Why consider transitional care nursing?
An aging population and the Affordable Care Act have increased demand for transitional care, says Karen Jamison, PhD, a registered nurse who teaches in the nurse practitioner program at the University of Phoenix Main Campus.
“This area of nursing deals with transitioning high-risk patients from the hospital to the lowest level of care appropriate for their conditions, be it a nursing home, assisted living facility or their own homes,” Jamison explains.
Here’s why nurse practitioners might want to consider this growing specialty:
“The elderly and permanently disabled use up a high percentage of health care resources,” Jamison says, noting that the concept of transitional care evolved to address this situation. “Hospitals are not necessarily the best or safest places for people with stable chronic conditions like COPD [chronic obstructive pulmonary disease] or congestive heart failure."
Under the Affordable Care Act, Medicare may reduce payments for hospital readmissions for the same condition within 30 days, and Jamison notes that this new policy is creating opportunities for nurses to manage chronically ill patients outside hospitals.
Betty Parisek, EdD, an acute care nurse and area chair of the nursing program for the College of Health Sciences and Nursing at the Phoenix Main Campus, agrees. She cites a study by the Coalition for Evidence-Based Policy, which found transitional care can reduce unnecessary rehospitalizations by 30 to 50 percent, while saving almost $4,000 per patient. Health care providers are hiring more transitional care nurses as a result, she says.
“You have to be very independent and confident in your nursing abilities to do this work,” says Jamison, whose office is in her home. She notes that she visits patients at health care facilities and in their private residences as well. “You also need to know when to ask for help and support from other health care providers,” such as physicians, physical therapists and home health aides, she adds.
Parisek says this kind of independence was key when she had a transitional care practice, adding, “I enjoyed the autonomy and flexibility of scheduling visits.”
Professional and personal growth
Transitional care nursing is ideal for those looking to put their years of professional experience to the test, Jamison says. “You have to be a seasoned nurse practitioner to make most transitional care decisions or lead a team,” she says, noting that nurses with bachelor’s degrees can enter the field as support staff.
“The [BSN]-level nurse can do things like deliver medications and contact allied health resources to give the nurse practitioner more time to devote to complex cases,” Jamison explains, as well as help the medical provider by performing physical assessments, monitoring medications and being a gatekeeper for medical services.
Parisek notes that transitional care nursing is intellectually challenging as well. “It incorporates the skills of a nurse, case manager and patient advocate — and knowledge of evidence-based care,” she says. “[It] allows for one-on-one interaction with patients and families … [which] can be quite rewarding.”
In addition to reducing health care costs, helping patients stay out of the hospital has other benefits, Parisek says.
“[Transitional care] is a type of public health nursing that benefits not only patients, but communities as well, in terms of keeping people productive” and contributing to society, she says. “I have always personally loved nursing that allows for more holistic care … that takes into account the patient’s environment and family needs.”