Background: One way academic organizations recognize staff achievements and scholarly activities is through four levels of academic appointments: Instructor, Assistant Professor, Associate Professor and Professor. Nurse Practitioners and Physician Assistants (NPPAs) employed by the Mayo Clinic are highly encouraged to pursue an academic appointment. A 2016 survey at our three main sites showed that only 27.5% of NPPAs held an academic appointment.
Purpose: To improve and promote academic appointments for NPPAs by designing and implementing a quality improvement (QI) project using a framework to understand barriers, raise awareness, encourage and guide NPPAs through the application process.
Description: At the Rochester Mayo Clinic, Division of Hospital Internal Medicine (HIM), both a NP and a hospitalist completed a literature review and analyzed the process for NPPAs to achieve academic appointment. A QI project was then developed to target multiple opportunities that were identified.
At our division, only 17.5% of NPPAs had an academic appointment at baseline. A pre-intervention electronic survey was sent to 40 HIM NPPAs in Rochester with a 67.5% response rate. Perceived barriers to academic appointment were: lack of time, lack of knowledge pertaining to academic appointment, lack of mentorship, do not understand the process, and appointment not emphasized by department leadership.
Multiple interventions were implemented for the QI project including self-edit access to the Research & Education Academic Information Management System (RE-AIMS) for all NPPAs and the development and distribution of an informational brochure. Other key initiatives included presentations at HIM NPPA monthly meetings, inclusion of faculty development in the onboarding process of HIM NPPAs and the development of a mentorship program. Another key initiative included NPPA representation on the HIM Faculty Development Committee to provide additional awareness and support.
A post-intervention electronic survey was sent to 41 HIM NPPAs with a 58.5% survey response rate. Data from the pre- and post-intervention surveys were compared.
After implementation of the QI project, 46.5% of HIM NPPAs held academic appointment. There was a 29% increase in the number of HIM NPPAs that held academic appointment within 16 months of the initiation of the QI project. The post-intervention survey results demonstrated an increased awareness and interest in achieving academic appointment or promotion by HIM NPPAs. Additionally, HIM NPPAs recognized new opportunities for mentorship for staff to pursue academic appointment and an increased emphasis by the Division’s leadership.
Conclusions: Implementing a well-structured QI project does lead to a significant and sustainable improvement in NPPA academic appointments while raising awareness and interest in addition to addressing attitudes and perceived barriers. Recommendations include providing education and mentorship to NPPAs regarding the benefits and process of achieving academic appointment and promotion, as well as, additional research to test if this QI can improve burn out and be used at other institutions.