In a recent conversation with several advanced practice leaders among the nation's top children's hospitals, we discussed challenges in nursing and, particularly, advanced practice nursing that have occurred throughout the pandemic. With COVID-19, all has gone awry. Many challenges that were in existence before the pandemic were magnified, whereas other prepandemic challenges were allayed given the rapid and urgent demand for innovative solutions to healthcare. Early in 2020, I was called to work in our health system's COVID-19 command center as an advanced practice nurse leader. In my role at that time, as an associate chief nursing officer for advanced practice within the Vanderbilt University Medical Center in Nashville, Tennessee, I was able to call upon advanced practice RNs (APRNs) to meet many needs that emerged as a result of the pandemic. Advanced practice RNs developed and staffed our COVID-19 nurse hotline, helping patients get answers to their COVID-19-related questions and find testing centers. They developed and staffed our mobile testing centers providing testing across vast communities. They worked with physicians to develop COVID-19 treatment protocols for inpatient services, including the ICUs, and in addition, they staffed the ICUs 24/7. Advanced practice RNs worked with physicians, legal teams, and hospital administrators to launch inaugural telehealth services to promote access to care. In addition, APRNs provided care to COVID-19-positive patients in their homes. These activities launched APRNs into new and innovative spaces, expanding practices and providing much needed healthcare services throughout the pandemic. Many of these expanded and enhanced services have now become part of care models and will continue well beyond the pandemic.
In addition, APRNs have stepped in to help with the growing nursing shortage and meet needs for healthcare systems beyond the usual practices unique to an APRN. Advanced practice RNs, namely, certified RN anesthetists, certified nurse practitioners, certified nurse midwives, and clinical nurse specialists, stepped into RN roles to meet needs in ambulatory clinics, as well as inpatient acute and critical care units. Although APRNs, like many other nurses in various roles, have helped to meet the staffing needs, they too are experiencing burnout like other healthcare workers.
As we move to the future, it is time for APRNs to go back to the roles they were trained for and provide care at the top of their licensure. Somehow amidst the chaos of the pandemic, APRNs have been celebrated for their contributions but, unfortunately, also lost in the shuffle of their uniqueness. As healthcare systems struggle to right size their workforces, it is now a critical time to engage qualified and experienced advanced practice leaders to prioritize advanced practice infrastructure support, empowering APRNs to work to the full extent of their education and training, optimizing care outcomes across the continuum.1 Health system leaders must call upon the advanced practice leaders to reprioritize and reinvigorate the APRN workforce, recruitment and retention, health and well-being, opportunities for professional growth and development, continuing education, top of license practice, diversity, equity and inclusion, optimization of patient care outcomes, student placement, and reward and recognition programs.2 Each equally important, the top 10 priorities for nurse leaders relative to the APRN workforce are listed hereinafter.
Workforce optimization: Develop sustainable staffing models with manageable workloads, ensuring the best care can be provided.
Recruitment and retention: Lean to recruitment strategies that cast a wide net for the best and most qualified talent, matching education, training, and board certification with the appropriate patient population.
Health and well-being: Build effective programs to support health and well-being for both providers and patients.
Professional growth and development: Implement opportunities for professional development, such as clinical advancement models.
Continuing education: Provide ongoing, engaging continuing education to enrich practitioner practice and outcomes.
Top of license practice: Speak with legislators to modernize state laws so that APRNs can practice to the full extent of their education, training, and board certification.
Equity, diversity, and inclusion: Make equity, diversity, and inclusion intentional. Hire from a diverse pool to increase team capability and perspective.
Optimization of patient care outcomes: Educate others to the abundant evidence demonstrating highly reliable, accessible, and trusted care in all settings, primary, acute, and specialty provided by APRNs.
Student placement and preceptor support: Implement strategies for supporting preceptor engagement and increasing student placement opportunities.
Recognition and appreciation: Expand programs to recognize and celebrate achievements, honors, and accomplishments.
As the evidence is compounded, underscoring the positive impact APRNs are making across the United States and the world, health systems must invest in experienced and talented advanced practice leaders. Advanced practice leaders, seasoned in health systems management, organizational leadership, and advanced practice, can strengthen infrastructure to meet health system priorities in quality care delivery, innovation, growth, expansion, and access to care.3-6
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