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

The Hospital of the University of Pennsylvania

The Hospital of the University of Pennsylvania (HUP) is an 805-bed urban, academic, and quaternary referral center located in Philadelphia. It's part of the larger Penn Medicine system, which is one of the largest employers of APRNs and PAs in the region, with over 1,300 employed across the system and just under 300 at HUP. With plans to open a new 500+ bed patient pavilion on HUP's campus in the summer of 2021, APRN and PA workforce growth is projected to continue as Penn demonstrates how clinically agile these providers are and the clinical, quality, and financial outcomes they can drive.

Reporting structure

The department of advanced practice at HUP is led by a director of advanced practice providers who reports to the CNO. This role is responsible for setting strategic priorities and aligning operational goals at the hospital and sometimes at the system level. HUP has two pillars of APRN and PA governance: a formal leadership structure and the advanced practice steering committee. In addition, the department has a senior credentialing coordinator and a project manager. The director of advanced practice sits on the hospital's credentials committee and on the medical (non-voting) and nursing boards. In addition, the director is one of the senior leaders for advanced practice across Penn Medicine, who meet as a group to set priorities, align work, and integrate APRNs and PAs across the system.

HUP's advanced practice leadership team includes nine advanced practice managers and three lead APRNs and PAs who have direct oversight of 26 advanced practice clinical teams. These leaders have direct line authority to the director of advanced practice, and partner with physician and nursing leaders in their respective clinical services. The APRNs and PAs on their teams are employed by the hospital and report directly through their advanced practice managers and leads. Their human resources responsibilities include planning, hiring, conducting performance management and reviews, workforce development, fiscal planning and management, onboarding, and employee engagement.

Adding Advanced Practice Providers

The advanced practice steering committee at HUP is charged with creating a model for advanced practice initiatives and activities. The work of the committee is aligned with HUP's goals and the health system's Blueprint for Quality and Safety. This committee is the hub for all advanced practice activities. These advanced practice steering committee leadership positions are elected to a 2-year term, with a set time as a past chair for continuity and consistency. The steering committee has administrative oversight and responsibility for all committee projects and work.

When proposals are made to add APRN or PA resources at HUP, key considerations include the justification for the request. Specifically, at the practice level, full-time equivalent requests are categorized according to whether they're being proposed to address increased volume, support new clinical programs or an evolving model of care, or optimize a clinical team. At the system level, considerations for developing and expanding APRN and PA roles have included strategic workforce planning to predict opportunities and needs, as well as to maximize the integration of these providers. With a goal of aligning APRNs and PAs across the larger Penn Medicine system, a team of nine APRN and PA senior leaders from across the system meet as a collaborative council to discuss strategic priorities, state regulations, practice, workforce planning, recruitment and retention, credentialing and onboarding, and large-scale projects and initiatives.

Advanced Practice Impact

The COVID-19 pandemic has provided a unique opportunity to recognize APRNs' impact in healthcare. They've led community-based testing centers, coordinated COVID-19 telephone hotlines, managed and expanded telehealth services for patient care, conducted home visits to monitor patients who test positive for COVID-19, and provided care to hospitalized patients.

As APRN and PA roles continue to evolve during the pandemic and beyond, sharing specific information related to job descriptions, scope of practice, peer performance evaluation processes, recruitment and retention strategies, and clinical impact is essential. Integrating these advanced practice providers into a healthcare organization requires a focus on developing models of care that meet a current or projected clinical need, ensuring leadership support, and providing opportunities for APRNs and PAs to serve in administrative roles to promote a supportive structure. (See Developing and expanding APRN and PA care models.)