MEDICAL

Providing high-quality care for more than 1.4 million older adults in the nation’s 16,000-plus nursing homes is the responsibility of RNs in both the nursing home and hospital setting. It’s estimated that the population of older Americans will double by 2030, growing from 31 million to 62 million among people ages 65 to 84 and from 4.3 million to 9.6 million for those ages 85 and older. Currently about 4% of people age 65 and over and 18% of people age 85 and over reside in nursing homes. By 2020, when it’s predicted that 46% of those who reach age 65 will spend some time in a nursing home, geriatric competence will become a professional necessity. Just as cultural competence cuts across all nursing practice, so does geriatric competence. As older adults will constitute the majority of patients cared for by all nurses, this issue of Nursing Counts addresses the readiness of the RN workforce to care for frail older adults.—Mathy Mezey, EdD, RN, FAAN

Nurse practitioners (NPs) are RNs who’ve received additional training, especially in diagnosis and treatment. Current educational standards for NPs require graduation from a master’s degree program. Functioning as primary care providers, NPs have expanded into areas vacated by physicians in their quest for higher paying specialties. An excellent example of one such area is nursing home care. Geriatrics, once thought of as a specialty area, has developed into a major area of focus for NPs because of the growing number of older adults in need of primary care service. While the total numbers working in nursing homes aren’t known, estimates show that fewer than 2% of NPs work in long-term care facilities; we also know that much of geriatric nurse practitioner (GNP) care is given by adult nurse practitioners (ANPs) and family nurse practitioners (FNPs).

Typically, NPs are employed by physicians or physician practices; NPs are less commonly employed by nursing homes or by HMOs to oversee the primary care needs of nursing homes residents. A few GNP programs have expanded their curricula to include the care of nursing home patients, providing training opportunities in primary care, institutional care, and hospice care of older residents. Since 1999 NPs have been able to apply for their own Medicare provider identification numbers and bill for services provided to nursing home residents, which has enabled them to establish independent practices and contract with physicians to provide collaborative care. This has led the way for other insurance companies to pay directly for nursing services.

In a literature search of Medline and CINAHL databases, looking at studies conducted in the United States between 1966 and 2004, I found 20 studies that examined the benefit of NPs providing care in nursing homes. The studies indicate that the NP role is different from that of physician—beyond acting as the physician’s substitute, NPs also participate in staff development and quality initiatives within their facilities. All of the studies demonstrated that NPs were cost-effective and that their clinical outcomes were equivalent to physicians’. The studies also showed that when compared with physicians, NPs spent more time in the facility with patients, had higher reported levels of family satisfaction, and had patients with fewer hospital admissions and ED visits.

RNs should seek to refer patients to practices and facilities that employ NPs. Since many NPs working in nursing homes are not prepared as GNPs, it’s essential to include geriatric training in ANP and FNP programs. Research on NPs in the nursing home environment would help to validate NPs. Debra Priest, MSN, FNP Editor’s note: For more information on this metaanalysis, please contact Debra Priest: debrap@gerimedcare.com.

Tags: nurse practitioners | Nursing Home

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<h2>NPs in Nursing Homes: An Issue of Quality</h2> <p style="text-align: justify;">Providing high-quality care for more than 1.4 million older adults in the nation’s 16,000-plus nursing homes is the responsibility of RNs in both the nursing home and hospital setting. It’s estimated that the population of older Americans will double by 2030, growing from 31 million to 62 million among people ages 65 to 84 and from 4.3 million to 9.6 million for those ages 85 and older. Currently about 4% of people age 65 and over and 18% of people age 85 and over reside in nursing homes. By 2020, when it’s predicted that 46% of those who reach age 65 will spend some time in a nursing home, geriatric competence will become a professional necessity. Just as cultural competence cuts across all nursing practice, so does geriatric competence. As older adults will constitute the majority of patients cared for by all nurses, this issue of Nursing Counts addresses the readiness of the RN workforce to care for frail older adults.—Mathy Mezey, EdD, RN, FAAN</p> <p style="text-align: justify;"><a title="Nurse" href="http://911medicalcare.com/healthcare/nurse/">Nurse</a> practitioners (NPs) are RNs who’ve received additional training, especially in diagnosis and treatment. Current educational standards for NPs require graduation from a master’s degree program. Functioning as primary care providers, NPs have expanded into areas vacated by <a title="physicians" href="http://911medicalcare.com/medicalcare/physicians/">physicians</a> in their quest for higher paying specialties. An excellent example of one such area is nursing home care. <a title="Geriatrics" href="http://911medicalcare.com/medicalcare/geriatrics/">Geriatrics</a>, once thought of as a specialty area, has developed into a major area of focus for NPs because of the growing number of older adults in need of primary care service. While the total numbers working in nursing homes aren’t known, estimates show that fewer than 2% of NPs work in long-term care facilities; we also know that much of geriatric nurse practitioner (GNP) care is given by adult nurse practitioners (ANPs) and family nurse practitioners (FNPs).</p> <p style="text-align: justify;">Typically, NPs are employed by physicians or physician practices; NPs are less commonly employed by nursing homes or by HMOs to oversee the primary care needs of nursing homes residents. A few GNP programs have expanded their curricula to include the care of nursing home patients, providing training opportunities in primary care, institutional care, and hospice care of older residents. Since 1999 NPs have been able to apply for their own Medicare provider identification numbers and bill for services provided to nursing home residents, which has enabled them to establish independent practices and contract with physicians to provide collaborative care. This has led the way for other insurance companies to pay directly for nursing services.</p> <p style="text-align: justify;">In a literature search of Medline and CINAHL databases, looking at studies conducted in the United States between 1966 and 2004, I found 20 studies that examined the benefit of NPs providing care in nursing homes. The studies indicate that the NP role is different from that of physician—beyond acting as the physician’s substitute, NPs also participate in staff development and quality initiatives within their facilities. All of the studies demonstrated that NPs were cost-effective and that their clinical outcomes were equivalent to physicians’. The studies also showed that when compared with physicians, NPs spent more time in the facility with patients, had higher reported levels of family satisfaction, and had patients with fewer hospital admissions and ED visits.</p> <p style="text-align: justify;">RNs should seek to refer patients to practices and facilities that employ NPs. Since many NPs working in nursing homes are not prepared as GNPs, it’s essential to include geriatric training in ANP and FNP programs. Research on NPs in the nursing home environment would help to validate NPs. Debra Priest, MSN, FNP Editor’s note: For more information on this metaanalysis, please contact Debra Priest: debrap@gerimedcare.com.</p><br/><a href="http://www.socialmarker.com/?link=http://911medicalcare.com/nurse/nps-in-nursing-homes-an-issue-of-quality/&title=NPs+in+Nursing+Homes%3A+An+Issue+of+Quality&text=...&tags=" target="_blank"><img src= "http://www.socialmarker.com/bookmark.gif" border="0" /></a><noscript><a href="http://www.socialmarker.com" >Social Bookmarking</a></noscript> <p>The article <a href="http://911medicalcare.com/nurse/nps-in-nursing-homes-an-issue-of-quality/">NPs in Nursing Homes: An Issue of Quality</a> is provided by <a href="http://911medicalcare.com" title="Manual Nurse and health Guidelines"> Manual Nurse and Health Guidelines</a>. The article from<a href="http://911medicalcare.com" title="Medical"> Medical</a> site is freely distributed for non-commercial purposes to include the source for the article and does not alter the content.</p>

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