St. Luke's Nursing Home

PLANNED CHANGE AT ST. LUKE'S NURSING HOME

The St. Luke's Nursing Home is a 200bed facility located in a metropolitan service area of approximately 200 thousand persons. The funding for the facility is derived from both public and private sources.

The administration of the St. Luke's Nursing Home is confronted with a critical need to reduce operating costs. At the same time, however, the institution was criticized during a recent state inspection for providing unacceptable levels of patient care in many instances. The administration, thus, feels that it is on the horns of a dilemma.

There exists a widespread recognition in the early1990s, that changes in health care delivery practices are essential, if the cost of services delivery is to be controlled, while either maintaining or improving care levels (DenteCassidy, 1992, pp. 4345). Such changes are of particular relevance when special care services, such as mental health, are involved (Merwin and Fox, 1992, pp. 139148). A contemporary movement in many contemporary health care services institutions is a move toward a more patientfocused care practice (Brider, 1992, pp. 2633). Among other things, patientfocused care requires a decentralization of authority and action. Critical in this context is the ending of the oft times rigid lines of practice jurisdiction between health care professionals within an institution. Consistent wit

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values, advances in treatment therapies, and many others), the delivery of health care services in the United States is undergoing rapid and important change. One of the more significant of the changes occurring involves the direct delivery of health care services by non physician health care professionals. There exists both substantial support for this trend, as well as substantial opposition to it. Nurse practitioners are among the most prominent of the non physician health care professionals involved in the direct delivery of health care services to patients. Nurse practitioners engage in the delivery of a wide variety of health care services without the direct supervision of physicians. The role of the nurse practitioner may not be best described, however, in terms of independence and dependence upon physician supervision. The role of the nurse practitioner is best viewed in the context of a primary health care team. When viewed in the team context, the role of the nurse practitioner appears as less of a departure from accepted practice, and more as an expected and a desirable evolution in the delivery of effective health care services. Opposition to nurse practitioners will still be present; however, it is more dif

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