1. Mezey, Mathy EdD, RN, FAAN
  2. Harrington, Charlene PhD, RN, FAAN
  3. Kluger, Malvina

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Nurse practitioners (NPs) are RNs who've received additional training, especially in diagnosis and treatment. Current educational standards for NPs require graduation from a master's degree program. Functioning as primary care providers, NPs have expanded into areas vacated by physicians in their quest for higher paying specialties. An excellent example of one such area is nursing home care. Geriatrics, once thought of as a specialty area, has developed into a major area of focus for NPs because of the growing number of older adults in need of primary care service. While the total numbers working in nursing homes aren't known, estimates show that fewer than 2% of NPs work in long-term care facilities; we also know that much of geriatric nurse practitioner (GNP) care is given by adult nurse practitioners (ANPs) and family nurse practitioners (FNPs).


Typically, NPs are employed by physicians or physician practices; NPs are less commonly employed by nursing homes or by HMOs to oversee the primary care needs of nursing homes residents. A few GNP programs have expanded their curricula to include the care of nursing home patients, providing training opportunities in primary care, institutional care, and hospice care of older residents. Since 1999 NPs have been able to apply for their own Medicare provider identification numbers and bill for services provided to nursing home residents, which has enabled them to establish independent practices and contract with physicians to provide collaborative care. This has led the way for other insurance companies to pay directly for nursing services.


In a literature search of Medline and CINAHL databases, looking at studies conducted in the United States between 1966 and 2004, I found 20 studies that examined the benefit of NPs providing care in nursing homes. The studies indicate that the NP role is different from that of physician-beyond acting as the physician's substitute, NPs also participate in staff development and quality initiatives within their facilities. All of the studies demonstrated that NPs were cost-effective and that their clinical outcomes were equivalent to physicians'. The studies also showed that when compared with physicians, NPs spent more time in the facility with patients, had higher reported levels of family satisfaction, and had patients with fewer hospital admissions and ED visits.


RNs should seek to refer patients to practices and facilities that employ NPs. Since many NPs working in nursing homes are not prepared as GNPs, it's essential to include geriatric training in ANP and FNP programs. Research on NPs in the nursing home environment would help to validate NPs.-Debra Priest, MSN, FNP


Sources: Kane RL, et al. Gerontologist 2004;44(1):95-103; Rosenfeld P, et al. J Am Med Dir Assoc 2004;5(1):9-15; Spratley E, et al. 2000.