Advanced practice nurses key to improving SNF care, researchers say

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Training an advanced practice nurse to lead a nursing home care team has shown promise for improving staff communication and the way facilities handle mobility, hydration and end-of-life care issues, a new study shows.

The research was conducted by a team at the University of Missouri as part of the Missouri Quality Initiative for Nursing Homes. The program is in its fifth year of researching healthcare improvements for older adults. Part of that program included placing APRNs at 16 skilled nursing facilities to gauge how their skills influenced care coordination.

For their update on the APRN's impact, the team collected data from the facilities on hospitalizations, “basic” care needs like hydration and mobility, care discussions, and communication. In total, 12 of the 16 facilities reported reductions in hospitalizations rates since hiring an APRN.

The APRNs themselves also documented their experiences, detailing successful initiatives they had implemented at the facilities including having fall huddles with staff, setting up hydration stations around the facility, and coordinating end-of-life care discussions with social workers.

In order to be successful in their placements, APRNs required leadership support, the researchers found. Without it, management became a barrier to improving care quality. And even then, change wasn't immediate, the study's authors said.

“It was challenging to embed APRNs into nursing homes and expect that they can immediately change practice,” the researchers wrote. “Not every APRN has the skill set to facilitate systems change, but when they have adequate support to develop those skills, they can begin to implement the changes needed to improve care to older adults by improving basic care and communication.”

Results appear in the July/September issue of the Journal of Nursing Care Quality.

“With specialized training and certification, APRNs can play a key role in managing resident care, which helps decrease the likelihood of hospitalizations and improves care,” explained lead author Lori Popejoy, Ph.D., in a statement on the findings.