Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000–2010

Intrator, Orna; Kelli, Miller, Msn, Aprn, Fnp-Bc,; Gadbois, Emily A; Acquah, Joseph; Makineni, Rajesh; Tyler, Denise

doi:10.1111/1475-6773.12410

Cited by 24 publications

(18 citation statements)

References 14 publications

(26 reference statements)

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“…The result confirmed the findings of other studies: that skill mix change in nursing homes shows great variety and is still evolving (Intrator et al, ; Lovink, Persoon, Koopmans, et al, ; Martin‐Misener et al, ). All NPs, PAs, and RNs worked at the unit level.…”

Section: Discussionsupporting

confidence: 90%

“…Moreover, quality deficits, such as use of unnecessary restraints, in nursing homes are an issue of international concern (Organisation for Economic Cooperation and Development, ). Changing the skill mix by introducing nurse practitioners (NPs), physician assistants (PAs), and baccalaureate‐educated registered nurses (RNs) in nursing homes might diminish physicians' workload and enhance quality of health care (Caprio, ; Intrator et al, ). These professionals can perform tasks previously reserved for physicians.…”

Section: Introductionmentioning

confidence: 99%

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Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

Lovink

Vught

Persoon³

et al. 2019

Nursing & Health Sciences

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Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

Lovink

Vught

Persoon³

et al. 2019

Nursing & Health Sciences

View full text Add to dashboard Cite

show abstract

“…Interestingly, FPA had a negative or no effect on NPs’ involvement in nursing homes (Intrator et al, 2015). The researchers pointed out that this may reflect the unique working environment in nursing homes wherein NPs play a more complementary role rather than as a substitute for physicians compared with other care settings (Intrator et al, 2015; Levy et al, 2005). This explanation could be related to existing superseding federal-level nursing home regulations precluding FPA in nursing homes (e.g., The Omnibus Budget Reconciliation Act [OBRA]-87), which takes priority over any state FPA practice regulations.…”

Section: Discussionmentioning

confidence: 99%

State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

et al. 2020

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There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

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“…Currently, NPs are key providers in safety-net primary care settings that serve as the main source of primary care for more than 23 million minority and low-income patients, including nearly 1,300 community health centers and over 250 nurse-managed health clinics (Hansen-Turton, Bailey, Torres, & Ritter, 2010; National Association of Community Health Centers, 2014). They are increasingly becoming an important part of the nursing home workforce with over 35% of nursing homes employing NPs by 2010 (Intrator et al., 2015).…”

Section: The Role Of Nps In Primary Care Delivery For Vulnerable Popumentioning

confidence: 99%

Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform

Xue

Intrator

2016

Policy, Politics, & Nursing Practice

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The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform.

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Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000–2010

Abstract: Objective. Conclusions. NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended.

Cited by 24 publications

References 14 publications

Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform

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