by Christen Hunt, DNP, NP-C, CPNP-AC, Director, Nursing Programs

We can learn a lot when we pause and listen. So the Vizient Center for Advancing Provider Practices (CAP2™) thought leader group did just that. The group has advanced practice provider (APP) leadership representation from each member organization within the CAP2 program and they come together multiple times a year to identify key topics affecting APP practice. During a recent meeting, we wanted to know what some of the greatest challenges the APPs within their organizations face.

Here is what we heard, along with some suggestions for maximizing the performance of this valuable resource.

“We have a lot of trained professionals on our workforce who aren’t being utilized; instead they are just performing supportive tasks.”

The APP workforce continues to expand at a rapid pace: many organizations’ employed providers are made up of 60 percent physicians and 40 percent APPs. The rapid growth in the APP workforce led to an expansion into specialty health care fields which created variations in care team development. The expansion may have helped fill an immediate need, but without adequate forethought the result is a significant underutilization of talent and misuse of resources, causing waste. It also leaves a void in understanding of the staffing model for the care team. To ensure there is optimal utilization of APPs on your workforce, start by gathering some basic information: how many there are, the areas they are practicing and what they are doing. Having insight into both their limitations and capabilities leads to a more effective staffing model and efficient use of resources.

“Our organization’s medical staff bylaws related to scope of practice are far more restrictive than those of the state.”

Scope of practice is not a new topic nor is it uniquely specific to APPs; just about every profession within health care has struggled to discern their scope of practice. Understanding an APP’s scope of practice is two-fold: there’s a state level and an institutional level, based on medical staff bylaws. Each state has a slight variation to the deciding body of scope of practice. This could include Medicare, state legislatures, professional board or a combination. In many cases, medical staff bylaws present limitations because they may be outdated or don’t have APP representation on the medical staff to advocate for change. The first step is to ensure your organizational bylaws match the state level scope of practice. If they don’t, ask why and advocate to grant the fullest possible practice authority for your APPs. Then advocate for appropriate committee representation throughout the organization to ensure all expertise is utilized.

“A lack of role clarity has become a real source of conflict on our clinical teams.”

Role clarity goes far beyond the job description. Clarity allows the employee to understand what is expected of them and allows others to know what to expect from them. When there is role ambiguity, it’s increasingly challenging to have representation on any interdisciplinary team due to the potential for conflict, which leads to decreased team effectiveness. When there is not a clear understanding of the role, it results in a lack of accountability. Organizations that allow a lack of accountability send the message that lower standards are acceptable, creating a demotivating culture. Providing role clarity within your organization decreases the variation of utilization, elevating the entire APP workforce. This clarity will help guide accountability and responsibility across the organization and lead to a culture of excellence with the highest standards.

“I’m not sure our teams are as productive as they could be.”

Measuring the productivity of APPs is nearly impossible without fully understanding how they are utilized, their scope of practice, and what they are held accountable for. In addition, the electronic medical record (EMR) adds another element that further complicates calculating APP productivity. Much of their work effort is lost in the EMR, adding to the challenge of calculating their contribution to the patient. Also, many organizations utilize work relative value unit (wRVU) as an incentive which often leads to a competitive environment instead of one of a team. Competition just further hinders the ability to maximize resources through appropriate utilization of all staff members. Don’t create an environment that results in non-productive teams. Many organizations leave APP and physicians to fight for the wRVU instead of focusing on the overall team productivity. Creating a cohesive team that focuses on the right provider seeing the right patient is a win for everyone, the provider team, the organization, and most importantly, the patient.

Although these were identified as different topics, it’s interesting to see how they can be linked together. Organizations that take time to acknowledge and address these potential roadblocks will be rewarded with the positive contribution this provider group brings. I invite all health care organizations to pause and listen as well. You just might learn something.

About the author. In her current role as director, nursing programs, Christen Hunt is responsible for the Center for Advancing Provider Practice (CAP2), where her focus is providing subject matter expertise while engaging with members to assist them in interpreting and utilizing data to improve advanced practice. She is also charged with providing educational and networking opportunities for members, addressing key issues encompassing utilization of advanced practice. As a strong advocate of advanced practice, she collaborates with research colleagues across the nation in an effort to provide evidence-based solutions addressing difficult questions surrounding advanced practice. Prior to joining Vizient, Hunt served as manager of advanced practice providers for the Department of Pediatric Medicine at Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., as well as a joint appointment with Johns Hopkins School of Nursing.

Published: January 17, 2019