Restructuring Advanced Practice Leadership

National utilization of Advanced Practice Clinicians (APCs), specifically Nurse Practitioners (NPs), throughout the healthcare system has significantly increased in recent years, especially within the hospital setting. As a result, NPs are seen as a vital component to providing quality healthcare. However, despite their growing importance, NPs often lack adequate representation at the executive level of hospital leadership. Therefore, a new managerial authoritative position is required to help facilitate the transformation of advanced practice (AP) representation and advocacy at the executive level of leadership within a large nonprofit health care organization in the Western United States. The objectives were: 1) Identifying existing executive AP leadership structures currently being utilized in different hospital settings, 2) Develop a new Executive Director of Advanced Practice position to help facilitate the transformation of AP representation, and 3) Disseminate this information through preapproved methods. The method for this study included obtaining Institutional Review Board (IRB) approval and then conducting a convenience sample of eight out of twenty willing healthcare organizations to evaluate the different AP leadership structures being utilized throughout the nation. Structured interviews were completed with varying AP executives, and a strengths, weaknesses, opportunities, and threats (SWOT) analysis was performed on decentralized and centralized leadership structures, which were identified in the study. Results indicated that of the eight healthcare systems interviewed, four organizations reported a decentralized structure and the other four reported a centralized structure. Major themes resulting from this study are that decentralized leadership revealed greater weaknesses than strengths as compared to centralized leadership, which revealed greater strengths than weaknesses. Each structure had the same opportunities and threats. Although some APCs in this sample had Medical Staff Organization (MSO) representation, none had voting rights. In conclusion, those that were part of a larger healthcare system in this sample were more likely to have a decentralized leadership structure versus those that were part of a smaller healthcare system. The reasoning for such a discrepancy is not entirely known. Decentralized leadership may be an obstacle to proper utilization of APCs and is inefficient and confusing, which may place patient safety at risk. Incorporation of a centralized leadership structure promotes standardization for APC practices and policies, and allows for direct representation and better advocacy with key administrators. As such, a job description was written for an Executive Director of Advanced Practice, which provides the necessary centralized leadership structure for all APCs within the intended large nonprofit healthcare organization in the Western United States.