Advanced practice providers play key role in cancer care

Brandon Sterling’s first week as an advanced practice registered nurse (APRN) was a crash course in collaboration.

As a newly credentialed advanced practice provider (APP) on a busy unit, he was tasked with transferring a post-operative urology patient who had a stroke to a nearby hospital.

“I was working with the family, case manager, social worker, nursing team, attending physician, insurance company and receiving hospital. I was doing what I needed to do to ensure the whole patient received the care needed as quickly as possible,” Sterling says.

This connector role appealed to Sterling, now an acute care nurse practitioner in MD Anderson’s intensive care unit. It enabled him to wear many hats, make sure others had the information they needed and take action to ensure the best possible outcomes for patients.

Advanced practice providers play key role in patient care

MD Anderson has more than 850 advanced practice providers, which include approximately 312 physician assistants, 448 advanced practice registered nurses and 95 certified registered nurse anesthetists. They manage about 325,000 autonomous patient encounters each year and share another estimated 250,000 encounters with physicians.

“Nurses and physicians recognized a need in care coordination around the same time,” explains Todd Pickard, director of our Physician Assistant Program. As the volume of practice expanded for both professions in the 1960s, there was room for a third group that could take on aspects of both roles, reducing stress on the system and meeting patient needs with the right level of care.

 “MD Anderson’s advanced practice providers run survivorship, fast track and procedure clinics across the institution and are critical partners in our nocturnal program, covering inpatients on nights and weekends together with moonlighting physicians,” adds Joyce Dains, Dr.PH, J.D., a board certified family nurse practitioner who is responsible for our Nurse Practitioner Program.

Ten of the most common advanced practice provider responsibilities include:

1. Taking patient histories and performing physical examinations
2. Ordering and performing procedures
3. Forming a diagnosis
4. Developing and implementing a treatment plan
5. Monitoring treatment effectiveness
6. Assisting in surgery
7. Offering patient counseling and education
8. Signing orders for certain prescriptions
9. Making referrals
10. Participating in discharge process

Advanced practice providers “almost become part of the family”

“Advanced practice providers are involved in so many aspects of care, we almost become part of the family,” Dains says, noting that patients frequently write letters about their advanced practice providers’ tenacity, resourcefulness and involvement. 

For Whitney Throckmorton, a physician assistant in Pediatrics, the decision to become an advanced practice provider was based on her own experience as an inpatient while in college.

“I was pre-med and had never even heard of the profession until then,” she says. “My physician assistant spent so much time with me explaining what was happening and why, which had a significant positive impact on me. I wanted to follow in her footsteps.”

Throckmorton says she cherishes the time she spends with patients and the rapport they build.

“It’s truly an honor and a privilege to take care of these kids,” she says. “Perhaps that relationship is even more significant in oncology care because we get to know our patients so well.”

Meeting a unique need

Pickard, like Throckmorton, believes there’s a special use for advanced practice providers in cancer care. He’s chair of the American Society of Clinical Oncology’s Workforce Advisory Group, which published findings from a 2018 Practice Census Survey showing the growing importance and use of advanced practice providers in delivering care to cancer patients.

Even though most advanced practice providers don’t have a specific certification in oncology, it takes a fully integrated care team of physicians, advanced practice providers, nurses, pharmacists, social work counselors and business staff to provide the entire spectrum of care for oncology patients.

At MD Anderson, we’ve seen a 70% increase in advance practice providers since 2011, when we had just over 500 advanced practice providers. While that growth slowed in the past two years, Pickard and Dains expect to see another 15% to 20% growth in this role over the next five years.

“Cancer care is like a jigsaw puzzle,” Pickard says. “All the pieces have to fit together to make sure the patient has everything they need.” He jokingly refers to an underground army of MD Anderson advanced practice providers who work behind the scenes to connect dots and navigate complicated cases.

Sterling says that network is real. “If the first advanced practice provider I call doesn’t know the answer, they’ll know whom I should call next,” he says.

A longer version of this story originally appeared in Messenger, MD Anderson’s quarterly publication for employees, volunteers, retirees and their families.

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