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

Memorial Sloan Kettering Cancer Center

Memorial Sloan Kettering Cancer Center (MSKCC) is a 498-bed comprehensive cancer center and academic facility located in New York City. Currently, the division of advanced practice employs about 600 APRNs and 200 PAs who work in most departments and subspecialties, including inpatient, outpatient, and nonclinical (such as research).

Reporting Structure

At MSKCC, APRNs and PAs report through a division led by an executive director who reports to the executive vice president and deputy physician-in-chief with a dotted-line report to the CNO. CRNAs (130) report through the anesthesiology, critical care, and pain department; CNSs (45) report through the nursing department. Five advanced practice directors cover inpatient and outpatient settings, and approximately 50 advanced practice managers oversee specific service areas. APRNs and PAs serve as clinical program managers and education/fellowship specialists. At the director level, an advance practice provider serves as associate director of education, practice, and quality. As associate medical staff members, APRNs and PAs have voting privileges on issues pertinent to practice, and one associate member is elected to serve on the medical board.

Adding Advanced Practice Providers

Many key considerations—including added patient volume, new clinical/quality programs, and organizational/divisional strategic goals—are used to expand and develop advanced practice roles and positions. For example, when justifying the need for a clinical program manager to oversee the hospital-wide sepsis program, clinical time was built in to support patient volume and administrative time. New roles must be able to justify a need, given time to develop, and evaluated annually. New positions are vetted extensively through executive leadership.