The state of APP experience: Progress amid persistent challenges
By Milissa Eagle, MA, Director of Workforce Analytics, and Anita Opdycke, DNP, RN, APRN, PMHNP-BC, NP-C, SVP/Partner, Advisory and Consulting
Healthcare leaders are facing a difficult reality. Demand for care continues to rise while traditional workforce models struggle to keep pace. Persistent nursing and physician shortages, combined with growing expectations around access and care, have elevated the importance of one workforce segment: advanced practice providers (APPs).
Nurse practitioners and physician assistants are now central to how care gets delivered. They expand access in primary care, specialty care, behavioral health, acute care, and virtually every clinical setting. The Bureau of Labor Statistics also projects nurse practitioner employment to grow 41% and physician assistant employment 21% between 2025 and 2035, placing both among the fastest-growing occupations in the country.
But plenty of organizations still run on leadership models designed for a different era of care delivery: structures built around physicians and nurses, with APPs layered in later, often as an afterthought. That mismatch is a governance problem before it’s a staffing problem. Authority, accountability, and decision rights were drawn for a different workforce than the one actually delivering care.
The data tells a nuanced story. APP engagement is rising, but is still the lowest across healthcare roles. We’re seeing other improvements, too, like greater confidence in senior leadership. That rising confidence is trust—the social capital that determines whether communication and teamwork actually convert into results. Resilience measures are moving in the right direction. But the persistent challenges APPs identify, from staffing and compensation to communication, influence, role clarity, and governance continue to impact the APP experience. Together, these findings suggest that while progress is underway, many organizations still have an opportunity to better align their structures, leadership practices, and workforce strategies with the increasingly central role APPs play in care delivery.
This first blog examines where APP engagement stands today, and what the trends tell us about the evolving APP experience. Additional blogs throughout National Advanced Practice Provider Week will explore the role of trust and leadership, the importance of safety culture, and why governance may be the missing foundation of an APP strategy.
Where APP engagement stands today
We analyzed responses from over 41k APPs within Press Ganey’s 2025 healthcare database, comparing year-over-year movement on every employee engagement item.
We found:
- APP engagement is rising. After a decline the previous year, engagement rose from 3.88 to 3.94 in 2026.
- Every engagement item moved in the right direction. Overall satisfaction gained 0.08 points, “Likelihood to Recommend” (LTR) the organization as a place to work gained 0.08, intent to stay gained 0.07, and belonging gained 0.07.
- Healthcare organizations still face significant hurdles. APPs remain the lowest-engaged role year over year.
These gains may look incremental up close, but they’re massive at a national scale. More importantly, they remind us that APP engagement is highly sensitive to workplace conditions. Even small improvements in leadership visibility, teamwork, scheduling predictability, and recognition can have a measurable impact on workforce stability, productivity, and patient care.
APP engagement also has a close link to patient experience. On average, patients who see APPs that are highly engaged rate “likelihood to recommend the care provider” 28 percentile ranks higher than patients who see APPs that are disengaged.
What 15,000+ comments tell us about APP experience
While APP engagement is improving, comments provide important context around what APPs are experiencing day to day. We analyzed 15,891 APP comments from 181 organizations and saw three themes rise to the top:
- Compensation and benefits (21.9%)
- Workplace culture (21.8%)
- Collaboration and communication (20.1%)
And the most discussed subtopics reinforce several themes that appear in APP survey data:
- Staffing shortages (14.1%)
- Pay and bonuses (12.7%)
- Leadership communication (9.2%)
- Employee appreciation (8.4%)
- Patient care quality (6.4%)
- Departmental communication (5.4%)
- Transparency in decisions (5.1%)
Most feedback wasn’t about perks. APPs are focused on fundamental elements of the work experience: fair compensation, stronger communication, clearer governance, meaningful recognition, and enough people to do the work safely. Read the comments as a whole, and they add up to a workforce asking for one thing: partnership.The data also raises important questions.
- What is driving APP engagement?
- What is happening in their work environment?
- What role does governance play in creating a stronger APP experience?
We’ll explore those questions in upcoming blogs, beginning with what the data reveals about trust, leadership, and safety culture, and why they have become some of the strongest drivers of APP engagement today.