Role of the geriatric nurse practitioner in the healthcare team

Nurse practitioners (NPs) and other advanced practice nurses take on tasks previously reserved for doctors, independently or under supervision, as part of a change in the skill mix of the care team.

The need: growing numbers of older people with chronic disease and multimorbidity, heavy workloads for doctors, and few medical students choosing careers in the care of older people.

Clinical care: consultations in the practice and at home for people who cannot attend, often for less complex patients, so that doctors can concentrate on the most complex.

Proactive care: preventive home visits and screening for frailty with a full or partial geriatric assessment.

Long-term conditions: within the same team, practice nurses run protocol-led care of chronic diseases such as diabetes, COPD and heart failure, while NPs work more independently.

Coordination: organising multidisciplinary meetings, acting as liaison between general practitioners and district nurses, and developing care pathways.

Supporting care teams: coaching, educating and training staff in residential and home care, and being an accessible point of contact for the team.

Continuity and person-centred care: often the main care provider for older people, knowing their social networks, accessible to patients and families, holistic and proactive.

In nursing homes, they substitute for or support physicians; stakeholders report better quality of care, more patient-centred care and stronger support for care teams.

In a Swiss randomised trial in people aged 80 and over, an advanced practice nurse programme (comprehensive geriatric assessment, then four home visits and three phone calls over 9 months) reduced acute events (relative risk 0.70), falls (0.71) and hospital admissions (0.70), although quality of life did not change.

Responsibility: in general practice the doctor often keeps final responsibility, though some NPs share it; boundaries should be agreed and documented where possible.

The doctor's role shifts towards coordination and complex patients, with a lower workload but less patient contact.

Barriers to making the most of the role: no clear vision of it in organisations, variable acceptance, and legal uncertainty about tasks and responsibilities.