Advanced Registered Nurse Practitioners
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About ARNPs
At UW Medical Center, Advanced Registered Nurse Practitioners (ARNPs) along with our Physician Assistant (PA) colleagues play an important role in fulfilling our mission to improve the health of the public. ARNPs are registered nursing with a graduate degree in nursing and advanced training in the diagnosis and treatment of acute and chronic health conditions. Washington State recognizes the four different ARNP roles – Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife and Certified Registered Nurse Anesthetist. All four ARNP roles play a critical role in care delivery across the UWMC enterprise, from providing direct patient care and improving health outcomes for our patients and families to collaborating on teaching and research projects throughout the organization. Seen as a critical element in the professional development pathways for our nurses, advanced practice nursing leadership encourages the development of our nurse practice in a variety of ways.
ARNPs serve in many leadership roles across the organization. Laurie Soine, ARNP, PhD, is the Director of Advanced Practice Nursing at UW Medical Center as well as Chief ARNP. Laurie is a valued member of the leadership team and sits on nursing and medical leadership committees that guide everything from practice development to financial management. Laurie collaborates with Leah Yoke, PA, who serves in the role of Chief Physician Assistant. Together Laurie and Leah work across the organization creating professional structures to support the 800+ Advanced Practice Providers (APPs) practicing across UWMC. Laurie and Leah likewise represent APPs at the Medical Leadership Committee and the Medical Staff Advisory Council. They also serve as advisors to the Advanced Practice Professionals Council.
Academic medical centers, including UWMC NW and ML have re-envisioned our clinical teams over the last decade. Higher patient acuity, increasing demands for improvement in quality and safety, and the challenges of retaining a high-quality workforce are just a few of the drivers of these changes. Increasingly, APPs have been hired to serve as the foundational care providers on almost all of our medical and surgical specialty areas, units, and clinical programs. UWMC recognizes APPs as full voting member of the Medical Staff. APPs are credential via Office for Medical Staff Appointments and are granted clinical privileges through a Department in the UW School of Medicine.
It is common across UWMC for PA and NPs to practice on the same teams and function in very similar, if not identical roles. While their education and training differ, the end result of this training is an APP who is prepared to:
- obtain a complete medical history & physical examination
- formulate differential diagnosis and management plan
- order, conduct and interpret diagnostic tests
- identify and prescribe pharmacologic and non-pharmacologic interventions
- evaluate, reassess, and modify the plan of care to achieve health goals
- conduct preventative screening
- provide telehealth/telemedicine services
- make referrals to other health professionals and community agencies
- develop and provide patient education
- admit or discharge a patient from an inpatient stay
In addition to core PA and NP privileges described above, APPs may apply for special privileges to provide specialty and subspecialty procedures.
APPs manage patient care while also performing procedures, ordering diagnostic, pharmacologic, and therapeutic interventions and serving in roles as consulting specialists. APPs practice within a variety of practice models. Common practice models across UW Medicine include APPs practicing independently, with RNs, alongside attending physicians, with fellows and attending physicians, and embedded in resident-driven services with attending physicians.
Contributions of Advanced Registered Nurse Practitioners
“We learned that these highly complex code situations could benefit from improved coordination between code team members, the surgical team, the ECMO team, nursing staff, and the required equipment. This work has helped us define, streamline, and most importantly, practice our response together with the multidisciplinary team in a high-fidelity simulation environment to best care for our patients in the event of arrest.” -Jennifer Peterson, ARNP
Advanced Practice Nurses across UWMC lead and participate in quality improvement projects aimed at improving the safety and efficiency of patient care.
One of the projects embarked upon this year was led by Jennifer Peterson, ARNP, Lead Advanced Practice Provider in the Division of Cardiothoracic Surgery, reimagining the code response process across UWMC. Patients with cardiovascular diseases are amongst the most likely to experience a “code blue” in the hospital. Advanced cardiac life support (ACLS) was developed decades ago to provide an emergency response for these patients and is the standard of care. However, patients who have undergone recent cardiac surgery require a specialized emergency response given their underlying cardiac conditions and recent sternotomy.
In 2017, the Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery endorsed a modification known as CALS (Cardiac Advanced Life Support). CALS prioritizes defibrillation and cardiac pacing before chest compressions and prepares for emergent sternotomy. This new process, Surgical Cardiac Code, led to the creation of a new code team within UWMC with specific training and expertise in the management of patients with cardiovascular diseases, postoperative patients, and those with mechanical circulatory support devices. In an emergency situation, this team is capable of performing heart surgery in the ICU, including placing patients on ECMO (extracorporeal membrane oxygenator—a mobile variation of the heart lung machine used in the operating room).
Jordan Surrusco, PA, in the Division of Cardiothoracic Surgery, and Janet Regan-Baggs, DNP, ACNS-BD, CCNS, CCRN-K Critical Care & MCS Clinical Nurse Specialist, led the trainings, which included high-fidelity simulation.