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At Seattle Children’s, the Care Team Evolves

Blog Trends In The Use Of Advanced Practice Providers Full Size

Shannon Fitzgerald hasn’t just watched the roles of nurse practitioners (NPs) and physician assistants (PAs) change in recent years – she’s been instrumental in making change happen. An advanced registered nurse practitioner for more than 35 years, Shannon has devoted her career not only to caring for patients but to advancing the scope of practice for her profession. She developed an NP graduate program at Pacific Lutheran University in Washington, and in 1996 was appointed to the Washington State Nursing Care Quality Assurance Commission, where she worked on legislation to remove restrictions on prescribing narcotics for NPs.

Today Shannon is the Chief of Advanced Practice Services at Seattle Children’s Hospital (SCH). She is the first person at SCH to hold that title – a reflection of the growing involvement of advanced practice providers (APPs) in care delivery. In this interview, she describes how the roles of NPs and PAs have evolved over the course of her career, how they’re changing at SCH, and what she expects to see for APPs going forward.

How has the use of NPs and PAs changed over the course of your career?

The presence of NPs and PAs in pediatric medicine has increased dramatically. Around the year 2000, PA and NP roles began to diversify. This pivot was the result of multiple forces within the industry, including mandatory restrictions on resident work hours, specialist physician shortages in pediatrics, and ever-increasing care complexity. All three of these circumstances yielded an environment confronting labor shortages while striving to improve patient access and quality of care. Hospitals increasingly relied on staffing additional NPs and PAs as part of the solution, which proved to be a successful strategy. For example, at SCH we now employ neurosurgery NPs who complete inpatient rounds, serve as first call for complications, see patients in the clinic, and manage some preoperative processes.

How are new NPs and PAs integrated into care teams at SCH?

An intricate training program augmented with peer mentoring is pivotal in developing NPs and PAs. At SCH we are in the early stages of developing formal fellowship programs to advance education for each of our service lines. We almost exclusively employ NPs and PAs in the specialty care environment; therefore, we understand that developing an extensive proficiency in a particular specialty is a multiyear process for our NPs and PAs. I’m confident that postgraduate clinical fellowship programs will accelerate NP and PA specialization and proficiency across all care settings. For example, at SCH we commenced the 9-month neonatology fellowship to advance training in preparation for work in the NICU, and we recently hired our first three fellows.

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What role do NPs and PAs play in the industry’s increased focus on population health management?

NPs and PAs facilitate care coordination, which is a critical component of an effective population health strategy. At SCH PAs, NPs, and nurses work together to ensure a seamless experience is delivered to our patients across care settings. In endocrinology, for example, NPs and PAs manage care for diabetic patients, scheduling quarterly visits with them to ensure care plans are properly followed. Physician awareness, understanding, and appreciation of NP and PA roles have enhanced the effectiveness of SCH’s care coordination endeavors. In addition, NPs and PAs manage care plans for a diverse group of patients, often overseeing services for non-critically ill patients, permitting physicians to focus on the highest-acuity cases.

What are your top three wishes for advancing NP and PA practice at SCH in the next year?

I’m thrilled to share that one of my wishes will be coming to fruition in 2016. Starting this year, all NPs and PAs at SCH will receive a new benefit upon employment – an allowance for continuing education. My second wish is that our team continues to refine SCH’s model for collaboration between NPs, PAs, and their physician and nurse colleagues. Across 39 medical specialties, there are varying degrees of collaboration, and we hope to further develop best practices through analyzing specialties that implement the best strategy. Finally, my hope is that NPs and PAs continue to be further integrated with service line managers, in order to be a resource that can help guide clinical management decisions.

Shannon Fitzgerald, ARNP, MSN, is Chief of Advanced Practice Services at Seattle Children’s Hospital.

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