RITUAL Y CEREMONIA

For residential aged care facility 7 surveys and discussions were conducted with the stakeholders/ collaborators of the Nurse Practitioner.

When discussing the role of the Nurse Practitioner during the focus group discussion, stakeholders and collaborators made several observations. They discussed the positive impact the Nurse Practitioner had had on achieving positive health outcomes for residents.

These outcomes included a reduction in transfers from the facility to acute care hospitals. In particular, the focus group participants discussed the reduction in transfers following a fall. This was achieved through Nurse Practitioner assessment of residents after a fall which enabled advanced clinical decision making regarding which residents required further assessment and potentially admission at an acute tertiary hospital

Prior to the appointment of the Nurse Practitioner, all residents would routinely be transferred to hospital after a fall. The carers stated that the reduction in hospital transfers is integral to the continuity of care received by residents.

The stakeholders/collaborators perceived that continuity of care is broken and often disabled by a hospital admission or even a short stay in an emergency department, due to an inability of acute care services to meet the immediate needs of the frail, elderly patient.

These comments are supported by documentary evidence collected by the organization regarding a reduction in unplanned transfers from the facility to hospital, presented earlier in this report.

The Nurse Practitioner was viewed, by care workers, to be particularly supportive and effective in the management of residents requiring palliative care. Specifically this was evidenced by her ability to plan and institute palliative care regimes, which assisted all staff in providing appropriate ongoing patient care. Further, the nurse practitioner was effective in liaising with the patients’ General Practitioners in order to maintain the regimes.

The geographical difficulties were also discussed in the focus group discussion. Participants observed that the service provided by the Nurse Practitioner could be utilised more effectively if she was “…not so thin on the ground”. Unavailability of the Nurse Practitioner when travelling to and from other multiple other facilities at times led to a lack of “consistency” in the benefits from the Nurse Practitioner position. From a logistical perspective the effective review and evaluation of end of life care plans was seen to be

Final Report Implementing the Nurse Practitioner Role in Aged Care

Australian Capital Territory, November 2007



The care staff viewed the Nurse Practitioner as being a bridge between the role of Registered Nurse and General Practitioner. She was perceived to be “…a wonderful resource” and “the link we need…”. In addition to liaising with General Practitioners, the Nurse Practitioner was seen to be an essential and skilled source of liaison between the facility and acute sector hospitals, pharmacies and community services. She was perceived as a “networker” within the community health sector.

The stakeholders/collaborators were of the opinion that the Nurse Practitioner had improved the confidence of Registered Nurses in regard to their decision-making processes. This was seen to benefit the residents through skill enhancement of on-site staff. During the focus group discussion staff also commented on the high value they placed on the Nurse Practitioner’s clinical advice and support with particular acknowledgement being given to her in depth clinical knowledge of the aged. Furthermore, the role of resident advocate was seen to be integral to the position.

Staff, both Registered Nurses and care workers, verbalised the significant difference the Nurse Practitioner made to the work environment and professional development for them all. In particular they noted the clinical support that was available to them, usually at short notice, from the Nurse Practitioner when residents required immediate or prompt response to a clinical issue.

They stated that prior to the implementation of the Nurse Practitioner position, within the residential aged care facility, it would have been necessary to wait for a medical officer to be able to visit and assess the patient whereas now they had access to a Nurse Practitioner with advanced assessment skills to provide clinical support and decision-making.

Further to this, the stakeholders and collaborators were very clear in their observations of the Nurse Practitioner’s ability to diagnose and develop a treatment plan without the subsequent ability to immediately order pharmacological interventions. There were numerous occasions witnessed where treatment was delayed until a medical officer was contacted and available to endorse the Nurse Practitioner recommendation.

The stakeholders/collaborators were firm in their belief that the Nurse Practitioners ability to prescribe could further reduce hospital transfers as well as to improve residents’ health outcomes. This was evidenced and supported by verification of occasions where residents had experienced increasing symptoms and greater ill health whilst waiting for medical staff to write prescriptions for the Nurse Practitioner.

The stakeholders and collaborators in the focus group discussion were outspoken in their high regard of the communication support provided by the Nurse Practitioner. They reported feedback from families regarding how they valued the Nurse Practitioner, noting the importance of the role in supporting residents, families and staff. Her depth of knowledge and understanding of processes, both clinical and personal, within the aged care facility and associated bodies was perceived to provide a link that had previously been absent.

It is apparent, that the Nurse Practitioner is now well accepted as part of the organizational culture by both staff and management. From a clinical management perspective this is evidenced by staff reporting that they now refer to the Nurse Practitioner in the first instance as their primary source of clinical advice and support.

The positive response and support given to the Nurse Practitioner by the collaborators/stakeholders, in the focus group discussion, is evidence in itself of the Nurse Practitioners success in implementing the role at this facility.