Looking Back to Move Forward

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• Looking Back to Move Forward

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Looking Back to Move Forward

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

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Looking Back to Move Forward

• 1987
• 27Centers of Excellence in Geriatric Medicine
• Major source of geriatric faculty
• Increased prestige, credibility, status and
  internal funding

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Looking Back to Move Forward

• 1996
• Hartford Institute for Advancing Geriatric
  Nursing Practice

• 1998
• Hartford Social Work Faculty Fellows Program

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Looking Back to Move Forward

• 2000
• Multidisciplinary Expert Panel
• Presented white papers on state of the science in
  geriatric nursing
• lt.005 of U.S. RNs certified in geriatrics
• lt25 of SON had required geriatric courses or
  faculty to teach geriatrics
• lt5 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

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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

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Looking Back to Move Forward

• BAGNC 10 years of investment

2005
2008
2001
2004
2000
2003
2010
Total 31.8
1.2
2.2
7.2
10.4
3.0
7.8
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Looking Back to Move Forward

• As of July 1, 2010
• 102 completed 2 year predoctoral scholarship
• 4 completed 2 year MBA scholarship
• 70 completed 2 year postdoctoral fellowship

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Looking Back to Move Forward 2001
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Looking Back to Move Forward 2010
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Looking Back to Move Forward

• Panel Members
• Mathy Mezey
• Neville Strumpf
• Cornelia Beck
• Susan Reinhard

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

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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

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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

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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

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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

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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

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Specialty nurses

• 60 associations representing gt500,000 nurses
• Associations have developed products specific to
  care of older adults
• Critical Care Nurses Association
• Emergency Room Nurses
• Oncological Nurses Association

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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

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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)
• AONEs 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

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NICHE

• gt350 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

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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

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Neville Strumpf, PhD,RN, FAAN
Looking Back to Move Forward Focus on Education
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Cornelia Beck, PhD, RN, FAAN
Looking Back to Move Forward Focus on Research
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Susan Reinhard, PhD, RN, FAAN
Looking Back to Move Forward Focus on Policy