Advanced Practice Providers: Caring for Patients in All Settings

When you are treated in just about any health-care setting, you likely interact with a talented group of medical professionals known as advanced practice providers (APPs)—clinical nurse specialists, nurse midwives, nurse anesthetists, nurse practitioners, and physician assistants. At Penn Medicine Lancaster General Health, there are more than 600 advanced practice providers caring for patients every day. Our advanced practice team works at the top of their license with our physician partners to provide the highest quality care to our community. Since September 2023, we have:

• Graduated the second cohort from our family medicine APP onboarding program
• Onboarded 118 APPs to the medical and dental staff
• Enhanced APP orientation and onboarding to include an early career advanced practice series focused on developing soft skills and confidence as APPs enter their professional roles
• Continued enhancement of the student nurse anesthetist stipend program
• Developed future APP leaders, alongside future physician leaders, through the Pennsylvania Medical Society Leadership Program
• Expanded the APP leadership team, matrixed closely with our physician leadership, and developed the Penn Medicine Advanced Practice Strategic Plan to keep our future bright
• Recognized the outstanding work of advanced practice through both Penn Medicine LG Health Medical and Dental Staff Awards and University of Pennsylvania Health System Advanced Practice Awards ceremonies

Who are clinical nurse specialists?

• A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) prepared by a master’s, doctoral, or post-graduate certificate level CNS program. CNSs diagnose, prescribe, and treat patients and specialty populations across the continuum of care. The CNS improves outcomes by providing direct patient care, leading evidence-based practice initiatives, optimizing organizational systems, and advancing nursing practice. A CNS’s specialty may be identified in terms of a population, a setting, a disease, type of care, or type of problem. 
• The National Institute of Health (NIH) believes the full impact of the role is demonstrated when a CNS functions in and across three spheres—patient/client, nurses/nursing practice, and the organization/system sphere. Therefore, the role fluctuates at any given time, depending on the needs of the health-care system, but remains grounded in evidence-based practice. 
• CNSs play a critical role in health care system innovation impacting the patient, the nurse, other disciplines, and the organization to ensure safe, cost-effective, and high-quality evidence-based health care services.
  
  

Who are nurse midwives?

• Certified nurse midwives (CNMs) are advanced practice registered nurses who hold a master’s or doctoral degree from one of 40 accredited midwifery programs in the U.S. Recertification is required every five years following completion of practice-specific continuing medical education.
• CNMs attend births and provide general health care throughout a woman’s life.
• According to the American Congress of Obstetricians and Gynecologists, 49 percent of U.S. counties do not have obstetric care providers, and a 25 percent shortage of OB/GYNs is predicted by 2030. CNMs are valuable in meeting women’s health-care needs.

Who are nurse anesthetists?

• Certified registered nurse anesthetists (CRNAs) are advanced practice registered nurses. They administer more than 50 million anesthetics to patients in the U.S. each year.
• Nurse anesthesia programs range from 24-51 months, depending on university requirements. As of August 2022, there are 130 nurse anesthesia programs in the U.S. and all programs are approved to award doctoral degrees for entry into practice. Nurse anesthetists have an average of 9,369 hours of clinical experience at the time of graduation.
• Nurse anesthetists follow a Continued Professional Certification Program comprised of two, four-year cycles each, requiring 60 continuing education credits, 40 professional activities credits, four core modules, and a performance standard assessment at the end of the eight-year cycle.

Who are nurse practitioners?

• Nurse practitioners (NPs) are advanced practice registered nurses who are trained in the advanced practice of nursing in specific concentrations including family/across the lifespan, primary or acute adult-gerontology, women’s health, neonatal, primary, or acute pediatrics, and psychiatry-mental health through a master's or doctoral degree program.
• There are more than 385,000 NPs licensed in the United States. Over the next decade, the U.S. Bureau of Labor Statistics projects 45 percent employment growth for nurse practitioners between 2022 and 2032. 
• NPs work in various settings including family practice, hospital outpatient clinics, inpatient hospital units, emergency rooms, urgent care, community health centers and federally qualified health centers. 88 percent of NPs are prepared in primary care.
  
   

Who are physician assistants?

• Physician assistants (PA-Cs) are educated at the master’s degree level. They train for 27 months using a curriculum modeled on medical school education, and complete at least 2,000 clinical rotation hours.
• Over the next decade, the U.S. Bureau of Labor Statistics predicts employment of PAs will increase 27 percent. There are approximately 178,000 PA-Cs in the U.S. who practice in all specialties of medicine.
• To maintain their certification, PA-Cs must attain 100 hours of continuing medical education credits every two years, and recertify every 10 years through an examination that evaluates general medical knowledge.