It’s time to establish and framework for NP and PA leadership…
Take a health systems science approach with insights from our experts!
As published in the Journal of the American Academy of Physician Assistants
NP and PA leadership plays a critical role in shaping the future of healthcare.
This article highlights how nurse practitioners (NPs) and physician associates (PAs) are stepping into key leadership positions to influence clinical practice, mentor care teams, and improve patient outcomes. Through strong communication, collaboration, and advocacy, NP and PA leaders are driving innovation and elevating standards of care across diverse health care settings.
As health care systems evolve, empowering NPs and PAs with leadership opportunities has become more important than ever. The article examines effective strategies for developing leadership skills, fostering interprofessional respect, and ensuring that advanced practice providers have a voice in decision-making. Readers will gain insights into how NP and PA leadership strengthens organizations, enhances care delivery, and inspires the next generation of health care professionals.
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Abstract: Physician associates (PAs) and nurse practitioners (NPs) are vital members of the health care team. Increasing opportunities for leadership roles have emerged for PAs and NPs in the past decade. PAs and NPs often utilize other health professions’ frameworks for leadership, but no framework exists for PAs and NPs specifically. This article examines existing leadership structures and proposes a leadership framework specifically for PAs and NPs through the health systems science lens.
Authors: Will, Kristen PhD, MHPE, PA-C; Marbach, Justine BS; Buckler, Lacey DNP, ACNP-BC, FAANP; Hartsell, Zachary DHA, FACHE, PA-C; Grubb, Bethany PhD, MPH, PA-C; Essary, Alison DHSc, MHPE, PA-C
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Between 2010 and 2017, the physician associate (PA) and nurse practitioner (NP) workforce doubled and is projected to grow another 25% to 35% in the next decade. As key providers of patient-centered care, PAs and NPs help address the challenges of an aging population, physician shortages, and issues worsened by COVID-19, such as burnout and care disparities. Increasingly, they also serve in leadership roles within healthcare systems – 65% of organizations now have a PA or NP leader, though they represent only about 2.6% of the total workforce compared with 5% of physicians.
These leaders bring a unique clinical and administrative perspective that can reduce turnover and strengthen team performance, but research and leadership frameworks tailored to their professions remain limited. To keep pace with workforce growth and evolving healthcare demands, PAs and NPs must expand their leadership skills and adopt frameworks designed specifically for their roles, such as those based on health systems science (HSS).
Beckground
The American Academy of Physician Associates (AAPA) and the National Organization for Nurse Practitioner Faculties (NONPF) each define professional competency frameworks for physician associates (PAs) and nurse practitioners (NPs). While both emphasize clinical practice and patient care, the frameworks differ in scope. The AAPA’s PA competencies focus primarily on patient care and education, with leadership only indirectly referenced through attributes like professionalism and collaboration. In contrast, the NONPF’s NP competencies extend beyond clinical practice to include research, systems thinking, and leadership.
Overall, NPs have a clearer foundation for leadership development embedded in their professional standards, while PAs lack a formal leadership framework. This gap highlights the need for PA-specific leadership competencies and structured training pathways that align with their expanding roles in modern healthcare.
Previous Research
Although leadership among physician associates (PAs) and nurse practitioners (NPs) has been studied in various contexts, there is still no agreed-upon framework tailored to these professions. Research on PA leadership has explored areas such as postgraduate and global health training, but studies have not produced a standardized model for leadership development. A 2021 study found that while leadership effectiveness and competency were correlated, neither was linked to lower burnout or influenced by formal leadership training, suggesting that burnout remains a persistent issue regardless of leadership preparation.
For NPs, more research exists on leadership competencies, with studies identifying four key domains—clinical, professional, health systems, and health policy leadership—though no unified framework has been established. Recent insights from healthcare executives indicate that PA and NP leadership roles are becoming increasingly diverse and strategic, extending from daily clinical management to broader system-level responsibilities in areas such as population health and organizational strategy. This growing complexity underscores the need for a standardized, profession-specific leadership framework for both PAs and NPs.
Health Systems Science Leadership Framework
Health systems science (HSS) is the study of how healthcare is delivered, how professionals collaborate, and how systems can improve care, emphasizing systems thinking and continuous learning. Within this framework—recognized as the “third science”—leadership is a core domain encompassing both self-leadership and leading others, offering PAs and NPs a practical, integrated pathway for effective leadership in advanced practice roles. Within this domain, there are two main components:
- Leading Self
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PAs and NPs already demonstrate strong intrapersonal leadership skills—such as professionalism, service to others, and pursuit of excellence—through their clinical work with patients, families, and healthcare teams.
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Leading self involves developing emotional intelligence, self-awareness, and self-control, which are essential for effective leadership and can be applied beyond clinical settings to administrative or managerial roles.
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The character-based leadership model highlights additional key traits for PA and NP leaders, including courage, integrity, selflessness, empathy, collaboration, and reflection.
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Leading Others
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In addition to self-leadership, HSS leaders must develop skills for leading others—including team leadership, communication, influence, systems thinking, and vision execution—often supported by formal training, executive coaching, and mentoring.
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As PAs and NPs progress from leading self to leading others, they leverage their clinical experience to guide teams through mutual respect, clear communication, and role clarity; developing these skills—along with mentoring and coaching others—is essential for building strong, high-performing healthcare teams within the HSS leadership framework.
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As PAs and NPs advance into higher leadership roles, they must develop advanced communication and influence skills—advocating for others, handling difficult conversations, and navigating complex organizational dynamics—since influence is a key form of leadership power within healthcare systems.
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Executing a vision is a key responsibility for system-level PA and NP leaders, involving developing strategy, shaping culture, and sustaining progress; while some may have natural aptitude, mentorship and training are essential to cultivate these skills as more PAs and NPs are called to lead organizational vision and strategy within healthcare systems.
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Conclusion
As PA and NP leadership roles expand, adopting the Health Systems Science (HSS) framework offers a structured approach for developing essential leadership skills and integrating them into professional training and competencies. Continued investment in leadership education, research, and professional development will be crucial to support the growing influence and responsibilities of PAs and NPs in healthcare leadership.
