A thesis presented to the School of Graduate Nursing
Mountain State University
In partial fulfillment of the requirements for the degree
Master of Science in Nursing
Nurse Practitioners (NPs) play a key role in long term health care by ensuring provision of holistic healthcare services particularly in remote areas and in those areas that have few physicians. Currently, there is a concern where there is a shortage of physicians in nursing homes and in other critical health care services questioning the care being provided (Colwill, Cultice, & Kruse, 2008). Due to population growth, aging, and other factors, demand will outpace supply (Colwill, Cultice, & Kruse, 2008). Simply educating and training more physicians will not be enough to address these shortages (Colwill, Cultice, & Kruse, 2008). According to Colwill, Cultice, and Kruse (2008), population growth and aging will increase family physicians’ and general internists’ workloads by 29% between 2005 and 2025.
The United States is growing older (Johnson, Toohey, & Wiener, 2007). According to one study completed by Johnson, Toohey, and Wiener (2007) the number of older persons in the United States is projected to increase from 35 million persons to 87 million persons between 2000 and 2050. In coming decades, the number of “baby boomers” alone will cause the number of elderly with disabilities to soar and the need for long term care will skyrocket. This huge increase of disabled elderly will exacerbate current problems in the provision and financing of long term care. Currently, public and private spending on long term care is about 137 billion (Johnson, Toohey, & Wiener, 2007). Spending is projected to increase approximately four times in the next 40 to 50 years reaching as much as 379 billion dollars for the elderly alone (Walker, 2002). This increase in cost will place a huge financial burden on Medicare, Medicaid, and private insurance companies. Given these projections, 2
assuring access to healthcare will require more than an increase in the enrollment in medical school. The growing demand for cost effective and cost efficient long term care warrants the close attention of policymakers. According to Caprio (2006) due to these problems there is a need to incorporate NPs in many fields such as long term care. Problem Statement
Demographics from the American Academy of NPs in 2004 documented about 13% of nurse practitioners have privileges in long term care; in practice, only two percent work in nursing home settings (Caprio, 2006). This shows a large number of NPs not having the authorization to practice in long term care due to some limitations within the system. There is a need to identify problems. This research will focus on identifying barriers that prevent NPs from practicing in long term care, providing quality holistic healthcare to residents. The need for long, unnecessary, and expensive trips to the local emergency department can also be eliminated. Purpose
The purpose of this study is to identify the perceived barriers that may hinder the nurse practitioners interactions during long term health care. By identifying barriers, possible solutions may be initiated to continue quality healthcare in the long term care setting. Research Question
What are the barriers that prevent nurse practitioners from practicing in long term care facilities? 3
Definition of Terms
The term perceived barriers is common in nursing literature. This study will measure perceived barriers to practicing NPs based on a questionnaire: Study of Barriers to Advanced Practice Nursing. Theoretical Framework
The General System Theory (GST), by Ludwig von Bertalanffy, is a useful theoretical model used for transferring information and analyzing vague analogies within human societies and...