Document Type


Publication Date


Date of Final Presentation


Committee Chair

Sara Ahten, DNP, RN, NC-BC

Committee Member

Leslie Hough Falk, DNP, MBA, RN, PMP

Coordinator/ Chair of DNP Program

Pamela Gehrke, EdD, RN

Abstract/ Executive Summary

Background: Hospitals are increasing utilization of advanced practice nurses (APNs). APNs do not fit within the traditional nursing or medicine department structures. They are often hired by organizations without full evaluation and assessment of management issues and structures to support them.

Problem: APNs are employed to work throughout an acute care hospital. They report to medical leadership but have no voting rights or representation on medical committees. They lack connection to nursing staff and existing structures which impairs their ability to exhibit leadership and advance nursing practice.

Purpose: This project seeks to answer: What organizational support and leadership structures are needed for APNs to practice to their fullest ability in the hospital setting?

Outcomes: Interventions to clarify APN domains of practice, increase visibility, implement peer review, and create support structures were implemented. The transformational advanced professional practice (TAPP) model was utilized.

Results: APNs perceived increased knowledge in domains of practice, shared governance, and the TAPP model. A pilot APN shared governance council was established. Eighty percent of APNs in a department participated in a newly created peer review process.

Impact: There is increased awareness of APN domains of practice. Shared governance brings a structure for APNs to participate in activities that impact their practice. The process begins with small steps of change. Adoption is highly dependent on the context and culture of the organization.

Included in

Nursing Commons