Long-Term Care Survey Alert

These physician extenders can be the ticket to a show-case survey record.

Nursing facilities are realizing that nurse practitioners bring to the table a number of skills and services that translate into improved outcomes in every arena.

For example, one company in Southern California with 23 nursing homes thinks it's worth the money to hire two nurse practitioners per building, reports Clare Hendrick, a nurse practitioner and consultant in San Clemente, CA. The company "believes quality outcomes offer the best marketing strategy."

For one, nurse practitioners can provide assessment and clinical response in a more timely manner, says Hendrick. NPs are "in the facility so they can see the unstable patient and start treatment quickly without necessarily having to interrupt the physician" immediately, which the nursing staff have to do, she says.

The NP can also help triage residents and know when the staff can handle a clinical issue or needs to talk to the doctor. "The nurses may call the physician and say the resident has a fever," says Hendrick. "But the NP can say it's a fever and I hear rales, and the patient has had this before and we tried these medications, which didn't work."

The bottom line: "When you give the physician more complete assessment information about a resident's problem, you're going to get a better answer," says Hendrick.
NPs can also help interpret lab results. "It's much easier to manage INRs and Coumadin dosing when you're in the building regularly and know firsthand how the patient is doing--for example, if he has any subtle signs of bleeding, Hendrick notes.

4 More Ways NPs Can Make a Difference

NPs can also improve care and regulatory compliance by:

• Facilitating relationships with residents' family members. As we move into culture change and really make care resident-oriented, we need practitioners who understand family dynamics, which can include nurse practitioners, says Francis Battisti, a social worker and nursing home consultant in Binghamton, NY.

Also: The NP can help families understand their loved one is changing, which impacts family satisfaction and liability claims, says Hendrick.

• Supporting the medical director's role. The NP can work with the medical director to identify variances and inconsistencies among attending physicians that "merit medical director intervention and coordination," says Howard Sollins, JD, partner, Ober/Kaler in Baltimore.

• Bridging the gap between nurses and attending physicians. Hendrick notes that "the NP can speak the language of the physician and the nurse" and "help connect the dots" between doctors, RNs and LVNs. "The NPs do round every day and can help the licensed nurses improve their assessment skills and meet the requirements of increasing acuity levels."

• Homing in on CNAs' knowledge about a resident. Hendrick notes that CNAs sometimes say the nurses are "too busy to listen to them or forget to get back to them because they are multi-tasking. But the NP can tap into the CNAs' familiarity with subtle changes in a resident's condition."