by: Terri Schmitt PhD, APRN, FNP-BC, FAANP, NPACE Executive Director
As we move one month into a new year and new goals, I reflected on our new resources at NPACE. In our effort to support all APPs in resources we have opened a new job board. Much goes into looking for a new job and applying. Included in this job search is an understanding of how and why we want to change jobs.
Check out the NPACE job board here and then read on about workforce factors besides moving that affect job change and find some tips for job searching and interviewing!
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APPs practice in a healthcare environment characterized by increasing demand, workforce shortages, and escalating administrative and clinical pressures. In my own experience, the swift changes to the clinical practice – in the same place I have been for over 5 years – has been staggering in the last 6 months beyond the constant change I have experienced continually in healthcare. Although employment opportunities for APPs remain strong, burnout is a significant factor influencing job dissatisfaction, career mobility, and decisions to seek new positions. Understanding the intersections of job distress and exploring new jobs, stepping on to applications and interviewing, and career transitions is both interesting and insightful. This month, I wanted to bring together some evidence from literature, professional guidance, and NPACE resources to help you navigate career moves.
I know this will come as no surprise to practicing clinicians, but APP burnout is associated with workplace stressors rather than individual resilience deficits. In one study of NPs and PAs, Klein et al. (2020) found job stressors, including workload, role ambiguity, and limited autonomy, were strongly associated with burnout. Importantly, burnout mediated the relationship between job stress and engagement at work, meaning work stress contributes to burnout and the amount of burnout means people begin to disengage. Not surprisingly, better work–family balance was associated with lower stress and burnout and higher engagement.
Additional evidence from primary care research reinforces the presence of burnout among all clinicians and how it affects the whole human. Goldberg et al. (2020) identified anxiety and withdrawal behaviors as key indicators of burnout among physicians, advanced practice clinicians, and staff. In that 2020 publication conducted even pre-pandemic, 31.6% of the physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff. Although burnout prevalence among APPs was lower than among physicians, the presence of burnout was still associated with emotional distress and disengagement often contributing to or preceding job dissatisfaction and turnover intentions.
Job stress leads to disengagement and burnout and is a meaningful contributor to workforce instability. Further, When APP roles are poorly defined or underutilized, frustration and disengagement increase, raising the likelihood of job change (van der Biezen et al., 2017).
Organizational and system-level factors can boost retention. Published research examining APP employment in primary care highlights adequate staffing, clear role delineation, and supportive team structures in association with higher job satisfaction and lower burnout (van der Biezen et al., 2017). Find the systems that understand what you do and have key support structures in place.
Interestingly but not surprisingly health policy context also matters. Government and organizational policies support role clarity, training, and trust in NP and PA practice and employment and workforce integration. In contrast, limited institutional support and unclear scope implementation contribute to dissatisfaction and turnover (Dankers-de Mari et al., 2023). For APPs this means know your state scope, be active in a local organization to understand and impact policy and look for jobs and employers who understand and support this knowledge and action.
Workforce research consistently shows APP retention improves when organizations invest in supportive structures including onboarding, mentorship, leadership pathways, and adequate staffing. The Sullivan Cotter (2025) turnover data emphasizes this and highlighting that environments lacking clear roles, sustainable workloads, and professional development pathways see higher rates of APP turnover. For job‑seeking APPs, these findings reinforce the importance of evaluating not just the position, but the system behind it.
For the younger or newer APPs. Transition‑to‑practice and that entire process and experience is relevant to career stability. Structured transition‑to‑practice programs for NPs and PAs may improve confidence and readiness for practice, although evidence linking these programs directly to long‑term retention remains limited, more research is needed (Batchelder et al., 2023). However, knowing that a good transition program may improve your knowledge, satisfaction, and impact your patient outcome, it remains important to consider. For those of us practicing a while, there is still always more to be learned. one knows finding a supportive employer with a solid time for orientation and support is key.
Job Evaluation Considerations
|
Area |
APP: What to Assess & Ask |
Employer: What to Provide & Demonstrate |
|
Role Clarity & Scope |
• Is job scope clearly defined/ optimized? |
• Provide a clear APP role description |
|
Workload & Productivity |
• Daily patient volume? |
• Be transparent about volume, RVUs, quality metrics |
|
Team-Based Culture |
• Are APPs respected as clinical partners? |
• Demonstrate interprofessional respect |
|
Leadership & Voice |
• Are APPs included in decisions? |
• Include APPs in committees or leadership structures |
|
Onboarding & Support |
• Is there structured onboarding? |
• Provide formal onboarding timelines |
|
Schedule Control |
• Schedule predictability? |
• Design schedules that support sustainability |
|
Administrative Burden |
• Who handles inboxes, prior authorizations, refills? |
• Invest in support staff and workflow efficiency |
|
Growth & Advancement |
• What does growth look like after year one? |
• Offer advancement tracks |
|
Values & Mission Fit |
• Do I feel aligned with how care is delivered? |
• Clearly articulate mission and values |
|
Burnout Awareness |
• Is burnout acknowledged as systemic? |
• Name burnout openly |
Recognize that no job is perfect, but preparation for your and your patients’ best outcomes begins at job hunting. Evaluate the total package and not just compensation.
________________________________________________________________
|
APP |
Employer |
|
• Research the organization’s care model and APP utilization |
• Prepare all interviewers to speak consistently about APP role |
|
APP |
Employer |
|
• Frame experience in terms of outcomes, access, efficiency, and collaboration |
• Ask structured, role-relevant questions |
|
APP |
Employer |
|
• Frame job changes around alignment, sustainability, and growth |
• Avoid labeling candidates as “burned out” |
|
APP Questions to Ask |
Employer Topics to Address |
|
• How is APP performance evaluated? |
• Productivity expectations |
|
APP |
Employer |
|
• Observe how APPs are discussed |
• Ensure messaging is aligned and respectful |
|
APP |
Employer |
|
• Reflect on red flags. |
• Offer realistic job previews |
For APPs a “good job” is one that is clinically meaningful, structurally supportive, and professionally sustainable, not just well-paid. For Employers, strong APP recruitment isn’t about critically scrutinizing the candidate or selling the role, but instead about building a system where APPs can thrive long term, and thus the system and patients do better.
Batchelder, H. R., Barnes, H., Morgan, P., & Tuttle, B. T. (2023). Nurse practitioner and physician assistant transition‑to‑practice programs: A scoping review. Journal of the American Association of Nurse Practitioners, 35(12), 776–783. https://doi.org/10.1097/JXX.0000000000000836
Dankers‑de Mari, E. J. C. M., Laurant, M. G. H., van Vught, A. J. A. H., & Wensing, M. (2023). How does government policy influence the employment and training of nurse practitioners and physician assistants? Journal of Advanced Nursing, 79(7), 2553–2567. https://doi.org/10.1111/jan.15607
Goldberg, D. G., Soylu, T. G., Grady, V. M., Kitsantas, P., Grady, J. D., & Nichols, L. M. (2020). Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium‑sized primary care practices. Journal of the American Board of Family Medicine, 33(3), 378–385. doi: 10.3122/jabfm.2020.03.190260
Health Jobs Nationwide. (n.d.). Advanced practice provider interview secrets: How to stand out and land the job. https://blog.healthjobsnationwide.com/advanced-practice-provider-interview-secrets-how-to-stand-out-and-land-the-job/
Klein, C. J., Weinzimmer, L. G., Cooling, M., Lizer, S., Pierce, L., & Dalstrom, M. (2020). Exploring burnout and job stressors among advanced practice providers. Nursing Outlook, 68(2), 145–154. https://doi.org/10.1016/j.outlook.2019.09.005
Ochsner Health. (n.d.). Interview tips and tricks for healthcare professionals. https://www.ochsner.org/careersblog-interviewtips/
SullivanCotter. (2025). APP turnover: A costly reality. https://sullivancotter.com/wp-content/uploads/2025/12/APP-Turnover-A-Costly-Reality.pdf
van der Biezen, M., Derckx, E., Wensing, M., & Laurant, M. (2017). Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care. BMC Family Practice, 18(1), 16. https://doi.org/10.1186/s12875-017-0587-3