SUPPORT AND UTILIZATION OF ADVANCED PRACTICE NURSES IN LONG-TERM CARE TO MAXIMIZE OUTCOMES AND EMERGENCY RESPONSE

Abstract

Abstract Incorporation of Advanced Practice Registered Nurses (APRNs) into Long-Term Care (LTC) results in sustained positive outcomes and has potential to help guide LTC facilities in times of emergency such as the COVID-19 pandemic. To optimally utilize the role of an APRN in the care of older adults and people with disabilities requires understanding the needs of LTC while balancing the personal characteristics of APRNs transitioning into practice (TTP). Findings from an ethnographic dataset (participant observations, interviews, field notes) of a cohort of 9 APRNs embedded full-time into 5 LTC settings over their first year of practice (overlapping with the first 3 ½ months of the COVID-19 pandemic) were integrated to glean lessons about LTC and APRN characteristics associated with successful APRN transition and utilization during stable and emergent care. Guided by a complexity science sensitizing framework focused on emergent and holistic systems, findings lead to multiple conclusions. The ability to influence positive outcomes in routine and emergent situations must be modeled. APRNs require meaningful mentoring relationships and acceptance by administrators and practitioners to develop successful TTP. Successful TTP included their embrace of role as resident caretaker, their participation in facility quality improvement, and their positive impact in an emergency response. Utilization and transition were enabled by facilities with organized characteristics versus inhibited by chaotic ones, which was exacerbated by the pandemic. Personal role fulfillment drove many APRNs to push through adversity. Administrators must address and honor concerns and attempts at self-care during times of doubt.