All right, guys. So we are very aware that the time that we have here today is not enough, which is why we're going to pitch the free reception tonight at the Hilton from 5 to 7. It comes with a little drink ticket that'll loosen the lips a little bit more. And so we're going to go ahead and do our report out. So we're going to have a representative from every table come up to these mics. And this is the Twitter TikTok generation. So 60 seconds or less, tell us all the value added to your table. All right, so let's start. Kwame, are you in the house? So we're going to start with the first burnout table to come up and give your 60 seconds. Maybe Kwame isn't in the house. All right, well, let's start with burnout table number one. You know what, when you say it like that, you're number one. All right, come on up. Hey, everyone. I'm Callie Tennyson. In our burnout table, we talked about how wellness needs to start in education, PA and NP education. So working coping skills into the simulations that we do at the school is really important. And we also talked about the value of changing staffing structure and hours can be really beneficial and increase retention. Excellent. Good bullet points. Thank you. All right, good job, burnout number one. Let's go to burnout number two, because that's a hard act to follow. What do you have? So we pivoted. We discovered that we had a bunch of APP leaders who were burning out on their leadership roles. So we focused our discussion on burnout of APP leaders and some of the challenges presented by the expectations of the new graduates we're hiring, some of the challenges of the revenue requests. And mostly, we talked a little bit about our worry that we were going to burn out before we could find anyone to take over for us. So that was the focus of our conversation. How can we preserve ourselves as leaders? Excellent. And I mean, looking around, we really have a room full of leaders here. So that's very pertinent. All right, do we have the godfather of billing available? Dave, do you or somebody from your table want to come up? Tell us how to make the money. So, a lot of our talk actually, you know, it's this interesting conundrum is you don't have enough people that you have time to bill and write notes, and they won't give you the more people to have enough time to bill. So, you know, it's how you break that cycle. There's a lot of discussion like how do you integrate APPs and residents, and I'm kind of a fairly firm believer that it's best to kind of separate them into two teams, where the residents, because after a certain amount of time, APPs don't really benefit from more teaching. Like, you've heard all the attending jokes by then, and so it's better if you're autonomous and taking care of your patients, and then at some separate time, you round with the attending and then, you know, the patients and the families get face time. So those are kind of the two takeaway points. Excellent. Thank you. And then, Melissa, should I start calling you the godmother of APP postgraduate training? This has actually become more and more of a hot topic, so always waiting room at this table. I'll accept godmother. Thank you. Okay. Just kidding. Just kidding. Yes, I'm Melissa Ricker from Atrium Health in Charlotte, North Carolina. So at our table, we had program leadership from formal programs. We had alumni from programs. We have a brand new program director who's welcoming their first fellow on Monday. Good luck, Joe. And some administrative and educational leaders who were perfectly supporting, but maybe less informed of the day-to-day operations. We had a great diversity of perspectives. Number one, the enthusiasm and curiosity is definitely growing, and I think how we're able to eloquently speak about and support why these programs are beneficial is huge. Number two, we talked about challenges. No matter what stage you're in, I feel like we've been up against a lot of challenges, both financially, recruiting, the institutional ask and return on investment are areas where I think we as a society could better support and guide these leaders. Number three, we talked about opportunities acutely, so networking with each other, which shameless plug again for tonight, and then resources that SECM can put out. Again, shameless plug, we've got a white paper that's in the works. Hopefully we'll have that out later this year, early next year. And last, what are sort of our stretch goals or horizon type visions? And I think growing and expanding what we either currently offer or making the leap. For those who are looking to make the leap, what does your current landscape look like? GME or a degree-granting institution has a lot of administrative frameworks that you can not reinvent the wheel for them. And then for us, it's I think just increasing the presence within SECM and how we can sort of do that long-term. Diane's an incredible advocate and fearless leader. Thank you. Thank you. And now a topic that's unfortunately become more to the forefront is disaster management. So come on up. Hi, everyone. My name is Phum. I work at North Shore University Health System about 15 minutes north of Chicago for hospital system. We had a great table to talk about disaster management. Of course, how was your pandemic, everyone? Welcome back. We all shared our struggles with our pandemic responses. You know, as APPs, we are the core of critical care. We all contributed in our ways, either by allocating resources, training non-critical care personnel, how to manage ventilators. We talked about the resource limitations at each one of our institutions, Charlotte, Anne-Marie, at the border with very resource-limited patients, Hina at NYU, dumpster fire, as she said, dumpster fire earlier in the pandemic. That's a good description. And where I work, you know, we relatively had the usual COVID response by allocating one hospital as a COVID. The residents left. We had to staff an ICU in which we were not familiar with. But in our institution, we realized that what was very beneficial was to have one system across all hospitals. We're not silos. We all can walk into any of our ICUs and practice. Same EPIC, same workflow, same nursing staff, same rotating physicians, same team. And we really pride ourselves in being that flexible with any disaster we have. We talked about other disasters, such as a train derailment in New York City. Our hospital was involved with the July 4th shootings at Highland Park, Illinois. When we stepped on the unit, everyone on the unit was gone. There was only one nurse, one PCT, one secretary. Everyone in the ICU was down in the ER helping our ER colleagues. We had every single APP come and ask how they could help, either in person or out of the hospital. I mean, we are the core of critical care, and I think that shows how much we are dedicated to the profession. It's awesome. Well, let's hope that we can get through this without a disaster here, right? Yep. All right. So can we have Scott's table come up with procedural competency, and how do we determine who will stab us with a needle? Well, luckily, one of the things I've learned is that it's very much more common for advanced practice providers now to do these things. Some questions came up like, should it be a requirement for all ICUs? There's some variability in interest, and at what point should it be something that all ICU providers in their own institutions, and maybe that's institution specific. I was pleased to see that even though the quote unquote numbers needed were small, there was a wide respect the fact that the numbers are one part of it. Competency comes over time, because it's not a 10, and you can automatically do it. It's an evolution. You learn on your 10,000th one, or even 20,000th one. There was some talk about how do you get that competency? How do you get some more additional practice education, whether it's through a boot camp, some more simulation, but at the end of the day, you've got to practice on real people to really become proficient. The amount of those simulations can only go so far, and so we talked about that as a good learning opportunity that we could take back to the resource committee, et cetera, and then really just one thing came up at the end is really goes back to the should we be doing procedures is maybe a statement from SCCM really highlighting the fact that this should be the value of APPs as part of the team doing these procedures may help out propel some institutions that may be a little bit more hesitant, at least for the very basic critical care procedures, airways, central lines, arterial lines. Thank you. Excellent. And now, Danny, how do you get involved with SCCM other than attending the APP reception from 5 to 7 at the Hilton in Imperial Room B? That's a great plug, and I've been plugging that all day. So what came up for us is a lot of people really want to get involved and that people so desperately want to get involved but just can't find ways, or they just are inundated with the SCCM Connect emails but not in a way that's always productive. So some of the things we talked about is networking here, but also things that we can do in the future. One person suggested, and I loved this idea, that when you join a section, if we could somehow send out an email and say, welcome to your section, here's the leadership, here's how we're organized, and here's our next event. I thought that was a great idea because I do feel like you get into a section, but you don't even know what's going on in that section. We also talked about how sections are now moving all of their meetings outside of Congress for their business meetings, and I think that's another thing just to remember and be aware and on the lookout for. All right, excellent. And now, Brandon, if you're not busy posting this on social media. So we actually had a table of a lot of sort of normal people who make use of social media in limited ways. So we talked about how social media is useful in that setting. We talked about some different social media platforms and how they all have their own flavors. Facebook seems to be kind of a dying one. Twitter kind of remains at the forefront of medical discussion. TikTok, mostly for younger people. LinkedIn, potentially useful for professional activities, like even recruiting, things like that. The importance of considering privacy and how the things you post are interpreted because there's a lack of context, and anything you post can be seen by anybody anywhere, and it's probably not good to think that they're not going to know who you are. And I think just a general theme that social media as an activity into itself and an isolated echo chamber is probably not the most useful way to treat it. I mean, that might be a fun activity if that's what you're into, but for kind of, again, regular people, using social media as a tool for your own ends and considering how it ties into real life is much more useful. It is a part of real life. It is still a representation of you, and if you're able to do something useful with it, whether it's recruiting staff, getting out some message you have, then that's great, and also considering, of course, that it can have harms, too, if people are misunderstanding things you say and so on. But much like we're all here networking and having discussions, if you can get that kind of utility out of it, then it's doing something good for you. You may or may not enjoy that. Using certain platforms in certain ways may not be your thing, but if there's value there, then it may still be worth it. Hashtag awesome. All right, Chelsea, you want to tell us about rural medicine? Yeah. Hi. I'm Chelsea. So we actually had a good little mix of people at our table. We had a couple people who have practiced in rural medicine, and we kind of reviewed briefly what a critical access hospital is and the limited resources that you might have in that setting. And then we had people, wonderful people, who joined us that were more from tertiary settings like level one trauma centers in that extent. So we kind of talked about the teams that we have of APPs in all those different settings, the size, our interactions with learners. And then we kind of divulged into the lack of nursing that we have at all of our different facilities and the amount of travelers and how we as APPs might be able to maybe help with retention on that of keeping our own staff there. So we kind of went all over. Well I think you're going to hear our table, so I'm going to have you come up for the mentorship table. Did something similar. I guess a lot of you might have so much to talk about in such a limited time. So it would be great if there was an opportunity to meet again later to discuss this further. Hi, I'm Carrie Boom. I'm from Seattle, Washington. I'm a nurse practitioner. We had a pretty big table with people from across the country. We talked about mentorship, both in our own institutions as well as from societies like SCCM. We talked about the importance in early career and mid-career mentorship. And we talked about how we can help to support each other to help with retention, et cetera. And we also talked a little bit about some of the siloing that happens between PAs and nurse practitioners and how we can potentially sort of start to bridge some of those gaps from a society level, which was a really interesting conversation. And I think that was it. That's awesome. One big happy family we are. Whoop whoop. And to finish us off, Heather's going to tell us about leadership, which I'm seeing a room full of current and future leaders, so. Awesome. Thank you. Thank you. Okay, so we did discuss a lot of different leadership challenges. We started out by talking about how to justify FTEs through development of performas or looking at quality outcomes, metrics that we can tie back to APP for performance to ensure that our units are staffed appropriately. We also had a lot of conversation around something that I think is very important. Having an APP at the table for decision making, if that's through credentialing committees or through QI initiatives or discussing staffing our ICUs, it's just really important that APPs have a voice when those critical decisions about our practice are being made. We of course talked about scope of practice and the issues that surround that, especially for our nurse practitioner colleagues. And what am I leaving out? I didn't take notes. That was it. Huh? Awesome. Oh, yes. Oh, the most innovative idea that came from the table that we must share. One of our colleagues has a nurse, a rounding nurse, which is essentially a APP extender to help with documentation, specifically with discharge documents and things like that, that has really helped them to spend more time with patient care and less time on documentation, which I think it sounds lovely. And so come pick her brain if y'all want to hear more about that. Awesome. Seems like a great idea for throughput. All right. So I'm going to introduce you to Chris Newman, who's our incoming chair for the APP Resource Committee. Thanks, Chris. Thanks, Diane. So we do know that sometimes you've got one burning question, but you don't sit at the table with that topic, and that's okay. So we did want to provide a few minutes that we have left. If there was a burning question you had for a different table, I want to invite you to shout it out, and let's see if we can get some answers. So does anyone have a question they didn't get to ask, a piece of advice they're looking All right, why don't we throw that back to the fellowship And she will have a handout to go with it. It's not called P-TAP anymore, though, right? I'm happy to address this. In disclosure, I do serve on the commission for ANCC APFA and help write some of the criteria that went into that. From a very early stage of APP fellowships, we knew that there needed to be a joint process. Now that is different for every institution, but having two separate processes is not financially viable, especially in programs such as ATRAM that have 23 fellowships and it's just not a financial sustainability. I do partially like APFA, so I have to disclose that, but I think it's also important that as an institution you look at each criteria with each different program to see what best fits you. They are all financially the exact same cost, but what is really going to help your institution grow because having accreditation validates your program as being a robust program and it is incredibly important to seek out that accreditation. Just what I was going to say. Full disclosure, I am the SCCM representative to the ARC-PA Postgraduate Commission. I think all of the various accrediting bodies are working out negotiations between two parties. I think very shortly there really will be only the options to go through joint accreditation because it's simply not practical and the market drives competition and competition drives change. One other thing I talked about briefly is investing in your school, in your feeder schools, sending faculty back to your feeder schools to not just educate about diabetes, but educate about culture, to educate about professionalism, to start from day one, giving them more realistic expectations for what the career is like than they are necessarily getting from the people trying to get them to pay them money. Kwame. Chris, I don't have a question, but just a plug for the team. A couple of months ago, we've been doing some work on the critical care models to look at what different models were used during COVID, so we can actually look at the outcomes and start to establish something more concrete. We did send a survey out, so just in case if you did forget to do the survey, we'll probably send out again. Just try to do it. I love you. If you can do it, I'll be great. But Kwame raises a really good point. One of the opportunities that this place provides is a chance to network with people within your own profession. There was mention of this white paper on postgraduate education. That white paper came out of work within the APP Resource Committee. Kwame presented an abstract. There was a second abstract on Saturday looking at burnout and APPs. Those came from a demographic survey that was originally developed by the PA section and sent out under SCCM. So I know you get inundated with surveys, but you might ask yourself if you're going to spend the time to answer the questions, is it worth answering the questions from your society that wants your input on what you do every day, and maybe just say, I know it's one more survey, but I'm going to do it anyway. Sorry. Shameless plug. You will have to come at 5 p.m. to the Hilton. Anyone else? I want to be respectful of the exciting speakers starting at 1.30 who are going to depress us about nursing burnout. So thank you all for coming. We hope to see as many of you as possible next year.

burnout

billing

mentorship

social media

rural medicine

SCCM involvement