An Innovative Approach to Maximizing the Role of Advanced Clinical Practitioners

Carolinas HealthCare System is one of the first healthcare systems in the country to create a System-wide, comprehensive approach for optimizing the role of advanced clinical practitioners (ACPs) to help us adapt and succeed in the ever-changing healthcare environment.

The three-pronged initiative established the following new programs:

  • Carolinas HealthCare System's Center for Advanced Practice (CAP) launched in the spring of 2013. CAP is a centralized department that facilitates customized core services for ACPs, such as outreach, education, mentoring, communication and retention. ACPs include:
    • Nurse Practitioners (NPs)*
    • Physician Assistants (PAs)*
    • Certified Registered Nurse Anesthetists (CRNAs)
    • Clinical Nurse Specialists (CNSs)
    • Nurse Midwives (NMs)

*CAP is seeking existing PA accreditation and is developing NP accreditation.

  • A graduate acute care nurse practitioner (NP) program, in partnership with UNC Charlotte's School of Nursing, began in August 2013 and will prepare graduates for the new NP certification in adult/gerontology with acute care focus (AGACNP). Each year, the program will accept 12-14 students after a competitive application and interview process. 
  • A paid, post-graduate ACP fellowship program for NPs and PAs begins in October 2013. This one-year fellowship is unique because the fellows will receive not only a stipend but will also be temporarily hired as employees so they can receive full health benefits. The first class includes 13 students selected from a pool of 26 applicants and represents students from Duke, Vanderbilt, UNC-Chapel Hill, Nova Southeastern University, the University of Kentucky and the University of Alabama.
    • The initial fellowship program will offer six acute care tracks, including:
      • Cardiology
      • In-Patient Medicine (Carolinas Hospitalist Group)
      • MICU (Pulmonary Critical Care)
      • Trauma/Surgical Critical Care
      • Urgent Care
      • Urology
    • A primary care track will begin in April 2014, accepting 5-10 fellows.
    • Fellows will utilize the Carolinas Simulation Center and online classrooms for each specialty track.

 A large team of physicians, ACPs and administrators have been collaborating for several years to bring these new programs to life. The original steering committee that conceptualized this initiative included:

  • Chris Teigland, MD: chair of the McKay Department of Urology at Carolinas Medical Center
  • Brian Jefferson, MSN, RN, ACNP-BC, FCCM: trauma and surgical critical care nurse practitioner at Carolinas Medical Center
  • Dennis Taylor, DNP, ACNP-BC: assistant vice president of system nursing
  • Ellen Sheppard, EdD: president of Carolinas College of Health Sciences
  • Ginger Marshall, ACNP-BC, ACHPN, FPCN: director of palliative care services
  • Mary Ann Wilcox, RN: senior vice president and system nurse executive
  • Steve Wagner, PhD, FACMPE: director of organizational development

Through this ACP initiative, Carolinas HealthCare System has the opportunity to be positioned as a national leader in healthcare system transformation by refining the care delivery model. This program also supports the System's strategic priority of providing clinically integrated, coordinated care.

"By embracing this streamlined, team-based approach to patient care, physicians and ACPs together will help transform Carolinas HealthCare System from a volume-based enterprise to a value-driven system," said Chris M. Teigland, MD, medical director of CAP and co-chair of the ACP fellowship program. "This model is the way of the future in healthcare."

The American Association of Nurse Practitioners recently named Dr. Teigland the 2013 Advocate State Award of Excellence winner for his ongoing support of NPs and for his work creating CAP. This prestigious award is given annually to an individual who made significant contributions toward increasing awareness and acceptance of NPs in their state.

"Dr. Teigland is very deserving of this award, as he leads by example on the importance of physicians and ACPs working together as a team to deliver the highest possible care to our patients," said James McDeavitt, MD, chief academic officer of Carolinas HealthCare System. "Dr. Teigland helps to foster an environment of mutual respect among providers. Investment in the professional development of ACPs is not only the right thing to do, it is critical to our future success as a health delivery system."

Ultimately, optimizing the role of ACPs and embracing this team-based care model will improve productivity, care coordination, clinical outcomes and patient experience, while reducing readmissions and cost trends. Additionally, the System's culture will be enhanced by more satisfied providers with less burnout and turnover.

The ACP educational programs were created purposefully, as there is a need for well-trained ACPs at Carolinas HealthCare System. In fact, there are many ACP job openings, especially in acute care. The programs' robust, curriculum-based clinical training will produce more confident, successful ACPs working in our hospitals – which will make the entire System stronger and more efficient. Utilizing ACPs is especially critical now, when facing an imminent nationwide shortage of physicians.

Paul S. Franz, executive vice president of Carolinas HealthCare System Medical Group, was a strong advocate for CAP's development. "This initiative is a win-win for everyone," he said. "Not only will this team-based model allow providers to spend more time practicing at the highest level of their specialty, it will also enable physician leaders to use their strong inter-professional skills to shape and optimize our healthcare teams to ensure we provide the highest quality care."

Learn more about the Center for Advanced Practice and its educational programs.

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