Written by Ashley Kaminski Petkis, DNP, APRN, AGACNP-BC; Alyssa Widen, MSN, BSN, RN
Staffing challenges remain pervasive across the healthcare continuum, with particular severity in the post-acute care setting. Skilled nursing and long-term care facilities are facing high turnover, specifically with direct-care staff such as licensed practical nurses (LPNs), registered nurses (RNs), and certified nursing assistants (CNAs). Recent data from Consumer Voice (2022) indicate that nursing homes experience an average annual turnover rate of approximately 52%.
High turnover rates lead to a series of poor outcomes for patients and facilities, including lower star ratings and reported patient abuse. The constant turnover of staff, often described as a “revolving door,” is a familiar reality in today’s healthcare environment. Patients and families are frequently required to repeat their histories, preferences, and specific needs to new clinicians, which contributes to dissatisfaction and, consequently, lower performance on quality measures and consumer reporting outcomes. According to Consumer Voice, a “nursing turnover rate between 50%-59% are cited for abuse at a rate 1.5 times higher than nursing homes with a turnover rate between 30%-39%” (Consumer Voice, 2022). This creates a vicious cycle in which dissatisfaction contributes to worsening staffing shortages, escalating frustration, and a subsequent decline in the quality of care delivered to patients and families.
High turnover and staffing shortages are unfortunately not the only cited issues in today’s literature. Additional issues include gaps in knowledge and varying levels of education (Gassas, 2021). The complex environment of the SNF, where acute, long-term, and rehabilitative care intersect, requires advanced clinical oversight, mentorship, and system-level leadership. These disparities can result in inconsistent clinical decision-making and uneven quality of care delivery. Furthermore, they underscore the need for standardized training and ongoing professional development to ensure competency across the healthcare workforce.
In the current healthcare climate, hiring an advanced practice registered nurse (APRN), specifically a nurse practitioner (NP), is emerging as a strong solution to resolve these issues: this multifaceted position can serve as a clinical mentor, educator, leader, driver of quality improvement, and flexible clinician. According to the Commonwealth of Massachusetts (n.d.), APRNs are RNs with graduate education; prepared with “expert knowledge, complex decision-making skills, and clinical competencies to engage in advanced practice nursing activities.” When utilized strategically, APRNs can function to improve quality, competence, and confidence, which in turn improve retention. As evidenced by a multi-year study published in PubMed, APRNs improve nursing home outcomes, reduce hospitalizations, and improve quality scores (Vogelsmeier et al., 2021).
APRNS as Clinical Mentors
Mentorship can be described as “a dynamic process of learning between individuals that creates space for guidance, partnerships, leadership, collaboration, personal and professional growth” (Swanson et al., 2015). In the post-acute care setting, immediate access to guidance and support is not always available. APRNs provide an implanted resource within the team, offering expertise for higher-acuity patients and complex decisions when a charge nurse, physician, or supervisor is not readily present.
APRNs can assist with wound assessments, medication titration, acute change in condition management, and physical assessment skills. They also serve as real-time consultants for nurses uncertain about whether a resident’s condition requires a provider call or can be managed on site. This guidance builds confidence and prevents unnecessary transfers, directly supporting the Centers for Medicare & Medicaid Services’ (CMS’s) initiatives aimed at reducing avoidable hospitalizations.
By mentoring bedside nurses in early clinical recognition, Situation-Background-Assessment-recommendation (SBAR) communication, and documentation for change in condition protocols, APRNs promote a culture of critical thinking and accountability. Their mentorship aligns with CMS quality and regulatory standards such as F684 (Quality of Care) and F697 (Pain Management), ensuring consistent, high-level care while empowering nurses at every level.
APRNs as Educators
As evidenced by research, retention is highly influenced by factors such as onboarding, development opportunities, department resources, and job environment (De Vries, et al., 2023). This shows that retention is not just about productivity expectations and wages, but also about professional development and clinician confidence. APRNs, by definition, are “registered nurses with master’s and/or doctorate degrees with advanced education and training beyond registered nurses” (Boehning & Punsalan, 2023). Given this higher level of education and training, APRNs are equipped with skills such as quality improvement (QI) and implementation of evidence-based practice (EBP).
Although organizational educators are an invaluable resource, their focus is typically on periodic training, such as orientation, new device instruction, and annual competencies, whereas APRNs are integrated into the organization’s clinical structure to provide real-time expertise and ongoing support. This creates opportunities to recognize everyday teachable moments and transform them into microlearning experiences. Microlearning offers brief, targeted lessons on issues or gaps in learning and can include topics such as fall reduction strategies, wound-care techniques, documentation tips, and emergency response. The result of microlearning equals increased staff confidence and strategies that can be applied to real-life situations.
APRNS as Leaders
APRNs’ further clinical experience, professional background, and higher-level education lend naturally to positions in leadership roles. In a study by Lamb et al, two themes emerged regarding APRN leadership: “patient-focused leadership” and “organization- and system-focused leadership,” reflecting the APRN’s ability to enhance care for patients and families, support the healthcare team, and strengthen the overall healthcare system (Lamb, et al., 2018).
Patient-focused leadership encompasses the APRN’s role as an expert clinician who delivers high-quality, evidence-based care while simultaneously promoting the growth of professional practice within the team. This form of leadership is also reflected in the ability to facilitate meaningful interdisciplinary collaboration, ensuring that patients and families receive holistic, coordinated, and compassionate care across settings. By actively mentoring colleagues, modeling best practices, and addressing gaps in communication, APRNs contribute to a culture of continuous improvement that directly benefits patients and families.
At the organizational and system level, leadership extends beyond direct patient care to initiatives that shape the broader delivery of healthcare. This includes spearheading innovative clinical ladder programs designed to foster professional development and retention, as well as demonstrating the ability to interpret, apply, and optimize key performance metrics. Through strategies such as supply chain efficiency, workforce deployment optimization, and utilization management, APRNs help align organizational resources with patient needs and quality outcomes. In addition, their leadership fosters a culture of growth and adaptability, one that is distinct from the traditional career ladder by emphasizing system-level transformation, sustainability, and forward-thinking approaches to healthcare delivery. Together, these dimensions of leadership highlight the unique and complex role of APRNs in advancing both patient care and organizational performance.
APRNs as Versatile Clinicians
SNFs require clinicians who can adapt to fluctuating census, varying acuity, and unpredictable staffing. NPs, specifically, are uniquely positioned to “wear many hats” within the post-acute care setting. Their dual licensure allows them to function as independent practitioners and, when needed, to step in as direct-care nurses, depending on state regulations and facility policy. This versatility becomes particularly critical during times of severe staffing shortages, when NPs can be strategically utilized in whichever role is most urgently needed to ensure continuity of care and operational stability.
In many post-acute care settings, APRNs also facilitate transitional care management by coordinating post-discharge follow-up, completing medication reconciliations, and ongoing communication with primary care providers. The advanced autonomy afforded by the APRN scope of practice further enhances their value, enabling them not only to provide direct clinical care but also to contribute at a systems level by addressing workforce gaps, supporting QI initiatives, and ensuring patients receive timely, high-quality care.
Practical Application of the Post-Acute APRN Model
The APRN role is inherently multi-faceted, designed to optimize professional capabilities. In practice, the APRN functions as an NP providing direct patient care, an educator supporting training and competency development, a resource for complex clinical consultations, and, when necessary, a bedside nurse during staffing shortages. At the same time, the APRN maintains a leadership role, enabling influence that extends beyond day-to-day care to encompass strategic planning informed by intimate knowledge of clinical practice.
This integrated role can notably improve agency operations, specifically through increased clinician confidence, improved quality outcomes, and a culture of resilience. By serving as an additional resource for troubleshooting complex clinical issues, advancing QI initiatives, and providing leadership during high-stress situations, the APRN role can make a substantial contribution to the organization.
Conclusion
As the complexity and acuity of the post-acute care setting continue to increase, so too does the need to integrate more APRNs into practice. Their ability to remain flexible, shifting seamlessly between roles as APRNs, RNs, educators, and leaders, allows APRNs to foster professional growth within teams, elevate the quality of care, and stabilize the workforce.
Beyond filling gaps, APRNs bring the added value of autonomy in clinical decision-making, systems-level thinking, and the capacity to support QI initiatives that directly impact patient outcomes. The evidence is clear that APRNs are not a “nice-to-have” addition, but rather a strategic investment in both workforce stability and the long-term success of healthcare organizations. By embedding APRNs into post-acute care models, organizations can better navigate the challenges of rising acuity, workforce nursing shortages, and increasing demands for high-quality, patient-centered care.
References:
Boehning, A. P., & Punsalan, L. D. (2023). Advanced practice registered nurse roles. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/sites/books/NBK589698/
Consumer Voice. (2022, September 8). High staff turnover: A job quality crisis in nursing homes. Retrieved from Consumer Voice: https://theconsumervoice.org/wp-content/uploads/2024/06/High_Staff_Turnover-A_Job_Quality_Crisis_in_Nursing_Homes.pdf
De Vries, N., Lavreysen, O., Boone, A., Bouman, J., Szemik, S., Baranski, K., Godderis, L., & De Winter, P. (2023). Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace. Healthcare (Basel, Switzerland), 11(13), 1887. https://doi.org/10.3390/healthcare11131887
Gassas, R. (2021). Sources of the knowledge-practice gap in nursing: Lessons from an integrative review. Nurse Education Today, 106, 105095.
Lamb, A., Martin-Misener, R., Bryant-Lukosius, D., & Latimer, M. (2018). Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing open, 5(3), 400–413. https://doi.org/10.1002/nop2.150
Swanson M., Perez E., Smith M. A., Stanton M., Keith L. A., Witmer A. (2015). The efficacy of a Doctor of Nursing Practice mentoring program. Clinical Scholars Review, 8(2), 150–159. https://doi.org/10.1891/1939-2095.8.2.150
Vogelsmeier, A., Popejoy, L., Canada, K., Galambos, C., Petroski, G., Crecelius, C., Alexander, G. L., & Rantz, M. (2021). Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalizations of Nursing Home Residents. The journal of nutrition, health & aging, 25(1), 5–12. https://doi.org/10.1007/s12603-020-1552-8
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