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AP Leadership, Achievements Increase Satisfaction, Reduce Burnout

December 29, 2022

January 2023

Katie Robinson

Katie Robinson is a medical writer based in New York.

Direct action planning and leadership support can increase job satisfaction and reduce burnout among advanced practitioners (APs) working in oncology. This is according to a study presented at the Journal of the Advanced Practitioner in Oncology (JADPRO) Live 2022 meeting, which showed the greatest improvements when these efforts were directed by the APs.

Burnout, satisfaction, and engagement among APs are often measured with limited evidence on how to best address team concerns, explained Heather Koniarczyk, MSN, APRN-CNP, AOCNP, and Mailey Wilks, DNP, APRN-CNP, of Cleveland Clinic Cancer Center in Ohio, in their presentation.

Researchers used multiple data sources to identify areas of high impact and high reward to increase satisfaction and reduce burnout. In addition to using the National Comprehensive Cancer Network Advanced Practice Provider Best Practice Committee survey, researchers reviewed staff meeting minutes, Press Ganey summary documents, and AP leadership annual performance review feedback dated between 2018 and 2020. The priority matrix was started as a living document in 2019 and adapted over the years to focus the leadership team on priority action items, Ms. Koniarczyk explained.

Barriers encountered in 2018 and 2019 included unsupported time away from patient visits, lack of value to pay APs at market rate, and not valuing the APs’ ability to prescribe antineoplastic therapy. The action items were to remove these barriers, enhance current structures that were valued and working well, and to innovate solutions. Areas identified as most valuable included APs reporting to AP leaders, the right people doing the right work, competitive pay, growth opportunities, and flexibility. Multiple actions were taken to address these areas.

“Careful planning, collaboration with physician and administrative leaders, and building trust within those groups was instrumental in improving relations, negotiating, and positive outcomes for APs,” Ms. Koniarczyk noted. “In 2019, we advocated to grow our leadership team as we were growing our oncology and palliative care footprint.”

AP leadership full time equivalent (FTE) growth was achieved by providing deliverable outcomes, including revenue generation by documentation auditing and education, new clinical opportunities and procedures, cost savings by quality improvement work, and better access by working with physician leaders to understand AP productivity metrics. The authors hypothesized that a larger AP leadership team would improve engagement, reduce turnover, and further cost savings. From 2019 to 2022, the AP leadership team increased from three FTEs/89 APs to seven FTEs/122 APs.  

Meanwhile, common themes that created workflow inefficiencies included clerical work, scheduling, and care coordination, along with an insufficient number of team members to complete the job safely. To address this, the cancer center defined staffing ratios and clinic templates and invested in back-up staffing, while AP leaders advocated for regular market assessments and wage adjustments to support a competitive pool of applicants, which was achieved twice in five years.  

Further, meeting the request for work-hour flexibility, where possible, created a culture of ownership and team responsibility. Outpatient APs were allocated time to practice support activities, such as electronic health record inbox management.

“We propose cancer centers advocate for AP leadership structures that support opportunities for increasing project work, publications, speaking engagements, and relationship building with their teams,” the authors said. “This has shown to be beneficial to the direct reports and financially impactful to our cancer center in a favorable way. Engagement work can be more meaningful and structured as well as a better opportunity for resource allocation with appropriate leadership.” 

Any conflicts of interest declared by the authors can be found in the original meeting materials.

Reference

Koniarczyk H, Wilkes M. Advanced Practitioner Leadership, Achievements in Increasing Satisfaction and Reducing Burnout. Presented at JADPRO Live 2022, Aurora, Colorado.

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