Job Seekers

Advanced Practice Structure Is Good for NPs and PAs

Does your current, or prospective, employer have an Advanced Practice Structure? Here’s what it means for your career path.

When you evaluate a job offer, do you focus on attributes such as location, job role, clinical focus, compensation and benefits? While these are all important considerations, many people forget to consider the organizational leadership structure of their prospective employer. Look for a hospital that has an effective Advanced Practice staffing model. This often leads to greater job satisfaction for Advanced Practice Providers (APPs) such as NPs, PAs, and CNSs down the road.

Defining Advanced Practice Structure

Diagram showing a staffing model
Advanced Practice Structure often provides higher levels of support for NPs and PAs than traditional hospital staffing models.

The concept of the Advanced Practice hospital has been championed by the Center for Advanced Practice at Stanford Health Care (SHC). SHC recognized that APPs needed to be formally recognized and supported to keep up with changing healthcare roles. This led the organization to develop reporting structures, leadership roles, and hospital processes with the needs of APPs in mind.

According to the SHC website, “The Center for Advanced Practice is innovative in its administrative infrastructure and centralization of resources for APPs, which has hospitals around the country looking to SHC as an example of how to structure their APP practices.”1

APPs have much to gain by working in a clinical environment that recognizes their unique qualifications. With their advanced education and clinical expertise, APPs fall outside the traditional categories of medicine and nursing. They thrive in hospitals that are well resourced and lead APPs to practice at the fullest scope of their qualifications.

The Benefits of Advanced Practice Structures

Experts are considering the benefits to Nurse Practitioners who operate under a centralized leadership approach. These voices include Carmel McComiskey, DNP, CRNP and Director of Advanced Practice at the University of Maryland. Some of the issues this new approach have been shown to improve include:

  • Streamlined reporting structures that provide clarification on roles and professional advancement within the organization
  • Standardization of processes for hiring, credentialing, and orienting advanced practice providers
  • Efficient means to address NP professional issues
  • Improved recruitment and retention
  • Centralized budgeting and resource allocation, productivity measurement, clinical quality, and patient care
  • Ability to anticipate and effectively respond to needs and changes in the practice environment2

Questions to Ask a Prospective Employer

As you’re evaluating an offer, there are questions you can ask of your prospective employer. They include:

  • Can you give me information about your organizational structure? Who would I report to?
  • Can you describe the orientation program you have for new employees, including transitional programs for new grads?
  • How would you define my role? What resources do you provide for professional development and continuing education?
  • Does the department have multi-directional communication, especially when it comes to policies, procedures, and practices?
  • Are there opportunities for Advanced Practice Providers to have a seat at the table in decision making? Are there collaborative relationships between hospital leadership, physicians and nursing? If so, can you share some examples?

The Advanced Practice Structure is a relatively new development. However, it is becoming more widely implemented as the workforce continues to grow. At Melnic, we believe that NPs and PAs should know their worth and seek employment with organizations that support their professional growth and scope of practice. Choosing a supportive Advanced Practice hospital is a good move in the right direction.

If you would like to know more about the opportunities we currently have with Advanced Practice hospitals, please contact us.


  1. Advanced Practice at Stanford. Stanford Health Care website. Accessed April 22, 2016
  2. Bahouth, Mona N., Ackerman, Michael et. Al. Centralized Resources for Nurse Practitioners: Common early experiences among leaders of six large health systems. American Academy of Nurse Practitioners. January, 2011. Accessed April 22, 2016