Jackie Iseler, DNP, MSN, RN, ACNS-BC, CNE, FCNS, NACNS President
I had the wonderful opportunity to speak on a panel alongside our Advanced Practice Provider Colleagues at the University of Virginia Health (UVA) for National APP Week held September 21-25 and hosted by UVA Health this year. This year’s theme: The Pulse of Progress: APPs Powering Tomorrow.
I was joined by the following presidents:
- Valerie Fuller, American Association of Nurse Practitioners (AANP)
- David Bunnell, American Academy of Physician Associates (AAPA)
- Peter Johnson, American College of Nurse-Midwives (ACNM)
- Tracy Young, American Association of Nurse Anesthesiology (AANA)
- Emily Mycyk, American Academy of Anesthesiologist Assistants (AAAA)
We spoke about metrics and outcome measurement, and how APPs can be involved at the organizational level — understanding how healthcare at the systems level affects the care provided to the individual patient, and vice versa. What we do doesn’t stay within the four walls of where care happens; it impacts care everywhere.
One question posed to me was: which metrics and outcomes matter most when evaluating APP impact? My answer: there isn’t a single metric or outcome we should follow, and relying solely on productivity is short-sighted. We should look at it from a portfolio framework:
- Clinical and Quality: Are our patients receiving evidence-based guideline-concordant care? Are we practicing evidence-based practice – using the best available evidence, with the resources available, within our clinical expertise, and with shared decision-making with our patients?
- Business case: Of course, clinics and hospitals are a business that need to stay financially viable. We should track productivity, return on investment, and value on investment – data that gives our C-suite and administrators the full picture, both the financial and clinical story of the care we provide.
- Workforce well-being: What is the level of engagement and retention rate? When APPs leave an organization, they take those years of experience and productivity with them.
- Patient access and satisfaction: Are patients getting timely, high-quality care because an APP is available? Has access improved as a result?
I was also asked what opportunities exist for APPs to play a larger role in system-wide clinical strategy and innovation. CNSs, fortunately, understand how care at the patient level affects the organizational level—our foundation: the spheres of impact, our competencies, and what makes us indispensable in healthcare. APPs understand clinical work at a granular level; what we need to do is build the same fluency at the systems level and finance.
I shared a personal story of when I worked at Mayo Clinic, and we were moving from paper charting to electronic charting. I was one of many nurses asked to advise the clinical nurse specialist leading the charge on how we would like the electronic charting to look and feel. That is the kind of seat at the table APPs need to be claiming.
Artificial Intelligence is here; it is a tool that our organizations are implementing – from ambient listening to summarizing provider documentation. As end-users, we should be working alongside our computer scientists and informaticists to build and improve these tools. Because these are tools, they are supposed to make our work easier and safer.
I also had the opportunity to speak with the CNSs at UVA and learn about their role as APPs there. Kim Elgin asked me: what can they do to help NACNS? My reply was simple: help amplify the CNSs! Share on social media, write manuscripts, and share with your leaders and one another the work and the metrics you move.
Presidents of APP organizations.
Jackie Iseler (NACNS); David Bunnell (AAPA); Tracy Young (AANA); Peter Johnson (ACNM); Vallerie Fuller (AANP); Emily Mycyk (AAAA); and Bill Lombardi
CNSs at UVA and Bill Lombardi, Associate Chief Nursing Officer