- Email: [email protected]
The Role of the GNP in a Continuing Care Retirement Community
THE ROLE OF THE GNP IN A CONTINUING CARE RETIREMENT COMMUNITY Barbara Resnick, PhD, CRNP, FAAN, FAANP Editor, Geriatric Nursing1 I maintain a full-time position as professor and program director for the Geriatric Nurse Practitioner Program at the University of Maryland School of Nursing but have a clinical contract with a Continuing Care Retirement Community, Roland Park Place. I engage in clinical work there 3 days a week and have been involved with this facility now for 22 years. My clinical responsibilities involve direct primary care of residents in the outpatient Ambulatory Care Center for those living in independent living and assisted living areas and nursing home visits for those in the nursing home. I also am fortunate that I am able to provide continuing education and work with the staff to implement innovative care techniques. Likewise, I do continuing education with the residents, giving monthly health talks on topics such as restless legs, maintaining health records, immunizations and new findings, memory, exercise, and other topics. I generally have graduate students with me 1 to 2 days a week for their clinical experience and undergraduate and graduate students for independent study working on research projects with me in the clinical site. The clinical days are generally long— close to 12 hours— but I would not trade this for anything. It is an honor to take care of these individuals, many of whom I have known for 20 years and at the end of life to help them to die with the dignity they so deserve. Moreover, maintaining clinical skills is critical, I believe, to my ability to teach. Are there challenges? Of course! The fear of litigation weighs heavy on us all as do some of the frustrations within our current health care system. I also am challenged by working close to 20 hour days, 7 days a week to maintain my university and research activities. As my favorite coffee cup says, I will sleep when I am dead!
We Want to Hear Your Story Nurse practitioners caring for older adults do so in a multitude of settings and in multiple ways. Our diversity related to models of practice is remarkable. In describing some of these models, perhaps we can help those of you who are trying to find the perfect fit for your special talents. This month GN’s editor and past NCGNP president Dr. Barbara Resnick, describes her role as practitioner, teacher, and academician. Now it is your turn. It is very easy to do. 1) Open your e-mail program. 2) Click “new.” 3) In the
234
“To” space type in [email protected]. 4) Answer the questions found below. 5) Add a few words or additional thoughts if you would like to do so. 6) Click “Send.” 7) Receive in return an edited version of your work for your review. 8) See your story in print. 9) Inspire others. Mini portraits of advance practice nurses working with older adults: 1. What is your background and preparation for your role (master’s certificate, etc.)? 2. What is your area of certification (GNP, FNP, ANP etc.)? 3. Where do you spend most of your working day? 4. What is/are your role/roles related to the care of older adults? 5. What best prepared you for your role? 6. What is your biggest challenge in gerontological nursing? 7. What is the greatest satisfaction of your role, the reason you keep coming back? For more information or a pep talk, contact the section editor Kathleen Jett at the e-mail listed earlier.
Research For Gerontological Nurse Practitioners The Utilization of Nurse Practitioners: A Comparison With Physicians* Nurse practitioners (NPs) have substituted or complemented physician care (MD) in the nursing home setting. Most studies have shown that NPs provide a high quality of care with similar outcomes to physician at a lower cost. However, many of these and other studies cite a variety of barriers to NP practice. Unfortunately, almost all of these studies have been conducted in the managed care or academic settings. The purpose of this study was to examine the used of NPs compared with MDs in a fee-for-service setting. This study was a secondary analysis of the 2004 Medicare claims file with between-groups independent variables comparing the 2 groups (NPs and MDs) on number and type of nursing home visits and overall costs of care. The study examined the differences between NPs and MDs in the types of nursing home visits, patient populations, and state variability. NPs were the third largest provider (16%) of nursing home evaluations and management services following internal medicine (37.7%) and family practice (22.7%) MDs. NPs provided a higher percentage of comprehensive subsequent visits than the primary care physician. The regression found that whether a patient was in a nursing facility versus a skilled care facility was the best predictor for use of an NP. There
Geriatric Nursing, Volume 28, Number 4
was great variability between states in the number of NPs per capita and per Medicare population, with some less populated states having a greater proportion of NPs than larger states. NPs were paid an average of $38.79 per visit compared with MDs at $45.73. NPs provide substantial services to the nursing home population; however, there are still significant barriers to practice. Given the projected increase in this population and the current shortage of primary care physicians, policy changes need to be implemented to facilitate better utilization of NPs. This study provided a solid base for the understanding of the current utilizations and practice processes of NPs and MDs in the nursing home setting. DEBRA BAKERJIAN, PhD, MSN, FNP, is currently a postdoctoral fellow at the University of California at San Francisco. She is also the Treasurer of NCGNP. The award winning paper associated with this research abstract was presented at the September 2006 at the annual meeting of NCGNP.
Research in the News: Elder Abuse A study conducted by Bonnie Fisher and Saundra Regan examined the types of abuse, repeated abuse, and the experiences of multiple abuse among women over 60. Participants included 842 women living in the community who responded to a telephone survey. Almost half of the women had experienced some type
of abuse since the age of 55, and many of these reported repeated abuse. The abused women were more likely than the nonabused women to complain of health problems, including bone and joint problems, digestive problems, depression or anxiety, chronic pain, high blood pressure, or heart problems. Source: Fisher BS, Regan SL. The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. Gerontologist 2006;46:200-9. In a survey of members of a heath care delivery system on the West Coast of the United States, more than a quarter of the 370 women surveyed who were 65 or older, reported physical or psychological abuse by an intimate partner at some time during their adult lives; 5.5% reported that the abuse had occurred in the last 1–5 years. About 18% of the women who reported abuse reported sexual or physical mistreatment, and 22% reported psychological abuse of some kind. Only 3% of the women reported that they had been asked by a health care provider about the possibility of abuse since they had become adults. Source: Bonomi AE, Anderson ML, Reid RJ. Intimate partner violence. Gerontologist 2007;47:34. 0197-4572/07/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2007.06.006
Geriatric Nursing, Volume 28, Number 4
235
We Want to Hear Your Story Nurse practitioners caring for older adults do so in a multitude of settings and in multiple ways. Our diversity related to models of practice is remarkable. In describing some of these models, perhaps we can help those of you who are trying to find the perfect fit for your special talents. This month GN’s editor and past NCGNP president Dr. Barbara Resnick, describes her role as practitioner, teacher, and academician. Now it is your turn. It is very easy to do. 1) Open your e-mail program. 2) Click “new.” 3) In the
234
“To” space type in [email protected]. 4) Answer the questions found below. 5) Add a few words or additional thoughts if you would like to do so. 6) Click “Send.” 7) Receive in return an edited version of your work for your review. 8) See your story in print. 9) Inspire others. Mini portraits of advance practice nurses working with older adults: 1. What is your background and preparation for your role (master’s certificate, etc.)? 2. What is your area of certification (GNP, FNP, ANP etc.)? 3. Where do you spend most of your working day? 4. What is/are your role/roles related to the care of older adults? 5. What best prepared you for your role? 6. What is your biggest challenge in gerontological nursing? 7. What is the greatest satisfaction of your role, the reason you keep coming back? For more information or a pep talk, contact the section editor Kathleen Jett at the e-mail listed earlier.
Research For Gerontological Nurse Practitioners The Utilization of Nurse Practitioners: A Comparison With Physicians* Nurse practitioners (NPs) have substituted or complemented physician care (MD) in the nursing home setting. Most studies have shown that NPs provide a high quality of care with similar outcomes to physician at a lower cost. However, many of these and other studies cite a variety of barriers to NP practice. Unfortunately, almost all of these studies have been conducted in the managed care or academic settings. The purpose of this study was to examine the used of NPs compared with MDs in a fee-for-service setting. This study was a secondary analysis of the 2004 Medicare claims file with between-groups independent variables comparing the 2 groups (NPs and MDs) on number and type of nursing home visits and overall costs of care. The study examined the differences between NPs and MDs in the types of nursing home visits, patient populations, and state variability. NPs were the third largest provider (16%) of nursing home evaluations and management services following internal medicine (37.7%) and family practice (22.7%) MDs. NPs provided a higher percentage of comprehensive subsequent visits than the primary care physician. The regression found that whether a patient was in a nursing facility versus a skilled care facility was the best predictor for use of an NP. There
Geriatric Nursing, Volume 28, Number 4
was great variability between states in the number of NPs per capita and per Medicare population, with some less populated states having a greater proportion of NPs than larger states. NPs were paid an average of $38.79 per visit compared with MDs at $45.73. NPs provide substantial services to the nursing home population; however, there are still significant barriers to practice. Given the projected increase in this population and the current shortage of primary care physicians, policy changes need to be implemented to facilitate better utilization of NPs. This study provided a solid base for the understanding of the current utilizations and practice processes of NPs and MDs in the nursing home setting. DEBRA BAKERJIAN, PhD, MSN, FNP, is currently a postdoctoral fellow at the University of California at San Francisco. She is also the Treasurer of NCGNP. The award winning paper associated with this research abstract was presented at the September 2006 at the annual meeting of NCGNP.
Research in the News: Elder Abuse A study conducted by Bonnie Fisher and Saundra Regan examined the types of abuse, repeated abuse, and the experiences of multiple abuse among women over 60. Participants included 842 women living in the community who responded to a telephone survey. Almost half of the women had experienced some type
of abuse since the age of 55, and many of these reported repeated abuse. The abused women were more likely than the nonabused women to complain of health problems, including bone and joint problems, digestive problems, depression or anxiety, chronic pain, high blood pressure, or heart problems. Source: Fisher BS, Regan SL. The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. Gerontologist 2006;46:200-9. In a survey of members of a heath care delivery system on the West Coast of the United States, more than a quarter of the 370 women surveyed who were 65 or older, reported physical or psychological abuse by an intimate partner at some time during their adult lives; 5.5% reported that the abuse had occurred in the last 1–5 years. About 18% of the women who reported abuse reported sexual or physical mistreatment, and 22% reported psychological abuse of some kind. Only 3% of the women reported that they had been asked by a health care provider about the possibility of abuse since they had become adults. Source: Bonomi AE, Anderson ML, Reid RJ. Intimate partner violence. Gerontologist 2007;47:34. 0197-4572/07/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2007.06.006
Geriatric Nursing, Volume 28, Number 4
235