Rates of satisfaction with professional development opportunities among nonfaculty advanced practice registered nurses (APRNs) and PAs increased nearly twofold following implementation of a pilot clinical advancement program at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. The findings were reported in the Journal of the American Association of Nurse Practitioners.

The program was developed in response to a center-wide study of burnout at VUMC, which showed that contributors to burnout among APRNs and PAs included lack of opportunities for professional growth and development, lack of recognition for accomplishments, and lack of opportunity for career advancement, lead author April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCN, FAAN, said in an interview. Dr. Kapu is president of the American Association of Nurse Practitioners (AANP), an acute care nurse practitioner, associate dean for clinical and community partnerships, and professor of nursing at Vanderbilt University School of Nursing in Nashville, Tenn.

About the Clinical Advancement Program

A Clinical Advancement Task Force was created to develop, implement, and evaluate an advanced practice clinical advancement pilot program for APRNs (certified nurse midwives, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists) and PAs in nonfaculty roles at VUMC. The Task Force developed a 9-square tool that was used as a rubric for evaluating practitioners’ progress. Advancement committee members made decisions based on applications, leader assessments, and recommendations that were housed in a secure database. 

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About the Tool and Advancement Levels

The 9-square tool consists of 3 levels: proficient, advanced leader, and expert consultant. Each taxonomy has a set of exemplars on achievement in the 3 taxonomies of research and knowledge translation, education and teaching, and excellence in clinical practice. Thus, to advance to the expert level, a total of 9 exemplars must be demonstrated. 

To apply for the advanced leader level, clinicians must have at least 3 years of experience and demonstrate expertise locally within their unit, clinic, hospital, or health system, Dr. Kapu said. Examples include leading a quality improvement project for a clinical department, participation in a leadership development course, and hosting a workshop or class, leading a grand rounds presentation, or publishing an article on the clinician’s patient population.

To apply for the expert consultant level, clinicians must have at least 5 years of experience and demonstrate exemplars on a regional, national, or global level. These clinicians are recognized as national experts in a particular field, Dr. Kapu explained. Examples include chairing a multi-institutional research study, hosting a national conference, and speaking at national or international conferences.

Dr. Kapu said the tool was developed based on research on successful clinical advancement programs in a variety of clinical settings including private, not-for-profit, academic, and corporate. Thus, the tool is generalizable to other institutions and clinics.

APRNs and PAs Report Satisfaction with Pilot Program

A total of 23 participants completed surveys at baseline and after the 6-month pilot program. The percentage of APRNs and PAs who reported satisfaction with professional development opportunities increased from 47% at baseline to 84% after the pilot program.

April N. Kapu, DNP, APRN, ACNP-BC,

“The feedback from our APRNs and PAs has been very positive,” Dr. Kapu explained. “Participants say they feel like they have been recognized for their accomplishments and that the program laid a pathway for career advancement.” The tool has led to salary increases and title changes. Participants are also given time blocked off from their clinical practice to work on activities to advance their professional growth and development.

Dr. Kapu said that this program may help improve burnout rates among clinicians by “providing an infrastructure for professional growth and development,” but other solutions are needed to address the physical, emotional, and mental exhaustion stemming from the COVID-19 pandemic such as providing counseling and daily support and not asking clinicians to work overtime on weekends.

Feedback from post-pilot focus groups was used to improve the tool and the clinical advancement program process at VUMC.

“Our final conclusion of the study is that we need more studies of the impact of this program for APRNs on job satisfaction, engagement, and retention,” Dr. Kapu said. “If any Clinical Advisor readers are putting programs like this into place in their own organizations, I would ask that they publish their findings so that we can collectively continue to improve our programs.”


Kapu AN, Card E, Jackson H, et al. Development and testing of an advanced practice clinical advancement program within an academic medical center. J Am Assoc Nurse Pract. 2020;33(9):719-727. doi:10.1097/JXX.0000000000000456

This article originally appeared on Clinical Advisor