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Nursing: About
The Center for Advanced Practice at Stanford
The Center for Advanced Practice at Stanford Health Care (SHC) is dedicated to promoting the role of the Advanced Practice Provider (APP) within SHC as well as the medical community at large. Advanced Practice Provider roles include: physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs). APPs are medical providers who are able to treat, diagnose, prescribe, and perform or assist in surgical procedures in collaboration with physicians.
Formally launched in 2012, the Center for Advanced Practice develops processes and provides resources for the approximately 440 credentialed and privileged APPs practicing in more than 50 specialties in both inpatient and outpatient settings at SHC, in addition to the many more employed by Lucile Packard Children's Hospital and Stanford University.
APPs play an increasingly visible role in health care both at SHC and throughout the nation. The Center for Advanced Practice is innovative in its administrative infrastructure and centralization of resources for APPs, which has hospitals around the country looking to SHC as an example of how to structure their APP practices.
The Center for Advanced Practice:
- Expanded membership in the Interdisciplinary Practice Committee (IDPC) to include more PAs and NPs, along with more physicians to improve representation among different specialties where APPs practice.
- Instituted a monthly onboarding program for new and transitioning APPs.
- Constructed a 10-point recruitment plan to address hiring needs of APPs across the organization.
- Improved APP job descriptions, detailing a clearer scope of practice and responsibility, and privilege forms were developed in partnership with the Medical Staff Office to better align with physician structures and processes.
- Coordinated with the Human Resources and the Medical Staff Office to improve regulatory oversight, data acquisition, tracking, and evaluation.
- Promoted APP practice on various specialty clinic cites to showcase the Center for Advanced Practice and the roles it represents.
- Built a mentorship program to support and guide APPs with 3 years or less of experience in the APP role.
- Launched a 12-month APP Fellowship program in 2016 to support newly graduated NPs and PAs in various specialties with one year or less of experience.
- Created the APP Career Ladder, which is a voluntary clinical leadership and career advancement program designed to recognize and reward professional excellence.
- Established several platforms for APPs to become more engaged within the organization, including APP Grand Rounds, Round Table Discussions, and APP General Council initiatives.
- Recognized the need to assess APP professional fulfillment within the organization, and are continuously working on initiatives to improve wellness and decrease burnout.
Advanced Practice Provider Roles
A physician assistant (PA) is a health care professional who is licensed to practice medicine in collaboration with their supervising physician. PAs are committed to personalized, high-quality health care and are held to the same legal and ethical standards of care as physicians.
At Stanford Health Care (SHC), PAs serve adults and families in an extensive range of practice settings throughout the medical center. They are involved as adult healthcare providers for acute, chronic and critically ill adults in both primary care and specialty settings. Physicians delegate duties to PAs, and within those range of duties, PAs use autonomous decision-making for patient care.
This team model is an efficient way to provide high-quality medical care.
Physician assistants may:
- Obtain health history and conducts physical exams.
- Diagnose and treat medical problems.
- Dispense and manage medications and other treatments (e.g., physical therapy).
- Order and interpret diagnostic (e.g., X-rays, CT scans) and laboratory tests.
- Educate and counsel individuals, families and groups on health behaviors, self-care skills, and treatment options.
- Refer patients to other health professionals as needed.
- Work collaboratively with primary care and specialty practice physicians.
- Provide primary and specialty care services.
- Provide care for patients in acute and critical care settings.
- Assist with surgery.
- Perform minor surgeries and procedures (e.g., dermatological biopsies, suturing, casting, lumbar puncture, bone marrow biopsy, paracentesis).
A nurse practitioner (NP) is a health care professional who is licensed to practice medicine in collaboration with a supervising physician. NPs are committed to personalized, high-quality health care and are held to the same legal and ethical standards of care as physicians.
At Stanford Health Care (SHC), NPs serve adults and families in an extensive range of practice settings throughout the medical center. They are adult healthcare providers for acute, chronic and critically ill adults in both primary care and specialty settings. Physicians delegate duties to nurse practitioners, and within those range of duties, NPs use autonomous decision-making for patient care.
This team model is an efficient way to provide high-quality medical care.
Nurse practitioners may:
- Obtain health history and conduct physical exams.
- Diagnose and treat medical problems.
- Prescribe medications and other treatments (e.g., physical therapy).
- Order and interpret diagnostic (e.g., X-rays, CT scans) and laboratory tests.
- Educate and counsel individuals, families and groups on health behaviors, and treatment options.
- Refer patients to other health professionals as needed.
- Work collaboratively with primary care and specialty practice physicians.
- Provide primary and specialty care services.
- Provide care for patients in acute and critical care settings.
- Assist with surgery.
- Perform minor surgeries and procedures (e.g., dermatological biopsies, suturing, casting, lumbar puncture, bone marrow biopsy, paracentesis).
Certified registered nurse anesthetists (CRNAs) are Advanced Practice Nurses who safely provide more than 32 million anesthetics for surgical, obstetrical and trauma care each year in the United States. They administer every type of anesthetic to patients, work in every type of practice setting, and provide care for every type of operation or procedure – from open heart surgery to pain management programs.
At Stanford Health Care (SHC), CRNAs provide anesthesia and anesthesia-related care services upon request, assignment, and referral by the patient's physician most often to facilitate diagnostic, therapeutic and surgical procedures. The scope of practice includes, but is not limited to, the following:
Pre-anesthetic preparation and evaluation of the patient:
- Obtaining an appropriate health history.
- Conducting an appropriate physical screening assessment.
- Recommending or requesting pertinent diagnostic studies and evaluating the results.
- Selecting, obtaining, ordering, and administering pre-anesthetic medications.
- Documenting the pre-anesthetic evaluation and obtaining a comprehensive informed consent for anesthesia and related services.
Intraoperative care
- Obtaining, preparing, and using all equipment, monitors, supplies and drugs used for the administration of anesthesia and sedation techniques; performing and ordering safety checks as needed.
- Selecting, obtaining or administering the anesthetics, adjuvant drugs, accessory drugs, fluids and blood products necessary to manage the anesthetic.
- Performing all aspects of airway management, including fiber optic intubation.
- Performing and managing regional anesthetic techniques including, but not limited to, subarachnoid, epidural and caudal blocks; plexus, major and peripheral nerve blocks; intra-venous regional anesthesia; transtracheal, topical and local infiltration blocks; intracapsular, intercostal and ocular blocks.
- Providing appropriate invasive and noninvasive monitoring modalities using current standards and techniques.
- Recognizing abnormal patient response during anesthesia, selecting and implementing corrective action and requesting consultation whenever necessary.
- Evaluating patient response during emergence from anesthesia.
The clinical nurse specialist (CNS) possesses specialty knowledge and experience in their area of expertise. Their focus is to collaborate with members of the health care team to enhance patient care by developing and supporting nursing staff and intervening with patients within an identified specialty.
Through the roles of expert clinician, interdisciplinary consultant, educator, researcher, and leadership, clinical nurse specialists:
- Direct specialty knowledge and skill acquisition.
- Shape core competencies of clinical practice.
- Promote evidence-based outcome-guided nursing care.
- Integrate quality patient care across SHC practice sites.
- Promote an environment of mentoring and system changes that empower the nurse to experience professional growth and development.
Stanford's Advanced Practice Fellowship Program is a fully benefitted 12-month program designed to provide post-graduate training to new Advanced Practice Providers (APPs) who wish to transition into specialty care. Our goal is to provide support and training during transition to practice, allowing the APP clinician to build confidence and knowledge in the specialties of Cancer Care, Cardiothoracic Surgery, and Emergency Medicine.
The fellowship teaches the core competencies for specialty certification and offers the opportunity for new APPs to gain in-depth exposure to complex specialty care. APP fellows work with diverse teams of providers focused on specific patient populations through Stanford's inpatient and outpatient settings.
Please visit our careers page for a job position titled "APP Fellow" to apply for the position.
Our Team
APP Fellowship Program Director
APP Fellowship Program Director
Please visit our careers page for new job opportunities.
Last Updated January 2018