Organizational Advancement for Advanced Practice Providers:

Professional Advancement Models and Other Professional Development

Pathways

Twoorganizationalperspectives…

Anne Swantz, RN, MS, CPNP-PCDirector of Advanced Practice

University of Rochester Medical Center

J. Eliopoulos-Tsirambidis, MSN, CFNP, CPNP-PCDirector of Advanced Practice

Akron Children’s Hospital

Objectives

1. Define the purpose of an advancement model or clinical ladder for APPs2. Identify criteria for advancement and specific pathways for applicants 3. Identify organizational leadership roles opportunities for advancement for APPs4. Discuss additional professional development pathways to develop leadership skills

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University of Rochester Medical Center

Demographics• 836bedtertiary/quadandary carehospital• Census– 102-110%• AcademicMedicalCenter• 630APP’s(NP/PA)• Variousclinicalsettings

– Criticalcare– ED/urgentcare– Specialtycare– HMD– Peds

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CenterforAdvancedPractice

• Established2006• NP’s– clinicalladderestablished2009• PA’s– clinicalladderestablished2016• Criteriaisverysimilartoeachdiscipline

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Reviewoftheliterature

• LittleavailableforAPPbutmuchintheliteratureforRN’s.TherearealsoclinicalladdersforRT’sandChildLife.

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NursePractitionerCriteria

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NPcriteria

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PhysicianAssistantCriteria

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PAcriteria

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Process§ Applicantexpressesinterestorseeksinformationregardingtheclinicalpromotion

• Atthetime,thecriteriaisreviewedandpotentialgapsareidentified– typicalscenario– opportunityforcareersculpting

• Applicationpacketthatincludes– PromotionEligibilityForm– Professionalrecommendationfrom2people– Interviewevaluationform

• Presentation/Interview– Speakstoallthecriteriathatmakesthemeligiblefor– thepromotion

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RoleopportunitiesforAdvancement

• Expertforinternalclinicalconsultation• Speakingreferrals/Education

– Conferences– CommunityTalks– Lectures

• Leadershiprepresentative• Leadcommitteegroupsonvarioustopicsbothclinicalandadminstrative.

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Otherprofessionalopportunities

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DonotJudgetooquickly

www.akronchildrens.org/giving

Akron Children’s Hospital Center for Advanced Practice

About Akron Children’sq Ranked a Best Children’s Hospital by

U.S. News & World Report

q Magnet® Recognition for Nursing Excellence

q Largest independent pediatric provider in northern Ohio

q 2 hospital campuses

q 90 locations offering primary care, specialty services and urgent care

q The second busiest pediatric emergency department in Ohio

q Perform more pediatric surgeries than any other hospital in northeast Ohio

q 5,500 employees, 300+ APPs

With more than 800,000 patient visits each year, we’ve been leading the way to healthier futures for children and communities through expert medical care, prevention and wellness programs since 1890.

Where Do We Fit Inq Formalized Advanced Practice Center 2011

q Identification of unique needs of APPsq Identification of specific certification requirementsq Voice within medical staff and nursing administration

q Criteria for Reviewq No standardization for professional advancement

q C.A.R.E. Ladderq Nurse Practitioners fitting into modelq Physician Assistants not recognizedq No national standard

Backgroundq Successful APP role integration and satisfaction requires a commitment to professional

advancement by the APP body administration and collaborating physicians. q Collaborating physicians and APP peers play an important role in fostering the development

of novice APPs and ongoing advancement of seasoned APPs. q A PAM is an objective tool to effectively measure accomplishments and contributions within

an institution. q A model for professional advancement allows for role definition with clearer expectations and

guidelines for ongoing growth.

Identifying Needsq 2009 Article published identifying dissatisfaction with professional growth and

intra practice collegialityq National need identified through Advance Practice Summit in Fall 2011 for

measures for professional growth and developmentq Published article on ACH PAM in Spring 2015

q Stratton, A., Breedlove, K., Kulasa-Luke, D., Tsirambidis, J., and Brandon, G. (2015) Creating a model for professional advancement. The Nurse Practitioner Perspective. March-April (2)2.

Akron Children’s ModelLevel I APP Level II APP Level III APP

≥3years practice(1 pt) ≥6 years practice(1 pt) ≥10 years practice (1 pt)Clinical Practice: • Reviews current clinical

processes, procedures and standards and works with others to make/implement changes to improve outcomes through quality improvement projects (1 pt)

• Maintains certifications necessary for job performance (1 pt)

Clinical Practice:• Lead role in reviewing

current clinical processes, procedures and standards and leads implementation of changes to improve outcomes through leadership in quality improvement projects (2 pts)

• Maintains certifications necessary for job performance and seeks/obtains other certifications specific to specialty (2 pts)

Clinical Practice:• Leads and implements

reviews of current clinical processes, procedures and standards and implements changes to improve outcomes through quality improvement projects (3 pts)

• Maintains certifications necessary for job performance and obtains other certifications specific to specialty (2 pts)

Akron Children’s ModelLevel I APP Level II APP Level III APP

Education: • Involved in staff education

processes for division/subspecialty (1 pt)

• Lectures within division (1 pt)

• Involved in development of educational resources for staff and patients/family (1 pt)

Education: • Mentorship of staff (1 pt)• Preceptor for students (2

pts)• Development of staff

education processes for division/subspecialty (2 pts)

• Lectures within division (1 pt),

hospital/locally (2 pts)• Development of

educational resources for staff and patients/family (2 pts)

Education: • Mentorship of staff (1 pt)• Preceptor for students (2

pts)• Development and

implementation of staff education processes for division/subspecialty (3 pts)

• Lectures within division (1 pt), hospital &/or schools (2 pts), nationally (3 pts)

• Development of educational resources for staff and patients/family (2 pts)

Akron Children’s ModelLevel I APP Level II APP Level III APP

Professional Contributions:• Involvement in research

project (ie data collection, review of literature) (1 pt)

• Involved in institutional conferences (1 pt)

• Attendance at national conferences/meetings (1 pt)

Professional Contributions:• Lead role/co-PI in research

project (2 pts)• Involved planning (1 pt)

/presenting (2 pt) at institutional conferences

• Attendance at national conferences/meetings (1 pt)

• Poster/paper presentations local/nationally (2 pts)

Professional Contributions:• Develop and PI in research

project (3 pts)• Plan (1 pt) / present

(2 pts) at institutional conferences

• Attendance at national conferences/meetings (1 pt)

• Poster/paper presentations local/nationally (2 pts)

• Author journal article/book chapter (3 pts)

Akron Children’s ModelLevel I APP Level II APP Level III APP

Professional Leadership:• Unit committee member

(1 pt)• Division resource (1 pt)• Member professional

specialty organization (1 pt)

Professional Leadership:• Hospital committee

member (2 pts) /leader (3 pt)

• Division lead (2 pts)• Committee member of

professional specialty organization (2 pts)

Professional Leadership:• Hospital committee leader

(3 pts)• Division lead (2 pts)• Committee lead of

professional specialty organization (3 pts)

• Elected/lead position to local/national committee (3 pts)

Akron Children’s ModelLevelI APP LevelII APP LevelIII APP

Community Service:• Involvement in community

outreach (1 pt)

Community Service:• Leadership in community

outreach (2 pts)

Community Service:• Plan and leader in

community outreach (2 pts)

Total Possible Points: 13 points Total Possible Points: 26-29 pts Total Possible Points: 38-41 pts

Points Needed to Achieve Level I: 10 points

Points Needed to Achieve Level II: 20 points

Points Needed to Achieve Level III: 29 points

Additional considerations…

q Review Processq 2015 Inaugural Year: Received a total of 69 intent forms with a total of 49

completed applicationsq 2016: 86 intent forms to dateq Teams of reviewers

q Financial Incentivesq Where do funds come from? q How is it processed and by whom?

q PAM oversightq Should it be an % FTE position ?

Criteria & Incentives

BENEFITS: Financialrecognition Annualprofessionalbenefit Other

APPNovice LumpSumBonusInitial$750*Maintenance$250

$75yearlyforprofessionalcertification/recertification,duestoprofessionalorganization,GRE,journal/books,clinicalpracticeequipment,orshoes

APPCouncilRecognition,Certificate,$5annualcoffeecard

APPJunior LumpSumBonusInitial$1000*Maintenance$350

$175yearlyforprofessionalcertification/recertification,duestoprofessionalorganization,GRE,journal/books,clinicalpracticeequipment,orshoes

APPCouncilRecognition,Certificate,$5annualcoffeecard

APPSenior LumpSumBonusInitial$1500*Maintenance$500

$275yearlyforprofessionalcertification/recertification,duestoprofessionalorganization,GRE,journal/books,clinicalpracticeequipment,orshoes

APPCouncilRecognition,Certificate,$5annualcoffeecard

YouareeligibletoapplyasanAPPLevelINoviceuponcompletionofyour90-dayAPPonboardingchecklisttopracticeandafteryourFPPEFocusedProfessionalPracticeEvaluationtimeperiod(ifapplicable).YouareeligibletoadvanceonthePAManytimebeyondyourFPPEperiod.

Additional APP Leadership Rolesq APP Director (0.6 FTE Director, 0.4 Clinical FTE)q APP Educator (0.5 FTE)q Lead APP (1.0-2.0 FTE Lead, 0.8-0.9 Clinical FTE)q Reporting Structure?q HR/JD, Roles and Scope of Work ?

Additional Professional Development Opportunities & Incentives

q Annual Quality Bonus Incentive (4 of 7 identified annual APP or specialty specific metrics measured)

q Additional Roles Stipend (ie newborn nursery rounds/call, high risk deliveries)q Medical Staff Committee Membershipq Chairing APP Council Committeesq Leadership Academy q Leadership Challengeq Academic & Preceptor Opportunities

References

1. Bahouth Mona, et al. Nurse Practitioner Orientation: The transition. In: Transitioning Into Hospital Practice.1st ed. New York. Springer Publishing Company; 2013: 19.2. Bryant-Lukosius D, DiCenso A. A framework for the introduction and evaluation of advanced practice nursing roles. J Adv Nurs. 2004;48(5):530-540.3. Faris JA, et al. Job satisfaction of advanced practice nurses in the Veterans Health Administration. J Am AcadNurse Pract. 2010;22(1):35-40.4. Lutes J. A clinical ladder for NNPs. Neonatal Netw. 1998;17(8):47-48.5. Torstad S, Bjork T. Nurse leaders' views on clinical ladders as a strategy in professional development. J NursManag. 2007;15(8):817-824.6. Pye S, Green A. Professional development for an advanced practice nursing team. J Contin Educ Nurs. 2011;42(5):217-222.7. Clements J, Parrinello K. Climbing Higher: An expanded career ladder creates opportunities for nurse managers and advanced practice nurses. Nurs Manage. 1998;29(12):41-45.8. Ackerman MH, et al. Creating an organizational model to support advanced practice. J Nurs Admin. 2010;40(2):63-68.9. Monarch K. From Theory to Practice . a career ladder that works. J Nurs Staff Dev. 1994;10 (4):202-206.

ThankYou