Abstract
Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.
Highlights
The number of older adults with chronic diseases and multi-morbidity increases rapidly, resulting in rising pressure on nursing homes (World Health Organization, 2015)
Four groups were purposefully selected to participate in a monodisciplianry focus group: ECPs and nurse practitioners (NPs), physician assistants (PA), and registered nurses (RNs) working in Dutch nursing homes
Skill mix change by introducing NPs, PA, and RNs was organized in various ways
Summary
The number of older adults with chronic diseases and multi-morbidity increases rapidly, resulting in rising pressure on nursing homes (World Health Organization, 2015). Few medical students are pursuing a career in health care for the aging population (Golden, Silverman, & Issenberg, 2015) Quality deficits, such as use of unnecessary restraints, in nursing homes are an issue of international concern (Organisation for Economic Cooperation and Development, 2005). Changing the skill mix by introducing nurse practitioners (NPs), physician assistants (PA), and baccalaureate-educated registered nurses (RNs) in nursing homes might diminish physicians' workload and enhance quality of health care (Caprio, 2006; Intrator et al, 2015). These professionals can perform tasks previously reserved for physicians.
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