Driving high-functioning clinical teams: An advanced practice registered nurse and PA optimization initiative

JAAPA. 2020 Jun;33(6):1-12. doi: 10.1097/01.JAA.0000662400.04961.45.


Background: Rapid changes in the healthcare marketplace are driving healthcare systems to modify operations by which advanced practice registered nurses (APRNs) and physician assistants (PAs) serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands, resulting in high-functioning clinical teams.

Local problem: With the growing number of APRNs and PAs in a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these healthcare providers.

Methods: Directors of the APP Best Practice Center developed an internal NP/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service which conducted evaluations to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists.

Interventions: Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and more than 200 individual NP/CNM/CNS/PA interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members.

Results: Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support.

Conclusions: Several recommendations were presented to department leaders about NP/CNM/CNS/PA practice. Departments that implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.

MeSH terms

  • Advanced Practice Nursing*
  • Cost-Benefit Analysis
  • Delivery of Health Care* / economics
  • Efficiency*
  • Health Care Sector
  • Humans
  • Interdisciplinary Communication
  • Intersectoral Collaboration*
  • Nurses*
  • Patient Care Team* / economics
  • Physician Assistants*
  • Surveys and Questionnaires