Michelle Falci; Nikki Kean | Clinical Advisor
Through surveys and focus group interviews, APRNs indicate that representation with leadership would improve their wellbeing in their professional life.
In the country’s largest rural health system in the country, advanced practice registered nurses (APRNs) nurses are looking for a seat at the table, better training for nurses transitioning from one position to the next, more support staff, and improved compensation to better reflect their professional identify, according to study results presented at the American Association of Nurse Practitioners (AANP) annual meeting, held from June 17 to 22, 2025, in San Diego, California.1
“The past 5 years have been extremely stressful for nurses,” reported the authors of the primary featured study.2 In another study, interviews with 19 frontline nurses in the upper Midwest during the pandemic revealed feelings of being overwhelmed, role frustration related to the chaos in the care environment, and feelings of abandonment by leaders, families, and communities.3 Reports at the time found increased levels of burnout and secondary traumatic stress among frontline NPs, including a study by Kapu et al that found that 26.3% of NPs and physician associates (PAs) had burnout.4
To assess the wellbeing of APRNs in the upper Midwest post-pandemic, researchers conducted a mixed methods study in 2 phases. The health care system includes APRNs working at 58 hospitals in 6 states.
In phase 1, 110 APRNs and 1319 RNs completed the integrative health and wellness assessment (IWHA V2 2022) survey. The average age of participants was 42 years, with the majority being women (89.9%). In phase 2, focus groups of APRNs (4 in rural areas and 8 in tertiary markets) met virtually to gain a deeper understanding of participants’ wellness in both their professional and their personal lives.
Phase 1 Results
Compared with other nursing professionals, APRNs had the highest IWHA V2 2022 mean score (138.92); the mean score among all participants was 134.72, 134.17 for clinical nurses (N=830), and 132.66 for nursing leaders (N=224). Nurses 55 to 64 years old had significantly higher wellness scores compared with younger participants (P <0.001). Similarly, nurses with 21+ years of clinical experience had higher wellness scores than newer nurses (P <0.001).2
Their number one priority is we need formal leadership, someone at the table, someone that has a voice.
Deb Hickman, DNP, APRN, CPNP-PC
In their survey responses, APRNs mentioned several interventions that could enhance wellness, including having more time for administrative tasks during the workday, optimization of their roles, the ability to take breaks, adequate orientation for new APRNs, decreasing the need for documentation at home, compensation for on-call or additional work hours, flexible schedules (4-day work week), and protected time away from work (for example, not being called after hours when not on call).
Phase 2: APRN Focus Groups
In phase 2, 4 rural APRNs and 8 APRNs in tertiary care discussed desired interventions to maintain and enhance wellness for RNs.
“ The number 1 priority for both rural and tertiary APRNs was the need for organizational representation with a formal leadership, an APRN at the table, someone that has a voice,” said Deb Hickman, DNP, APRN, CPNP-PC, in an interview with The Clinical Advisor. “The 2 groups met separately. They didn’t have any idea what the other group said.”
In addition to representation with a formal leadership structure, focus group participants in both rural and tertiary groups indicated that an evaluation of compensation and productivity would improve wellness.
In the tertiary group, participants noted that having a physical workspace would help reduce distractions. In the rural group, participants shared their desire for a transition to a practice model for new APRNs. Both groups expressed a desire for more support staff.
Implementing Changes
“Every single participant said, ‘Well, this looks like a great plan for other people, but it’s not going to work at our practice because we’re different and here’s why,’” said Abigail Gramlick-Mueller, DNP, APRN, CCM, in an interview with The Clinical Advisor. “We did a lot of handholding through the process.”
For the transition to practice model for new APRNs/RN, “we met with the preceptor, the director, and the new hire once a month throughout the process, but it went really well,” Dr Gramlick-Mueller said. “The tools went well. We made some modifications based on what they have to say, and now we’re implementing throughout the organization.”
