In 1996, the article “The Emerging Role of ‘Hospitalists’ in the American Health Care System” in the New England Journal of Medicine gave name to an emerging cohort of physicians: hospitalists.1 It began with a statement: “The explosive growth of managed care has led to an increased role for general internists and other primary care physicians in the American Healthcare System,”1 necessitating specialists in inpatient medicine. This growth has since expanded to include advanced practice nurses (APNs) and physician assistants (PAs). As of 2020, 10% of APNs and 41.5% of PAs identify the hospital as their principal clinical setting with 83.3% of all hospital medicine (HM) groups reporting APN/PA utilization.2-4 This has led to an expansion of their clinical roles, the scope of practice, and independence within these roles. While inpatient APN/PA care models vary, successful integration into a hospital's broader clinical operations has the potential to improve the quality and efficiency of care, promote the development of cohesive interprofessional teams, and reinforce a positive reputation of APN/PAs.5-9 Conversely, a poorly integrated or failed APN/PA service can have detrimental effects on the reputation of APN/PAs and their future use at an institution. APN/PAs continue to be cited as an important resource to combat physician shortages and are increasingly being deployed in acute care inpatient settings in roles that go beyond the traditional extender model and broaden APN/PA autonomy.2, 3, 10 During the COVID-19 pandemic, numerous healthcare systems deployed APN/PAs to meet institutional needs; one study reported that 78.6% of 119 surveyed organizations had redeployed or planned to redeploy APN/PAs to front-line specialties.11 Additional publications have detailed recommendations to evaluate care models, review scope of practice limitations, and utilize APN/PAs in response to the economic healthcare crises posed by COVID-19.12-14 As APN/PA advocates at our institution, we share lessons learned and successful institution-specific examples based on our experience developing, sustaining, and expanding inpatient medical and surgical APN/PA care models with a goal to provide general considerations when establishing and/or evaluating an inpatient APN/PA care model. The University of Chicago Medicine (UCM) embraces the use of APN/PAs in acute care settings across a variety of care models, including those with APN/PAs working autonomously and to the limits of their scope of practice. UCM has a Director of Advanced Practice Providers and over 400 APN/PAs with approximately 25% inpatient providers and the remainder working exclusively outpatient or in hybrid inpatient/outpatient roles. We focus primarily on APN/PAs on HM services or the short stay unit (SSU). Additionally, over the course of eight years, three APN/PA coauthors have worked clinically within acute care settings and collectively helped to create, train, and/or sustain 10 APN/PA medical and surgical groups. In this work, they have served on hospital-level committees interfacing with senior-level executives and other APN/PA leaders and stakeholders. HM is a combined physician-APN/PA group, while SSU is entirely APNs, practicing independently with an on-call collaborative physician. Our key points, with examples, are outlined in Table 1, with additional discussion for each key point below. When investing in an APN/PA workforce, building an interprofessional foundation is critical, including garnering support from senior leadership and physician colleagues working clinically alongside APN/PAs. To accomplish this, we suggest Optimal Team Practice (OTP), an American Academy of Physician Assistant (AAPA) practice philosophy.15 According to AAPA, OTP occurs when PAs, physicians, and other healthcare professionals partner to provide quality team-based care without burdensome administrative constraints. Teams determine the level of autonomy at the practice level within the limits of state regulations; this approach fosters collaborative and efficient PA-physician care models.15 We believe OTP can be applied to care models incorporating APNs. Developing a culture grounded in the philosophy of OTP incorporates many of the tenets described in Table 1. In our experience, we had success in building a supportive APN/PA culture by focusing on three main components: investment in a strong leadership structure, intentional onboarding, and cohesive physician-APN/PA relationships. First, we have developed APN/PA leadership positions embedded within the core clinical team to include the APN/PA voice in operational planning and help mitigate APN/PA utilization pitfalls. We built upon the success of the SSU APN/PA pilot to launch eight additional APN/PA-led services. As these teams were built and launched, our SSU APN/PA leaders served as content and institutional experts for billing and compensation, remote physician oversight, and provided education as needed about APN/PA background and training to key stakeholders. Second, a standardized onboarding process that is focused on new hire knowledge and skills and tailored to their specific needs and clinical contexts helps create a supportive APN/PA culture.16-19 UCM has created a hospital-level onboarding committee. Within HM, this includes a required quality improvement project which exposes new hires to the importance of professional development and systems-based practice. Third, we support a strong foundation of respect and collaboration among APN/PA-physician teams. Both HM and SSU have advocated for our APN/PAs to work at their highest scope of practice, equitable general medicine patient censuses, bidirectional physician-APN/PA mentorship relationships, and robust professional development. For example, many APN/PAs contribute to quality improvement and educational projects on local and national levels. With time, a positive culture leads to reputational gains, which can promote the use of APN/PAs within an institution. UCM saw total APN/PAs grow from approximately 200 in 2019 to over 400 in 2022. Allowing APN/PAs to practice to the extent of their license and scope of practice promotes improved clinical and professional development and can also increase access to healthcare for patients. Therefore, it is imperative to define the parameters of autonomy, supervision, and clinical expectations of the APN/PA workforce. UCM has multiple service lines that were successfully implemented with a leadership structure including APN/PA managers with specific clinical experience in that field. Most managers complete 10% of their time on the service, allowing them to provide expertise for clinical care and daily operations. These leaders educate key stakeholders on the scope of practice and ensure alignment between practice regulations and institutional policies to successfully operationalize APN/PA care models. For instance, the limits of an APN/PA's clinical practice in a particular work environment are defined by institutional policies yet bound by state regulations. In some states, APNs can work as independent providers whereas PAs historically have been dependent providers, linked by licensure to a collaborating physician. Though these distinctions should be known, this should not limit practice settings from utilizing APNs/PAs in an autonomous fashion if supported by state law. Additionally, it is important to note APN/PA legislation continually evolves, For example, H.B. 1175 in North Dakota recently removed the requirement that a PA have a written agreement with a physician if they practice at licensed facilities such as hospitals with a credentialing and privileging process.20 To reduce variability across different hospitals, we advocate that institutional APN/PA leadership adjust their policies to align with state standards as the scope of practice expands nationally. Both professions have national organizations that provide resources for the scope of practice and legislation.21-23 This further supports investing in APN/PA leadership structure as they are often experts on profession-specific questions and trends. As institutions increase APN/PA utilization, defining the patient population for a care model is important to manage clinical expectations by aligning individual training with the service scope of practice. For this reason, we believe it is vital for clinical leaders to familiarize themselves with their individual team member's unique skills, training, and years of experience as an APN/PA to best leverage the collective expertise of each individual and identify areas to foster skill development to promote lifelong learning. At UCM, we have found value in focusing on the philosophy of the “right patient-right provider relationship,” which takes into consideration the variability of APN/PA training and experience, as well as patient acuity and complexity. Unlike physicians whose training is relatively uniform, APN/PAs have varied training models, which raises concerns such as their lack of standardized exposure to hospital settings during their clinical rotations and that hospitalized patients are too medically complex. While these critiques are not without merit, they fail to address the value of an institution's onboarding processes, clinical supervision, institutional support, and the individual integrity of each APN/PA. Multiple studies demonstrate the benefits of APN/PAs.6-9 One provided a literature review of ICU and acute care trained APN/PAs from 2008 to 2018.8 The authors found the studies identified the value of APN/PAs in patient care management, continuity of care, improved quality and safety metrics, and patient and staff satisfaction.8 These studies demonstrate that by focusing on the right patient-right provider relationship APN/PAs can provide high-quality care. Based on this principle, UCM has developed specific APN/PA service lines with specialized training to manage distinct diseases or therapies, such as chronic obstructive pulmonary disease and bone marrow transplants. APN/PAs are an undeniable part of the changing landscape of the American healthcare system. In the inpatient setting, APN/PAs are increasingly taking on clinical roles that broaden autonomy and encourage practicing to the limits of one's scope of practice, training, and licensure. Investments in these much-needed services are vital to ensure effectiveness and adaptability not only at a single institution but more broadly as a means for meeting growing demands within the healthcare system. For APN/PAs to thrive in these roles, careful consideration needs to be given to key aspects of the care model, its implementation, and the identification of institutional advocates and critics. Based on extensive experience, we have outlined key factors to consider when designing, implementing, and sustaining inpatient APN/PA care models to ensure success. The author Bridget A. McGrath has received a project grant and clinical buy-down from the Section of hospital medicine for a project entitled “L.E.A.D from Where You Are: A Framework to Advance the Academic Footprint of Hospitalist Physicians and NP/PAs” effective July 1, 2022. This manuscript counts toward the observed outcomes of the project. The topic of the manuscript did not require formal IRB or ethics approval as was not patient-facing, did not require data collection, and did not study human or animal subjects. The remaining authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.