Prime movers: Advanced practice professionals in the role of stroke coordinator

J Am Assoc Nurse Pract. 2017 Jul;29(7):392-402. doi: 10.1002/2327-6924.12462. Epub 2017 Apr 25.


Background and purpose: Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams.

Methods: Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure.

Conclusion: Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care.

Implications for practice: The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities.

Keywords: Acute care; advanced practice nurse; interprofessional; nurse practitioners; program development; qualitative analysis; veterans.

MeSH terms

  • Health Personnel / standards*
  • Health Personnel / statistics & numerical data
  • Humans
  • Nurse Practitioners / standards
  • Nurse Practitioners / statistics & numerical data
  • Nurse's Role*
  • Organization and Administration / standards*
  • Organization and Administration / statistics & numerical data
  • Physician Assistants / standards
  • Physician Assistants / statistics & numerical data
  • Program Evaluation / methods
  • Program Evaluation / statistics & numerical data
  • Qualitative Research
  • Quality Improvement / statistics & numerical data
  • Statistics as Topic / methods
  • Stroke / therapy*
  • United States
  • United States Department of Veterans Affairs / organization & administration
  • United States Department of Veterans Affairs / standards
  • United States Department of Veterans Affairs / statistics & numerical data