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Healthcare Flexibility Covid-19 – APP Redeployment Is It Here to Stay?

Posted on June 23, 2020   |   by   |   Advanced Practice Structure, Employers, Healthcare Teams, Job Seekers, Retention

Healthcare Flexibility COVID-19 – APP Redeployment Is It Here to Stay?

Author Jill Gilliland, MBA
Editor Elizabeth Moran, MSN, RN, CPNP-PC

Redeployment of the APP workforce was a key component of staffing solutions during COVID-19 surges. With an increased need for frontline providers in the ICU, Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), collectively referred to as Advanced Practice Providers (APPs), need flexibility. Strong APP leadership greatly enhanced the capability to manage the staffing challenges. Working with hospital leadership they are making difficult decisions following the financial hit incurred from this pandemic. Organizations need to review all organizational expenses, including choices made during the pandemic in regard to APP staffing.

To help hospitals make informed decisions, we spoke to organizational leaders involved in review processes.  Optimal staffing solutions continue to gain clarity as more institutions grapple with the impact of COVID-19.

Capabilities

Healthcare organizations identified versatility as one of the keys to solving healthcare staffing challenges during COVID-19. APP leaders developed flexible staffing solutions to address the need for patient access to frontline providers, especially in the ICU. One of the primary decisions was to redeploy CRNAs, as well as hospital-based NPs and PAs to the ICU.  

According to the American Association of Nurse Anesthetists (AANA), “CRNAs’ expertise in rapid systems assessment, vascular volume resuscitation, airway management, general and regional anesthesia and pain management, team coordination, and resource management is vital to supporting the facility’s effort to respond to this unprecedented emergency.”  

Organizations quickly identified how the training of CRNAs, in conjunction with  their previous RN ICU experiences made them ideal providers.  They were capable of  responding to ICU patient needs and ventilator management during COVID surges. The AANA has not endorsed this practice, however they understand the emergent needs of the situation. They made recommendations regarding utilization of CRNAs in this capacity.  

Another major redeployment of APPs included utilizing hospital based APPs in the Emergency Departments.  According the NEJM Catalyst article, A Primer for Clinician Deployment to the Medicine Floors from an Epicenter of Covid-19, Mount Sinai in New York stated “The first step in effective deployment was for the Department of Medicine (DOM) Chair to name the decision makers and establish a command structure with formalized roles and responsibilities.” Many organizations partnered with APP leaders.  These Directors and Chief Advanced Practice Officers partnered with physician leadership to strategically approach redeployment. 

APP Leadership

Leadership was crucial during the COVID-19 emergency as needs continually changed on a daily basis. Needs varied throughout each day in the areas of managing the patient volume, PPE availability, and many others.  APP leaders first identified the skills, experience, and demographics (such as age, pregnancy, or chronic conditions) of their teams. Then, in collaboration with physician leadership, they assessed needs and built new teams of frontline providers. The APPs who could be redeployed to the ICU were provided crash courses in ICU patient management. 

Flexibility on a day to day basis had a big impact on outcomes during COVID 19.  According to the NEJM Catalyst, “The ICU first call was the frontline role staffed by a wide variety of residents, advanced practice providers (from inpatient and outpatient settings), and certified nurse anesthetists (CRNAs). This group started at a 3:1 patient to clinician ratio, but quickly increased to a 5:1 ratio.”  View the Supervised ICU Staffing Model – NYP/CUIMC/ WC COVID-19 critical medicine planning committee NEJM Catalyst Massachusetts Medical Committee. APP flexibility resulted in challenging providers in new ways and increasing the patient load.

Going Forward with APP Redeployment

Organizations are reviewing their APP workforce in the light of the impact of COVID-19 patient surges. They are now considering different staffing models, including  APP float teams. Many leaders are now considering the creation of permanent, flexible teams of APP providers who are cross-trained in ICU care. These teams would provide preparedness and flexibility, when and if, the next wave or pandemic hits.

According to the American Academy of Physician Assistants (AAPA), in the article Behind the Scenes at Northwell Health as PAs Respond to COVID-19 by Eileen Denne, CAE, APR, “Responding to COVID-19 has led to hospitals creating new models of care and establishing innovative practices. At Lenox Hill Hospital, they created new roles such as intubation teams, central line teams, swab teams, and command center providers. As the inpatient landscape changed, and initially many patients awaited placement, Anderson says, they created new units and teams to account for the change in population.” 

APPs are a highly flexible, productive workforce. They are well trained, and provide safe, quality care at the top of their license. We will continue to explore the impact of COVID-19 on APP staffing and the need for flexibility in healthcare in blog posts to come, including on topics such as the scope of practice, credentialing, care, models, APP leadership, and mental health support. With many healthcare institutions evaluating all their expenses following COVID-19, Melnic is here to help you make informed decisions regarding APP staffing for the long term.

If you want to discuss building, growing, or making changes to your APP workforce, please contact Jill Gilliland. President, Melnic. jill@melnic.com 

 

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