Out of the Shadows: Nurse Practitioner Leadership in Skilled and Long-Term Care Facilities

The clinical and educational opportunities addressing quality improvement are endless, but they require time and resources. The breadth of NP work in nursing homes spans primary health care and advanced practice activities adapted to meet the unique needs of these settings (Martin-Misener et al., 2015). Many NPs and those employed by facilities have assumed some or all of this leadership role. W. Edwards Deming, an American engineer, statistician, and leading management thinker in the field of quality, is credited with a quote that seems especially applicable here: “Without data, you're just another person with an opinion.” Until the work is recognized as needed and necessary, the data to quantify the outcomes will likely go uncollected. Measurements of efficacy and accomplishments of this new role of AHD could also provide data for policy changes to assist with the shortage of medical directors. In an industry plagued with financial challenges and intense regulation, introducing a new role will be met with skepticism. However, the need for innovation and collaboration to improve quality of care and support for this complex population will benefit from taking advantage of the available resources NPs already have in their midst. Clear and practical guidelines of role expectations and deliverables are needed to avoid mission creep and frustration, especially as the proposed role is only part time and will likely be added or incorporated into already busy careers. Almost 2 decades ago, top leaders in the industry noted the need for educational, policy, and reimbursement strategies to encourage further involvement of NPs in the care of residents in nursing homes secondary to high resident, family, and physician satisfaction with provided services (Rosenfeld et al., 2004). The time has come for NPs to step out of the shadows and into a greater leadership role for which they are well prepared. It will be of benefit to the nursing home team and industry, but more importantly, to SNF/LTC residents. Copyright © SLACK Incorporated