“How are you feeling today, Esther?” asks Sarah Endicott, DNP, APNP, GNP-BC. Endicott is starting her rounds at the rural skilled nursing facility where she sees patients once a week.
“I’m Sarah, the nurse practitioner, and I’m just checking in with you today,” she says as she kneels before Esther’s wheelchair so Esther (not her real name) can see her better. Esther’s face lights into a smile as she clasps Endicott’s hand. “I know you!” says Esther. “I’m happy to see you.”
The residents here know Endicott well. She knows the residents well, too, as do the RN and CNA staff. Endicott works here every Wednesday, in addition to teaching in the University of Wisconsin–Madison School of Nursing’s Doctor of Nursing Practice program.
Wednesday mornings, Endicott reviews lab results and her rounding schedule, which includes residents due for their routine check-ups as well as anyone whose condition has changed. She rounds with the RN Care Coordinator in each of the skilled nursing facility’s four units.
“Nurses are paramount in long-term care,” says Endicott. “The unit RN’s here are so skilled and know the residents so well. They observe changes in condition that need my attention. Our RN Care Coordinators have advanced nursing skills, the ability to work autonomously and make care decisions with confidence. It’s called ‘skilled nursing’ for a reason.”
As in other long-term care organizations, nurses here are central to assessments and decision-making, care coordination and interprofessional collaboration. In addition to Endicott, four physicians rotate seeing patients. Occupational and physical therapists work with residents as needed, and there are social workers and a registered dietician on staff. It is the RN’s who are the thread of consistency, guiding residents’ medical care and their well-being.
Advanced practice nurses like Endicott provide leadership in long-term care settings. They can diagnose and treat, while observing patterns and considering residents in the context of their health, wishes, family and community. The practice of nursing is based in helping achieve optimal wellness no matter what the current state, and helping the patient and family respond in the situation.
During rounds, Endicott asks a woman who had experienced a stroke, “How has your mood been?” The woman bursts into tears. Her husband, who visits her daily, confirms that this has been happening frequently.
Endicott gently strokes the resident’s arm and wipes her tears, explaining that changes in the brain after a stroke can cause depression and uncontrollable emotions. She suggests starting a therapeutic anti-depressant. “I’ll check in next week to see how you’re doing,” she promises.
Long-term care organizations that add nurse practitioner providers can reduce hospitalizations and emergency room transfers, according to a study of nursing homes.
At this skilled nursing facility, Endicott is the only provider on staff with a board certification in geriatrics. This informs her approach of routinely reviewing residents’ medications and looking for changes in functional status that may be caused by medications. De-prescribing is common; Endicott and her physician colleagues work to get the medication list to the least amount needed to control chronic disease and maximize quality of life.
“Geriatric nursing is complex and provides many opportunities to affect positive changes with individual patients, families and communities,” says Endicott. “Providing excellent care for older adults means learning about their rich histories—not just health histories, but family life, support systems, goals and worldview. I truly feel I make a difference.”