations for developing and expanding advanced practice care models and addressing barriers at the organizational level. In this article, several organizations—Lahey Hospital & Medical Center, Memorial Sloan Kettering Cancer Center, Vanderbilt University Medical Center, Atrium Health, and The Hospital of the University of Pennsylvania—describe the strategies they use to expand APRN and PA care models, including their reporting structures and strategies to add advanced practice providers.