The Agile Advanced Practitioner

Sandy Kurtin, PhD, ANP-C, AOCN
Hematology/Oncology Nurse Practitioner at the University of Arizona Cancer Center and an Assistant Professor of Clinical Medicine and Adjunct Clinical Assistant Professor of Nursing at the University of Arizona

In this edition, ASH Clinical News Associate Editor Sandy Kurtin, PhD, ANP-C, AOCN, offers advice for promoting interprofessional agility to keep pace with an ever-changing health care environment.


 

The COVID-19 pandemic has required enormous individual, team, and institutional agility and adaptability with an immediacy that has rarely been required. Health care organizations and individual health care personnel have been forced to quickly adapt and shift priorities. This demand for interprofessional agility requires each team member, including advanced practitioners (APs), to work to the full scope of their practice, enhancing each team member’s role across the entire continuum of care.

In such a dynamic and unpredictable health care environment, interdisciplinary collaboration and robust information technology (IT) support are required to continue navigating these challenges. How do we, as APs in hematology/oncology, create and maintain interprofessional agility? We “build a bench,” of course.

Building a Bench for an Agile Practice

A long-standing strategy in sports (full disclosure: I am not a sports aficionado) is the concept of “building the bench,” or assembling a full roster of skilled players, including some specialists, to take advantage of an opponent’s weakness and to overcome unexpected events, such as injury or illness, or even a pandemic.

Similarly, health care organizations deepen their bench by including APs who are trained and ready to step in when challenges arise. This has allowed heath care organizations to successfully weather the continuous and unpredictable strain of this pandemic with the ability to quickly shift priorities and tackle endless challenges. Each individual within the organization is essential to the outcomes of the team, and the workflow processes must be constantly reimagined.

Engaging the Team

Effective teams promote agility by maximizing the full scope of each team members’ abilities. For APs, this includes independently evaluating patients, ordering and interpreting diagnostic tests, and prescribing medications as permitted by the state’s practice laws.

By expanding the depth, flexibility, and continuity of care that the team provides, APs are vital to building an agile practice. Recent events have accentuated the broad scope of the hematology/oncology AP’s role. Their familiarity with the practice and the panel of patients served provides stability to the practice.

Building AP expertise in patient assessment and strategies for prevention, mitigation, and management of disease or treatment-related adverse events allows for same-day visits, which limit emergency room visits and hospitalizations. These strategies are key to keeping patients on effective therapies.

APs understand the full scope of services provided by each team member, allowing them to recognize inefficiencies across the continuum of care. Participation in team huddles, town halls, end-of-day debriefings, tumor boards, committees, and workgroups can improve all team members’ awareness and engagement. If you do not have time to commit to workgroups or committees, take the opportunity to provide input to those involved.

How do we, as APs in hematology/oncology, create and maintain interprofessional agility? We “build a bench,” of course.

Tackling EMRs

Electronic medical records (EMRs) dictate most workflows in oncology practice and are one of the primary contributors to physician and AP burnout.1 The more we can document all components of care in the EMR, where all members of the team can access the information, the more efficient and agile we become as a team. This includes visits, tumor board recommendations, patient communications, authorizations, denials, appeals, and referrals. Knowing where to enter and find patient information in the EMR is an essential element of an agile team.

Changes in the EMR do not happen easily or quickly, but they can be accomplished with the right processes and engagement from all stakeholders. I recommend asking the IT department and leadership team in your practice about how to create new EMR processes that enhance communication to improve interprofessional agility. There are often hidden tools that can improve communication within the EMR. The on-site IT team can help develop a roadmap and tip sheets for training and onboarding, which should be updated regularly.

Recruiting the Unofficial Team Members

We do not often think of patients and their caregivers as members of the interprofessional team, yet they are at the core of what we do. As APs, we need to fully engage the patient and their caregivers to quickly identify, grade, and manage adverse events and promote health self-management.

Involving caregivers in the plans for patient care has been particularly challenging in the era of COVID-19 due to visitor restrictions necessary to reduce the risk of exposure. Taking the time to engage caregivers during telehealth visits or through portal communication can improve patient outcomes. “Prescribing” portal use, application use, or advocacy resources has been shown to improve decision-making, adherence, and self-care capabilities.2,3

Maintaining Agility

Developing and maintaining an agile practice requires ongoing commitment across the full health care team – from both leaders and team members. There are countless other opportunities to make interprofessional agility a priority in our practices.

I have found that involvement in professional and advocacy organizations is one of the best ways to build awareness about the role of the AP and the assets we bring to the interprofessional team. Take the time to create an elevator speech to succinctly articulate the value you bring to your organization and to the team. Embrace technology, engage in organizational projects, maintain a mindset of innovation, and commit to uninterrupted communication across the team.

References

  1. Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clinic Proc. 2019;94(9):1681-1694.
  2. LeBlanc TW, Baile WF, Eggly S, et al. Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies. Patient Educ Couns. 2019;102(9):1602-1612.
  3. Kurtin S. Mobile Health Technology, Technology Engagement, and Communicative Health Literacy in Older Adult Cancer Survivors [dissertation]. University of Arizona, Tucson, Arizona; 2018.