Looking Back to Move Forward

Looking Back to Move Forward

Claire M. Fagin Mathy Mezey Neville Strumpf Cornelia Beck Susan Reinhard

Looking Back to Move Forward

1987 27Centers of Excellence in Geriatric Medicine

Major source of geriatric faculty Increased prestige, credibility, status and internal

funding

Looking Back to Move Forward

1996 Hartford Institute for Advancing Geriatric

Nursing Practice

1998 Hartford Social Work Faculty Fellows Program

Looking Back to Move Forward

2000 Multidisciplinary Expert Panel

Presented white papers on state of the science in geriatric nursing

<.005% of U.S. RNs certified in geriatrics <25% of SON had required geriatric courses or faculty to teach

geriatrics <5% of APN students were pursuing geriatric specialty 16% PhD programs surveyed had a primary interest in geriatrics 16% of NINR funded programs specific to geriatrics

Looking Back to Move Forward

2000 5 Centers of Geriatric Nursing Excellence Predoctoral & Postdoctoral Award Program

2001 Nursing School Geriatric Investment Program

2007 4 Additional Centers of Geriatric Nursing Excellence

Looking Back to Move Forward

• BAGNC; 10 years of investment

2005 20082001 20042000 2010

$7.8

$2.2 $1.2

$10.4

$7.2

Total$31.8

2003

$3.0

Looking Back to Move Forward

As of July 1, 2010102 completed 2 year predoctoral scholarship 4 completed 2 year MBA scholarship 70 completed 2 year postdoctoral fellowship

Looking Back to Move Forward; 2001

Looking Back to Move Forward; 2010

Looking Back to Move Forward

Panel Members Mathy Mezey Neville Strumpf Cornelia Beck Susan Reinhard

Mathy Mezey, EdD, RN, FAAN NYU College of Nursing,

Hartford Institute for Geriatric Nursing

Looking Back to Move Forward: Focus on Practice

Panel 1: Looking Back to Move Forward: Focus on PracticeMathy Mezey, EdD, RN, FAAN, NYU College of Nursing, Hartford Institute for Geriatric Nursing

Focus of Presentation

• Achieving geriatric competency of all nurses• Structuring clinical settings to be receptive to

best-practice in care of older adults– Creating competencies and resources for the

individual nurse– Creating system change

Context of geriatric nursing over

the past 10 years • We have been supported by an unusually strong

commitment to geriatric nursing by foundations (JAHF: Atlantic Philanthropies; the Commonwealth Fund)

• Several key reports (IOM; Macy Foundation) have emphasized the need to “re-tool” for an aging America

• The aging of the “baby boomer” generation is clearly driving a new look at aging

Conceptual changes in geriatric nursing

• Movement towards geriatric competency for all practicing nurses rather than primarily specialization in geriatrics

• Movement towards language of “care of older adults” and away from “geriatrics”

• Movement towards a systems approach in the practice setting in addition to a focus on the individual nurse

Achieving geriatric competency of all nurses: The education “pipeline”

Entry-level nurses– AACN Baccalaureate Competencies– AACN/HI GNEC program– NLN Advancing Care Excellence for Seniors (ACES)

Graduate nurses– AACN Adult/Gerontology NP and CNS Competencies– AACN/HI Resources for Adult/Gerontology NPs and CNS

Programs

Achieving geriatric competency of all nurses: Reaching the practicing nurse

• Nurses in specialty practice: the REASN project

• The Adult-Gerontology Nurse Practitioner and Clinical Nurse Specialist (the LACE model)

• The STTI Center for Nursing Excellence in Long-term Care

Specialty nurses

• 60+ associations representing >500,000 nurses

• Associations have developed products specific to care of older adults– Critical Care Nurses Association– Emergency Room Nurses– Oncological Nurses Association

Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on the individual nurse

• Competencies:

– The Hartford Institute Geriatric Nursing Hospital Competencies

– Geropsychiatric Nursing Collaborative Core Competencies

– Nurse Competencies for Nursing Home Culture Change (Pioneer Network)

• Evidence-based Resources (web-based and print)

– Assessment tools (e.g. Try This ®)

– Practice protocols

– Age specific and specialty nurse Web sites

– Texts

Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on achieving system change

• NICHE (Nurses Improving Care to Healthsystems Elders)

• AONE’s Guiding Principles for the Elder-Friendly Hospital/facility and the Role of the Nurse Leader

• Transitional care models• Resident-directed care & culture change

movement in nursing homes

NICHE

• >350+ NICHE hospitals in North America• A systems approach to improving care to

older adults• Specific role for the geriatric APRN• Use of evidence-based models, e.g. the

Geriatric Resource Nurse (GRN)• Implementation of geriatric protocols and QI

indicators

Concluding observations

• “Pipeline” entry and graduate nursing students are now likely to graduate with competencies in care of older adults

• Practicing nurses have access to a wide variety of competencies and resources in care of older adults

• Health systems still have a lot to do to be receptive to best-practices in care of older adults

• Yet to be fully explored and implemented is the role of inter-disciplinary teams in care delivery to older adults

Neville Strumpf, PhD,RN, FAAN

Looking Back to Move Forward: Focus on Education

Cornelia Beck, PhD, RN, FAAN

Looking Back to Move Forward: Focus on Research

Susan Reinhard, PhD, RN, FAAN

Looking Back to Move Forward: Focus on Policy