Nursing at Seattle Children’s

New Advanced Practice Provider Leadership Structure Enhances Communication and Collaboration

When Ronna Smith became chief of advanced practice provider (APP) services at Seattle Children’s in 2019, she brought a fresh set of eyes. Her predecessor grew the program significantly; the group started from only 60 APPs in 2005 to 390 across 39 specialties today. As the new chief, Smith embarked on a large task — restructuring leadership roles to better serve APPs at Seattle Children’s. “This restructure was an attempt to be more proactive and plan for our future growth, while also addressing some gaps in the current leadership structure,” says Smith.

While APPs have similarities with physician and nurse roles, they are different from both positions — they can diagnose and treat patients independently or in conjunction with a physician.

Seattle Children’s previous APP structure had 50 to 60 people reporting to one person — too many to foster a personal relationship with leaders, or for leaders to be effective and engaged in the work of their direct reports.

Today, under the new structure, there are five to seven APPs on a team. Each team has an APP supervisor who splits their time between administrative duties and their clinical role. Smaller teams are grouped under a manager.

“It was important to me that every APP had access to a direct frontline supervisor — someone who can be immediately available to them and can be close enough to the work that they understand it,” says Smith. “With fewer reports, our senior leadership team can participate in the bigger picture strategy and planning with physician leadership and service line leadership.”

Creating the director and manager roles

The manager position was redefined to fill a gap so APPs would report to someone who knew them and their job and could help with administrative tasks. The former manager role was redefined as director. These individuals are responsible for leading larger groups and multiple front-line supervisors on big teams. For example, April Morris is the director of APP practice for the neonatology team. She has five supervisors who report to her; her team encompasses 70 APPs across six different practice sites. 

Positive outcomes

Smith says the new structure frees up more time for strategic planning from the leadership positions that were retitled to “associate chief.” Smith says APPs also have much more direct contact with their leader and can escalate issues more effectively and stay in touch with their leadership team more often. “We have received positive feedback from physician leadership and service line leadership about improved communication and collaboration because of the more streamlined approach,” says Smith.

Looking toward the future

The past couple of years have been challenging due to the pandemic; APPs have helped fill gaps and provide contingency staffing. APPs, nurses, physicians and other disciplines work together to provide care.

“The care provided by the APP team at Seattle Children’s is stellar,” says Smith. “I’m incredibly proud to be a part of the team and see their commitment and professionalism every day. They go above and beyond, especially in these last two years, for our patients and families.”

As the APP program continues to grow, the newly implemented structure will help support that growth. In 2021, Seattle Children’s hired 65 APPs. Smith says if they hire another 65 in 2022, the system is set up and ready for them.

Learn about this work and more in the 2021 Nursing Annual Report. (PDF)