The prospective payment programs implemented across the country this past year to cut hospital costs have resulted in quicker shifts of patients from hospitals to nursing homes and home care settings. These patients frequently need more intensive and more costly services than many discharged patients in the past.
This trend has created a situation having both positive and negative possibilities for nurses in long term care. The increased acuity and complexity of patients being discharged early from hospitals reinforces the need for more registered nurses in long term care, both in institutions and home care agencies. The need for nurses to carry out technical tasks, such as placing IVs and gastrostomy feedings, is more generally acknowledged by administrators, physicians and the lay public than any other nursing roles. There has been little recognition of the nurse's role in assisting the chronically ill individual to cope with and accomplish activities of daily living.
Nurses must seize this opportunity to increase their number and their visibility concerning their contributions to persons with long term care needs. Nurse administrators can use these new demands for service to enlarge their RN staffs and meet the new demands for service as well as the needs that have always existed in long term care. These latter needs too often went unfilled due to a lack of staff RNs.
The danger, of course, is that the focus of supplemented RN time will be completely absorbed by delegated medical tasks, or by modeling hospital routines. The major nursing role should be assisting patients to accomplish activities of daily living and establishing an environment that promotes control by the patient and opportunities for the patient's growth.
For too long, there have been so few nurses in most long term settings that most of their time is spent supervising other staff or administering medications. The RN staff has not been large enough to permit nurses to spend adequate time in assessing patient problems, identifying goals with patients, and testing ways to best reach those goals with clear nurse prescriptions. In this way all other staff involved in care are consistently carrying out the plan to reach the goals. With nurse power put to that effort of assessing patient problems, I believe it is possible to reduce, instead of manage. incontinence, promote decision making instead of compliance, increase patient expression of wants and needs instead of using attention-seeking behavior, decrease patient contractures, increase client activity. The list is endless and the potential tremendous.
Let's all use every opportunity to realize this goal and not let it slip away