Elderly patients with heart failure present a tremendous challenge to the current health care system. Decreased length of hospital stay for patients with increased numbers of comorbid conditions and complex medication regimens contribute to a revolving door of rehospitalizations. Using a transitional care model designed to decrease rehospitalizations, advanced practice nurses (APNs) in an ongoing clinical trial provide discharge planning in the acute care setting with home follow-up by the same APN for a 3-month period. This article reviews three case studies to provide a view of the complex and challenging situations in which elders with heart failure live and the care provided by APNs using the transitional care model to guide their practice. Social, economic, and emotional factors overlay the illness in each of these cases. The APNs, with advanced knowledge of cardiac disease and research-based management, help the patients and their caregivers to prioritize information and take the appropriate actions, while coping with the complexity of their conditions and the challenges they face. Keeping these patients from returning to the hospital provides evidence of the success of this transitional model of care.

Background Standards for advanced practice registered nurse (APRN) licensure in the United States require certification programs to analyze practice in order to document the knowledge and skills necessary for entry-level adult-gerontology acute care nurse practitioners (AGACNPs) and wellness-through-acute-care clinical nurse specialists (AGCNSs). The practice analysis done every 5 years by the AACN Certification Corporation provides research data for use in establishing test plans for certification of APRNs. Objectives To describe the development of a survey to collect information on the current practice of AGACNPs and AGCNSs, and to compare the results from practitioners in the 2 roles. Methods In 2016, a task force of subject matter experts created a survey of the practice activities and competencies of AGACNPs and AGCNSs. Respondents rated activities and competencies according to their applicability and significance to APRN practice. The subject matter experts analyzed the ratings to determine which patient care problems, skills and procedures, and competencies would be included in the updated certification test plans. Results After analyzing the survey responses, subject matter experts retained 135 patient care problems, 45 skills and procedures, and all national competencies for AGACNPs and 123 patient care problems, 56 skills and procedures, and all national competencies for AGCNSs. Both roles involve several of the same patient care problems, skills and procedures, and competencies. Conclusions Data from practice analysis surveys formed the basis for developing reliable and valid certification examinations for entry-level APRNs. The information from such studies of practice should inform practicing nurses and students, as well as educators, accreditors, legislators, and regulators, about the work of AGACNPs and AGCNSs.