Amy Hull, MSN, WHNP-BC

 president-elect of the Society of Urologic Nurses and Associates, is assistant professor at Vanderbilt University, Nashville, TN.

	In her article, “Is your ideal practice fit within reach?,” 

 writer Lisette Hilton offers a very nice discussion of the possible practice options that urologists may consider. Change in health care has demanded modifications in the way many physicians choose to practice medicine and offer services to their patients. Adapting to change has meant the addition of new services, the creation of niche service lines, or the addition of new partners who have supplementary skill sets to draw business.

	With the U.S. health care system’s rapid change, Hilton’s article notes there has been a significant shift from the dominance of the private-practice urologist, with up to 40% of practicing urologists choosing to work for an employer such as an academic institution or hospital system. Additionally, as the complexities and difficulties of single-physician practices have grown, the number of physicians “going it alone” dropped to an all-time low of 10% in 2016.

	The health care system is going to continue to grow and evolve and it would be interesting to see Hilton write a follow-up article regarding physician collaboration with advanced practice registered nurses (APRNs) and physician assistants (PAs). Utilization of these professionals’ skills and experience may enable the urology provider to realize his/her ideal practice, for such colleagues may enable greater flexibility within the practice setting. Patient care can continue in the office while the urologist is in the OR; APRNs and PAs can serve as a conduit for readying patients for surgery, and these providers can evaluate for potential complications post-surgery, all excellent facets of care that may achieve the ideal practice setting.

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"Patient care can continue in the office while the urologist is in the OR; APRNs and PAs can serve as a conduit for readying patients for surgery, and these providers can evaluate for potential complications post-surgery," writes SUNA's Amy Hull, MSN, WHNP-BC.

APRNs, PAs can help achieve the ideal practice setting

	With changes occurring in the health care arena at a rapid pace, there is great opportunity for growth as well as potential risk for error. In his recent 

, Robert Dowling, MD, discusses the use of a survey tool that practices may utilize to assess practice culture and openness to change. Use of this very simple tool may aid the leaders of a practice to determine if there are areas of concern requiring modifications.  

	Created by the Agency for Health Care Research and Quality, the survey is meant to be disseminated to all parties within the practice as a means for completeness of viewpoints. Dissemination of the survey to everyone may also help provide a better measurement of a practice’s growth and receptiveness to change with regard to patient safety and quality of care. With the myriad options patients have for their care today, this simple and easy-to-complete tool may prove to be a valuable measurement of workplace culture, possibly serving as an identification of concerns for staff retention and morale, patient satisfaction and retention, and safety.

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	When compared to eight other specialties, such as endocrinology, neurology, cardiology, and others, the culture within the specialty of urology appears to be relatively positive, with an overall placement of second, just behind general surgery. Specific domains evaluated included the following:

		Patient care tracking follow-up: approximately 90%

		Overall perception of patient safety and quality: 80%-90%

		Organizational learning: just under 80%

		Owner/managing partner/leadership support for patient safety: above 70%

		Communication about error: approximately 70%

		Office processes and standardization: approximately 70%

	Use of the survey allows a practice to make positive or negative comparisons with other practices within the same specialty.

	While urology can boast a robust second place among specialties, there are areas of concern that must be discussed. The recommended measurement of success is within five percentage points of the overall scores, yet not one of the percentages is above 90% and the lowest (work pressure and pace) is 50%-60%. These measures are important to consider when setting goals for positive practice culture and indicate significant areas that may require improvement.

	The health care field does not show any signs of slowing in pace or growth, and as many people view health care as a service, it is important to strive for an environment that is high in quality, care, support, and acceptance.

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"The health care field does not show any signs of slowing in pace or growth, and as many people view health care as a service, it is important to strive for an environment that is high in quality, care, support, and acceptance," writes SUNA's Amy Hull, MSN, WHNP-BC.

 discussing a recent survey of advanced practice providers (APPs) by Joshua Langston, MD, and colleagues is a very timely and telling discussion of how APPs are practicing in urologic settings throughout the U.S.

	APPs are increasingly utilized across a variety of specialties, serving as valuable members of many health care teams. However, with greater need and greater visibility of these providers, physicians, inpatient, and out-patient institutional leadership (as well as APPs themselves) have realized a tremendous need for structured education. APPs, which include physician assistants and advanced practice registered nurses, are highly educated professionals who desire to grow their skill set through educational offerings that will allow them to practice to the height of their licenses and feel confident in their skills.

	Of the 1,347 APPs surveyed, only 296 responded. Of these 296 respondents, only 6% reported some type of postgraduate training for their subspecialty role. Yet, 63% of the respondents stated they were performing moderate- to high-complexity procedures. As discussed in the article, this leads many health care providers in the field to question the quality and expertise of the procedures being performed.

Survey: Majority of APPs perform advanced procedures

	It is also concerning that out of 1,347 people surveyed, 1,051 subjects did not respond to the questionnaire, leading one to question why they did not participate. Is there a common theme that connects these APPs as non-responders? Could the actual number of APPs receiving structured training be less than 6%? Could that number actually be greater? These are questions one cannot answer without more tangible information about the non-responders.

	Whether or not the survey is accurate, it is still important to ensure APPs receive proper education to perform their urologic duties. Unfortunately, much of the training needed to enable APPs to practice in urology is not offered in traditional educational settings.

	However, organizations exist to meet the growing educational needs of these APPs, including the Society of Urologic Nurses and Associates (SUNA). With its symbiotic relationships with the AUA and the American Urogynecologic Society, SUNA is in a unique position to collaborate with physicians to provide expert education to the APPs who are coming into the urologic specialty. Many of the urologic providers within the SUNA organization are experts in their fields and are poised to serve as mentors for new urologic APPs. Structured educational offerings, networking with colleagues, and seeking out mentorships with qualified professionals may ensure the profession has well-trained APPs who enhance the urologic team, provide excellent patient care, and ensure continued growth of the specialty.

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