In 2014, Dr. Mark Connolly, Chairman of Surgery of a 700 bed trauma center, created the opportunity to create a hybrid bedside vascular access program. Dr. Connolly will discuss what is involved on the administrative and corporate levels to create, initiate and expand a new program as a physician champion. St Joseph's University Medical Center is unique in having the largest dialysis population in the state of New Jersey. Our leading nephrologist Dr. Rae will discuss the current Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and the impact the vascular access program has provided this patient population. The wide reach of a multi-disciplinary vascular access model incorporating, registered nurses, technicians, respiratory therapists, Nurse Practitioners, and or Physician Assistants offers the most comprehensive bedside program. Acute Care Nurse Practitioner Matthew Ostroff will present the data from St Joseph's Registered Nurse Vascular Access program, and the impact of the advanced practice nurse in both scope of practice from the NICU to the ICU and its role in oversight providing a completely independent service.