Selected Podcast
Advanced Practice Providers
Linda Irle, the director of the Advanced Practice Provider program, joins us to discuss the history and importance of APP week.
Featuring:
Learn more about Linda Irle, NP
Linda Irle, NP
Linda Irle, NP is an Advanced Practice Provider Director.Learn more about Linda Irle, NP
Transcription:
Dr David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're going to be talking with Linda Irle, NP, who is the Director of the Advanced Practice Provider Program at Carle. Linda, welcome.
Linda Irle: Thank you. I'm very happy to be here.
Dr David Hill (Host): Wow. I'm happy to be talking with you today. So, I was wondering if you could sort of walk us through the history of advanced practice providers at Carle. I know when I was training, this is a fresh new idea, but we're talking about the mid to late 1990s and they tell me it's been a minute since then. So, what's going on there and how did we get to this place?
Linda Irle: Okay. So definitely very interesting history at Carle Foundation. In 1979, our current CNO, who is Sandy Reifsteck, she pulled five RNs who had been at Carle for a long time. She felt like they were very experienced. They did a good job in their role, and she had them join the second year medical students every afternoon for a fall semester. Then, during the spring and summer semesters, they rotated through different MD preceptors at Carle for a six to nine-month period. And then, in 1980, after they had completed this training, we had five nurse practitioners on board. And around the same time, they started hiring physician assistants to help in the surgical areas. And by 2010, we had 120 APPs at Carle. And fast forward to 2022, we have 450 APPs at Carle, so that includes both the advanced practice registered nurses and physician assistants.
Dr David Hill (Host): That is fantastic. I know that I cannot function without advanced practice providers. I also happen to be married to a pediatric physician's assistant. So, this is my life professionally and at home. So, I'm so excited to see that program has come so far there at Carle.
Let's look a little bit at the present and at the future. Can you tell me about some of the projects that Carle has going on in terms of how they're training and utilizing their advanced practice providers?
Linda Irle: Sure. So backing up just a little bit, so back when the APRN and PA positions were started, the roles were very limited as to what they could do. The program started back in the mid-1960s with the first physician assistant program at Duke University and the first nurse practitioner program at the University of Colorado.
So they created these professions, seeing well into the future. We've had a lot of population growth and underprepared complex healthcare system. And so, these early visionaries definitely thought differently about our medical training model. But saying that, definitely in the early years, the APP or the advanced practice providers worked as physician extenders, so they were coined the mid-level provider group. They had very little independence. And if you fast forward currently we work very independently. All APPs, both APRNs and PAs, are state-licensed and nationally-certified. They're credentialed and privileged to perform many procedures. We bill independently. We can have our own patient panels in some primary care areas. Full practice authority was made available for APRNs in 2018 when they meet certain requirements. So definitely, we've come a far, far distance and work very independently and very much help with access in the healthcare world.
Dr David Hill (Host): That's fantastic. Can you describe, if I'm at Carle, where I might encounter an advanced practice provider and what they might be doing for me?
Linda Irle: Definitely. Currently, we have apps in over 65 specialty areas. They work definitely in the clinics. They work in the OR. They work in the inpatient setting. They work in the SNFs group, so in the nursing home rounds. They work definitely with our insurance health alliance. They do home visits with the Health Alliance Program. So really, you can find an APP in about every area at Carle, performing what their specialty area is and what they've been trained to do.
Dr David Hill (Host): Are there any misconceptions or myths about the role of advanced practice provider that you just wish people understood better?
Linda Irle: The APP, definitely we're here to serve the patients. We're definitely working in a team environment. A lot of people have different perception as to what an APP can and cannot do, but our state license really allows us to do anything but operative surgery, so we can be trained to do any procedure that would help the group. In our CCU, we have a group of APPs that do a lot of procedures. They've been privileged to do airways and all kinds of things. We also have a large CRNA group that does a lot of the anesthesia services at Carle and also at some of the rural hospitals.
Dr David Hill (Host): And do you see specific strengths that the APPs have that maybe don't apply to other members of the team?
Linda Irle: I think the APP group is very good at communication and so I think they're very good at educating patients both inpatient and outpatient. We have apps that have been with the organization for over 30 years and they know their patient population better than some of the other members of the group. But they go maybe at a little bit different angles in the medical model, but definitely provide wonderful service to the patients that we serve.
Dr David Hill (Host): That is a really great insight for us and thank you for sharing. Do you mind sharing a little bit about your own pathway? How did you choose this career and what has it done for you?
Linda Irle: I have been at Carle for 33 years. I started out as an RN in the OB area and helped develop a Family Suites Program, which was a market program to try and increase our population in the OB area, our market share in the community, and just really enjoyed the increased independence. So, the family suites unit was a unit that patients would come to after they delivered babies and they were actually discharged patients. So they came to our unit as an outpatient and it offered a free 24-hour stay where we could give them extra education. We offered sibling classes offered care of the newborn illness in the newborn breastfeeding classes. It was a very fun project.
So after doing that, I went back to school and received my family nurse practitioner degree from Illinois State, and then also continued to work at Carle, but also taught 12 years in the nursing program at the U of I here locally in Urbana and taught women's health and OB, so kind of stayed in that rein. And then, I went back in 2011 and received my doctorate in nursing practice. I also received my full practice authority in 2018 when it became available in the state of Illinois. And I just have always enjoyed working with families and patients and educating them on their conditions, and it's just been a very fulfilling career.
Dr David Hill (Host): That sounds really satisfying and I love how innovative that program was that you founded. What do you see for the future of advanced practice providers at Carle?
Linda Irle: So in the future, I think with the increased shortage of physicians in both specialty and primary care, that you're going to see a higher ratio of APPs to physicians to provide access to care to the people at Carle.
Dr David Hill (Host): So Linda, I understand that you have an APP Council and that you guys have a big occasion coming up here. Is that right?
Linda Irle: That is correct. So our APP Council is the day that we celebrate every year as APP week at Carle Health, which is the third week of October, so it's coming up here very shortly. This was a big win for APPs at Carle when it was founded for early leadership structure, growth, practice definition and elevation of our group. The APP Council was started around the mid-1980s as a way for us to network among our specialties and bring practice issues to the table and discuss solutions. It later mirrored the shared governance model that the hospital was embarking on for Magnet certification. So we continue to meet the third Wednesday of the month. We currently have around 50 active members across the organization and we continue to grow. And we're a very active and busy council, and definitely have a lot of projects that we're working on currently.
Dr David Hill (Host): Anything else you wanted to make sure we touched on?
Linda Irle: I want to recognize our officers of our current APP Council. So, our chair is Amy O'Dell. Our co-chair is Stephanie Snyder, and our secretary is Terri Rizzo and they've done a wonderful, fantastic job this year. And definitely, I want to recognize our entire APP group during a APP week. They're all appreciated for all the hard work they perform each and every day to take care of our patients. And they're an amazing group that I'm honored to represent and they can never be thanked enough for all they do.
Dr David Hill (Host): Well, we can start by thanking them for their work right now, and I have to thank you for representing them and leading them so well.
Linda Irle: Thank you so much.
Dr David Hill (Host): For more information and to get connected with one of our providers, please visit carle.org. For a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.
Dr David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're going to be talking with Linda Irle, NP, who is the Director of the Advanced Practice Provider Program at Carle. Linda, welcome.
Linda Irle: Thank you. I'm very happy to be here.
Dr David Hill (Host): Wow. I'm happy to be talking with you today. So, I was wondering if you could sort of walk us through the history of advanced practice providers at Carle. I know when I was training, this is a fresh new idea, but we're talking about the mid to late 1990s and they tell me it's been a minute since then. So, what's going on there and how did we get to this place?
Linda Irle: Okay. So definitely very interesting history at Carle Foundation. In 1979, our current CNO, who is Sandy Reifsteck, she pulled five RNs who had been at Carle for a long time. She felt like they were very experienced. They did a good job in their role, and she had them join the second year medical students every afternoon for a fall semester. Then, during the spring and summer semesters, they rotated through different MD preceptors at Carle for a six to nine-month period. And then, in 1980, after they had completed this training, we had five nurse practitioners on board. And around the same time, they started hiring physician assistants to help in the surgical areas. And by 2010, we had 120 APPs at Carle. And fast forward to 2022, we have 450 APPs at Carle, so that includes both the advanced practice registered nurses and physician assistants.
Dr David Hill (Host): That is fantastic. I know that I cannot function without advanced practice providers. I also happen to be married to a pediatric physician's assistant. So, this is my life professionally and at home. So, I'm so excited to see that program has come so far there at Carle.
Let's look a little bit at the present and at the future. Can you tell me about some of the projects that Carle has going on in terms of how they're training and utilizing their advanced practice providers?
Linda Irle: Sure. So backing up just a little bit, so back when the APRN and PA positions were started, the roles were very limited as to what they could do. The program started back in the mid-1960s with the first physician assistant program at Duke University and the first nurse practitioner program at the University of Colorado.
So they created these professions, seeing well into the future. We've had a lot of population growth and underprepared complex healthcare system. And so, these early visionaries definitely thought differently about our medical training model. But saying that, definitely in the early years, the APP or the advanced practice providers worked as physician extenders, so they were coined the mid-level provider group. They had very little independence. And if you fast forward currently we work very independently. All APPs, both APRNs and PAs, are state-licensed and nationally-certified. They're credentialed and privileged to perform many procedures. We bill independently. We can have our own patient panels in some primary care areas. Full practice authority was made available for APRNs in 2018 when they meet certain requirements. So definitely, we've come a far, far distance and work very independently and very much help with access in the healthcare world.
Dr David Hill (Host): That's fantastic. Can you describe, if I'm at Carle, where I might encounter an advanced practice provider and what they might be doing for me?
Linda Irle: Definitely. Currently, we have apps in over 65 specialty areas. They work definitely in the clinics. They work in the OR. They work in the inpatient setting. They work in the SNFs group, so in the nursing home rounds. They work definitely with our insurance health alliance. They do home visits with the Health Alliance Program. So really, you can find an APP in about every area at Carle, performing what their specialty area is and what they've been trained to do.
Dr David Hill (Host): Are there any misconceptions or myths about the role of advanced practice provider that you just wish people understood better?
Linda Irle: The APP, definitely we're here to serve the patients. We're definitely working in a team environment. A lot of people have different perception as to what an APP can and cannot do, but our state license really allows us to do anything but operative surgery, so we can be trained to do any procedure that would help the group. In our CCU, we have a group of APPs that do a lot of procedures. They've been privileged to do airways and all kinds of things. We also have a large CRNA group that does a lot of the anesthesia services at Carle and also at some of the rural hospitals.
Dr David Hill (Host): And do you see specific strengths that the APPs have that maybe don't apply to other members of the team?
Linda Irle: I think the APP group is very good at communication and so I think they're very good at educating patients both inpatient and outpatient. We have apps that have been with the organization for over 30 years and they know their patient population better than some of the other members of the group. But they go maybe at a little bit different angles in the medical model, but definitely provide wonderful service to the patients that we serve.
Dr David Hill (Host): That is a really great insight for us and thank you for sharing. Do you mind sharing a little bit about your own pathway? How did you choose this career and what has it done for you?
Linda Irle: I have been at Carle for 33 years. I started out as an RN in the OB area and helped develop a Family Suites Program, which was a market program to try and increase our population in the OB area, our market share in the community, and just really enjoyed the increased independence. So, the family suites unit was a unit that patients would come to after they delivered babies and they were actually discharged patients. So they came to our unit as an outpatient and it offered a free 24-hour stay where we could give them extra education. We offered sibling classes offered care of the newborn illness in the newborn breastfeeding classes. It was a very fun project.
So after doing that, I went back to school and received my family nurse practitioner degree from Illinois State, and then also continued to work at Carle, but also taught 12 years in the nursing program at the U of I here locally in Urbana and taught women's health and OB, so kind of stayed in that rein. And then, I went back in 2011 and received my doctorate in nursing practice. I also received my full practice authority in 2018 when it became available in the state of Illinois. And I just have always enjoyed working with families and patients and educating them on their conditions, and it's just been a very fulfilling career.
Dr David Hill (Host): That sounds really satisfying and I love how innovative that program was that you founded. What do you see for the future of advanced practice providers at Carle?
Linda Irle: So in the future, I think with the increased shortage of physicians in both specialty and primary care, that you're going to see a higher ratio of APPs to physicians to provide access to care to the people at Carle.
Dr David Hill (Host): So Linda, I understand that you have an APP Council and that you guys have a big occasion coming up here. Is that right?
Linda Irle: That is correct. So our APP Council is the day that we celebrate every year as APP week at Carle Health, which is the third week of October, so it's coming up here very shortly. This was a big win for APPs at Carle when it was founded for early leadership structure, growth, practice definition and elevation of our group. The APP Council was started around the mid-1980s as a way for us to network among our specialties and bring practice issues to the table and discuss solutions. It later mirrored the shared governance model that the hospital was embarking on for Magnet certification. So we continue to meet the third Wednesday of the month. We currently have around 50 active members across the organization and we continue to grow. And we're a very active and busy council, and definitely have a lot of projects that we're working on currently.
Dr David Hill (Host): Anything else you wanted to make sure we touched on?
Linda Irle: I want to recognize our officers of our current APP Council. So, our chair is Amy O'Dell. Our co-chair is Stephanie Snyder, and our secretary is Terri Rizzo and they've done a wonderful, fantastic job this year. And definitely, I want to recognize our entire APP group during a APP week. They're all appreciated for all the hard work they perform each and every day to take care of our patients. And they're an amazing group that I'm honored to represent and they can never be thanked enough for all they do.
Dr David Hill (Host): Well, we can start by thanking them for their work right now, and I have to thank you for representing them and leading them so well.
Linda Irle: Thank you so much.
Dr David Hill (Host): For more information and to get connected with one of our providers, please visit carle.org. For a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.