JL1015C: Implementation of an Advanced Practice Provider Career Pathway at a Major Metropolitan NCI-Designated Comprehensive Cancer Center

BACKGROUND
Implementation of career pathways improves Advanced Practice Provider (APP) relationships with physicians and patients as well as job satisfaction, contributes to institutional Magnet recognition, increases retention, and promotes ongoing professional development. While institutional cost and return-on-investment of career pathways have not been well reported by current APP literature, successful examples can be drawn from the nursing profession.

A large cost savings was noted at Akron’s Childrens Hospital for a nurse progressing through the career pathway program of $730 compared to the replacement of a newly hired nurse annual salary ranging between $82,000-$88,000. Additionally, a career pathway program for nurses was introduced to the Inova Health System in Virginia and job turnover rates decreased from 8.9% to 5.2% and job satisfaction rates were improved by 21%.

The APP Professional Development Council (PDC) at a major metropolitan National Cancer Institute- designated comprehensive cancer center was tasked with the objective of developing a career pathway for APPs with a clear application, transparent evaluation criteria, and a peer review board to align with the physician and nursing models already utilized within the institution.

METHODS
The council conducted a literature search using the electronic database, PubMed, with the terms “professional development” OR “clinical ladder” OR “clinical pathway” AND “advanced practice providers” OR “nurse practitioner” OR “physician assistant.” A total of eight manuscripts were identified and reviewed by individual group members, and a matrix was created. From this matrix, the council compiled a summary outlining common themes, theory application and overall structure. Additionally, the council performed a multicenter assessment of APP career advancement pathways at key institutions.

RESULTS
The PDC incorporated tenants of The Strong Model of Advanced Practice Nursing and Benner's from Novice to Expert Model to create the Memorial Sloan Kettering Cancer Center (MSK) that meets the distinct needs of MSK APPs named The MSK APP Ascend Program. The program consists of a four-tiered advancement pathway with over 70 enrichment steps to accrue eligible points over a one-year period. The enrichment steps are derived from seven domains of practice encompassing the variety of professional initiatives APPs perform outside of their role responsibilities. The domains, adapted from The Strong Model of Advanced Practice Nursing, to create the MSK ADVANCE Model© include Direct Comprehensive Care, Research, Driver of Change, Education, Professional Development and Leadership, Technology and Innovation, and Mentorship. When APPs reach Level IV, they choose to specialize in one of the three focused tracks, Education and Professional Development, Research and Quality, and Technology and Informatics.

CONCLUSIONS
The APP PDC was tasked with the goal of creating an inclusive career pathway, promoting advancement and excellence among APPs to complement and enhance professional growth. The council created the MSK APP Ascend Program to highlight APP engagement in professional development, create a formal pathway for promotion and recognition, and establish a foundation for the development and advancement of ongoing APP practice.

RECOMMENDATIONS
The development of an APP career pathway has the potential to support evidence-based practice, increase job satisfaction, encourage recruitment and retention of motivated and competent employees, provide mentorship, capture professional accomplishments, identify and create a roadmap for developing leaders, motivate APPs to establish career goals and gain entry to doctoral programs, and encourage scholarly work.