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Advanced Practice Providers (APP)

2020 and 2021 were years of growth for Advanced Practice Providers (APP). Starting with 100 APPs in 2007, the department now has over 620 APPs throughout the organization! The Center for Advanced Practice (CAP) hosts several events and runs programs to engage, support, and strengthen its rapidly growing team.

2020 APP Wellness Survey

A total of 595 APPs were eligible and invited to participate in the 2020 APP Wellness Survey. Of these, 452 APPs participated (76% response rate). Of the respondents, 60.2% were nurse practitioners, 31.1% were physician assistants, 6.0% were clinical nurse specialists, and 2.7% were certified registered nurse anesthetists. When examining practice setting, 47.6% of responding APPs worked outpatient, 28.1% inpatient, 19.0% hybrid (both inpatient and outpatient), 2.9% in the operating room/procedural, and 2.4% in the emergency room. There were improvements

across the three core metrics with increased professional fulfillment from 37% in 2017 to 45% in 2020, decreased burnout from 30% in 2017 to 26% in 2020, and decreased intent to leave from 40% in 2017 to 33% in 2020. Findings from the 2017 survey provided a roadmap of areas to focus on for future initiatives and programs to support APP well-being. The wealth of quantitative and qualitative data from the 2020 survey highlights the direct impact of these initiatives on the APP workforce within our organization.

Inaugural National Advanced Practice Provider Recognition Week 2021

In 2021, Stanford Health Care spearheaded and organized the first National APP Week. To align with the theme of the event, "APPs United", over 100 organizations across the nation participated, representing over 50,000 APPs. Various events were organized including a panel discussion with the presidents of the national APP professional organizations, a virtual talk on self-compassion coordinated by the APP Wellness Committee, a virtual event celebrating Hispanic Heritage month coordinated by the APP’RECIATE Diversity Committee, and a volunteer event to distribute health information packets at senior living communities coordinated by the APP Outreach Committee.

APP Fellowship Program

Year 2021 also welcomed the new APP Fellowship sub-specialty in Electrophysiology, in addition to the previously established specialties:

  • Cardiothoracic Surgery

  • Cancer Care

  • Administration

The Stanford Health Care APP Fellowship Program continues to maintain its accreditation with distinction status. In 2021, the APP Fellowship Program at Stanford Health Care became recognized by the ANCC Practice Transition Accreditation Program® (PTAP) as an Industry-Recognized Apprenticeship Programs (IRAP).

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APP Workforce Planning Committee

In March 2021, a multidisciplinary workforce planning committee was formed to evaluate all new and replacement full-time equivalent APP positions at Stanford Health Care (SHC). Within six months of the launch of the committee, there was a 10% increase in the number of visits and procedures performed by APPs, therefore providing better access for patients. In addition, there has been a 38.7% improvement in ambulatory APPs meeting their productivity target, 19.4% improvement in ambulatory APPs meeting their utilization target, and 36.8% improvement in ambulatory APPs meeting the 50th percentile and above as per the Relative Value Unit (RVU) benchmark published by the Medical Group Management Association (MGMA) for Academic Medical Centers (AMCs). For inpatient APPs, there has been a 38.8% improvement in APPs meeting the average daily census target. Since its inception in 2021, over 200 requests have been submitted and reviewed.

Legislation - SB 697

SB 697 (Chapter 707, Statutes of 2018) became effective on January 1, 2020 and made numerous changes to the Physician Assistant Practice Act (Act), which provides for licensure and regulation of physician assistants by the Physician Assistant Board (Board). Generally, the new law removes requirements that the medical record identify the responsible supervising physician and surgeon, removes requirements that the physician be physically available to the physician assistant for consultation, removes requirements for review and countersignature of patient medical records, and removes requirements that written guidelines for adequate supervision be established. The new law instead authorizes a physician assistant to perform medical services authorized by the Act if certain requirements are met, including that the medical services are rendered pursuant to a practice agreement, as defined, and the physician assistant is competent to perform the medical services.

Legislation - AB 890

With the passage of AB 890 the Nurse Practitioner may be able to practice independently once certain provisions have been met. All Nurse Practitioners will not meet the provisions outlined within AB 890 by January 1, 2023. Until those conditions are met, the Nurse Practitioner will continue to operate using Standardized Procedures, the mechanism for Nurse Practitioners to perform functions which would be considered the practice of medicine.

2021 APP Awards

In addition to previously established awards, 2021 introduced the APP Volunteer of the Year, as well as APP Leader of the Year. These awards highlight the clinical expertise and institutional contributions of our outstanding APPs.

2019 marked the expansion of Shared Leadership Council into the ambulatory care settings.

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