The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

Posted on Mon, Oct 10, 2016
The Emerging Role of Advanced Practice Providers Requires Comprehensive Training

As the population ages and consumer demands grow, the need for physicians is increasing faster than the supply. Simultaneously, the industry is experiencing profound changes in major healthcare reimbursement methods.

There’s no simple solution, but adjustments to how we approach healthcare delivery are being made at practice sites across the country - each with a mission of supporting quality, value and both fiscal and clinical accountability.

One change that seems to be highly effective at helping alleviate the impact of reductions in reimbursement and overtaxed physician resources is the use of advanced practice providers (APPs).

APPs are advanced, certified or registered professional caregivers, including nurse practitioners (NPs) and physician assistants (PAs), who are licensed to evaluate and treat patients under the general (if not immediate) supervision of an onsite physician. PAs, NPs or advanced registered nurse practitioners (ARNPs) have advanced medical training to conduct examinations and diagnose and treat patients under the general direction of a physician. APPs are largely seen as analytical, efficient problem-solvers who are detail-oriented and patient-focused.

According to the American Association of Nurse Practitioners, more than 205,000 nurse practitioners (NPs) are licensed in the U.S., with 44.8 percent holding hospital privileges. The National Commission on Certification of Physician Assistants reports more than 95,000 physician assistants in the U.S. All signs point to increasing demand and growth in job creation in these fields.

Licensure requirements, which often determine the level and scope at which APPs may practice, can vary significantly state to state. More importantly, there exists a great deal of variability in education, clinical training and experience among APPs, which impacts both the roles they can serve and the degree of acceptance they may receive by physicians and other healthcare workers.1

APP Academy Provides Training Continuity

Training and experience is crucial, and unfortunately for most APPs, this can only occur on the job as part of their clinical practice. To reduce variability among providers and improve overall training and clinical expertise, EmCare developed an innovative APP Training Academy. Developed by Andy Mulvey, MD, FACEP, and Richele Wright, MSN, FNP, the academy began training APPs at Community Hospital South in Indianapolis. More than 25 providers have completed the academy.

The program has prepared participants for improved interactions with patients and staff, including emergency physicians and medical staff. Documentation improvements along with more efficient patient flow have been additional benefits of the program. And, perhaps most importantly, patient satisfaction scores have improved.

Lead APPs from EmCare’s North Division have participated in monthly calls to share best practices, disseminate organizational updates, learn from guest speakers and get updates on recruiting, enrollment, human resources issues and quality. By nurturing the APPs and APP leaders, both patients and the healthcare industry are benefitting from well-equipped practitioners who are helping to close the gaps in access to care and the physician shortage.

“This has been such a rewarding experience for everyone involved,” explained Wright. “The additional training allows both the APPs and physicians to practice at the full extent of their licenses and education. Word is spreading about our approach to emergency medicine, and we now have a waiting list for the academy.”

Implications for Emergency Medicine and Hospital Medicine

While there are still barriers and resistance in some areas, APPs are forging ahead with new roles and responsibilities in the fields of emergency medicine as well as hospital medicine.

APPs in the emergency medicine field help physicians achieve goals for providing efficient, quality patient care. These highly trained professionals conduct an evaluation, order tests, diagnose and provide urgent treatments for minor to support improved access to care.

Some of the benefits that APPs can provide in the E.D. include:

  • Fast evaluation and treatment of acute conditions
  • Communication to patients and families about diagnoses and treatment
  • Communication with patients’ other physicians
  • Stabilization and monitoring of acute conditions

In hospital medicine, APPs become an important part of the hospital team through:
  • Careful ongoing monitoring of the patient condition, progress and treatment through rounding
  • Coordinating the services patients need within and outside of the hospital
  • Answering questions presented by patients and families
  • Providing ongoing communication with patients’ other physicians
  • Timely discharge and planning to ensure continued treatment after discharge
  • Sending records to patient’s other physician

The roles and responsibilities of advanced practice providers are likely to grow as the healthcare industry evolves to support consumer demands and better manage costs. Finding ways to help provide quality patient care will be essential to building a better healthcare system.

For more information about APP jobs at EmCare, visit our Clinical Careers page.

1 Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., Wong, F., Beauchesne, M., (May 31, 2014) "Addressing Issues Impacting Advanced Nursing Practice Worldwide" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 5.

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