A Canadian study led by researchers from Ryerson University and Dalhousie University found that nurse practitioners play a vital role in providing rapid access to health care for residents living in long-term care settings, such as nursing homes and homes for the aged.

"As Canada's population ages, there will be an increasing demand on long-term care settings to provide the best quality of care for older adults," says Faith Donald, one of the co-principal investigators of the study, and a nursing professor in Ryerson's Daphne Cockwell School of Nursing.

Ryerson University is in Toronto, Ontario, and Dalhousie University is in Halifax, Nova Scotia.

Ontario launched a pilot program for 17 nurse practitioners in long-term care settings in 2000. Since then, other provinces have created similar programs in a variety of settings, such as nurse practitioners working in a single nursing home, collaborating with family health teams that provide health care to long-term care residents, or providing rapid response to a number of nursing homes in a region.

Donald and her co-principal investigator, Professor Ruth Martin-Misener, were interested in exploring how these nurse practitioners were integrated into the long-term care system and what their roles were. Co-investigators on the research team were from McMaster University, Ontario; University of Waterloo, Ontario; and University of Victoria, British Columbia.

During a period of 3 1/2 years, the research team conducted a two-phased study. The first phase involved surveying nurse practitioners across Canada working in long-term care settings and their administrators and directors of care. The second phase involved conducting interviews and focus groups in case studies in four different locations with a wide range of health-care providers, including physicians, pharmacists, and social workers, as well as residents living in long-term care and their family members.

The researchers found overwhelming evidence emphasizing the value of nurse practitioners working closely with residents, their family members, and health-care professionals in long-term care settings.

"Across the board, we found that when nurse practitioners were present in these settings, the people interviewed in our study reported improvements in quality of care and access to timely assessments for residents," says Martin-Misener.

Donald says the study found that nurse practitioners were able to conduct rapid health assessments of a resident, reducing the need to rely on physicians who may not be available on site.

Nurse practitioners not only provided timely assessments of residents, they also managed chronic illnesses, conducted medication reviews, collaborated with nursing staff, and communicated with residents, their families, physicians, and staff members.

Family members also talked about the improved communication they had about their loved one's health and well-being if their family member was cared for by a nurse practitioner.

"I recall one man who talked about how important having a nurse practitioner was to his parent's care," says Donald. "He told me if he had to pay extra money in order to have a nurse practitioner care for his parent, he would do that without question."

The greatest barrier that nurse practitioners faced in the study was not having enough secure funding.

"If you're not sure you're going to have the nurse practitioner role for very long, there is a hesitancy to put in place programs that can make a big difference in residents' health and well-being. Having consistent funding for nurse practitioners would alleviate this," says Donald.

Looking toward the future, the research team said it will explore further the specific types of care that nurse practitioners provide and their impact on residents' health in long-term care settings.

The study, "Understanding the Individual, Organizational, and System Factors Influencing the Integration of the Nurse Practitioner Role in Long-Term Care Settings in Canada," was funded by the Canadian Institutes of Health Research: Partnerships for Health Systems Improvement, Nova Scotia Health Research Foundation, and the British Columbia Ministry of Health Services.