APRNs on the GO

Article excerpt

Advanced practice RNs play a key role in a behavioral healthcare program reaching long-term care residents

Established a decade ago, a unique partnership involving long-term care (LTC) facilities and a community hospital's inpatient psychiatric unit and outpatient services in south-central Nebraska provides behavioral healthcare to LTC facility residents. The Geriatric Outreach (GO) Program has several key goals:

* manage psychotropic agents taken by LTC residents to foster their continued stabilization (In this article, "LTC residents" includes those in skilled nursing, assisted living, and other senior care environments);

* reduce psychiatric inpatient hospitalizations of LTC residents;

* provide ongoing behavioral healthcare resources for LTC staff, residents, and families; and

* fulfill related regulatory requirements.

Participating agencies include, but are not limited to, the following:

* 19 LTC facilities (home to 445 residents) in south-central Nebraska;

* Mary Lanning Memorial Hospital (MLMH) and its Behavioral Services Unit (BSU) in Hastings, Nebraska; and

* MLMH's outpatient behavioral service clinics, offering community mental health services in Hastings and York.

In the GO Program advanced practice registered nurses (APRNs) play a key role in coordinating continuity of care for seniors in LTC settings. When the GO Program began, three to four multidisciplinary team members would visit LTC facilities, but the GO Program ultimately streamlined to use APRNs for direct resident care. The GO Program uses APRNs certified by the American Nurses Credentialing Center to handle the integrative complexities of coordinating the individual needs of the severely and persistently mentally ill and the healthcare systems serving their needs. The GO Program's APRNs:

* provide psychiatric consultation/evaluation for residents in LTC facilities;

* manage residents' medications (e.g., monitor lab results and screen for drug interactions);

* offer treatment strategy recommendations; develop in-service trainings for LTC facility staff; and

* make referrals for inpatient treatment (LTC facilities reserve a place for residents admitted to the BSU until discharged, ensuring their placement once their inpatient care is complete).

APRNs with questions can turn to the expertise offered by the staff at MLMH's outpatient services (i.e., the Lanning Center), which operates a 24/7 call center. The Lanning Center also provides individual, family, and group therapy for LTC residents who can visit the center; psychological testing and assessments; and medication management and therapy following BSU discharge.

Now in its 11th year, the GO Program continues to evolve. With initial program goals now met, more long-term benefits the GO Program is hoping to achieve include reducing injuries caused by residents with behavioral health issues to themselves, visitors, and staff, as well as increasing retention of staff members who work with residents with behavioral health issues. LTC facility administrators, directors of nursing, social workers, and direct nursing care providers have been impressed by the GO Program, and LTC facilities in the region continue to request to be involved. One LTC facility administrator stated, "Through the Geriatric Outreach Program we are able to...promote or maintain the resident's highest... mental, physical, and psychosocial well-being." Another commented, "We have found that the Geriatric Outreach Program to be an amazing resource, they have done remarkable things with our patients."

The GO Program demonstrates a successful and growing long-term commitment to the larger community of vulnerable residents, their loved ones, and caregivers on the part of a comprehensive and dynamic hospital-based nonprofit organization using a cost-effective and versatile profession: APRNs. We encourage further exploration of the APRN role in relation to seamless care in community behavioral healthcare programs. …