Clinical Practice Characteristics of Nurse Practitioners Managing the Care of Older Adults

Friday, 28 July 2017: 10:45 AM

Laurie Kennedy-Malone, PhD
School of Nursing, UNCG School of Nursing, Jamestown, NC, USA
Marianne Shaughnessy, PhD
Department: Veterans Health Administration, Institution/Organization: Department of Veterans Affairs Washington DC, Alexandria, VA, USA

Purpose: A national survey of nurse practitioners (NP) who manage the care of older adults in the United States was conducted to determine the practice characteristics in terms of engagement in professional activities and clinical skills in relationship to years of experience as a nurse practitioner, practice setting, and population foci nurse practitioner preparation (adult, gerontological, adult-gerontology, family, or other).

Methods: The Advanced Practice Nurses Managing the Care of Older Adults Practice Profile (APNMCOA), a 153 item survey designed to ascertain practice characteristics of nurse practitioners managing the care of older adults was developed to be administered in an on-line survey format. Using a variety of electronic communication to invite nurse practitioners to participate in the study, the survey was made available for two months for nurse practitioners to voluntarily complete and submit. The APNMCOA is divided into five sections. The first section pertains to demographic information, followed by a section on type of national certification, educational preparation and prescriptive privileges. The nurse practitioners are then asked to rate the frequency and importance of 61 professional activities. Given next a list of 41 clinical procedures, the nurse practitioners were asked to indicate where they learned how to perform the procedure and how often they performed the procedure. The final section of the survey pertained to prescribing patterns of specific classes of medications.

Results: Over 1200 nurse practitioners responded to the survey during the two month time period that the survey was available on-line. With an average age of 51, the majority of respondents were master’s prepared Caucasian females with prescribing privileges, DEA number billing under their National Provider Identifier Standard number. The average number of years practicing as a nurse practitioner was 11. Only a small percentage of the NPs (12%) responded that they were billing “incident-to” the work of a physician in their practice. Many of the respondents indicated that they held more than one national certification as a nurse practitioner and multiple subspecialty certifications. The educational preparation of nurse practitioners responding was almost divided evenly amongst adult, gerontological, and family nurse practitioners with a small remaining percentage indicating preparation as an adult-gerontology acute or adult-gerontology primary care nurse practitioner. The majority reported having prescription privileges their own DEA number and billing using the NP special national provider number. When examining the responses to the 61 professional activities which were indicative of engaging in gerontological specific practice, the respondents more often responded that they valued the activity more than they actually engaged in the activity. Procedures that nurse practitioners responded that they regularly perform included clinical skills performed by primarily by registered nurses as well as procedures often deemed medical acts in state nurse practice regulations.

Conclusion: The results of this study indicate that nurse practitioners manage complex care of older adults across multiple practice settings. Findings of this study need to be disseminated to nurse educators, policy makers and consumers alike.