Staffing Challenges

Despite the availability of APPs across the hospital, staffing challenges existed.  Many APPs who were originally identified for a role ended up being redeployed to inpatient floors.  Other APPs were furloughed after testing positive for COVID-19 or while waiting for results after a possible exposure.  A combination of online training and preceptor-run sessions met the needs of APPs to quickly gain proficiency in their new roles.  While training for each APP role was deft, it did require time and created lapses in staffing and loss of efficiency in managing high volume throughput which impacted patient care. Due to rapidly changing information and workflows in all roles, introducing an APP to a new role or reintroducing an APP to a prior role required training that used clinical resources and slowed down other team members. For APPs in remote roles, it was a benefit that if they were asymptomatic while they awaited definitive results after a possible exposure, they could continue to work.

Implications for Practice

Integrating these new roles into regular, non-crises operations presents an opportunity to be prepared for a future pandemic. Patients were willing to engage in virtual care and follow up with APPs whose strong communication skills may create additional access for some patient populations.  Alternatively, virtual care may not be accessible to populations without access to personal communication devices despite a hospital system having a robust patient portal.

Many APPs have special skills, such a language proficiency, that when leveraged can engage patients more effectively. Other APPs have technical skills, like vascular and enteral access competency, that can benefit regular hospital care as well as be sustained for future patient surges.

Providing patient education is a central function of APPs and in every role, APPs needed to be versed in the basics of infection control, public health measures, and how to identify available community resources for food, housing, and legal issues. In preparation for operations during crises, organizations should create information sources that can be accessed by APPs and patients so there is broad availability and dissemination during regular, non-crisis operations.


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To fully understand implications for practice, organizations should engage in a formal debriefing and evaluation with all APPs to better understand their experience and perceptions of preparedness for these new roles. Post-crisis is also the time to reach out to the hospital’s capacity management team to document staffing models while addressing factors that might be addressed in future responses.

Jean M. Bernhardt, PhD, CNP, is Administrative & Nurse Director, Massachusetts General Hospital.

Melissa Chittle, MBS, PA-C, is Interventional Radiology Lead Advanced Practice Provider, Massachusetts General Hospital.

Julie Marden MSN, NP-BC, DGIM, is Director of Advanced Practice Providers & Primary Care Nursing, Massachusetts General Hospital.

Darlene Sawicki, MSN, NP-BC, is Director of Advanced Practice Providers, Massachusetts General Hospital