Besides high costs and hospital reputation issues, readmission rates directly influence the role of all health care providers in general and the mission of nurse practitioners in particular. In broadest terms, the medical practices associated with preventing readmission have considerably increased in number and complexity (Schoenfeld, 2016). As a result, a whole range of new responsibilities has been imposed on nurse practitioners, whose successful performance in this area largely predetermines the statistical outcomes (contributing to their job satisfaction at the same time) (Donzé, Aujesky, Williams, & Schnipper, 2013).
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Here are some new components that have been added to the role of nurse practitioners in connection to increased readmission rates:
- Nurse practitioners have to perform a comprehensive analysis to understand which groups of patients run the highest risks of readmission. It is necessary for being able to address the most difficult cases in due time before the discharge. For instance, uninsured patients are more likely to be rehospitalized than those who have private insurances. It does not mean, however, that nurses can neglect other patients – their role is to provide equally competent care shifting the focus of attention according to the situation (David, Britting, & Dalton, 2015).
- Nurse practitioners must be able to establish successful communication with patients who do not speak English or have very limited knowledge of it. Such patients constitute a separate risk group. If an interpreter’s services are unavailable, a nurse practitioner is responsible for delivering all the necessary information that could help avoid readmission caused by communicative failures (Hamric, Hanson, Tracy, & O’Grady, 2013).
- Nurse practitioners must participate in educational programs that are aimed at upgrading their theoretical knowledge and practical skills in readmission avoidance. It is important to ensure their awareness of required qualifications as well as the most recent methods that can help eliminate the risks of readmission (David, Britting, & Dalton, 2015).
- Nurse practitioners must constantly collaborate with other health care providers to share their practices and strategies that they use to reduce readmission rates. Teamwork is especially helpful in identifying the causes of readmissions and devising ways to address similar cases to save time for unprecedented ones (Buppert, 2014).
- Nurse practitioners have to participate in a follow-up program. It has been proven that patients who continue to be supervised (especially during the first week after the discharge) are much less likely to be rehospitalized. Nurse practitioners must arrange follow-up visits to patients’ homes and identify if they have recovered completely or further medical interference is required (Buppert, 2014).
- Nurse practitioners must be able to provide post-discharge care that would maintain patients’ health. It is crucial not only to check if patients have problems immediately after the discharge but also to provide all the necessary means for preserving the results. It especially concerns chronically ill patients who cannot recover completely and need continuous care (David, Britting, & Dalton, 2015).
- Nurse practitioners must provide smooth transitional care by giving clear post-discharge directions to patients and their families. They should make sure that patients know enough about their condition and can render themselves first medical aid in case of emergency. Besides, patients must know what kind of lifestyle they must adhere to (a recommended diet, physical activities, etc.). All these measures help achieve a significant decrease in readmission rates (Buppert, 2014).
- Nurse practitioners should be able to deal with telemonitoring technology installed at patients’ homes. It implies the ability to understand the data sent by personal transmitters and to give effective instructions to patients to follow at home step by step, which would help them manage without visiting a hospital (Buppert, 2014).
As it is evident from the new responsibilities nurse practitioners have, the problem of hospital readmission has considerably complicated and extended their role in health care delivery. They are now concerned not only with direct health care services provided while patients stay in hospital but also with post-discharge care, which also includes a whole number of activities. This new role may tell positively and negatively on nurse practitioners’ job satisfaction as they can feel both more significant and much more overloaded with work. It means that it is highly essential for them to apply the most reliable strategies to achieve visible results. Otherwise, nurse practitioners may encounter the problem of the loss of their professional confidence and consequent disappointment in their qualifications, which makes many of them quit their jobs (De Milt, Fitzpatrick, & McNulty, 2011).
Competencies and/or Characteristics of the Nurse Practitioner that can be Employed to Resolve the Issue
The significance of the nurse practitioner’s role in reducing hospital readmission rates is largely explained by a wide range of competencies and personal characteristics that he/she is supposed to possess. Taken together, they contribute to the common efforts of health care providers aimed to resolve this issue. They include:
- Scientific competences (Buppert, 2014):
- a nurse practitioner has enough knowledge and skills to analyze evidence of readmission risk groups;
- he/she can synthesize all the data about the patient (his/her cultural background, social status, the general state of mental and physical health);
- he/she can integrate various theories and studies to decide which approach would be effective in each readmission case.
- Leadership characteristics (Hamric et al., 2013):
- a nurse practitioner can assume the role of a leader if there is no one else to take responsibility for the decision about whether readmission is required;
- he/she is comfortable while interacting with stakeholders (including policymakers) if he/she is required to persist in his/her point;
- he/she promotes innovative practices and principles of change implementation among his/her coworkers to inform them about the necessity of the collaborative effort needed to resolve the issue;
- he/she can communicate her point of view concerning the reasons and the necessity of each case of readmission to the upline executives (both orally and in writing).
- Quality competences (Buppert, 2014):
- a nurse practitioner accumulates knowledge about the problem for being able to apply it in clinical practice with the purpose to improve its quality;
- he/she is capable of estimating the cost, safety, health consequences, and general implications for health care in each particular case of rehospitalization;
- he/she can evaluate what can be changed in organizational structure, health care processes, funding, and communicative approach to achieve the greatest impact on readmission rates reduction;
- he/she is willing to promote the culture of excellence both among her colleagues and patients (especially those who are in risk groups).
- Practice inquiry competencies (Hamric et al., 2013):
- a nurse practitioner can use not only the deductive approach (applying general theories to practical nursing) but also the inductive one, which implies being able to generalize facts obtained from practice and make conclusions about which cases of readmission are common, what actions of patients lead to a readmission or which intervention procedures prove to be most effective;
- he/she is ready to improve her investigative skills if they are insufficient for affecting the outcomes;
- he/she leads practice inquiry both on his/her own or in collaboration with other sides involved;
- he/she is careful and attentive enough to collect and record all the evidence from the inquiry performed and disseminate the data to various audiences involved in the issue using all the modalities available.
- Technological literacy competencies (Hamric et al., 2013):
- a nurse practitioner possess enough knowledge of all the recent medical technologies that contribute to the advanced health care;
- he/she can implement this knowledge of technologies during the translational period after the discharge to ensure that the patient stays under supervision;
- he/she can coach patients and caregivers for them to be able to change their habits in technology application;
- he/she can demonstrate his/her skills when it concerns decision-making practices (e.g. the ability to estimate whether the patient needs to be readmitted or he/she can be safely monitored using personal technological devices);
- he/she is competent enough to participate in the development of clinical information systems that can improve the quality of health care;
- he/she can track data on dependent and independent variables to be able to do correct evaluations.
- Policy competences (Buppert, 2014):
- a nurse practitioner can understand the interrelation of policy and practical nursing;
- he/she can analyze financial, social, legal, and other factors that influence policy development connected with the issue of readmission;
- he/she possesses enough competences to be able to provide evidence that could change the health policy;
- he/she can estimate what policy changes are required and which of them are possible to achieve as well as the impact they could have on readmission rates.
- Health delivery system competencies (Buppert, 2014):
- a nurse practitioner possesses advanced communicative skills that allow him/her establish contact with patients to be able to perform a more accurate evaluation of their state;
- he/she has the primary objective of minimizing the risk of readmission for the patients who are likely to be rehospitalized;
- he/she facilitates the development of practices that take into consideration the cultural diversity of the population to address the culturally-specific needs of patients belonging to minority groups.
- Independent personal characteristics (Buppert, 2014):
- a nurse practitioner can account for his/her actions no matter how guilty he/she may be in hospital readmission of a patient;
- he/she feels personal responsibility for her actions both in the process of health care delivery and after the discharge;
- he/she tries to establish long-lasting relations with patients that are based on mutual trust, respect, collaboration, and support;
- he/she never projects her problems on patients and never tries to advance the discharge to get rid of an undesired patient.
All these competencies and personal qualities of nurse practitioners overlap and complement one another. It is highly important to remember that a nurse practitioner is not a medical tool that can be used for certain purposes but a highly professional specialist and a sympathetic individual, whose qualities are valuable in resolving the issue.
Buppert, C. (2014). Nurse practitioner’s business practice and legal guide. Burlington, MA: Jones & Bartlett Publishers.
David, D., Britting, L., & Dalton, J. (2015). Cardiac acute care nurse practitioner and 30-day readmission. Journal of Cardiovascular Nursing, 30(3), 248-255.
De Milt, D. G., Fitzpatrick, J. J., & McNulty, S. R. (2011). Nurse practitioners’ job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider. Journal of the American Academy of Nurse Practitioners, 23(1), 42-50.
Donzé, J., Aujesky, D., Williams, D., & Schnipper, J. L. (2013). Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Internal Medicine, 173(8), 632-638.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced practice nursing: an integrative approach. New York, NY: Elsevier Health Sciences.
Schoenfeld, A. J., Zhang, X., Grabowski, D. C., Mor, V., Weissman, J. S., & Rahman, M. (2016). Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery. Surgery, 159(5), 1461-1468.