Workplace Belonging Among Critical Care Advanced Practice Clinicians: Evaluation and Recommendations at a Tertiary Academic Medical Center

Abstract

PURPOSE: In 2024, a well-being survey at a tertiary academic medical center revealed that advanced practice clinicians (APCs) scored 5.75 out of 10 on professional belonging, with critical care (CC) APCs scoring notably lower. This quality improvement project aimed to evaluate workplace factors contributing to CC APC belonging, identify shared concerns across units, and develop evidence-informed recommendations for institutional leadership. METHODS: A qualitative descriptive design was used to examine professional belonging among CC APCs at a single academic medical center. An interview guide was developed based on three evidence-based determinants identified in the literature: mentorship and professional development, organizational support and recognition, and professional autonomy and role clarity. CC APCs were recruited via unit posters and team listservs; screening and scheduling were conducted through Qualtrics. Semi-structured interviews were conducted via Zoom with live transcription. De-identified transcripts were coded independently by the investigator using Quirkos and validated through AI-assisted thematic analysis (Claude AI, Microsoft Copilot). Themes present in more than half of the interviews were prioritized for analysis. RESULTS: Thirteen CC APCs participated across six ICUs (CCU, CICU, CTICU, MICU, Oncology BMT ICU, and SICU). The sample was predominantly female (85%) and White or Caucasian (77%), with a mean of 10 years of critical care experience. Thematic analysis identified deficits across all three evidence-based determinants: professional autonomy and role clarity (variable and context-dependent voice, inconsistent role expectations); organizational support and recognition (lack of institutional valuation, barriers around sick time, absence of formal work recognition); and mentorship and professional development (informal mentorship, unstructured orientation without milestones, and limited professional development resources). IMPLICATIONS FOR PRACTICE: Deficits across all three determinants do not operate independently; rather, they interact in a reinforcing cycle that compounds erosion of belonging and well-being over time. Team cohesion emerged as the strongest protective factor for APC belonging and retention. Evidence-informed recommendations were stratified by implementation effort: low-effort, high-impact actions include a protected sick time policy, APC recognition programs, updated service recognition, and expanded CME access; high-effort strategic investments include structured onboarding, formal mentorship programs, protected administrative time, and a faculty advancement framework. Targeted qualitative interviews offer a replicable model for translating well-being survey findings into actionable institution-specific interventions, and AI-assisted analysis offers a scalable approach for solo investigators, strengthening trustworthiness through concordance with human coding.