Creating order out of chaos: models of GNP practice with hospitalized older adults

It has been well documented that hospitalization of an older adult can trigger a cascade of events that negatively affect quality of life long after hospitalization. Three models of care directed by hospital-based geriatric nurse practitioners (GNPs) are described. The GNPs' roles include primary care provider, consultant, educator, researcher, and/or administrator. In one model, the GNP collaborated with a multi-disciplinary team to create a clinical pathway, the Functional Recovery Pathway. In the second model, the GNP and nurse manager addressed the issue of fall risk with an education program for the staff. As a result, the fall rate decreased 5.8%. In a third model, the GNP coordinated care of hospitalized nursing home residents in a "scatter bed" program. Working synergistically with a case management program, the length of stay for this group of patients decreased from a median of 12 days to 9 days in the first year to 6.8 days in the third year. All three models showed that the GNP facilitate change, improve resource utilization, and create innovative strategies to optimize care for hospitalized elders.