NPs take on broad range of tasks in LTC: report
Wednesday, December 13, 2006 -- Natalie Miller
From conducting psychogeriatric assessments to managing chronic illnesses, nurse practitioners fulfill a variety of clinical roles in long-term care homes across the province, a study of a pilot project concludes.

In addition, nurse practitioners in the long-term care environment are leading educational activities including bedside teaching and in-service programs on various topics relevant to resident care.

The placement of nurse practitioners (NPs) in community health centres in doctor-strapped areas of the province has received attention in recent years as a means of helping address Ontario’s shortage of family physicians. Receiving less attention are the 17 nurse practitioners working in long-term care. In March 1999, the provincial government announced a pilot project to introduce primary health care nurse practitioners into long-term care facilities and a year later funded 20 full-time NP positions in 10 long-term care pilot projects.

æstima research, a Health Services Research, Planning and Evaluation group in London, conducted an evaluation of The Ontario Nurse Practitioner in Long-Term Care Facilities Pilot Project.

Here’s what one nurse practitioner working in long-term care contributed:

“I had a fellow, this is not too long after I started, (who) was in a rural facility. He fell and had a major laceration. He was blind and deaf; his cognition was impaired. And so they called the hospital, the local hospital, and they said there’s no doctor bring him in, in a couple of hours. Well by that time it would be 8:00 am and I could be there. So they called me. I went to the hospital. I got the equipment that I needed to do the suture. The hospital was more than happy to give it to me because the last time he had had to go into hospital it took five staff, so the ambulance arrived from this rural facility and it would probably be 15 or 18 miles to the hospital. Five people it took to hold him down and then another ambulance ride back. Plus he was upset for days and it created all kinds of problems for the long-term care facility. So you can picture this. So what happened instead was, I went to the hospital, got the stuff, drove out to the facility, and the nursing staff was on, and we put him in his own bed and said as best we could communicate with him that we were going to fix his head, and he very quietly lay down while I put in all the sutures we needed to. So, there was no ambulance ride, no emergency visit, no five staff holding him down, no long-term consequences, five minutes later he was up walking around like he normally did and basically no unusual behaviors, no major concerns for anybody.”

Jane Sanders, executive director of the Nurse Practitioners’ Association of Ontario (NPAO), reports NPs are doing good work in areas including managing medications, reducing the number of transfers to hospitals and even discharging residents of long-term care back into their own homes.

A NP is an advanced practice nurse, functioning within the full scope of nursing practice and as such is neither a second level physician nor a doctor's assistant. Nurse practitioner skills include the ability to: provide wellness care including health screening activities such as Pap smears and monitoring infant growth and development, diagnose and treat minor illnesses such as ear and bladder infections, diagnose and treat minor injuries such as sprains and lacerations, screen for the presence of chronic disease, such as diabetes and monitor people with stable chronic disease, such as hypertension.

Here’s what the study found:

• Nurse practitioners have assumed a wide scope of practice activities.

• Responsibilities vary across facilities and projects depending upon resident needs, physician preferences, service agreements, and the presence of established programs (e.g., immunization clinics), and on-site specialists (e.g., wound care specialists).

• Their clinical activities are varied and include the assessment and management of episodic and chronic illness, psychogeriatric assessments, palliative care, pain and symptom management, counseling with families and residents, and prevention initiatives (dehydration, falls, immunizations).

• They consult with community resources or partner agencies to meet resident’s treatment needs and facilitate access to High Intensity Needs funding.

• Nurse practitioners are involved in various educational activities including bedside teaching and in-service programs on various topics relevant to resident care, teaching nursing courses at local community colleges, continuing education programs, preceptoring student Nurse Practitioners, involvement in curriculum development, serving as resources for multi-disciplinary teaching, and the development of specific treatment initiatives (e.g., wound care teams) for which they provide ongoing continuing education and clinical support.

• Professional development activities include conferences, workshops and courses to increase their level of expertise (e.g., pyschogeriatrics, wound care, palliative care, and continence management), and involvement in professional associations ranging from general membership to active participation in administration and executive committees.

• Committee work such as organizational and strategic planning committees, wound care committees, and health professional advisory groups.

• Development, implementation and evaluation of care protocols, best practice guidelines, and new care procedures.

• Additional activities include presentations to various community groups about the role of Nurse Practitioners in long-term care (e.g., to Nursing and Medical Advisory Committees, local hospital committees, Rotary Clubs), media interviews about the Nurse Practitioner role, research studies and clinical trials, and staff recruitment.