Advanced Practice Registered Nurses Improve Quality of Care for Nursing Home Residents


Marilyn Rantz still remembers the day she received the call that her mother, whose health was in decline, had fallen and had fractured her shoulder. After rushing to the hospital, her mother told her that she did not understand how she ended up on a helicopter runway after the traumatic incident.

A nearby nurse told Rantz that the sound of the MRI scan tube caused her frightened mother to mistakenly believe she had been airlifted to hospital by helicopter.

Determined to avoid avoidable hospitalizations, as well as the stress and panic that often accompany the ambulance ride, Rantz, now Professor Emeritus of Conservatives at the Sinclair School of Nursing at the University of Missouri, has dedicated her career to improving the quality of care in nursing homes.

In a recent study, Rantz and his team evaluated the effectiveness of the Missouri Quality Improvement Initiative, a $ 35 million program funded by the Centers for Medicare and Medicaid that put nurses in place. Full-time advanced practice (APRN) in 16 Missouri nursing homes.

They recently evaluated the program over a six-year period and found that APRNs have improved the quality of care for nursing home residents, resulting in fewer avoidable hospitalizations and emergency room visits, which has resulted in fewer avoidable hospitalizations and fewer emergency room visits. resulted in better overall health and over $ 31 million in savings.

“These highly qualified nurses have a doctorate or master’s degree in nursing, and their impact on reducing costs and improving the quality of care is significant,” said Rantz. “Most of the care nursing home residents need can be provided directly in the nursing home. Through the advanced training of APRNs, they were able to help nursing home staff quickly recognize problems and quickly identify declines in health status so that evidence-based interventions could be implemented to help avoid problems such as hospital transfers or emergency room visits. “

Rantz added that dehydration tends to be an underlying cause in many preventable hospitalizations, and the Quality Improvement Program is putting protocols in place to ensure residents are hydrated and active and moving to improve. mobility.

“We have systems of care in place to allow residents to receive additional fluids several times a day,” Rantz said. “Having APRNs teaching nursing home staff the types of things to look out for helped identify small issues and early signs of illness before they became bigger issues that required preventable hospitalization.

Given the high rate of staff turnover in nursing homes, the establishment of APRNs working full time in nursing homes while being guided by a support team has successfully maintained the improved quality of care in the majority of nursing homes over a six-year period.

“When residents have fallen ill, whether it is a urinary tract infection or pneumonia, we have already seen these types of illnesses often lead to hospital transfers or emergency room visits. Said Amy Vogelsmeier, associate professor at the Sinclair School of Nursing corresponding author of the study. “Now, with the coaching and mentoring of APRNs, nursing home staff can provide the appropriate intravenous fluids or administer antibiotics so residents receive proper care while still being able to stay in the hospital. long-term care facility.

Since older adults tend to lose their functional mobility with age, Rantz is committed to avoiding traumatic and stressful hospital transfers like the one her mother went through.

If we can step in and manage these residents in nursing homes where they already know the staff and the routine, this is the best place for them. This is really why I believe I was put on this Earth. It’s my life’s work to help improve care for the elderly. “

Rantz, Professor Emeritus of Conservatives, Sinclair School of Nursing, University of Missouri


Journal reference:

Vogelsmeier, A., et al. (2021) Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalisations of Nursing Home Residents. The Journal of Nutrition, Health and Aging.


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