The APP environment today
By Milissa Eagle, MA, Director of Workforce Analytics, and Anita Opdycke, DNP, RN, APRN, PMHNP-BC, NP-C, SVP/Partner, Advisory and Consulting
In our last blog, we explored how trust, leadership credibility, and safety culture are helping drive improvements in advanced practice provider (APP) engagement. Those gains are encouraging, but they raise another important question: What is it actually like to practice as an APP today?
The answer lies in the day-to-day work environment. APPs continue to face significant challenges related to staffing, workload, resilience, and operational efficiency. These realities shape the APP experience.
Staffing is still the top concern
The lowest-rated items nationally center on staffing. Stress-related measures sit among the lowest performers too. And the comments say the same thing the scores do: Staffing shortages were the single most discussed topic, appearing in 14.1% of APP comments.
Many APPs now serve as an operational “buffer” for their organizations, absorbing patient demands, filling care gaps, and helping patients access care despite staffing shortages elsewhere in the system.
That means recruiting more APPs won’t solve the challenge on its own. The better approach is making sure your APPs are practicing on well-governed, well-designed care teams.
The organizations making progress have moved past historical staffing ratios. They factor patient acuity, workload intensity, and clinical support resources into staffing decisions. And they’ve found that investing in nurses, medical assistants, care coordinators, and technicians often do as much for APP sustainability as hiring more APPs.
Resilience is improving. Sustaining it is a different question.
After several years of workforce strain, APP resilience indicators are climbing. The gains are noteworthy:
- Ability to disconnect from work communications: +0.14
- Enjoying personal time without focusing on work: +0.14
- Freeing their minds from work when away: +0.12
- Avoiding lost sleep over work concerns: +0.12
However, these gains are also incomplete. 37% of APPs still report difficulty disconnecting from work, compared to 25% of RNs. APPs also rank third-lowest of all roles for decompression, even after a year-over-year improvement.
We’ll frame the leadership challenge this way: The goal isn’t to make APPs more resilient, but to build environments that demand less resilience in the first place. That means sustainable scheduling practices, protected recovery time, adequate coverage resources, and accessible mental health support.
Operational efficiency has become a workforce issue
APPs keep clinical workflows moving. But every inefficiency they hit, from cumbersome documentation requirements to communication breakdowns between departments, costs productivity, throughput, and morale.
Some of this is getting better, though. For example, satisfaction with electronic medical records (EMRs) improved 0.15 points year over year, one of the most notable gains in the data.
At the same time, other gaps are widening: APPs rate their organization lower on balancing quality with efficiency—and lower still on making the appropriate investments in clinical technologies and innovation. Both were among the largest declines.
As healthcare pursues greater productivity and access, operational excellence becomes a workforce imperative—not just a technology initiative. Redesigning workflows, optimizing EMRs, standardizing templates, automating routine work, and providing APP-specific training improve both the APP experience and organizational performance.
When did your APPs last have input into a workflow decision that affected their day? Without a standing channel for that input, workflow decisions default to whoever is loudest in the room, not necessarily the person closest to the problem.
That observation points to a broader issue running through many of the challenges APPs describe. Staffing models, operational processes, role expectations, and decision-making authority are often addressed separately. In reality, they are frequently symptoms of the same underlying issue: APPs are central to care delivery, but not always fully integrated into the structures that govern how care is delivered.
The organizations making the most progress have recognized that improving the APP work environment requires more than tactical fixes. It requires clear leadership structures, defined decision-making pathways, and consistent mechanisms for APP participation and representation.
In the last blog in this series, we’ll explore why governance may be the missing foundation of APP strategy—and how leading organizations are building the structures that enable APPs to practice at the top of their license, contribute to organizational decisions, and thrive over the long term.