Harkness Fellowship in Health Care Policy and Practice 2016-2017

Project Title: Nurse practitioners in U.S. nursing homes: Current trends and the role of NPs in reducing rehospitalizations The importance of my Harkness research project to the U.S. and Norway Nursing homes continue to be a corner stone in long-term care of societies? oldest and most frail in both Norway and the United States. Another similarity between the nurse home sector in these two countries is the increasing use of nursing homes as arenas for post-acute care. As a result of this trend, nursing home care is more complex and the population being served is more diverse than ever before. As clinical complexity increases in nursing homes, it is expected that both the number of health care professionals and their skills levels, includign the use of nurse practitioner, is likely to go up. Nurse practitioners? scope of practice is regulated at the state level and determines the level of independence in their practice. This research is the first to explore the most recent trends in the use of nurse practitioners in US nursing homes. Overall, we found a steady growth in the number of nursing homes that utilize nurse practitioners, with nurse practitioners providing care in more than half of U.S. facilities. However, this statisic belies the fact that there is a large varition in the use of nurse practioners in nursing homes nationwide. Moreover, we rejected our initial hypothesis that there would be a steeper growth in nurse practitioner utilization in states that allow them full practice rights. Most importantly, preliminary findings suggest that facilities with nurse practitioners have fewer rehospitalizations than those without. Norway and the United States are facing many of the same challenges associated with an aging population, and both countries need to develop sustainable models of care that can be safely and effectively provided by the lowest possible level of healthcare providers. This study contributes important information necessary for U.S. policy work related to nursing home setting, particularly around issues such as staffing and effective practices of care. Nursing homes are redefining their role in the continuum of healthcare services and nurse practitioners do appear to play an important role in the U.S. setting. Further work is needed to clarify and define the role of nurse practitioners in nursing homes, including exactly how they contribute to reducing rehospitalizations. Many countries, including Norway, look to the U.S. when facilitating task shifts, new role development and innovations in long-term care. As such, there is a strong interest in the role of nurse practitioners and how this fits with the needs of an aging populations.