SHARON H. FITZGERALD

Senior housing options from assisted living to nursing homes all face a similar challenge: finding nurses with a desire and the special training needed today to care for America’s aging population.

“It’s really difficult for three reasons: No. 1, there are not that many nurses in general who are trained geriatrically. That does not mean that they have to be geriatric nurses, but that in their curriculum they actually have significant exposure to the issues related to caring for an elderly population,” explained Robyn Stone, DrPH, executive director of the Institute for the Future of Aging Services (IFAS) in Washington, DC. “Secondly, there is almost no specific training on how to be a nurse in long-term care settings, whether that’s a skilled-nursing environment or assisted living or home care or adult day.

There’s very little emphasis in most of the formal curriculum around those specific issues. Finally, it’s very hard to attract nurses into long-term care. They are much more interested in going into acute care. They’d rather work in an ICU. It’s much more sexy, it pays better and nursing students are often even discouraged from going into a long-term care setting. So you’ve got all those problems to deal with.”

IFAS tries to attack the problem with a three-pronged approach, creating bridges between practice, research and policy. In fact, after Stone completed an interview with Medical News, she was on her way to Capitol Hill to testify before the U.S. Senate Special Committee on Aging regarding the shortage of nurses trained in geriatrics.

“I believe we need to start talking about how we get an investment from the public side as well as the private side in supporting the kind of training and education that will lead to these professions, and to identify these as careers as opposed to a default position that you go into when you don’t want to be in a hospital anymore,” she said.

That scenario sometimes results in older nurses taking care of aging patients or nurses who stay at one senior facility for a long time “and just age in place,” she said. “We’ve just got to turn that around.” One way to do that is to further develop formal education tracks, curricula and clinical training sites that provide students optimal education and experiences in the discipline, she pointed out.

Stone acknowledges that the efforts of her organization and others are stymied by an image problem when it comes to geriatric nursing, that student nurses and younger nurses picture only frail, elderly patients.

“Certainly at the individual level, we have to start creating images of the profession of nursing in long-term care as a very complex and exciting and challenging environment, particularly for nurses who are interested in managing as well as clinical,” she said. “A lot of what happens in long-term care is about managing systems and managing people as well as clinical oversight and clinical work.”

Patty Franklin, program manager of Building Academic Geriatric Nursing Capacity (BAGNC), agreed the image problem is a stumbling block. “You think of the nursing home with people who are in end-stage dementia, and student nurses find that’s not as enticing as other fields,” she said. “Really, the numbers of elderly who are in nursing homes is very small. About 4.5 percent of older adults are living in nursing homes, and the rest are living in communities with us.”

BAGNC is a program coordinated by the American Academy of Nursing, and since 2000 has worked to increase geriatric nursing training and geriatric research on university and college campuses. The program was launched with a $5.2 million grant from the New York City–based John A. Hartford Foundation, founded with the sole purpose of improving the healthcare of older Americans. In 2005, the foundation renewed the BAGNC grant, to the tune of $10.5 million. The Atlantic Philanthropies and the Mayday Fund also support the initiative.

Franklin said the Hartford Foundation identified nursing care as a critical issue for the elderly, and each year, much of the Hartford grant goes to fund scholarships for geriatric nursing’s future leaders.

“To date, we’ve awarded 154 awards to nurses in PhD programs as well as PhD-prepared nursing faculty to conduct research in the area of geriatric nursing. These are researchers early in their careers,” Franklin explained, noting the students enrolled in doctoral programs have a career goal to assume a faculty position at a school of nursing.

“We have an aging nursing workforce, and we also have an equally aging nursing faculty workforce. So this is an initiative to really accelerate the numbers of nursing faculty and especially nursing faculty prepared in geriatric nursing,” she said, noting the shortage of geriatrically trained nurses is much worse than the much-publicized nursing shortage as a whole. Fewer than 1 percent of the nation’s 2.2 million registered nurses are certified in gerontology, and only 3 percent of advanced-practice nurses specialize in gerontology.

“Geriatrics is a relatively young field, recognizing that an 80-year-old is not just an older 40-year-old adult, just like a 3-year-old is not just a very young adult,” she explained. “The 65 and older group have very specific needs and health issues that are not going to be treated the same as you would treat a 40-year-old or a 20-year-old adult. That field needs to build its science, and we are seeing significant research being conducted in this field, which will inform practitioners on the best, evidence-based way to care for elderly people and develop programs of care that will maintain and improve their health and effectively treat any of their disorders.”

Helping in that goal are the nation’s five Hartford Centers for Geriatric Nursing Excellence at universities across the country, and another one is expected to be announced later this year. “Every day, we’re learning more about effective care and responsive care to the elderly,” Franklin said. “People are living longer, and their lives are more engaged with the community. They’re a wonderful resource for us as our population ages, and we can learn from them. It’s just a wide, wonderful, open area for nursing.”

It’s certainly the reality as well. No nurse escapes geriatric nursing, since 46 percent of patients, even in critical care, are 65 and older. Fifty percent of hospital days are people 65 and older, and most specialty ambulatory-care visits are for the geriatric population. Primary care visits? About 60 percent are elderly. Home health? 70 percent.



September 2007