Nurse Practitioners in Long-Term Care

Kevin Hook | posted February 13, 2009 |

Nurse practitioners (NPs) play a vital role in long-term care by providing high-quality primary care, similar to that of a physician, but always under their own license. They are master’s-prepared advanced practice nurses, and much of their work involves collaborating with physicians, rather than just working alongside them.

NPs are able to diagnose and treat a range of health problems; order, perform and interpret diagnostic tests; treat acute and chronic conditions; prescribe medications and perform other treatments. Besides clinical care, nurse practitioners spend time focusing on health promotion, disease prevention, health education and counseling.

Why is it so important when nurse practitioners choose to work in long-term care? Of the approximately 115,000 nurse practitioners currently practicing in the United States, only 4.1 percent have specialized as geriatric. Although the majority of nurse practitioners who work in long-term care are not directly employed by a nursing facility, it has been shown that when the geriatric nurse practitioners are directly employed by the long-term care facility, they are able to better affect patient care and outcomes (Rosenfeld, 2004).

Nurse practitioners avoid the role of “physician substitute,” but rather emphasize the shared practice model of nurse practitioners and physicians. The model is more one where nurse practitioners and physicians perceive each other as a complement to one another, not as a substitute (Roblin, 2004). The role of the geriatric nurse practitioner involves a shared practice with all members of the healthcare team (Lambing, 2004).

Geriatric nurse practitioners and their expertise

The role of a geriatric nurse practitioner depends on the setting, but it commonly includes educating and coaching patients, families, and nurses and performing physical and psychological assessments. NPs also consult with other caregivers to evaluate individualized patient care. They may also serve as leaders by directing interdisciplinary teams and conducting or participating in research activities. (Bourbonniere, 2002).

What distinguishes the geriatric nurse practitioner is the ability to recognize and place importance of the “synergism of multiple disciplines” to manage the treatment of geriatric patients. Because of the many health conditions that tend to exist in the elderly population, this synergy can serve the long-term care residents, the clinical functioning of those facilities, and the continued role development of geriatric nurse practitioners.   

Geriatric nurse practitioners are the most successful model when they are able to provide formal education sessions for certified nursing assistants, form collaborative problem-solving teams with certified nursing assistants, consult with registered nurses and licensed practical nurses, and join the quality assurance committee (Krichbaum, 2005). Geriatric nurse practitioners are able to improve the quality of care for residents by influencing the ways in which structures and processes of care interact.   

The practice sites and models vary, but what is clear is that geriatric nurse practitioners, when working in various roles—not as physician extenders, but as high functioning collaborators—create positive changes in the care of our elders.