APRNs Improve Health Outcomes in Nursing Homes

The presence of APRNs can prevent delays in treatment and expensive hospital transfers, explains recent research.

While nursing homes strive to provide residents with the care they need, too often residents are transferred to hospitals from these facilities due to developing severe illness. It's happening too often, with repeat residents, and it can be prevented, said Alisha Johnson, assistant professor at the University of Missouri (MU) Sinclair School of Nursing.

Johnson is part of ongoing research at MU to see whether including advanced practice registered nurses (APRN) into nursing homes reduces hospital transfers and impacts resident health outcomes. According to an MU press release, ''billions of dollars are spent transferring residents from nursing homes to hospitals,'' which could have been avoided through detection of early illness and faster clinical decision-making.

The presence of APRNs in nursing homes can be beneficial to the quality of care provided to residents, with APRNs' advanced training, Johnson said.

"The staff [who work] in nursing homes are wonderful, caring people, but what I found was often a lack of understanding of the beneficial expertise the APRNs can provide, as they have advanced training in pharmacology, diagnostics, lab work, blood tests, radiology, early illness detections and medications, and this broadens their ability to direct care decisions that ultimately improve resident health outcomes," Johnson said.

When a resident needs care, nursing home staff must find a physician to direct them, which delays formulation of a treatment plan. Delays like these can lead to miscommunications, negative health outcomes, and hospital transfers that are costly and stressful to the resident.

"APRNs have a huge opportunity to fill these care gaps, as research shows residents receive much better care if they stay in the nursing home where they live rather than being transferred to a hospital," Johnson said. "APRNs can see what is going on in real time and make care decisions much more quickly."

In 2021, the university did a study on the effectiveness of the Missouri Quality Improvement Initiative. The $35 million program was funded by the Centers for Medicare & Medicaid Services, implementing APRNs full time into 16 nursing homes.

Results showed that APRNs improved the quality of care residents received, lowering the number of hospital and emergency room transfers; leading to improved health and saving the state $31 million.

"Missouri currently has a state requirement that APRNs can't provide assessments or write orders independently, they must work under a physician, but research shows states that do not have this requirement have just as good health outcomes among their nursing home residents," Johnson explained.

"The number of physicians working in geriatrics is decreasing, and there are three times as many APRNs working in long-term care facilities than physicians. So, APRNs can provide tremendous benefits in nursing homes when given the opportunity."