Introduction: Due to staffing needs exacerbated by an expansion of state FMLA regulations, persistent patient volume, and increasing acuity, an opportunity was identified to develop a full-time multispecialty transplant nurse practitioner (APRN) role. The APRN role would provide transplant coordinator coverage across a Pediatric Transplant Center (PTC) at an academic pediatric hospital. Traditionally, APRNs were hired within a designated department and transplant program (liver/intestine/multivisceral, heart, renal, or lung transplant). The multispecialty APRN role allowed for flexible, consistent transplant coordinator coverage across departments within the PTC.  
Methods: The purpose of this quality improvement project was to develop and pilot an inter-departmental and multispecialty pediatric transplant APRN role in the PTC. The APRN completed initial orientation in the lung transplant program to establish a primary team. An additional transplant coordinator competency checklist was developed to guide multispecialty training and credentialing. The APRN trained to all organ programs in a stepwise fashion starting with lung, then liver, renal, and heart. A scheduling process was developed to allow each program visibility to the cross-covering APRN’s calendar. Programs could then submit requests for coverage including priority tiers for equitability.  
Results: An APRN was hired with prior inpatient transplant nursing experience caring for patients on the liver/intestine/multivisceral, lung, and renal transplant unit. This APRN spent 16-24 hours per week working in the lung transplant program, and provided 313 hours of cross-coverage in 2021, and 616 hours in 2022 as of 9/30/22. This included inpatient, outpatient, and clinic coverage. Of the 313 hours in 2021, 201 were in liver, 48 in renal, and 64 in heart. Of the 616 hours in 2022, 424 were in liver, 48 in renal, and 144 in heart.
Conclusion: Healthcare organizations have adapted care delivery models to address staff nursing shortages, but the APRN role is not included in these models. The PTC is a unique setting that connects solid organ transplant programs under one umbrella to facilitate collaboration, streamline policies, and ensure regulatory compliance. The PTC conceptualized a multispecialist APRN role to fill staffing needs in the transplant coordinator role. This role has provided consistent coverage across all organ programs while keeping within budget. Key reasons for success include prior transplant and hospital system experience, inter-departmental collaboration through the PTC, development of a transparent coverage request process, and competency focused training. The APRN was able to share practices across organ teams. Additionally, the process broadened the APRN’s clinical knowledge by providing experience in multiple subspecialties. The success of the role has led to discussions amongst nursing leadership about developing similar roles elsewhere in the enterprise.