Efforts at reducing rehospitalization of nursing home residents can empower nurses, but such initiatives can also put them in challenging positions, according to study results published in the May issue of Research in Gerontological Nursing.

Researchers interviewed 76 registered nurses and licensed practical nurses at 38 Minnesota nursing homes, where a pay-for-performance program encouraged facilities to address unnecessary hospitalizations. To meet this goal, nurses increased their clinical capacity but felt added pressure as“boundary-spanners.”

“In cases of hospital transfer, nurses act as the ‘middle man’ between resident needs, resident and family preferences, nursing home capacity, and the clinical decisions of the physician,” wrote lead author Kathleen Abrahamson, Ph.D., RN, of the Purdue School of Nursing, and colleagues. 

Participating nurses reported improved communication and the ability to negotiate on a patient’s behalf with doctors and family members, in part because they had increased confidence in clinical skills such as IV insertion. 

But they also felt they were “being asked to do more without additional resources” or that they didn’t have the trust of other healthcare providers, the authors wrote. 

They found that some barriers still need to fall if nurses are to effectively negotiate the space between doctors, patients and families.