The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline S.

doi:10.1093/geront/45.4.486

Cited by 44 publications

(45 citation statements)

References 31 publications

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“…Higher payment rates would facilitate the provision of more medically oriented care as acuity increased but would also provide an incentive to nursing homes to continue to serve their patients in the nursing home. This too is consistent with the finding that nursing facilities in states with higher nursing home Medicaid payment rates are significantly more likely to hire advanced practice nurses and to have higher levels of skilled nurses on staff (Intrator et al 2005).…”

Section: Discussionsupporting

confidence: 87%

Where People Die: A Multilevel Approach to Understanding Influences on Site of Death in America

et al. 2007

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Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home beds and state Medicaid payment rate, was associated with higher probability of nursing home death. These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience.

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Section: Discussionsupporting

confidence: 87%

Where People Die: A Multilevel Approach to Understanding Influences on Site of Death in America

et al. 2007

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“…18,19 Studies have demonstrated the effectiveness of NPs in providing cost-effective, quality care in nursing homes. 16 Given their education and training in patient assessment, coordination of care, and communication skills, NPs are well suited to direct and deliver care to patients who are living with, and dying of, progressive disease.…”

Section: Introductionmentioning

confidence: 99%

An Educational Intervention for Nurse Practitioners Providing Palliative Care in Nursing Homes

Letizia¹,

Jones²

2012

Journal of Hospice & Palliative Nursing

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The nursing home is a major setting for death and dying in the United States, yet palliative care approaches are underused in these facilities. Nurse practitioners are increasingly responsible for the management of these patients and their families. Although they are well suited to provide palliative care, most nurse practitioners have not received formal education about this specialty practice.The purpose of this project was to develop, implement, and evaluate an online educational program designed to improve the knowledge of nurse practitioners who are directing and delivering care in nursing home facilities across the United States. Aims included (1) develop and deliver three learning modules; (2) measure improvement in knowledge by comparing pretest and posttest examination scores; and (3) describe relationships between nurse practitioner characteristics and examination scores. This educational project was based on the well-established End-of-Life Nursing Education Consortium curriculum.One hundred seven nurse practitioners registered for the program; 99 completed the program. Program evaluations were extraordinarily positive. Strong reliability of the test was demonstrated. A statistically significant difference in the mean pretest and posttest scores indicated significant learning gains among the participants. Reported level of confidence in providing palliative care increased from the beginning to the end of the program. Nearly 93% of participants reported changing their practice as a result of this program. These findings support both the need and the strength of the program.

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“…From 1993 to 2003, the rate of APN use doubled, with more than 20% of the nation's 16,000 nursing homes using APNs or physician assistants (PAs) in some capacity (Intrator et al, 2005). Two national surveys estimated that between 1,159 (Rosenfeld, Kobayashi, Barber, & Mezey, 2004) and 1,360 (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2001) APNs practiced in nursing homes.…”

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confidence: 99%

Expanding the Knowledge Base of Resident and Facility Outcomes of Care Delivered by Advanced Practice Nurses in Long-Term Care

Bourbonniere

Mezey

Mitty

et al. 2009

Policy, Politics, & Nursing Practice

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In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes. Recommendations are made for critically needed research in four key areas: (a) APN nursing home practice, (b) relative value unit coding, (c) outcomes related to geropsychiatric and mental health nursing services, and (d) outcomes related to geriatric specialization. The APN role could be significantly enhanced and executed if its specific contribution to resident and facility outcomes was more clearly delineated through the recommended rigorous research.

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The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

Abstract: More generous state Medicaid nursing home reimbursement and higher competition may advance the investment in medical infrastructure, which in turn may positively affect the quality of care provided to nursing home residents.

Cited by 44 publications

References 31 publications

Where People Die: A Multilevel Approach to Understanding Influences on Site of Death in America

Where People Die: A Multilevel Approach to Understanding Influences on Site of Death in America

An Educational Intervention for Nurse Practitioners Providing Palliative Care in Nursing Homes

Expanding the Knowledge Base of Resident and Facility Outcomes of Care Delivered by Advanced Practice Nurses in Long-Term Care

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