The vital role of Advanced Practice Providers

National Advanced Practice Provider (APP) Week, celebrated annually in the fourth week of September, gives us an ideal opportunity to highlight the vital role of these highly trained medical professionals. In an era of growing physician shortages, APPs represent a robust workforce of clinicians stepping up to ensure the availability of high-quality care.

What is an APP?

An APP is a medical professional trained and licensed to assess, diagnose, treat, and manage illnesses. APPs can prescribe medications, perform clinical procedures, and research whole-person clinical management.

Most APPs are Physician Assistants/Associates (PAs) or Nurse Practitioners (NPs). These professions arose in the 1960s in response to the growing shortage of Primary Care Physicians. Today, the U.S. Bureau of Labor Statistics lists Nurse Practitioner and Physician Assistant among the nation’s fastest-growing occupations.

Other APP roles include Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), and Certified Anesthesiologist Assistant (CAA). Each plays an important role in the healthcare ecosystem.

Empowering APPs 

In 2022, New York took a giant step toward ensuring the availability of high quality care in our state: It joined 24 (now 27) other states in adopting Full Practice Authority (FPA) allowing NPs to offer the full scope of services they are educated and clinically trained to provide.

A smaller number of states, not including New York, grant FPA status to Physician Assistants. PAs in New York may deliver medical services under the supervision of a physician.

Nurse Practitioners become Primary Care Providers

FPA enables Nurse Practitioners to use the full extent of their education, experience, and licensure to independently maintain their own “patient panels,” groups of patients for whom they take care responsibility.

After New York granted FPA status to Nurse Practitioners, Rochester Regional Health, where I work, identified APPs on staff whose advanced training and clinical experience qualify them to manage the care of complex patients—those with multiple medical conditions and likely on multiple medications. We then enlisted many of these NPs to take on their own patient panels. Today 25 Rochester Regional NPs maintain their own primary care panels, providing high quality medical care for close to 50,000 community members.

More capacity, less wait time, better patient experience

The results have been overwhelmingly positive. Rochester Regional can now see more patients, with shorter wait times for an appointment. This increases patient satisfaction and improves outcomes through faster diagnosis and treatment. The Nurse Practitioners are glad their professional skills are being applied in rich and meaningful ways. (See sidebar.) Doctors are happy for relief from the pressures of relentless demand. The community overall benefits from the timely availability of high-quality care.

Practicing “at the top of your license”

Nurse Practitioners in New York can now practice at what we call “the top of their license.” The top-of-license concept applies to other health professionals too, including other APPs, doctors, Registered Nurses, and Licensed Practical Nurses. Each has a regulated “scope of practice” defining permitted activities. Empowering them to practice “at the top of their license” is in part a matter of regulatory permission, as in New York’s recent action regarding Nurse Practitioners. But to gain the full benefit of top-of-license empowerment, healthcare organization must structure and manage their care teams more strategically than they traditionally have.

Patient care is delivered by collaborative teams. Optimizing the care model involves organizing these teams so that each member performs the job functions that best match their training, skills, and licensure. For example, overworked nurses don’t spend their time handing out meal trays when Food and Nutrition staff are better suited for that job. Efficient team orchestration increases the job satisfaction of the workers involved, as each plays a clear and vital role in the patient experience. It also drives down healthcare costs and improves patient outcomes.

A roadmap to better healthcare 

The U.S. healthcare system today is being forced to confront longstanding operational and financial challenges. At stake is the availability of high-quality care for the communities we serve.

For many years, the healthcare industry, hampered by both regulatory constraints and its own inefficiencies, fell short of incorporating APPs into care models in ways that most effectively leverage their professional capabilities. During APP Week this month, we can celebrate that this is changing. APPs are rising as a formidable force of care excellence—and the big winners are our patients and communities.

Selma Mujezinovic, DNP, FNP-BC, is Vice President of Advanced Practice Providers at Rochester Regional Health.

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