Research in Gerontological Nursing

Empirical Research 

Provision of Resident-Centered Care by Nurse Practitioners in Saskatchewan Long-Term Care Facilities: Qualitative Findings From a Mixed Methods Study

Theresa Diane Campbell, PhD, MN, RN; Melanie Bayly, PhD, MA; Shelley Peacock, PhD, MN, RN

Abstract

With their education and skill set, nurse practitioners (NPs) are ideally situated to provide primary care to long-term care (LTC) residents, and this is a timely development as physician presence in LTC has been decreasing. A sequential follow-up explanatory mixed methods design was used for the current study, which focused on the interviews that followed the initial survey. The sample included seven NPs who work with LTC residents in urban and rural settings in a western Canadian province. The interviews provided an opportunity for in-depth discussion regarding survey results. Interpretive description guided the data analysis. NPs provide timely access to primary care, address medication reconciliation, decrease transfers to hospitals, and take part in collaborative practice. NPs promote the health care goals of LTC residents. Departments of health would benefit from the inclusion of a wider range of health providers, including NPs, to provide timely access to quality care in LTC facilities. [Research in Gerontological Nursing, xx(x), xx–xx.]

Abstract

With their education and skill set, nurse practitioners (NPs) are ideally situated to provide primary care to long-term care (LTC) residents, and this is a timely development as physician presence in LTC has been decreasing. A sequential follow-up explanatory mixed methods design was used for the current study, which focused on the interviews that followed the initial survey. The sample included seven NPs who work with LTC residents in urban and rural settings in a western Canadian province. The interviews provided an opportunity for in-depth discussion regarding survey results. Interpretive description guided the data analysis. NPs provide timely access to primary care, address medication reconciliation, decrease transfers to hospitals, and take part in collaborative practice. NPs promote the health care goals of LTC residents. Departments of health would benefit from the inclusion of a wider range of health providers, including NPs, to provide timely access to quality care in LTC facilities. [Research in Gerontological Nursing, xx(x), xx–xx.]

The global population is aging. According to the United Nations Department of Economic and Social Affairs (UN DESA; 2017), the number of people age ≥60 is expected to double by 2050. Worldwide, there are 962 million people age >60, and by 2050 this number will increase to 2.1 billion. This increase in older adults will have a marked effect on policy as governments work to address the fiscal and political pressures that the aging population will place on national health care resources (UN DESA, 2017). To provide high-quality care for patients and residents in health care and long-term care (LTC) facilities, it is imperative that they have access to the right care, in the right place, at the right time, delivered by the right provider (Saskatchewan Health Authority, 2018). Physicians provide the majority of primary care services for older adults in LTC facilities, but nurse practitioners (NPs) can also provide quality primary health care to this population. The current article, using the qualitative data from a mixed methods study, describes how NPs provide timely resident-centered care in LTC settings in a western Canadian province.

Canadian Context

In 2015, Statistics Canada found the number of people age ≥65 was 16.1% (N = 5,780,900) of the population, and by July 2024 older adults will account for 20% of the population. This growth of the aging population is expected to place a strain on health care resources, as 44% of the health care budget is currently spent on care for Canadians age >65 and this percentage will increase accordingly (Canadian Institute for Health Information [CIHI], 2016). The LTC older adult population often has multiple chronic conditions and complex care needs, which will require significant ongoing care and will be a moderate driver for increasing health care resources (CIHI, 2015). Schoen et al. (2011) reviewed the health care needs of older adults with complex care needs in 11 high-income countries and found that the common issues for this age group were lack of follow up after discharge from the hospital, inadequate case management, lack of regular medication reviews, and poor communication (i.e., between provider/patient and different health care providers).

The 2015 national census found that approximately 10% of Canadian older adults lived in health care–related facilities or residences (Statistics Canada, 2015). LTC facilities will continue to face challenges in providing health care services for older adults with complex care needs as well as providing effective management of patient transfers to and from the hospital, timely access to acute health services, and communication and coordination of care/ treatment plans. At the same time, the proportion of Canadian physicians working in LTC facilities continues to decline. The College of Family Physicians of Canada, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada (2014) found that 22% of family physicians worked in LTC facilities in 2007, which decreased to 14% in 2014. The declining number of physicians in LTC facilities, and long wait times to see physicians in general (Health Council of Canada, 2013), have implications for resident access to timely primary health care services. The challenges that Canada's aging population pose to the health care system will require adapting how care is offered and coordinated, including the care provided in LTC settings. One strategy to provide quality resident care in LTC settings is increasing the role of NPs as primary care providers.

Nurse Practitioners and Their Role in Long-Term Care

There are two advanced nursing practice roles in Canada: clinical nurse specialist (CNS) and nurse practitioner (NP) (Canadian Nurses Association [CNA], 2019). As advanced practice nurses, CNSs and NPs (a) analyze and synthesize knowledge; (b) critique, interpret, and apply theory; (c) participate in and lead research; (d) use their advanced clinical competencies; and (e) develop nursing knowledge and the profession as a whole. “In addition, NPs have regulatory authority to autonomously diagnose, prescribe, and order and interpret tests for their clients” (CNA, 2019, p. 13). NPs who work in LTC also enhance resident/provider communication by creating connections between specialized health care providers/services and providing education to other LTC staff (American Medical Directors Association Ad Hoc Work Group on the Role of the Attending Physician and Advanced Practice Nurse, 2011; Sangster-Gormley et al., 2013). This enhanced communication and connection is important for a population with complex care needs who may see multiple providers for specialized services. In Canada, each of the advanced nursing practice roles currently require a master's degree, although there are some RNs with nursing diplomas and bachelor's degrees in nursing who have attained NP certification.

NPs have been successfully incorporated into Canadian LTC settings over the past 20 years (Donald et al., 2013), and a growing body of literature from the United States, where NPs have provided health care services since the 1970s (Ploeg et al., 2013), demonstrates their effectiveness in LTC contexts. Research suggests that having NPs as part of the health care team in LTC settings increases patients' access to timely care and specialized services, while decreasing hospitalization rates, length of stay, and emergency department (ED) transfers (Donald et al., 2013). Directors of care and other staff in LTC homes have reported a positive impact of NPs on the knowledge level, confidence, and abilities of staff members (Sangster-Gormley et al., 2013). Residents and family members are particularly appreciative of the information communicated by NPs to meet their health care goals (Donald et al., 2013; Laurant et al., 2005; Ploeg et al., 2013; Stanik-Hutt et al., 2013).

Although the literature illustrates numerous positive outcomes by including NPs in LTC settings in the United States, research in a Canadian context remains somewhat limited. Although national statistics on the number of NPs working in LTC in Canada are unavailable, in 2014 the Ministry of Health and Long-Term Care in the province of Ontario designed an initiative to fund 75 new NPs with the aim to reduce unnecessary ED transfers, incidence of falls, need for restraints, and improve resident and caregiver experiences in LTC (Government of Ontario, 2019). In Quebec, the government is poised to add 2,000 NPs to their health care workforce over the next 10 years to improve access to primary care in various settings including LTC (Kilpatrick et al., 2019). Despite the evidence that NPs provide timely primary care to older adults in LTC and reduce ED visits and hospital admissions, they are not normally included in LTC health care teams in Saskatchewan.

The Long-Term Care Context in the Province of Saskatchewan, Canada

The Ministry of Health reported there were 8,700 LTC residents and 250 people in respite care at any given time in the 156 LTC facilities and 17 LTC hospitals/health center units in Saskatchewan (Government of Saskatchewan, 2013). Chief executive officers of regional health authorities were assigned the task of surveying LTC facilities to determine which health care services were working well and to identify areas for improvement. Identified weaknesses included: (a) quality and variety of the food as well as the timing of meals; (b) aging infrastructure; (c) care issues including challenges with the increasing complexity of care; (d) behavior management; (e) delays in the provision of care; (f) safety issues including issues with residents' needs, staff training, and staffing levels; and (g) resident mixing issues. NPs have the skills and expertise to address the latter five of these issues.

As NPs become further incorporated into LTC in Saskatchewan and across Canada, it is important to continue to assess their role(s) and their contribution to resident care and outcomes. In addition to indices of improved resident outcomes, understanding NPs' perceptions of their role is important to understand their involvement in LTC settings. The purpose of the current study is to explain how NPs provide care in a sample of LTC settings in Saskatchewan.

Method

A sequential follow-up explanatory mixed methods design using a qualitative lens guided this portion of the study. The overall purpose of this design allowed the authors to have the qualitative data further explain or build on the initial quantitative results (Creswell, 2015). In Phase 1, NPs working in LTC in Saskatchewan were surveyed with a questionnaire regarding demographics and workplace issues. In Phase 2, semi-structured interviews were conducted with those who completed the questionnaire and consented to an interview. The interviews provided an opportunity for more in-depth discussion regarding the data obtained from the questionnaires. Interpretive description (Thorne, 2008) was used to guide the collection and analysis of the interview data. The focus of the current article is the presentation of the results from Phase 2 interviews.

Study Participants and Recruitment

Advanced practice nurses, including CNSs and NPs, who worked in LTC facilities in Saskatchewan over the previous 1 year were invited to take part in the current mixed methods study. Purposive sampling was used to ensure that participants considered typical of the population under study were invited to participate. Recruitment was completed through advertisements in the Saskatchewan Registered Nurses Association news bulletin, through contact with the CNS Professional Practice Group, and announcements on the Saskatchewan Association of Nurse Practitioners website. There are few CNSs who are employed in Saskatchewan and none that responded to recruitment efforts. Seven NP participants took part in both phases of the study. Attempts were made to snowball sample; however, the number of NPs working in LTC in Saskatchewan is limited and these seven NPs represented approximately one half of the population of NPs working in LTC at the time of the study. Their perspectives are important for understanding the NP role in LTC in the Canadian province.

Data Collection

After questionnaires were completed, participants were asked to take part in one 30- to 60-minute interview at a location of their choice with potential for a follow-up clarification session if needed. Interviews were conducted and recorded by the primary author (T.D.C.), a tenured faculty member at a Canadian university and qualitative researcher who has used interpretive description in five other studies, and a NP graduate student research assistant who has taken formal coursework in research ethics and qualitative methods. Interviews began with the following prompt/ question: “Please tell me about your work as it relates to caring for LTC residents” and “If you were to craft a story of how your work as a NP changed patient outcomes in your practice, what would this include?” These prompts/ questions incorporated many of the same comments that were explored in the questionnaire and provided NPs with an opportunity to expand on the questionnaire findings.

Data Preparation and Analysis

Interpretive description methodology was used for the data analysis. In this method, the collection of qualitative data and analysis are concurrent (Thorne, 2008). The goal of interpretive description is to answer specific questions related to practical aspects of the discipline of nursing (Thorne, 2008). Interviews were audiotaped and transcribed verbatim. Initial analysis of interview data took place by listening to the recordings and reading the transcripts to become immersed in the data. With interpretive description, coding can be done but is not necessary (Thorne, 2008). In the current study, an alternative to coding was used and included marginal memos and highlighting with colors to reflect thematic similarities, as Thorne (2008) contends that “these devices are generally more consistent with the evolving analytic thought of interpretive description than are the more formal coding systems” (p. 147).

The product of an interpretive description approach is a coherent conceptual description of common themes and patterns related to the topic of interest (Thorne, 2008). Themes were generated through questioning, using reflective techniques, and critical examination. As a research method grounded in nursing, interpretive description described and explained how NPs provided care in seven Saskatchewan LTC facilities.

Reliability and Validity of Interview Data

Morse, Barret, Mayan, Olson, and Spiers (2002) proposed that to ensure rigor in a qualitative study, the investigator first needs to be responsive to changes in the designed study and needs to use a set of verification strategies. These strategies include methodological coherence, an appropriate sample, concurrent data collection and analyses, and thinking theoretically (Morse et al., 2002). The aim of methodological coherence is to ensure that there is a congruence between the research question and the components of the method. The goal of interpretive description, which originates from an interpretive naturalistic perspective, is to answer specific questions related to the practical aspects of nursing (Thorne, 2008). The sample should comprise participants who best represent or have knowledge of the research topic (Morse et al., 2001); in the current study, NPs were asked about their work with residents in LTC. Concurrent data collection and analysis (Morse et al., 2002) forms a mutual interaction between what is known and what needs to be known and in the current study, it was important to know how these NPs are functioning with LTC residents. The fourth aspect of thinking theoretically “requires macro-micro perspectives, inching forward without making cognitive leaps, constantly checking and rechecking, and building a solid foundation” (Morse et al., 2002. p. 18). The memo highlighting and color highlighting to reflect thematic similarities occurred throughout the data collection and analysis process. Thorne (2008) does not recommend member checks as they can lead to false confidence if the members agree and they could also derail good analytic interpretation if they do not agree.

Ethical Approval

Ethical and operational approval was obtained from the University of Saskatchewan Behavioral Ethics Board. Each participant discussed and signed a consent form prior to the start of the interview. The geographic settings and size of facilities are not reported in the current article as this information could compromise confidentiality.

Results

Demographics

CNSs and NPs were invited to take part in the current study, and the authors' recruitment strategy was successful in attracting seven NPs for interviews. No CNS answered the recruitment advertisements. Participants were all registered as Primary Health Care NPs (Table 1).

Participant Demographics (N = 7)

Table 1:

Participant Demographics (N = 7)

Themes

After interviews were completed and analyzed, one main theme and four sub-themes emerged from the interviews (Figure 1). The overarching theme is NPs Provide Resident-Centered Care, and they do this by providing services in LTC settings that include: (a) timely access to primary care, (b) medication reconciliation, (c) decreased transfers to hospital, and (d) collaborative interprofessional practice. The overarching theme and the four sub-themes are explained below.

Current study themes.

Figure 1.

Current study themes.

Provision of Resident-Centered Care

NPs working in LTC facilities reflected on how their presence led to resident-centered care. Patient, client, and resident-centered care is the focus of the current Saskatchewan Ministry of Health. Reflecting on their objective, NP5 explained:

I see my role as a NP here being one where I invest the energy to get to know the resident and the family, establish where their priorities are for care, and more importantly their quality of life, and then I steer any interventions that we have around that sort of theme.

Similarly, in her full-time role, NP4 stressed the importance of having residents and their families as the central focus and stated:

The outcomes of having immediate care and immediate issues addressed without waiting, have prevented hospital admission…. Residents have had more resident-centered treatment because there is somebody there to actually see them and assess them, not to just diagnose them over the phone…. I can diagnose, treat, assess, do all of that right at their bedside and immediate treatment starts.

NPs perceived their role within the LTC facility as facilitating efforts to bring resident and family concerns into focus. NPs in their various practice settings provided resident-centered care that was congruent with their over-all mandate of health promotion, treatment, and condition management.

Timely Access to Primary Care. Timely access to primary care can be an issue for any member of the population, and LTC residents can be particularly affected by their lack of physical mobility and ability to access appropriate transportation. NP5 reported that she had reduced transfers to hospitals by “looking at optimal chronic care and having those discussions with the residents and families when a person is acutely ill to describe, you know, what we're seeing and enacting that early intervention.”

The importance of timely access to primary care for LTC residents was also highlighted by NP4, who related the following:

A resident is sitting in a nursing home, who is suffering in bed and their physician is called. But the physician isn't available to see them and maybe not for days, maybe not for weeks. “I can only manage them over the phone.” I'd like to ask policy makers if they would like to be managed over the phone…. And make no mistake, being in a nursing home and getting a doctor to call you and give you an order over the phone is not a visit, okay? And that is unacceptable.

NPs perceived that their work increased the provision of timely primary care to residents, which can prevent further complications and is one of the goals of resident-centered care.

Medication Reconciliation. NPs described reviewing residents' medications with the goal of ensuring that when they were prescribed, discontinued, or changed they were carefully evaluated. NP5 stated:

I work collaboratively with the physicians, but I'll do an onsite [medication] review whenever there's a change in status…to try to improve outcomes for the residents.

Some NPs practiced in facilities with the Eden philosophy, which stresses that medical treatment is important and needs to be the “servant and not the master of care” (Eden Alternative, n.d., para 1). NP6 stated:

Well, in the Eden philosophy you like to have them on eight medications or less. So, we've achieved that in, I think it's now at 75 of our residents…. And some of them come in [to the facility] with 32 medications. And it takes a long time to get them reduced because you don't want to reduce a whole bunch, you want to be done one at a time. You want to watch the cause and effect of all of that.

Similarly, NP3 described decreasing residents' medication, particularly anti-psychotic agents:

And I have taken a number of people off of their anti-psychotics very slowly…. I think it's now about 75% of our residents.... And it's really quite wonderful to see them interacting and brightening and feeling included and you know, even if it's just a smile here and there, it's better than not.

As the statement indicates, NPs perceive their role in ongoing medication review as essential to the health and well-being of LTC residents.

Decreased Transfers to the Hospital for Treatment or Palliative Care. Transfers to the hospital can be disruptive and detrimental for residents in LTC. Each NP found that since they started working at their facility, transfers to hospitals had decreased allowing residents to be treated in their residence. NP4 stated, “…with immediate care, we're not sending a lot of people to the hospital. Unless things are, you know, beyond what we can provide in the home, then obviously we do.” Rural LTC facilities face an added complexity in that an ED may be in another community that is ≥1 hour away, which also makes it difficult for families to be present. NP1 stated that she thought before she started in her position “a lot more people [residents] were being sent to the city…. So, I think it's my NP role that helped keep them in their community.”

Regarding palliative care, NPs were involved with facilitating the transition to comfort care with residents and families:

You know, the various medications that are needed for palliative care to keep them comfortable. And we do a lot of education with the family, so they know where we're at…. Certainly, we have, do very little emergency room visitation from our clinic, or from our LTC facility.

NP6 echoed a sentiment that was voiced by each of the NPs:

Since the NPs have started here, we've decreased hospital visits to the emergency room by about 75% because we can deal with a lot of the situations in-house. And we no longer send our residents out for palliative care or to the hospital to die.

Due to the work of NPs, residents and their family members received the care they needed in a place where residents were familiar with their surroundings. Provision of palliative care in their place of residence means residents can die in their home (i.e., LTC) rather than be moved to the hospital.

Collaborative Interprofessional Practice. NPs described how their role in LTC has led to several advantages for other health care team members including pharmacists, special care aides (SCAs), licensed practical nurses (LPNs), RNs, registered psychiatric nurses (RPNs), and physicians. Formal and informal collaborative practice among team members can enhance their knowledge and ultimately improve resident care. NP2 states she gets stopped in the hallways by SCAs who might say, “‘You know, so and so is doing this. What do you think?’ It's that kind of thing. Because I have developed that really collaborative team feel.”

NP6 made the following comment about the staff at her facility:

You know, they just appreciate having somebody there to talk to, to bounce things off, to mentor them. To explain things, to help them understand. Especially the [special] care aides, you know…. They can't go to the doctor because he's only there for five minutes. But because I am there, they can chat to me and find out all sorts of stuff.

This kind of immediate, available support and leadership is invaluable to effectively managing the complex needs of residents.

NPs also described working collaboratively with physicians, which led to a decrease in physicians' time spent in LTC settings. NP2 described a physician visiting the LTC facility who noted, “I don't know why I'm here other than just to sign my name to everybody else's [NPs] orders.” This collaborative teamwork speaks to the importance of having the right professional in the right role.

NP3 found that her relationship with physicians evolved over time:

By and large it's three physicians that come here once a week. And so that's really quite nice to have just that small group of physicians to work with on a consistent basis. And we all have a very good rapport…. Between the physicians and myself and the pharmacist and the nursing staff. And so now it's working well. And so that's actually pretty ideal to be able to have that kind of relationship with them. You know... they [the physicians] do not come here to see, you know, Mr. Joe's urinary tract infection or whatever. They really are coming here to enhance the education [of those who work with LTC residents].

NPs perceived one of their goals in LTC settings as collaborative holistic care where each member of the team is working to his/her full scope of practice. NPs' comments suggest that they free up physician time and act as mentors and educators for RNs, LPNs, and SCAs, ultimately leading to the provision of quality care for LTC residents.

Discussion

Although a small-scale study, the current research has added a new perspective to the need for NPs in LTC settings by illustrating NPs' perceptions of the core benefits that their role brings to colleagues and residents by providing the right care, in the right place, at the right time, by the right provider. Although performed in Canada, the results are relevant in other countries where health human resource issues with aging populations are being addressed.

The province of Saskatchewan conducted a review of LTC care in 2015. In the 2015 report, several health regions reported issues regarding lack of physician services, staff turnover, and communication issues (Government of Saskatchewan, 2015). The Saskatchewan Ombudsman released a report that stated that between November 20, 2014 and April 30, 2015, 89 new complaints were received about the quality of LTC from residents and families from all parts of the province (Ombudsman Saskatchewan, 2015). The introduction of NPs into LTC could be a way to promote resident-centered care and ideally lead to fewer issues regarding complaints about the quality of care.

Access to primary care is a salient issue for many Canadians. Compared to 11 other high-income Organization for Economic Cooperation and Development countries, Canadian individuals have the longest wait time to see family physicians and the situation has not improved since 2004 (Health Council of Canada, 2013). Care for older adults can become more complex and may require the skills and knowledge of a geriatrician. However, access to this specialty is even more challenging. The number of physicians holding subspecialty training in geriatric medicine is minimal compared to the population of older adults, and the ratio of specialists to population is much smaller for geriatric medicine compared to other specialties, such as pediatrics (Stall, Bear, & Sullivan, 2013).

Golden, Silverberg, and Issenberg (2015) state that medicine can learn lessons from the NP education model regarding care for older adults. Golden et al. (2015) draw attention to the literature that has found that NPs are able to provide care that is either equivalent or more effective than care provided by physicians (Christian & Baker, 2009; Laurant et al., 2005) and suggest that NPs shorter educational programs in comparison to physicians can meet the increasing need for older adult care. Findings from the current study suggest that the NP role can increase access to primary care for Saskatchewan LTC residents, as NPs can provide personalized, timely care to residents that might otherwise be delayed waiting for a visiting physician or only offered over the telephone.

As well as providing timely access to primary care, NPs in the current study helped provide medication reconciliation, which is a service where prescribed, discontinued, or changed medications are carefully evaluated. Klaasen, Lamont, and Krishnan (2009) stated that with the introduction of a NP at their Winnipeg, Manitoba setting, the annual average drug costs decreased by 17%. Findings from the current and previous research suggest that having NPs engage in medication reconciliation offers benefits to LTC residents' health and well-being, in addition to financial benefits, which may offset costs associated with implementing the NP role within LTC facilities.

Older adult patients who remain in acute care longer than necessary are more likely to “experience functional decline, or to be at risk for adverse events or infection” (Government of Saskatchewan, 2016, para. 5). Ploeg et al. (2013) also found that NPs had a role in preventing unnecessary and costly hospitalizations. Participants in the current study emphasized that not only were there cost savings, but there was the benefit of saving residents from the physical and emotional strain of visits to the hospital, which can be particularly challenging for residents with cognitive impairment.

NPs in the current study perceived their role to be a collaborative one, which enhanced interprofessional consultations and reduced physician stress, ultimately increasing the quality of resident care. Although some Canadian studies have detailed positive collaborative relationships between physicians and NPs (Roots & McDonald, 2014), others (Donelan, DesRoches, Dittus, & Buerhaus, 2013) have found sources of conflict between physicians and NPs. Despite the potential benefits of collaborative team approaches to health care within LTC facilities, structural and cultural changes do not come easily and may create conflict. Donelan et al. (2013) indicated that a substantial number of physicians are unlikely to support policy recommendations that promote further expansion of the supply and roles of NPs. In their study, physicians and NPs disagreed about whether NPs “should lead medical homes” (Donelan et al., 2013, p. 1902) or receive equal pay for equal provision of services. Although the potential for conflict exists in interprofessional teams, the group of NPs in the current study spoke at length about the extent to which they built collaborative relationships with members of the health care team and the benefits they perceived from this collaboration.

Bauer (2010), a medical economist, found that there are economic and clinical gains to be made by allowing NPs to be independent practitioners in any number of settings. He states that NPs are cost-effective and provide quality care within overlapping scopes of practice. Moreover, NPs do not increase liability claims or costs and have lower rates of malpractice claims and lower claim payments in general (Bauer, 2010). The resistance cited by previous research is based on traditional hierarchical roles. When NPs work in collaborative rather than substitutive roles, there is lessened resistance from physicians.

Limitations

The current study explored the views of voluntary participants, and these views may not be typical of those advanced practice nurses who did not participate. Although the smaller sample is a limitation of the current study, Thorne (2008) contends samples of more than four can inform an interpretive descriptive study. This sample represents approximately one half of NPs working in LTC in Saskatchewan when the current study was undertaken and their perspectives are important to understanding the NP role within Saskatchewan LTC, and the potential benefits they can bring to residents and other staff. Unfortunately, there were not any CNSs involved in the current study and this role is under duress in much of the country.

Implications

Next steps in future research pertaining to advanced practice nursing with LTC residents could include small scale case studies that examine resident and family perceptions of the care provided by CNSs and NPs, as well as larger scale regional studies (i.e., Prairie Provinces, Maritime Provinces), which could examine the themes and sub-themes in a more in-depth manner. Cost/benefit analyses of the work of advanced practice nurses would be warranted, especially as they are sometimes seen as “expensive” and are the first to be dismissed when nursing budgets are decreased.

Conclusion

The current and other research illustrate the benefits NPs can bring to residents of LTC. The current article is from a Canadian context but is relevant to other jurisdictions. For policymakers who are interested in improving the quality of care for LTC residents, the introduction of NPs to primary health care teams is an important first step, as they are the right provider, providing the right care, at the right time, in the right setting. Participants in the current study provided timely access to primary care and medication reconciliation, as well as decreased transfers to the hospital for treatment and palliative care as they worked collaboratively with the health care team in LTC facilities. Ministries or Departments of Health would benefit from a wider range of health professionals to provide innovative ideas to improve resident outcomes in LTC.

References

Participant Demographics (N = 7)

Demographicsn (%)
Age range (years)
  30 to 392 (29)
  40 to 491 (14)
  50 to 593 (43)
  60 to 691 (14)
Initial nursing education background
  Nursing diploma2 (29)
  Bachelor of science in nursing2 (29)
  Master of nursing2 (29)
  Master of health sciences1 (14)
NP education
  Post-RN or post-baccalaureate certification4 (57)
  Master or post-master NP program3 (43)
APN designation
  RN(NP)–family/primary care/all ages NP7 (100)
Length of time as an RN in LTC
  1 year2 (29)
  6 years2 (29)
  20 years1 (14)
  22 years1 (14)
  25 years1 (14)
Length of time as an APN in LTC
  1 to <2 years2 (29)
  2 to 3 years1 (14)
  4 to 5 years1 (14)
  6 to 7 years2 (29)
Employment status
  Full-time in LTC setting3 (43)
  Part-time in LTC setting2 (14)
  25% in LTC; 75% in community/primary health care setting2 (29)
Authors

Dr. Campbell is Assistant Professor, Dr. Bayly is Post-Doctoral Fellow, Department of Psychology, and Dr. Peacock is Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Theresa Diane Campbell, PhD, MN, RN, Assistant Professor, College of Nursing, University of Saskatchewan, 100-4400 4th Avenue, Regina Saskatchewan, Canada S4T 0H8; e-mail: diane.campbell@usask.ca.

Received: April 29, 2019
Accepted: August 16, 2019
Posted Online: November 06, 2019

10.3928/19404921-20191022-02

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