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Roles of advanced practice nurse
The role of the advanced practice nurse
Roles of advanced practice nurse
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For most people who have been admitted in the hospital wait for the moment when they are told that they will be discharged to either their home, nursing home or even rehab. Everyone know that the hospital can be a hard place to rest especially when sick or in pain with daily hourly visits from nurses, doctors, and even other hospital staff. Although rest is the first thing on a person's mind when sick or in pain we have to be certain that the body is getting the right treatment and time to heal before leaving the hospital. This a difficult task for both healthcare providers and patients and can cause hospital readmissions.
Over 35 million hospital discharges annually in the United States are involved in this challenge (Center for Disease Control and Prevention, 2017). The cost of unplanned readmissions is 15 to 20 billion dollars annually for Medicare patients, where about 20 percent who are discharged from a hospital are readmitted within 30 days (Jencks, Williams, and Coleman, 2009). If we are able to prevent readmissions into the hospitals it gives the possibility to greatly improve both the quality of life for patients and the financial responsibility of healthcare systems.
In order to insure the new standards when it comes to hospital readmissions, facilities
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Instead of having a transition coach an advanced practice registered nurse (APRN) works to come up with the best pre-discharge patient assessment depending on the patient and their needs. The APRN gives multiple phone calls and home visits after discharge to the patient to make sure the patients do not have any questions and directions given are followed to reduce hospital readmission. They even go with the patient on their first visit to the PCP to make sure all information needed is given to the PCP to ensure better recovery (Nelson & Pulley,
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
Under the Social Security Act, it is required that hospitals report quality measures for a set of 10 indicators. If hospitals do not report quality measures to CMS there is a reduction in payments. In the hospital readmission area of investigation, OIG reviews Medicare claims in hospital readmission cases to identify trends and oversights of cases. Readmissions are cases in which the beneficiary is readmitted to the hospital less than 31 days after being discharged from the hospital. Hospitals are only entitled to one diagnosed-related group payment if there is a same-day readmission for symptoms related to prior hospital stay. Quality improvement organizations are required to review hospital readmission cases also this is to see if standard of care are met. For coded conditions as present on admission, it is required for acute hospital to report these diagnoses on Medicare claims. The OIG will review Medicare claims for types of facility or providers most frequently transferring patients to hospital
Changing roles from RN to NP can have a big impact on the person, their family, and the workplace. A lack of support from administrators, co-workers, and mentors can lead to a failure of transition. Balancing the loss of the role as RN while expanding the role of NP can be a challenge. This challenging transition requires confidence. Confidence is most successful
There is limited data on predictors of discharge and readmission for hospital inpatients. According to Rothman, Rothman, & (), “Unplanned hospital admissions are a major quality and cost issue in the US healthcare system”. About 20% of Medicare patients are readmitted to the hospital within 30 days, at an estimated cost of $17 billion per year (). Now that Medicare has begun to reduce payment to hospitals with high readmission rates, hospitals are looking for more effective ways of reducing readmissions. In order to develop new systems to address these concerns, there must be evidence in place to support to their use.
Hospital readmission can impact the patient, nursing practice, the hospital, and the health care system. The patient’s quality of life can be altered physically, psychologically, and economically (Whittaker, 2014) and recurrent hospitalization is a good predictor of increased risk of mortality (Hummel, Katrapati, Gillespie, DeFranco, & Koellig, 2013). Moreover, a patient in an acute care setting has an increased risk of contracting hospital-acquired infections such urinary tract infections, sepsis, C. difficile, and methicillin resistant Staphylococcus aureus (medicare.gov|Hospital Compare, 2013). Nursing practice is impacted as patients spend the majority of their acute care stay with the bedside nursing staff. According to...
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
Standardizing The Hospital Discharge Process for Patients with Heart Failure to Improve the Transition and Lower 30 day Readmission. http://www.cfmc.org/integratingcare/files/Remington%20Report%20Nov%202011%20Standardizing%20the%20Hospital%20Discharge.pdf
This is counterproductive towards the patients’ own recovery from the ward to a normal life
Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge planning between any health care settings can be detrimental to patient care.
Just like any novice APN I would tend to be more focused on the clinical domain. Coaching and educating patients and family will be important to effect change in their lifestyle to be more compliant with the treatment plan. As we all know a patient’s care is not confined to nursing care but involves the other disciplines; doctors, therapist, social worker, nursing assistant, dietician, pharmacist, etc. and thus the importance of collaboration. Advocating for patient also requires expert communications skills and collaboration. As I continue with my journey to become an Advanced Practice Nurse, I hope to develop all attributes starting with the expert communication to the level where I can advocate for my patient’s needs in the health policy arena. I would also like to work on self-confidence. I know self-confidence comes in time with knowledge and experience. I believe that patients develop trust and confidence when they see confidence of their healthcare
Readmissions has become a spotlight in the healthcare world. “The problem of readmissions to the hospital is receiving increased attention as a potential way to address problems in quality of care, cost of care and care transitions. Interventions are underway to reduce hospital readmissions at the state and national level” (Elixhauser & Steiner, 2010). “Approximately 20% of Medicare beneficiaries are readmitted within 30 days of discharge and these readmissions have been estimated to cost the American public > $15 billion per year. The Patient Protection Affordable Care Ace of 2010 has created new incentives to reduce admissions using the publicly reported measures because hospitals with high readmission rates can lose
During the final stage broadening the perspective, the APN is starting to settle in in his/her new role, the NP experiences realistic expectations and a feeling that they are competent. During this phase, I will focus on identifying my strengths and work on strengthening them further. I will do this by seeking for biannual and annual evaluations from management/administrator. I plan on making changes in my work environment in order to increase the care delivery system.12
The transitioning nurse must be able to communicate clearly and effectively. Often times nurses working in the community are alone where there is no other health team member present, therefore complete communication is essential. Transitioning nursing must possess knowledge of computer technology. The use of computer technology allows the nurse to communicate with other healthcare providers, facilitate care and manage complex healthcare needs (Bates et al., 2016, p.342). Furthermore, nurses transitioning from an acute care setting must be able to adaptable to any given situation or community. For example, supplies and equipment found in a hospital setting can be different than the one found in a client’s home. They must take the opportunity to gather information on how to utilize the supplies or equipment that may be unfamiliar. Finally, transitioning nurses must be knowledgeable about community resources. Knowledge of community resources can provide the opportunity to access and share information and help to improve the client’s quality of life (Bates et al., 2016, p.
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).
Hospitals, long term care facilities, and mental health all serve as healthcare arenas serving the population in various ways. The hospital provides the most critical type of care, for the seriously ill. Hospitals originally served the poor and ill, but over time with the progression of technology and medical service specialties, they have grown to become healthcare meccas with many outlets. Over the past 30 years the degree of rigor of clinical practice and the scope of scientific knowledge has escalated greatly, and the hospital has become a center of high standards, scientific applications, and advanced technological capability (Williams & Torrens, 2008). The increasing shift of services to an ambulatory care arena facilitated by technological advancement itself has left the hospital with an evermore complex base of patient care, higher acuity, and higher costs (Williams & Torrens, 2008). Markets have changed, pricing pressures have increased, and consumer and payer expectations have evolved for hospitals, changes are constant in the medical arena, and hospitals are no exception.