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New Advanced Practice Leaders, 5 Steps to Setting Goals in the First 90 Days

Posted on September 26, 2019   |   by   |   Advanced Practice Structure, Communication Skills, Employers, Leadership Skills APPs

A Roadmap for Advanced Practice Leaders

Blog adapted from a presentation titled “New Advanced Practice Leaders, Your First 90 Days” presented at Vanderbilt University Medical Center Advanced Practice Leadership Summit, September 9, 2019.

Developed by:
Jill Gilliland, MBA, President, Melnic
Courtney Robinson MSN, APRN, CNS, CPNP-AC, Director of Advanced Practice Providers, Children’s Hospitals and Medical Center, Omaha
Korinne Van Keuren, DNP, CPNP-AC, PNP-BC, RNFA, Director,  Advanced Practice Providers, University of Virginia Health System

As a new Advanced Practice (APP)  Leader, your first 90 days on the job are critical for your long-term success. No matter what your role is – AP Leader, AP Director, or AP Manager – you’ll want to have a strategy to enact positive change in your organization quickly. 

So how do you do it? We suggest that you focus on five things: know your style, have a voice, identify opportunities, build relationships, and set goals. When you define annual goals and find small wins within your first 90 days, you’ll gain a reputation as someone who can have an impact. 

In September, Melnic conducted a survey of 49 advanced practice leaders across the country. The respondents included system-level advanced practice leaders (10%); associate chief nursing officers, chief nursing officers, and directors of advanced practice (24%); managers of advanced practice (16%); advanced practice leads (33%), and advanced practice providers (17%). The majority of respondents had been in their roles for more than 5 years and represented a variety of facility types including academic centers (41%), healthcare systems (27%), community hospitals (4%), freestanding children’s hospitals (14%), and clinics (22%). Some represented more than one facility type. 

The information these leaders shared was both instructive and encouraging for new advanced practice leaders on ways to identify and set goals within the first 90 days.

1. Know Your Style

Using self-assessment to identify your strengths and the strengths of the people around you helps to build a firm foundation.  In Four Steps to Discover your NP or PA Leadership Style you can find links to some recommended assessments. In a survey of 49 APP leaders, we found that 79% did not complete a leadership assessment before they started their role but, with experience, that number fell to 39%.  

Assessing the organization and its appetite for change is as important as assessing yourself and your team.  As a new leader, you will need to make changes in the organization to have a positive impact on APPs. This is especially true if you are the first APP leader for the organization. Evaluate alignment between your goals and the goals of the organization in areas such as values, capacity for change, priorities, clarity regarding goals and need for change, resource allocation, and overall support for any proposed changes. 

2. Have a Voice and Communicate Your Message

Communicating your presence and listening to others at all levels of the organization is foundational to your success.  This includes departments like finance and recruitment as well as leadership committees and the APP council. It is also important to set up an APP communication network to share your intent and support actions as you establish goals and make changes. Relationship building is the key to becoming a leader. As an individual contributor you’ll be much less effective. Our survey reported that 44% of respondents considered themselves a team of one while 56% felt they had the support of the organization for their goals and role.

3. Identify Opportunities with a Gap Analysis

A Gap Analysis is a research mission to identify opportunities and establish goals to improve Advanced Practice within your organization. For a vision of an optimized ‘desired state’ for APPs, check out our 11 Signs of a Successful  Advanced Practice Hospital.  Start by clarifying your leadership role and your responsibilities, identify your resources, and set up your reporting structure.  In the survey, 54% of respondents understood their role in the first 90 days.

4. Build Relationships

To assess the current state and the desired state of Advanced Practice in your organization, gather data and build relationships with key stakeholders. This is a three-part process, that includes:

  • Melnic First 90 Days Survey Results
    Melnic First 90 Days Survey Results

    Meeting with stakeholders to connect and establish a relationship 

  • Asking questions to understand their role, the history of the organization, and needs from their point of view
  • Listening and discussing their ideas of where APPs are and where they should be in the organization

As you prioritize these meetings, start with colleagues in your immediate circle. Sit down with the people you report to, your peers, and the people you supervise. In our survey of 49 Advanced Practice Leaders, 38% met with a CNO/Nurse Executive, 30% met with the CMO, 43% met with other APP Leaders, 40% met with their Credentialing Department, and 32% met with the Recruitment team. From there, depending on the feedback they received, many also reached out to subject matter experts in areas like compliance and legal. 

The goal of a Gap Analysis is to analyze your organization’s capabilities, processes, practices, structures, technologies, and skills to identify goals and create strategies and action plans. Another important goal is establishing a flexible, multidisciplinary team of people you can rely on who have the role and resources to get things done.

5. Clarify and Set Goals

The goals you identify from your Gap Analysis will be specific to your organization’s needs. To set yourself up for success, however, it’s important to align your goals with the priorities of your organization. Here are three tips to clarify and structure your goals:

  1. Set SMART goals: specific, measurable, attainable, relevant, and timely. 
  2. Develop a scope and timeline that aligns with your organization’s ability to mobilize people and resources.
  3. Ensure that your leaders support the desired outcome and are willing to commit to its execution. 
Melnic First 90 Days Survey Results
Melnic First 90 Days Survey Results

In our survey of APP Leaders, we asked about focus areas. The APP  scope of practice was a key priority for many. Over 50% spent time assessing their organizational bylaws and state regulations. Other priority topics for our respondents included delineation of privileges and APP new hire orientation procedures. 

Most APP leaders said that they identified considerably more opportunities than they could reasonably accomplish. That’s where the Gap Analysis became a valuable tool for prioritizing goals and gaining consensus. The top five goals and objectives identified among our survey respondents were as follows:

  • Evaluate APP recruitment metrics, FTE approval process,  total FTE and composition
  • Evaluate employment models for APPs, including who employs APPs and physicians, arrangements like leases, and compliance
  • Evaluate the credentialing process, NPI, and DEA numbers
  • Evaluate the process for measuring APP productivity
  • Evaluate professional development opportunities and protected time

Bonus: Go for the Low Hanging Fruit – Sample Goal Targets for the First 90 Days

First 30 Days

  • Identify APPs by role
  • Establish APP communication
  • Set up an APP professional day with speakers and fun activities

First 60 Day

  • Write Job Descriptions for APPs:  Clarify roles of APPs to the organization
  • Standardize the recruiting experience
  • Set Up APP Structure: Get FTE Approval (think budget neutral)

First 90 Days

  • Compensation Evaluation and Proposal (consider a bonus, incentive model)
  • Weekly Meetings: With agenda set up for APP Managers and Physician Leader
  • Establish protected time with a plan for accountability for projects
  • In the EMR, set up billing provider and service provider. Pull APP data and share with the organization
  • Standardize Orientation: Build a framework to be modified for department-specific needs

Positive Change is Possible in the First 90 Days

In the APP survey, almost 50% created clear goals with specific action plans and the majority of those respondents discussed their goals with senior managers in the first 90 days.  Just under 40% communicated their goals to their direct reports. We believe creating goals and communicating them in the first 90 days will position you as a leader who people can count on to get things done and will build your reputation as a leader who can have an impact. 

We share these results to show new AP Leaders what’s possible. Be encouraged that others are finding success and making a positive change in their organizations. We also acknowledge that every organization is different, with different cultures, support, and appetite for change. Starting a strong start in your first 90 days will set you up to positively impact APP work environments and patient care. 

Specialists in Advanced Practice Staffing

We are committed to helping hospitals and clinics build and grow APP services, through a focus on staffing, recruitment, and retention. If you would like more information about building an Advanced Practice Structure for APRNs and PAs, please schedule a call or email jill@melnic.com.

Here are some resources to help you in your leadership journey.

Please contact Jill Gilliland, President of Melnic, to help you on your way: 

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