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Introducing advanced nurse role has reduced hospital admissions from nursing homes

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The introduction of an advanced nurse practitioner role in nursing homes can reduce hospital admissions caused by falls and dehydration, according to US researchers.

Those in the role can improve care by serving as leaders and co-ordinators of healthcare teams in nursing homes, said the nurse researchers from the University of Missouri.

“Advanced practice nurses can play a key role in managing resident care”

Lori Popejoy

The university’s nursing research team is five years into the Missouri Quality Initiative for Nursing Homes (MOQI), a programme aimed at improving health care for older adults.

A core component of the programme is having “advanced practice nurses” working in 16 selected nursing homes across the city of St Louis to help co-ordinate care.

It sees advanced practice registered nurse “embedded” full-time within each nursing home to “influence resident care outcomes” by working with existing nursing home staff and leadership.

Their goal is to “identify, assess and manage ill residents, and influence changes in the nursing homes’ systems to improve resident outcomes”, said the study authors.

“Advanced practice nurses serve as ‘expert clinicians’, helping guide staff members to think about problems differently”

Marilyn Rantz

They are also supported and advised by the wider MOQI programme via a nurse with expertise in quality improvement and a social worker, said the researchers in the Journal of Nursing Care Quality.

As part of the study, the nurses are asked to routinely document actions taken to improve the care system in nursing homes – specifically problems related to mobility, hydration, medicines management and the use of end-of-life plans.

Examples of successful actions that the nurses have initiated included implementing “fall huddles” with nursing home staff to identify falls risk and identify solutions, and also co-ordinating care procedures and discussions about end-of-life goals with social workers.

In addition, they have set up “hydration stations” around the nursing home that family, friends and staff can use to help residents stay hydrated, and improved the monitoring of blood pressure and adjusted medication accordingly.

But the researchers also cautioned that for advanced practice nurses to be successful, leadership support was essential as nursing home managers often served as a barrier to improving patient care.

University of Missouri

Advanced nurse role improves health of nursing home residents

Lori Popejoy

Lead study author Lori Popejoy, associate professor of nursing at the university’s Sinclair School of Nursing, said: “With specialised training and certification, advanced practice nurses can play a key role in managing resident care, which helps decrease the likelihood of hospitalisations and improves care.

“They are being successful as they guide less experienced staff to care for residents and leading healthcare teams to manage ill residents effectively,” she said.

Marilyn Rantz, curators professor of nursing and lead researcher for the MOQI programme, added: “Advanced practice nurses serve as ‘expert clinicians’, helping guide staff members to think about problems differently and influence positive change.”

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