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

Lahey Hospital & Medical Center

Lahey Hospital & Medical Center (LHMC) is a 335-bed academic tertiary care facility in Burlington, Massachusetts, and a teaching hospital of Tufts University School of Medicine. LHMC employs 310 advanced practice providers in both inpatient and outpatient settings, offering a wide scope of clinical services in primary care and almost every medical and surgical subspecialty. APRNs and PAs work in primary care, outpatient subspecialty clinics, and a variety of hospital units (including ICUs). They also serve as hospitalists, specialty consultants, and surgical first assistants. Approximately two-thirds of advanced practice providers are APRNs (clinical nurse specialist [CNS], certified registered nurse anesthetist [CRNA], nurse practitioner), and one-third are PAs.

Reporting Structure

APRNs and PAs report to clinical division leadership—either a lead advanced practice provider or, in smaller divisions, directly to the physician division chair. They also serve on the advanced practice council, a hospital-wide elected body of advanced practice providers representing a variety of clinical services. The director of advanced practice reports to the chief medical officer with a dotted-line report to the chief nursing officer (CNO). APRNs and PAs indirectly report to the director of advanced practice, and they have medical staff voting privileges; the director has a voting membership on the medical executive committee.

Adding Advanced Practice Providers

The growth of advanced practice providers at LHMC has occurred in specialty and service-based roles. Decisions to add or replace an APRN or PA go through the same process as the decision to hire a physician. A role description, practice model, and business plan are created (or reviewed in the case of replacements) and presented by division leaders to a group of senior leaders who meet regularly. Everyone in attendance is encouraged to participate in the discussion and frequently a decision is made in the meeting. This and other leadership meetings also serve as information conduits to share role successes among divisions, which helps influence best practices throughout the organization. As members of the medical staff, APRNs and PAs are supported as part of a culture that promotes collaborative practice.