APRN Transformational Leadership: Implementation of Advanced Practice Nursing Leadership Structure Within an Academic Medical Center

To meet the health care drivers of cost-effective, high quality and safe patient care, there has been a rapid growth in the number of APRNS across multiple clinical settings. More and more APRNs are rising to executive leadership levels, leading APRNs in both professional and operational practice. Bridging from clinical expert to expert organizational leader can be challenging without role development, mentorship and structural empowerment.

In 2008, nursing executive leadership of an academic healthcare system recognized the need for specific leadership for APRNs deployed across multiple settings. Over a 6 year period, APRN clinical experts were placed in leadership roles across the organization.  The leaders were provided education, training and in some cases supportive funding for higher education, beyond the masters level. The organizational structure that evolved included direct linkage for the APRN leader to the responsible senior nursing leader and to a centralized office of advance practice for professional practice support. The APRN leadership structure mirrored the nursing leadership structure and emphasized a collaborative model of APRN, nursing and physician leaders. In 2015, a detailed analysis was conducted of APRN specific processes, leadership skill, evolution of the leadership structure, growth of the APRN programs, APRN perceptions of structural empowerment and APRN associated clinical outcomes.

There are now 760 APRNs with 42 operational leaders across the system, 12 of whom hold director level positions. A central leadership team, reporting to the Chief Executive Nursing Officer, offers advanced practice nursing resources and services as needed for all employees and provides professional practice support for system-wide APRNs and APRN leaders. The APRN leaders form the advanced practice nursing leadership board and work together across entities to improve APRN specific processes. These leaders serve as leadership support for the chairs and co-chairs of the advanced practice council and committees. The APRN leaders partner with nursing and physician operational leaders to improve healthcare practice and outcomes.

Skilled APRNs who are structurally empowered can succeed in nursing leadership roles. Having leaders who are knowledgeable of the advanced practice nursing role, scope and outcomes potential, can lead to effective utilization of APRNs across organizations and across the spectrum of health care delivery. 

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