Introduction to Advanced Practice Providers

Advanced Practice Providers (APP) are integral members of the health care team that promote and support the delivery of high quality, safe, and effective care here at Cook Children’s.

We are often called many terms, “midlevel providers,” “physician extenders," “non-physician providers" and “allied health providers.” The most widely accepted term now is “advanced practice provider.” What does that encompass? APPs consist of all types of advance practice nurses (nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse midwives ) and physician assistants.

Role:

Our APPs collaborate with our physicians to provide care to our patients in a variety of clinical settings. From the main campus, to our five urgent cares, to Dodson surgery center and specialty clinics, and many of our neighborhood and primary care clinics, APPs are able to provide a comprehensive range of healthcare services to our patients. With over 260 APP’s in our organization, we practice in almost every specialty and continue to grow in numbers. Since January 1 2017, we have hired over 30 APP’s.

Training:

Nurse practioners (NPs) are trained in accordance to a nursing model, emphasizing on the overall health and wellbeing of their patients. Physician assistants (PAs) are trained using a medical model (much like medical school), emphasizing in disease pathology. NPs must choose a “track” to specialize in, like pediatrics, mental health, geriatrics, or women’s health. PAs are not required to choose a track while completing their program. Although PA and NP training varies, NPs and PAs practice similarly at Cook Children's. We are both able assess the physical, developmental, and/or mental health status of patients by eliciting and documenting health and social histories, performing comprehensive physical exams, and ordering and interpreting lab tests, radiographic tests, and other diagnostic tests as necessary. Certified Nurse Anesthetist (CRNA) training involves obtaining RN licensure and at least one year of critical care experience before applying to a CRNA training program. Once the CRNA completes their program, they are able to provide a variety of types of anesthesia under the supervision of an anesthesiologist.

All APPs must be credentialed through our credentialing committee process and must complete all requirements for licensure in our state, including continuing education and obtaining and renewing appropriate certifications.

Supervision:

All APPs must be credentialed through our credentialing committee process and must complete all requirements for licensure in our state, including continuing education.

Supervision for NPs and PAs at Cook Children's requires a delegating (supervising) physician, a completed scope of practice, and a prescriptive authority agreement (for those practicing outside of the medical center). These documents serve as a legal agreement between the NP/PA and their supervising physicians regarding protocols, guidelines, and prescribing medications under their supervision. The documents are reviewed and renewed annually.

Future:

The future is bright for APPs at Cook Children's. Our physicians and administrators recognize our value we bring in delivering safe and effective care to our growing patient population. As the number of physicians continues to decline and our patient population continues to grow, the demand for APPs remains high. With representation on almost every committee at Cook Children’s, we have the opportunity to provide input on a variety of administrative and clinical decisions.

If you have any questions, or would like more information on hiring a NP or PA, please contact Allison Jackson (allison.jackson@cookchildrens.org) or Whitney Johannessen (whitney.johannessen@cookchildrens.org).