Nursing executives are ideally positioned to leverage advanced practice across the organization to optimize patient care in the most effective and efficient manner. Understanding the many nuances of advanced practice nursing can save valuable time and expense. Many nursing executives employ an advanced practice leader to provide expertise in education, licensure, regulation, scope of practice, and, when applicable, credentialing and privileging. As an experienced leader in hospital administration and finance, the nurse executive can partner with the advanced practice leader to optimize models of care to maximize the triple aim in healthcare1 focused on improved health of populations, patient experience, and long-term financial sustainability. Furthermore, clinician burnout, leading to the concept of the quadruple aim,2 can be tremendously impacted when nursing executives partner with advanced practice RNs (APRNs) to not only leverage the value contribution of this group to patient care but also create a culture where the APRN voice is heard, their education and training are valued, and APRNs are able to work to the top of their license.1

A few years ago, as an advanced practice leader, I was able to partner with other nursing and administrative leaders to evaluate inpatient and outpatient clinical models of care delivery. Common questions were as follows: "Were we overstaffed, understaffed, or ideally staffed?", Were we seeing the volume of patients needed in a specific area?", and "Was every staff member working to the top of their license?" The leadership team worked together to assess the activities of each staff member and the qualifications/training required to perform these tasks. Each healthcare worker, nurse, APRN, physician, social worker, nutritionist, medical assistant, and others have a specific skill set to which they are educated and trained. In a smaller clinic, it may make sense to combine tasks if there are less patients and healthcare workers, whereas in a larger clinic, with higher volumes of patients and more healthcare workers representing different backgrounds and professions, it is ideal for each to work to the top of their license. Partnering with experienced nursing leaders, the advanced practice leader can speak to the qualification and scope for the APRN role on the team.

This type of analysis is not uncommon to health systems because all are striving to optimize staffing and care delivery models. Dr Jennifer Rodgers shares a specific example where the nursing leaders and advanced practice leaders worked together at the University of Colorado (UC) Hospital and UC Health to create an innovative care delivery model. In her role as vice president of advanced practice and associate chief nursing officer, Dr Rodgers was able to partner with advanced practice nursing and nursing leadership, to develop a new model of care to support their cancer patients, while avoiding emergency room and inpatient visits. The program is called the Clinical Assessment Rapid Assessment and Evaluation Clinic. The clinic supports solid tumor cancer patients with a focus on symptom management, for common symptoms such as nausea, pain, constipation, dehydration, and respiratory symptoms. The clinic is staffed by APRNs, nurses, and medical assistants. The medical director is also an APRN.

Through this work, a program has been built that is patient centered and one in which all of the APRNs and team are working to the top of their education and training. Team members were able to demonstrate how this model could be scaled to other cancer and noncancer populations. The clinic is growing to the point of expanding to a 24/7 operation, expanding to a space of 12 to 14 bays. With the patient at the center and a focus on top-of-license work, outcomes of decreased emergency room visits and inpatient admissions, and improved patient experience were obtained. The advanced practice leader was able to blend administrative, nursing, and medical components of this program, and leverage their relationships with multiple healthcare team members to gain consensus. The advanced practice leader can speak to the scope of practice, hospital, and state regulations. In addition, they can tell the story of their patients and team, and the financial and outcomes metrics needed to gain initial support for a pilot and then for continued growth.

Not only are patient care quality and cost important drivers for the partnership of the nurse executive and the APRN working at the top of license, the nurse executive has a deep understanding of shared governance, professional practice, structural empowerment, and transformational leadership. Each of these concepts can be applied to advanced practice nursing. Once the advanced practice leader has a clear understanding of how these concepts are applied in nursing, the leader can overlay these concepts to advanced practice. Examples include the development of advanced practice councils and committees, and engagement in quality and process improvement. In the November issue of JONA, Hayley Brown and others shared their experiences in the development of an advanced practice council and how this council leveraged optimal practice, interprofessional relationships, and valuable perspective as a stakeholder in health system leadership.3 Advanced practice RNs can partner with nursing executives in targeted initiatives that benefit APRNs as part of the overall nursing structure such as achievement of Magnet(R) designation, APRN-focused clinical practice ladders, and performance appraisals meaningful to the APRN's professional growth and development.

Across health systems, optimization of the APRN role and models of care can be fully actualized if there is a nurse executive at the helm, empowering APRN leaders and supporting infrastructure that leads to high-value care and an engaged advanced practice workforce. In today's healthcare environment, each healthcare worker should be working to the full extent of their education and training. Advanced practice RNs are educated, trained, and nationally board certified to provide specific care. Optimization of this workforce can have a profound impact on the operations, quality, and financial sustainability of the organization.

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