- Email: [email protected]
Hartford Gerontological Nursing Leaders: From Funding Initiative to National Organization
HARTFORD GERONTOLOGICAL NURSING LEADERS: FROM FUNDING INITIATIVE TO NATIONAL ORGANIZATION☆ JANET H. VAN CLEAVE, PHD, RN*, SARAH L. SZANTON, PHD, ANP†, CASEY SHILLAM, PHD, RN-BC‡, KAREN ROSE, PHD, RN, FAAN§, ADITI D. RAO, PHD, RN||, ADRIANA PEREZ, PHD, ANP¶, MELISSA O'CONNOR, PHD, MBA, RN, COS-C#, RACHEL WALKER, PHD, RN, OCN**, BILL BURON, PHD, APRN, FNP/GNP-BC††, MARIE BOLTZ, PHD, RN, GNP-BC‡‡, JENNIFER BELLOT, PHD, RN, MHSA, CNE§§, AND MELISSA BATCHELOR-MURPHY, PHD, RN-BC, FNP-BC||||, ON BEHALF OF THE HARTFORD GERONTOLOGICAL NURSING LEADERS POLICY AND LEADERSHIP COMMITTEE In 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program initiative, acknowledging nursing's key role in the care of the growing population of older adults. This program has supported 249 nurse scientists with pre- and postdoctoral awards. As a result of the program's success, several Building Academic Geriatric Nursing Capacity Program awardees formed an alumni organization to continue to advance the quality care of older adults. This group of Building Academic Geriatric Nursing Capacity Program awardees joined others receiving support from the John A. Hartford Foundation nursing initiatives to grow a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The purpose of this article is to present the development, accomplishments, and challenges of the HGNL, informing other professional nursing organizations that are experiencing similar accomplishments and challenges. This article also demonstrates the power of a funding initiative to grow an organization dedicated to impact gerontological health and health care through research, practice, education, and policy. (Index words: Academic; Aged; Policy; Education; Practice; Nursing; Geriatrics) J Prof Nurs 0:1–7, 2015. © 2015 Elsevier Inc. All rights reserved.
E
ACH DAY, 10,000 people in the United States celebrate their 65th birthday. By 2030, the number of older adults, 65 years and older, will increase from the current 48 million to 73 million. Further, the age group
85 years and older will be the fastest growing population segment, doubling in number from today's 6 million to 12 million by 2035 (United States Census Bureau, 2012). Nurses are on the forefront of caring for the growing number
*Assistant Professor, NYU College of Nursing, New York, NY, 10010. †Associate Professor, Johns Hopkins University School of Nursing, Baltimore, MD, 21205. ‡Associate Professor and Nursing Program Director, Western Washington University, Bellingham, Washington. §Associate Professor of Nursing, Assistant Dean for Research and Innovation, University of Virginia School of Nursing, Charlottesville, VA. ||Research Scientist, Hospital of the University of Pennsylvania, Philadelphia, PA. ¶Assistant Professor, Arizona State University College of Nursing & Health Innovation, Phoenix, AZ. #Assistant Professor, Villanova University College of Nursing, Villanova, PA. **Post-Doctoral Fellow, Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD. ††Assistant Dean for Nursing, Clinical Assistant Professor, University of Arkansas for Medical Sciences, Little Rock, AR. ‡‡Associate Professor, Boston College, William F. Connell School of Nursing, Boston, MA.
§§Associate Professor and Director, DNP Program, Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA. ||||Assistant Professor, Duke University School of Nursing, Durham, NC. ☆ Funding: This study was supported by The John A. Hartford Foundation, The National Hartford Center of Gerontological Nursing Excellence, and The National Hartford Center of Gerontological Nursing Excellence Patricia G. Archbold Pre-doctoral Scholar Awards and Claire M. Fagin Fellowships. Address correspondence to Dr. Van Cleave: Assistant Professor, NYU College of Nursing, 433 First Avenue, New York, NY 10010. E-mail: [email protected] (J.H. Van Cleave), [email protected] (S.L. Szanton), [email protected] (C. Shillam), [email protected] (K. Rose), [email protected] (A.D. Rao), [email protected] (A. Perez), [email protected] (M. O'Connor), [email protected] (R. Walker), [email protected] (B. Buron), [email protected] (M. Boltz), [email protected] (J. Bellot), [email protected] (M. Batchelor-Murphy) 8755-7223/15
Journal of Professional Nursing, Vol 0, No. 0 (July), 2015: pp 1–7 © 2015 Elsevier Inc. All rights reserved.
1 http://dx.doi.org/10.1016/j.profnurs.2015.06.004
2
ARTICLE IN PRESS
of older adults. Consequently, the need for increasing gerontological nursing capacity grows stronger every day. Acknowledging the importance of gerontological nursing to the nation's health, in 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program. Since 2000, this program has supported 249 nurse scientists with preand/or postdoctoral awards. As a result of the program's success, several current and past Building Academic Geriatric Nursing Capacity awardees formed an alumni organization to extend their influence through networking and collaboration in scholarly endeavors. This group of Building Academic Geriatric Nursing Capacity awardees has grown into a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The HGNL members' accomplishments include conducting research on evidence-based practice initiatives, influencing faculty development, and promoting leadership opportunities. Recognizing that public policy impacts gerontological health care, HGNL members also focus on creating new paths to influence public policy. The purpose of this article is to present HGNL's development, accomplishments, and challenges, demonstrating the power of a single funded initiative to grow an organization dedicated to impacting gerontological research, practice, education, and policy. By presenting HGNL's experience, this article can inform other professional nursing organizations that may be facing similar growth and challenges.
From Geriatric Nursing Initiative to National Organization The underpinnings of the HGNL organization began in 2000 when the John A. Hartford Foundation partnered with the American Academy of Nursing to form the Building Academic Geriatric Nursing Capacity initiative. The Building Academic Geriatric Nursing Capacity Program had two goals: (a) to expand the scholarly and leadership base in geriatric nursing and (b) to establish centers of excellence in top-tier schools of nursing to enhance the schools' capacity to grow the next generation of gerontological researchers and leaders (Franklin et al., 2011). The Building Academic Geriatric Nursing Capacity initiative included predoctoral awards (later named the Patricia G. Archbold Predoctoral Scholar Award) and postdoctoral fellowships (later named Claire M. Fagin Fellow Award). As part of the Building Academic Geriatric Nursing Capacity initiative, pre- and postdoctoral awardees partnered with senior interdisciplinary mentors to undertake the critical work of research, leadership, and faculty development to advance gerontological nursing. In 2009, several past scholars and fellows formed an alumni organization to use their academic and leadership training to further advance gerontological nursing. The Building Academic Geriatric Nursing Capacity Alumni organization has since undergone multiple organizational changes while embracing the national trend toward interprofessional health care. These changes began
VAN CLEAVE ET AL
when their parent organization, the National Hartford Center of Gerontological Nursing Excellence (NHCGNE), moved from the American Academy of Nursing to become a planned unit of the Gerontological Society of America in July 2012. This move reflected the John A. Hartford Foundation's growing emphasis on interprofessional teams to promote health for older adults. Along with their parent organization, the Building Academic Geriatric Nursing Capacity Alumni also moved from the American Academy of Nursing to the Gerontological Society of America, and commenced organizational development planning under the direction of their parent organization. Between September 2012 and November 2013, the Alumni formally adopted a new name, HGNL. In November 2013, the HGNL ratified new organizational structure, rules, and guidelines to establish a more inclusive and robust organization. These organizational changes included a new mission to deliver quality care to older adults by providing nursing leadership and establishing strategic partnerships across all the gerontological disciplines. These organizational changes also formally expanded membership from those supported through the John A. Hartford Foundation's Building Academic Geriatric Nursing Capacity Initiative to all who have received support through any of the many John A. Hartford Foundation funding mechanisms, including membership in the NHCGNE. For example, the HGNL's monthly newsletter is sent to 245 individuals, including both the HGNL members and NHCGNE members. In 2015, to sustain HGNL's growth and mission, members voted to merge with their parent organization, National Hartford Center of Gerontological Nursing Excellence, forming a unified voice to influence gerontological health care (see Tables 1 and 2). Through small and large group activities, in a unified support of the mission, HGNL members have developed strong collaborative relationships resulting in publications, presentations, peer mentoring, and widespread networking. The group uses a variety of communication approaches including social media, newsletters, and email blasts. They are focused, strategically working together to impact the future of gerontological health and health care through engagement in research, practice, faculty and leadership development, and public policy.
Influencing Evidence-Based Practices HGNL members have generated important research that impacts gerontological evidence-based practice. As a framework for clinical practice, evidence-based practice integrates the best available scientific evidence with the expertise of the clinician and with the patients' preferences and values to make decisions about health care (Levin & Feldman, 2006; Straus, Richardson, Glasziou, & Haynes, 2005). The four components of evidencebased practice are evidence synthesis, translation, integration, and improvement science (Academic Center for Evidence-Based Practice (ACE), 2012). HGNL members have conducted research addressing all four components.
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
3
Table 1. HGNL Organization: Timeline of Events 2000 • John A. Hartford Foundation funds the Building Academic Geriatric Nursing Capacity Program 2009 • A small group of Building Academic Geriatric Nursing Capacity Program awardees form an alumni organization 2010 • The Building Academic Geriatric Nursing Capacity Alumni open their social media site on LinkedIn and hold their first business meeting 2012 • The Building Academic Geriatric Nursing Capacity Program moves to the Gerontological Society of America organization and forms the NHCGNE • The Building Academic Geriatric Nursing Capacity Alumni begin strategic planning to form an organization under the direction of the NHCGNE • The Building Academic Geriatric Nursing Capacity Alumni hold their first formal vote to elect Chair of the organization 2013 • The Building Academic Geriatric Nursing Capacity Alumni vote to change their name to HGNL and ratify new organizational structure, rules, and guidelines to establish a more inclusive and robust organization 2015 • HGNL members vote to merge with the NHCGNE
The collection of descriptive statistics of HGNL evidencebased practice activities is in progress. For this article, we present the following examples. HGNL members have published Evidence Syntheses that pose relevant clinical or policy questions, illuminate pertinent evidence, and critically appraise and synthesize studies (Petticrew & Roberts, 2006). These syntheses form the basis for practice guidelines and guide the formation of new research questions. For example, HGNL member Dr. Kristine Talley and colleagues (Talley, Wyman, & Shamliyan, 2011) published findings from their systematic review of interventions for urinary incontinence in frail older adults, an important and understudied problem. The researchers synthesized evidence from three randomized controlled trials and four quasi-experimental studies reporting urinary incontinence outcomes. From their analysis of urinary incontinence outcomes, the researchers determined that the strongest evidence favors multicomponent behavioral interventions, such as pelvic floor muscle exercises. HGNL members have conducted “translation” studies that promote and sustain adoption of evidenced-based practice (Chesla, 2008). These studies investigate which interventions work in various circumstances, types of settings and populations, and explicate how they are disseminated (Titler, 2010). For example, HGNL member Dr. Elizabeth Galik and colleagues (Galik, Resnick, Hammersla, & Brightwater, 2013) modified a functionfocused care intervention to meet the specialized needs of cognitively impaired nursing home residents. The researchers then conducted a cluster-randomized controlled trial to test the impact of the modified functionfocused intervention in nursing home residents with dementia. The study showed that residents with dementia who received the intervention experienced improved function, increased time and intensity of their physical Table 2. The HGNL Mission Consistent with the NHCGNE mission, the HGNL organization strives to enhance and sustain the capacity of gerontological nurses. The HGNL organization will provide leadership and partner with all disciplines to provide quality care to older adults through advancing nursing science, facilitating adoption of best practices, fostering nursing leadership potential and influencing public policy.
activity, and were less likely to fall. The researchers then translated the intervention to 20 assisted living sites, making significant changes in policies, environment, and care approaches. These changes led to positive trends in decreased falls, decreased hospitalizations, and number of emergency room visits (Resnick, Galik, & Vigne, 2014). HGNL members' research has supported the importance of “integration” of evidence-based practice into clinicians' skills, resources, and practices. This integration of evidence-based practice increases gerontological expertise and fosters interprofessional collaboration (Boltz et al., 2008; Rosswurm & Larrabee, 1999). One example is a study by HGNL member Dr. Mark Toles and colleagues (Toles et al., 2012). The team observed skilled nursing facility staff, residents, and caregivers to determine the transitional care processes used to prepare patients for discharge from the facility to home. The researchers found that transitional care services embedded in the interactions among older adult patients and providers optimized the delivery of patient-centered care. The work of nurse leaders in Nurses Improving Care for Healthsystem Elders program for hospitals is another example of HGNL members' promoting the integration of evidence-based practice into clinical settings. These leaders, including HGNL member Dr. Marie Boltz, have used evidence-based organizational assessments and process measures to guide the implementation of evidence-based geriatric practice into operations (Boltz et al., 2013; Capezuti et al., 2013). Consequently, a survey of over 2000 nurses at 27 hospitals showed that nurses' perception of their geriatric work environment and quality of care had significantly improved after the implementation of the Nurses Improving Care for Healthsystem Elders program (Capezuti et al., 2013). HGNL members have also generated “improvement” research that focuses on quality systems and practices that promote evidence-based practice and patient safety. One example is quality of care in nursing homes. Traditional approaches to quality improvement, such as regulation and public reporting, have led to only modest improvements in nursing home care (Werner & Konetzka, 2010). HGNL member Dr. Laura Wagner and colleagues (Wagner, McDonald, & Castle, 2012) proposed that voluntary Joint Commission accreditation of nursing homes stimulates organizational structure that promotes quality improvement in care, as evidenced by administrators'
4
ARTICLE IN PRESS
perception of nursing home safety culture. To illustrate the association between Joint Commission accreditation and nursing home safety culture, Dr. Wagner and colleagues queried more than 4,000 nursing home senior managers using the Nursing Home Survey on Resident Safety Culture. While controlling for facility and market characteristics, the researchers found senior managers from Joint Commission-accredited nursing homes rated their resident safety culture higher than those from nonaccredited nursing homes.
Impacting Faculty Development Experts predict a shortfall in the number of health care professionals who have specialized training in gerontology despite the growing population of older adults (Institute of Medicine [IOM], 2011). To address this shortfall, the HGNL organization has continued the work of building interprofessional academic capacity by growing the next generation of researchers and educators. HGNL members hold faculty positions in colleges, universities, and health care systems in every state except Nevada, New Mexico, Wyoming, Mississippi, Maine, West Virginia, and Vermont. Positively benefitting gerontological education, this network helps to ensure that the increasing health care needs of older adults are met through the assimilation and transfer of new knowledge from one generation to the next. This generational transfer of knowledge is especially critical considering the aging nursing faculty and competing faculty interests from a wide array of opportunities in nursing and other academic fields. From their mentorship experience during their preand/or postdoctoral awards, HGNL members are well equipped to continue faculty development in gerontological education. This work in faculty development includes new strategies to engage student learning about best practices in the care of older adults, and interprofessional research and education to improve health outcomes for older adults. One example is Dr. Karen Rose, who has participated in a Josiah Macy Jr. Foundation project to build skills for interprofessional education in the care of older adults. Dr. Rose's participation in this project, entitled Faculty Development in InterProfessional Team-Based Care, strengthened her skills in this increasingly important area. As a result, she and her colleagues developed and successfully implemented an interprofessional learning session, entitled “Transitions in care for older adults,” for undergraduate nursing and medical students at her home institution. Dr. Rose took the next step to advance gerontological nursing capacity through dissemination. As such, she reported her work at the 2011 Council for the Advancement of Nursing Science's Special Topics Conference, a presentation that highlighted HGNL members' projects related to the IOM (2011) report The Future of Nursing: Leading Change, Advancing Health. Dr. Rose also published her report on faculty development (Bellot et al., 2013). In a testimony to sustainability, this project continues today. Further, Dr. Rose uses her new skill set to educate others
VAN CLEAVE ET AL
who are interested in developing their expertise in interprofessional education.
Impacting Leadership Development One of HGNL's organizational goals is to promote leadership development and connect members with important leadership opportunities. In a 2014 survey, 80% of respondents reported networking and 62% reported building on mentorship from the NHCGNE are the main benefits from membership in HGNL (see Figure 1). A 2012 survey explicated that HGNL members already serve in leadership roles from local to international organizations, including the IOM's national guideline development, Centers for Disease Control and Prevention projects, and nursing and aging task forces at the city and county level. To build on this leadership experience, HGNL members collaborate with their colleagues and with the NHCGNE to expand leadership development activities and connect colleagues with new opportunities. Over the past 14 years, The NHCGNE's Annual Leadership Conferences, held prior to the Gerontological Society of America's Annual Scientific Meeting, has been the key component of this leadership development. At the conference, current and past John A. Hartford Foundation awardees' exchange ideas and discuss leadership opportunities in gerontological health care with leaders and peers across disciplines. The HGNL organization sustains its commitment to leadership development throughout the year by conducting Webinar-based peer mentoring programs (NHCGNE, 2015). Past Webinars have addressed publication ethics and interprofessional grant opportunities. HGNL's leadership development activities also include committee work, publication opportunities, and conference planning (see Table 3). The HGNL members have established a goal to leverage their network to increase gerontological nursing leadership representation. To accomplish this goal, the members are cultivating research and practice partnerships with interprofessional colleagues, most immediately through the John A. Hartford Foundation's current initiative, Change AGEnts (The John A. Hartford Foundation, 2015). This initiative leverages the John A. Hartford Foundation's community of scholars and grantees to adopt, evaluate, and sustain the changes in practice and service delivery that improve the health of older adults and their families. HGNL members also identify leadership positions in organizations where representation by gerontological experts is needed, and connect members to these opportunities. The HGNL organization is currently reaching out to regional, national, and international groups interested in advancing the care of older adults to foster mutually beneficial partnerships. These leadership opportunities provide HGNL members the opportunities to impact gerontological health care throughout the world.
Impacting Public Policy The HGNL organization's goals also include influencing gerontological public policy. The HGNL members took
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
5
Networking
Building on Mentorship from NHCGNE Program
Dissemination of Scholarly Work
Peer Reviews for Tenure
0
10
20
30
40
50
60
70
80
90
% of Respondents *Response rate: 196 of 237 (83%)
Figure 1. 2014 survey responses: main benefits of membership in HGNL*.
their first steps to advance policy initiatives supported by evidence with a presentation at the 2011 Council for the Advancement of Nursing Science's Special Topics Conference (Bellot et al., 2013). As described above, this presentation highlighted members' projects related to the IOM (2011) report The Future of Nursing: Leading Change, Advancing Health. During this presentation, Dr. Casey Shillam reported on her collaboration with the Robert Wood Johnson Foundation and the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. Dr. Shillam's work advanced the development of state action coalitions to implement the IOM report recommendations. Other HGNL members have joined Dr. Shillam to work at the national level to ensure a focus on gerontological nursing during the implementation of the IOM report. Primary goals of this work include support for nurses to practice to the full extent of their education and training to meet the needs of the nation's growing population of older adults (IOM, 2011). HGNL members recognize the important interrelationship between practice, research, and policy (Grady, 2010). Consequently, to date, they have edited three special journal issues that feature members' research that addresses issues important to both practice and policy (see Table 4). In these special issues, HGNL members' Table 3. List of HGNL Webinars ⁎ • April 2, 2015: Balancing Competing Priorities—presented by Dr. Vicki Conn • Oct. 16, 2014: Preparing for Congressional Education and Advocacy with Brian Lindberg, Gerontological Society of America's Public Policy Advisor • Feb. 11, 2014: PCORI Webinar—presented by Dr. Chad Boult, Healthcare Consultant and former director of PCORI Improving Healthcare Systems Program • October 16, 2013 - From the Editors: Publication Ethics Webinar ⁎ For access to Webinars, please email Michele Duchin, National Hartford Center of Gerontological Nursing Excellence Program Manager, [email protected].
articles spanned current policy challenges, from end of life care in rural dwelling older adults (Hansen, Cartwright, & Craig, 2011) to barriers to primary care for the older adult population (D'Avolio, Strumpf, Feldman, Mitchell, & Rebholz, 2013). Over time, HGNL members have used their policy experience to establish collaborations with their interprofessional colleagues, both inside and outside the Gerontological Society of America. In 2012 and 2013, the HGNL began building relationships with their social work and physician colleagues by holding interprofessional town hall meetings before the Gerontological Society of America Annual Scientific Meeting. Funded by the John A. Hartford Foundation and the NHCGNE, these town halls provided opportunities to meet interprofessional colleagues interested in gerontological policy. In 2014, HGNL built on their past opportunities to expand the audience for the third interprofessional town hall. In collaboration with their social work and physician colleagues, the NHCGNE, and the John A. Hartford Foundation Change AGEnts initiative, HGNL invited all John A. Hartford Foundation funding recipients to discuss potential collective contributions to advance gerontological initiatives. As a result of this collaboration, the HGNL organization more than tripled the town hall attendance, from approximately 30 to 40 attendees in 2012 and 2013 to 110 attendees in 2014. The Health and Aging Policy Fellows Program is another example of an opportunity that promotes interprofessional policy collaborations. HGNL members Drs. Adriana Perez and Tracie Harrison were selected as 2011–2012 nonresidential fellows, splitting time between their projects at their home institutions and attending policy related events in Washington DC. Their skills and knowledge from the Health and Aging Policy Fellowship enhance the HGNL organization's policy work. Currently, the NHCGNE is providing special funding to support a Health and Aging Policy Fellows Program Award for a nurse interested in embarking on this timely opportunity through a residential or nonresidential Health and Aging
6
ARTICLE IN PRESS
Table 4. Special Journal Issues Highlighting HGNL Members' Research • Clinical Nursing Research (November 2013) • Geriatric Nursing (March–April 2012) • Research in Gerontological Nursing (January 2012)
Policy Fellowship track. The first recipient of this award, for 2014-2015, is Dr. Rachel Roiland, Special Advanced Geriatric Fellow at the William S. Middleton Memorial Veterans Hospital.
Challenges and Transitions The HGNL organization has experienced a remarkable period of organizational growth and development. To continue its mission to enhance and sustain the capacity of gerontological nurses, the HGNL organization now faces the challenges of adapting to external and internal transitions. These challenges include the growth and transition of its parent organization, from the Building Academic Geriatric Nursing Capacity Program to the National Hartford Center of Gerontological Nursing Excellence, and the changes in vision by HGNL's funding organization, the John A. Hartford Foundation. From its inception in 2000 to 2012, the Building Academic Geriatric Nursing Capacity Program experienced a stable period. During this time, the program consistently focused on the development of academic geriatric nursing leaders and centers of gerontological nursing excellence. However, the year 2012 ushered in a new period of change and transition. The Building Academic Geriatric Nursing Capacity Program moved to the Gerontological Society of America and evolved to the NHCGNE. Also in 2012, the John A. Hartford Foundation adopted a new strategic plan to fund future grants and programs to put geriatric expertise to work in all health care settings by (a) advancing practice change and innovation; (b) supporting team-based care through interprofessional education of all health care providers; (c) supporting policies, regulations, and a health care infrastructure that promote better care; and (d) developing and disseminating new evidence-based models that deliver better, more cost-effective health care. Accordingly, the John A. Hartford Foundation began transitioning from its signature faculty development efforts, including the NHCGNE housed at the Gerontological Society of America, to fulfill their new practice-driven vision. As a result of these changes and transitions, the John A. Hartford Foundation's funding of the National Hartford Center of Gerontological Nursing Excellence will end in 2016. The National Hartford Center of Gerontological Nursing Excellence is now reinventing itself, evolving from a funded organization to a revenue-generating organization. In 2013, the NHCGNE moved to a “Member School” model. Since 2013, this model consists of one national center, uniting the nine original centers of gerontological nursing excellence and adding over 40 member schools. From a consultancy partnership, ideas for sustainability
VAN CLEAVE ET AL
continue to emerge, with the expectation that the NHCGNE will be able to sustain itself past 2016. In recognition of the need to support the efforts of sustainability for both organizations, the HGNL has worked with the NHCGNE to develop a model to merge the two organizations. This new model will ensure inclusion of all current and former Patricia G. Archbold Scholars and Claire M. Fagin Fellows who may not work at NHCGNE member institutions. The merger will be completed within the 2015–2016 academic year. Upon completion, the HGNL and the National Hartford Center of Gerontological Nursing Excellence will represent one focused effort to enhance and sustain the growth of gerontological nursing capacity.
Conclusion: The Future of Advancing Gerontological Nursing Science Nursing science is key to continued growth of the capacity of gerontological nurses. Several interacting factors make this a critical time in history to advance gerontological nursing science. The population of older adults is growing, becoming more diverse, and surviving longer with chronic conditions and disabilities. As a result, older adults are at risk for substantially more physician visits and hospitalizations than younger adults (Anderson, 2010). Furthermore, older adults' health care cost three times more per person than the average working age adult (Lassman, Hartman, Washington, Andrews, & Catlin, 2014). Older adults' increased disability and health care expenditures warrant creating, testing, and disseminating evidence-based, innovative programs to achieve the triple aim of improving health care, improving lives, and decreasing costs (Berwick, Nolan, & Whittington, 2008). In addition to HGNL's merger with the NHCGNE, building partnerships will be critical to continue advancing gerontological nursing science. National and international partnerships among groups with shared interests will serve as a vehicle for advancing gerontological nursing research. Potential collaborators include AARP, Robert Wood Johnson Foundation, World Health Organization, American Geriatrics Society, American Society on Aging, International Association of Gerontology and Geriatrics, Expert Panel on Aging within the American Academy of Nursing, American Association of Colleges of Nursing, and various local and state-level health coalitions. Nontraditional partners and those that focus on the needs of traditionally underrepresented groups, such as the National Hispanic Council on Aging and the Diverse Elders Coalition, will also be critical. Building these much needed alliances will cultivate new collaborations to facilitate research and advance the science of gerontological nursing. HGNL will also continue working with the John A. Hartford Foundation by participating in the new opportunities arising from the Foundation's new vision and funding structure. HGNL, in partnership with the NHCGNE, envisions its future as growing a force of highly educated nurses that will lead
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
and improve the future of gerontological health and health care throughout all 50 United States.
Acknowledgments The Authors would like to thank J Taylor Harden, PhD, RN, FGSA, FAAN, Executive Director, Coordinating Center, NHCGNE, for her careful review of this article.
References Academic Center for Evidence-Based Practice (ACE). (2012). Retrieved from, http://www.acestar.uthscsa.edu. Anderson, G. (2010). Chronic care: Making the case for ongoing care. Retrieved from, http://www.rwjf.org/content/ dam/farm/reports/reports/2010/rwjf54583. Bellot, J., Carthron, D. L., O'Connor, M., Rose, K., Shillam, C., Van Cleave, J. H., et al (2013). Advancing the future of nursing: A report by the Building Academic Geriatric Nursing Capacity (BAGNC) Alumni Policy and Leadership Committee. Nursing Outlook, 61, 55–57, http://dx.doi.org/10.1016/j.outlook.2012.11.005. Berwick, D. M., Nolan, T. W. & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27, 759–769, http://dx.doi.org/10.1377/hlthaff.27.3.759. Boltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Secic, M., Kim, H., et al (2008). Hospital nurses' perception of the geriatric nurse practice environment. Journal of Nursing Scholarship, 40, 282–289. Boltz, M., Capezuti, E., Shuluk, J., Brouwer, J., Carolan, D., Conway, S., et al (2013). Implementation of geriatric acute care best practices: Initial results of the NICHE SITE self-evaluation. Nursing & Health Sciences, 15, 518–524, http://dx.doi.org/10.1111/nhs.12067. Capezuti, E., Boltz, M. P., Shuluk, J., Denysyk, L., Brouwer, J. P. Roberts, M.-C., et al (2013). Utilization of a benchmarking database to inform NICHE implementation. Research in Gerontological Nursing, 6, 198–208, http://dx.doi.org/10.3928/1940492120130607-01. Chesla, C. A. (2008). Translational research: Essential contributions from interpretive nursing science. Research in Nursing & Health, 31, 381–390, http://dx.doi.org/10.1002/nur.20267. D'Avolio, D. A., Strumpf, N. E., Feldman, J., Mitchell, P. & Rebholz, C. M. (2013). Barriers to primary care: Perceptions of older adults utilizing the ED for nonurgent visits. Clinical Nursing Research, 22, 416–431, http://dx.doi.org/10.1177/1054773813485597. Franklin, P. D., Archbold, P. G., Fagin, C. M., Galik, E., Siegel, E., Sofaer, S., et al (2011). Building Academic Geriatric Nursing Capacity: Results after the first 10 years and implications for the future. Nursing Outlook, 59, 198–205, http://dx.doi.org/10.1016/j.outlook.2011.05.011. Galik, E., Resnick, B., Hammersla, M. & Brightwater, J. (2013). Optimizing function and physical activity among nursing home residents with dementia: Testing the impact of function-focused care. The Gerontologist, 54, 930–943, http:// dx.doi.org/10.1093/geront/gnt108. Grady, P. A. (2010). Creating a healthier tomorrow through research, practice, and policy. Nursing Outlook, 58, 268–271, http://dx.doi.org/10.1016/j.outlook.2010.07.007.
7
Hansen, L., Cartwright, J. C. & Craig, C. E. (2011). End-oflife care for rural-dwelling older adults and their primary family caregivers. Research in Gerontological Nursing, 5, 6–15, http:// dx.doi.org/10.3928/19404921-20111213-01. Institute of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: The National Academies Press. Lassman, D., Hartman, M., Washington, B., Andrews, K. & Catlin, A. (2014). US health spending trends by age and gender: Selected years 2002–10. Health Affairs, 33, 815–822, http:// dx.doi.org/10.1377/hlthaff.2013.1224. Levin, R. F. & Feldman, H. R. (2006). Teaching evidencebased practice in nursing: A guide for academic and clinical settings. New York: Springer Publishing. National Hartford Center of Gerontological Nursing Excellence (NHCGNE) (2015). HGNL. retrieved at, http://www. nhcgne.org/hgnl-alumni. Petticrew, M. & Roberts, H. (2006). Systematic reviews in the social sciences. Maiden, MA: Wiley Blackwell. Resnick, B., Galik, E. & Vigne, E. (2014). Translation of function-focused care to assisted living facilities. Family & Community Health, 37, 155–165, http://dx.doi.org/10.1097/ FCH.0000000000000021. Rosswurm, M. A. & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image Journal of Nursing Scholarship, 31, 317–322. Straus, S. E., Richardson, W. S., Glasziou, P. & Haynes, R. B. (2005). Evidence-based medicine: How to practice and teach EBM. (3rd ed.). Edinburgh, United Kingdom: Churchhill Livingstone. Talley, K. M. C., Wyman, J. F. & Shamliyan, T. A. (2011). State of the science: Conservative interventions for urinary incontinence in frail community-dwelling older adults. Nursing Outlook, 59, 215–220, http://dx.doi.org/10.1016/j.outlook.2011.05.010. The John A. Hartford Foundation (2015). The Hartford Change AGEnts Initative: An overview. Retrieved May 5, 2015, from, http://www.changeagents365.org/images/agents/ Overview_Updated.2014.pdf. Titler, M. G. (2010). Translation science and context. Research and Theory for Nursing Practice, 24, 35–55, http:// dx.doi.org/10.1891/1541-6577.24.1.35. Toles, M., Barroso, J., Colón-Emeric, C., Corazzini, K., McConnell, E. & Anderson, R. A. (2012). Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility: A multiple case study. Family & Community Health, 35, 334–344, http://dx.doi.org/10.1097/FCH.0b013e31826666eb. United States Census Bureau (2012). Population Projections. Retrieved from, https://www.census.gov/population/ projections/data/national/2012/summarytables.html. Wagner, L. M., McDonald, S. M. & Castle, N. G. (2012). Relationship between nursing home safety culture and Joint Commission accreditation. The Joint Commission Journal on Quality and Patient Safety, 38, 207–215 (Retrieved from, http:// www.ncbi.nlm.nih.gov/pubmed/22649860). Werner, R. M. & Konetzka, R. T. (2010). Advancing nursing home quality through quality improvement itself. Health Affairs, 29, 81–86, http://dx.doi.org/10.1377/hlthaff.2009.0555.
E
ACH DAY, 10,000 people in the United States celebrate their 65th birthday. By 2030, the number of older adults, 65 years and older, will increase from the current 48 million to 73 million. Further, the age group
85 years and older will be the fastest growing population segment, doubling in number from today's 6 million to 12 million by 2035 (United States Census Bureau, 2012). Nurses are on the forefront of caring for the growing number
*Assistant Professor, NYU College of Nursing, New York, NY, 10010. †Associate Professor, Johns Hopkins University School of Nursing, Baltimore, MD, 21205. ‡Associate Professor and Nursing Program Director, Western Washington University, Bellingham, Washington. §Associate Professor of Nursing, Assistant Dean for Research and Innovation, University of Virginia School of Nursing, Charlottesville, VA. ||Research Scientist, Hospital of the University of Pennsylvania, Philadelphia, PA. ¶Assistant Professor, Arizona State University College of Nursing & Health Innovation, Phoenix, AZ. #Assistant Professor, Villanova University College of Nursing, Villanova, PA. **Post-Doctoral Fellow, Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD. ††Assistant Dean for Nursing, Clinical Assistant Professor, University of Arkansas for Medical Sciences, Little Rock, AR. ‡‡Associate Professor, Boston College, William F. Connell School of Nursing, Boston, MA.
§§Associate Professor and Director, DNP Program, Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA. ||||Assistant Professor, Duke University School of Nursing, Durham, NC. ☆ Funding: This study was supported by The John A. Hartford Foundation, The National Hartford Center of Gerontological Nursing Excellence, and The National Hartford Center of Gerontological Nursing Excellence Patricia G. Archbold Pre-doctoral Scholar Awards and Claire M. Fagin Fellowships. Address correspondence to Dr. Van Cleave: Assistant Professor, NYU College of Nursing, 433 First Avenue, New York, NY 10010. E-mail: [email protected] (J.H. Van Cleave), [email protected] (S.L. Szanton), [email protected] (C. Shillam), [email protected] (K. Rose), [email protected] (A.D. Rao), [email protected] (A. Perez), [email protected] (M. O'Connor), [email protected] (R. Walker), [email protected] (B. Buron), [email protected] (M. Boltz), [email protected] (J. Bellot), [email protected] (M. Batchelor-Murphy) 8755-7223/15
Journal of Professional Nursing, Vol 0, No. 0 (July), 2015: pp 1–7 © 2015 Elsevier Inc. All rights reserved.
1 http://dx.doi.org/10.1016/j.profnurs.2015.06.004
2
ARTICLE IN PRESS
of older adults. Consequently, the need for increasing gerontological nursing capacity grows stronger every day. Acknowledging the importance of gerontological nursing to the nation's health, in 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program. Since 2000, this program has supported 249 nurse scientists with preand/or postdoctoral awards. As a result of the program's success, several current and past Building Academic Geriatric Nursing Capacity awardees formed an alumni organization to extend their influence through networking and collaboration in scholarly endeavors. This group of Building Academic Geriatric Nursing Capacity awardees has grown into a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The HGNL members' accomplishments include conducting research on evidence-based practice initiatives, influencing faculty development, and promoting leadership opportunities. Recognizing that public policy impacts gerontological health care, HGNL members also focus on creating new paths to influence public policy. The purpose of this article is to present HGNL's development, accomplishments, and challenges, demonstrating the power of a single funded initiative to grow an organization dedicated to impacting gerontological research, practice, education, and policy. By presenting HGNL's experience, this article can inform other professional nursing organizations that may be facing similar growth and challenges.
From Geriatric Nursing Initiative to National Organization The underpinnings of the HGNL organization began in 2000 when the John A. Hartford Foundation partnered with the American Academy of Nursing to form the Building Academic Geriatric Nursing Capacity initiative. The Building Academic Geriatric Nursing Capacity Program had two goals: (a) to expand the scholarly and leadership base in geriatric nursing and (b) to establish centers of excellence in top-tier schools of nursing to enhance the schools' capacity to grow the next generation of gerontological researchers and leaders (Franklin et al., 2011). The Building Academic Geriatric Nursing Capacity initiative included predoctoral awards (later named the Patricia G. Archbold Predoctoral Scholar Award) and postdoctoral fellowships (later named Claire M. Fagin Fellow Award). As part of the Building Academic Geriatric Nursing Capacity initiative, pre- and postdoctoral awardees partnered with senior interdisciplinary mentors to undertake the critical work of research, leadership, and faculty development to advance gerontological nursing. In 2009, several past scholars and fellows formed an alumni organization to use their academic and leadership training to further advance gerontological nursing. The Building Academic Geriatric Nursing Capacity Alumni organization has since undergone multiple organizational changes while embracing the national trend toward interprofessional health care. These changes began
VAN CLEAVE ET AL
when their parent organization, the National Hartford Center of Gerontological Nursing Excellence (NHCGNE), moved from the American Academy of Nursing to become a planned unit of the Gerontological Society of America in July 2012. This move reflected the John A. Hartford Foundation's growing emphasis on interprofessional teams to promote health for older adults. Along with their parent organization, the Building Academic Geriatric Nursing Capacity Alumni also moved from the American Academy of Nursing to the Gerontological Society of America, and commenced organizational development planning under the direction of their parent organization. Between September 2012 and November 2013, the Alumni formally adopted a new name, HGNL. In November 2013, the HGNL ratified new organizational structure, rules, and guidelines to establish a more inclusive and robust organization. These organizational changes included a new mission to deliver quality care to older adults by providing nursing leadership and establishing strategic partnerships across all the gerontological disciplines. These organizational changes also formally expanded membership from those supported through the John A. Hartford Foundation's Building Academic Geriatric Nursing Capacity Initiative to all who have received support through any of the many John A. Hartford Foundation funding mechanisms, including membership in the NHCGNE. For example, the HGNL's monthly newsletter is sent to 245 individuals, including both the HGNL members and NHCGNE members. In 2015, to sustain HGNL's growth and mission, members voted to merge with their parent organization, National Hartford Center of Gerontological Nursing Excellence, forming a unified voice to influence gerontological health care (see Tables 1 and 2). Through small and large group activities, in a unified support of the mission, HGNL members have developed strong collaborative relationships resulting in publications, presentations, peer mentoring, and widespread networking. The group uses a variety of communication approaches including social media, newsletters, and email blasts. They are focused, strategically working together to impact the future of gerontological health and health care through engagement in research, practice, faculty and leadership development, and public policy.
Influencing Evidence-Based Practices HGNL members have generated important research that impacts gerontological evidence-based practice. As a framework for clinical practice, evidence-based practice integrates the best available scientific evidence with the expertise of the clinician and with the patients' preferences and values to make decisions about health care (Levin & Feldman, 2006; Straus, Richardson, Glasziou, & Haynes, 2005). The four components of evidencebased practice are evidence synthesis, translation, integration, and improvement science (Academic Center for Evidence-Based Practice (ACE), 2012). HGNL members have conducted research addressing all four components.
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
3
Table 1. HGNL Organization: Timeline of Events 2000 • John A. Hartford Foundation funds the Building Academic Geriatric Nursing Capacity Program 2009 • A small group of Building Academic Geriatric Nursing Capacity Program awardees form an alumni organization 2010 • The Building Academic Geriatric Nursing Capacity Alumni open their social media site on LinkedIn and hold their first business meeting 2012 • The Building Academic Geriatric Nursing Capacity Program moves to the Gerontological Society of America organization and forms the NHCGNE • The Building Academic Geriatric Nursing Capacity Alumni begin strategic planning to form an organization under the direction of the NHCGNE • The Building Academic Geriatric Nursing Capacity Alumni hold their first formal vote to elect Chair of the organization 2013 • The Building Academic Geriatric Nursing Capacity Alumni vote to change their name to HGNL and ratify new organizational structure, rules, and guidelines to establish a more inclusive and robust organization 2015 • HGNL members vote to merge with the NHCGNE
The collection of descriptive statistics of HGNL evidencebased practice activities is in progress. For this article, we present the following examples. HGNL members have published Evidence Syntheses that pose relevant clinical or policy questions, illuminate pertinent evidence, and critically appraise and synthesize studies (Petticrew & Roberts, 2006). These syntheses form the basis for practice guidelines and guide the formation of new research questions. For example, HGNL member Dr. Kristine Talley and colleagues (Talley, Wyman, & Shamliyan, 2011) published findings from their systematic review of interventions for urinary incontinence in frail older adults, an important and understudied problem. The researchers synthesized evidence from three randomized controlled trials and four quasi-experimental studies reporting urinary incontinence outcomes. From their analysis of urinary incontinence outcomes, the researchers determined that the strongest evidence favors multicomponent behavioral interventions, such as pelvic floor muscle exercises. HGNL members have conducted “translation” studies that promote and sustain adoption of evidenced-based practice (Chesla, 2008). These studies investigate which interventions work in various circumstances, types of settings and populations, and explicate how they are disseminated (Titler, 2010). For example, HGNL member Dr. Elizabeth Galik and colleagues (Galik, Resnick, Hammersla, & Brightwater, 2013) modified a functionfocused care intervention to meet the specialized needs of cognitively impaired nursing home residents. The researchers then conducted a cluster-randomized controlled trial to test the impact of the modified functionfocused intervention in nursing home residents with dementia. The study showed that residents with dementia who received the intervention experienced improved function, increased time and intensity of their physical Table 2. The HGNL Mission Consistent with the NHCGNE mission, the HGNL organization strives to enhance and sustain the capacity of gerontological nurses. The HGNL organization will provide leadership and partner with all disciplines to provide quality care to older adults through advancing nursing science, facilitating adoption of best practices, fostering nursing leadership potential and influencing public policy.
activity, and were less likely to fall. The researchers then translated the intervention to 20 assisted living sites, making significant changes in policies, environment, and care approaches. These changes led to positive trends in decreased falls, decreased hospitalizations, and number of emergency room visits (Resnick, Galik, & Vigne, 2014). HGNL members' research has supported the importance of “integration” of evidence-based practice into clinicians' skills, resources, and practices. This integration of evidence-based practice increases gerontological expertise and fosters interprofessional collaboration (Boltz et al., 2008; Rosswurm & Larrabee, 1999). One example is a study by HGNL member Dr. Mark Toles and colleagues (Toles et al., 2012). The team observed skilled nursing facility staff, residents, and caregivers to determine the transitional care processes used to prepare patients for discharge from the facility to home. The researchers found that transitional care services embedded in the interactions among older adult patients and providers optimized the delivery of patient-centered care. The work of nurse leaders in Nurses Improving Care for Healthsystem Elders program for hospitals is another example of HGNL members' promoting the integration of evidence-based practice into clinical settings. These leaders, including HGNL member Dr. Marie Boltz, have used evidence-based organizational assessments and process measures to guide the implementation of evidence-based geriatric practice into operations (Boltz et al., 2013; Capezuti et al., 2013). Consequently, a survey of over 2000 nurses at 27 hospitals showed that nurses' perception of their geriatric work environment and quality of care had significantly improved after the implementation of the Nurses Improving Care for Healthsystem Elders program (Capezuti et al., 2013). HGNL members have also generated “improvement” research that focuses on quality systems and practices that promote evidence-based practice and patient safety. One example is quality of care in nursing homes. Traditional approaches to quality improvement, such as regulation and public reporting, have led to only modest improvements in nursing home care (Werner & Konetzka, 2010). HGNL member Dr. Laura Wagner and colleagues (Wagner, McDonald, & Castle, 2012) proposed that voluntary Joint Commission accreditation of nursing homes stimulates organizational structure that promotes quality improvement in care, as evidenced by administrators'
4
ARTICLE IN PRESS
perception of nursing home safety culture. To illustrate the association between Joint Commission accreditation and nursing home safety culture, Dr. Wagner and colleagues queried more than 4,000 nursing home senior managers using the Nursing Home Survey on Resident Safety Culture. While controlling for facility and market characteristics, the researchers found senior managers from Joint Commission-accredited nursing homes rated their resident safety culture higher than those from nonaccredited nursing homes.
Impacting Faculty Development Experts predict a shortfall in the number of health care professionals who have specialized training in gerontology despite the growing population of older adults (Institute of Medicine [IOM], 2011). To address this shortfall, the HGNL organization has continued the work of building interprofessional academic capacity by growing the next generation of researchers and educators. HGNL members hold faculty positions in colleges, universities, and health care systems in every state except Nevada, New Mexico, Wyoming, Mississippi, Maine, West Virginia, and Vermont. Positively benefitting gerontological education, this network helps to ensure that the increasing health care needs of older adults are met through the assimilation and transfer of new knowledge from one generation to the next. This generational transfer of knowledge is especially critical considering the aging nursing faculty and competing faculty interests from a wide array of opportunities in nursing and other academic fields. From their mentorship experience during their preand/or postdoctoral awards, HGNL members are well equipped to continue faculty development in gerontological education. This work in faculty development includes new strategies to engage student learning about best practices in the care of older adults, and interprofessional research and education to improve health outcomes for older adults. One example is Dr. Karen Rose, who has participated in a Josiah Macy Jr. Foundation project to build skills for interprofessional education in the care of older adults. Dr. Rose's participation in this project, entitled Faculty Development in InterProfessional Team-Based Care, strengthened her skills in this increasingly important area. As a result, she and her colleagues developed and successfully implemented an interprofessional learning session, entitled “Transitions in care for older adults,” for undergraduate nursing and medical students at her home institution. Dr. Rose took the next step to advance gerontological nursing capacity through dissemination. As such, she reported her work at the 2011 Council for the Advancement of Nursing Science's Special Topics Conference, a presentation that highlighted HGNL members' projects related to the IOM (2011) report The Future of Nursing: Leading Change, Advancing Health. Dr. Rose also published her report on faculty development (Bellot et al., 2013). In a testimony to sustainability, this project continues today. Further, Dr. Rose uses her new skill set to educate others
VAN CLEAVE ET AL
who are interested in developing their expertise in interprofessional education.
Impacting Leadership Development One of HGNL's organizational goals is to promote leadership development and connect members with important leadership opportunities. In a 2014 survey, 80% of respondents reported networking and 62% reported building on mentorship from the NHCGNE are the main benefits from membership in HGNL (see Figure 1). A 2012 survey explicated that HGNL members already serve in leadership roles from local to international organizations, including the IOM's national guideline development, Centers for Disease Control and Prevention projects, and nursing and aging task forces at the city and county level. To build on this leadership experience, HGNL members collaborate with their colleagues and with the NHCGNE to expand leadership development activities and connect colleagues with new opportunities. Over the past 14 years, The NHCGNE's Annual Leadership Conferences, held prior to the Gerontological Society of America's Annual Scientific Meeting, has been the key component of this leadership development. At the conference, current and past John A. Hartford Foundation awardees' exchange ideas and discuss leadership opportunities in gerontological health care with leaders and peers across disciplines. The HGNL organization sustains its commitment to leadership development throughout the year by conducting Webinar-based peer mentoring programs (NHCGNE, 2015). Past Webinars have addressed publication ethics and interprofessional grant opportunities. HGNL's leadership development activities also include committee work, publication opportunities, and conference planning (see Table 3). The HGNL members have established a goal to leverage their network to increase gerontological nursing leadership representation. To accomplish this goal, the members are cultivating research and practice partnerships with interprofessional colleagues, most immediately through the John A. Hartford Foundation's current initiative, Change AGEnts (The John A. Hartford Foundation, 2015). This initiative leverages the John A. Hartford Foundation's community of scholars and grantees to adopt, evaluate, and sustain the changes in practice and service delivery that improve the health of older adults and their families. HGNL members also identify leadership positions in organizations where representation by gerontological experts is needed, and connect members to these opportunities. The HGNL organization is currently reaching out to regional, national, and international groups interested in advancing the care of older adults to foster mutually beneficial partnerships. These leadership opportunities provide HGNL members the opportunities to impact gerontological health care throughout the world.
Impacting Public Policy The HGNL organization's goals also include influencing gerontological public policy. The HGNL members took
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
5
Networking
Building on Mentorship from NHCGNE Program
Dissemination of Scholarly Work
Peer Reviews for Tenure
0
10
20
30
40
50
60
70
80
90
% of Respondents *Response rate: 196 of 237 (83%)
Figure 1. 2014 survey responses: main benefits of membership in HGNL*.
their first steps to advance policy initiatives supported by evidence with a presentation at the 2011 Council for the Advancement of Nursing Science's Special Topics Conference (Bellot et al., 2013). As described above, this presentation highlighted members' projects related to the IOM (2011) report The Future of Nursing: Leading Change, Advancing Health. During this presentation, Dr. Casey Shillam reported on her collaboration with the Robert Wood Johnson Foundation and the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. Dr. Shillam's work advanced the development of state action coalitions to implement the IOM report recommendations. Other HGNL members have joined Dr. Shillam to work at the national level to ensure a focus on gerontological nursing during the implementation of the IOM report. Primary goals of this work include support for nurses to practice to the full extent of their education and training to meet the needs of the nation's growing population of older adults (IOM, 2011). HGNL members recognize the important interrelationship between practice, research, and policy (Grady, 2010). Consequently, to date, they have edited three special journal issues that feature members' research that addresses issues important to both practice and policy (see Table 4). In these special issues, HGNL members' Table 3. List of HGNL Webinars ⁎ • April 2, 2015: Balancing Competing Priorities—presented by Dr. Vicki Conn • Oct. 16, 2014: Preparing for Congressional Education and Advocacy with Brian Lindberg, Gerontological Society of America's Public Policy Advisor • Feb. 11, 2014: PCORI Webinar—presented by Dr. Chad Boult, Healthcare Consultant and former director of PCORI Improving Healthcare Systems Program • October 16, 2013 - From the Editors: Publication Ethics Webinar ⁎ For access to Webinars, please email Michele Duchin, National Hartford Center of Gerontological Nursing Excellence Program Manager, [email protected].
articles spanned current policy challenges, from end of life care in rural dwelling older adults (Hansen, Cartwright, & Craig, 2011) to barriers to primary care for the older adult population (D'Avolio, Strumpf, Feldman, Mitchell, & Rebholz, 2013). Over time, HGNL members have used their policy experience to establish collaborations with their interprofessional colleagues, both inside and outside the Gerontological Society of America. In 2012 and 2013, the HGNL began building relationships with their social work and physician colleagues by holding interprofessional town hall meetings before the Gerontological Society of America Annual Scientific Meeting. Funded by the John A. Hartford Foundation and the NHCGNE, these town halls provided opportunities to meet interprofessional colleagues interested in gerontological policy. In 2014, HGNL built on their past opportunities to expand the audience for the third interprofessional town hall. In collaboration with their social work and physician colleagues, the NHCGNE, and the John A. Hartford Foundation Change AGEnts initiative, HGNL invited all John A. Hartford Foundation funding recipients to discuss potential collective contributions to advance gerontological initiatives. As a result of this collaboration, the HGNL organization more than tripled the town hall attendance, from approximately 30 to 40 attendees in 2012 and 2013 to 110 attendees in 2014. The Health and Aging Policy Fellows Program is another example of an opportunity that promotes interprofessional policy collaborations. HGNL members Drs. Adriana Perez and Tracie Harrison were selected as 2011–2012 nonresidential fellows, splitting time between their projects at their home institutions and attending policy related events in Washington DC. Their skills and knowledge from the Health and Aging Policy Fellowship enhance the HGNL organization's policy work. Currently, the NHCGNE is providing special funding to support a Health and Aging Policy Fellows Program Award for a nurse interested in embarking on this timely opportunity through a residential or nonresidential Health and Aging
6
ARTICLE IN PRESS
Table 4. Special Journal Issues Highlighting HGNL Members' Research • Clinical Nursing Research (November 2013) • Geriatric Nursing (March–April 2012) • Research in Gerontological Nursing (January 2012)
Policy Fellowship track. The first recipient of this award, for 2014-2015, is Dr. Rachel Roiland, Special Advanced Geriatric Fellow at the William S. Middleton Memorial Veterans Hospital.
Challenges and Transitions The HGNL organization has experienced a remarkable period of organizational growth and development. To continue its mission to enhance and sustain the capacity of gerontological nurses, the HGNL organization now faces the challenges of adapting to external and internal transitions. These challenges include the growth and transition of its parent organization, from the Building Academic Geriatric Nursing Capacity Program to the National Hartford Center of Gerontological Nursing Excellence, and the changes in vision by HGNL's funding organization, the John A. Hartford Foundation. From its inception in 2000 to 2012, the Building Academic Geriatric Nursing Capacity Program experienced a stable period. During this time, the program consistently focused on the development of academic geriatric nursing leaders and centers of gerontological nursing excellence. However, the year 2012 ushered in a new period of change and transition. The Building Academic Geriatric Nursing Capacity Program moved to the Gerontological Society of America and evolved to the NHCGNE. Also in 2012, the John A. Hartford Foundation adopted a new strategic plan to fund future grants and programs to put geriatric expertise to work in all health care settings by (a) advancing practice change and innovation; (b) supporting team-based care through interprofessional education of all health care providers; (c) supporting policies, regulations, and a health care infrastructure that promote better care; and (d) developing and disseminating new evidence-based models that deliver better, more cost-effective health care. Accordingly, the John A. Hartford Foundation began transitioning from its signature faculty development efforts, including the NHCGNE housed at the Gerontological Society of America, to fulfill their new practice-driven vision. As a result of these changes and transitions, the John A. Hartford Foundation's funding of the National Hartford Center of Gerontological Nursing Excellence will end in 2016. The National Hartford Center of Gerontological Nursing Excellence is now reinventing itself, evolving from a funded organization to a revenue-generating organization. In 2013, the NHCGNE moved to a “Member School” model. Since 2013, this model consists of one national center, uniting the nine original centers of gerontological nursing excellence and adding over 40 member schools. From a consultancy partnership, ideas for sustainability
VAN CLEAVE ET AL
continue to emerge, with the expectation that the NHCGNE will be able to sustain itself past 2016. In recognition of the need to support the efforts of sustainability for both organizations, the HGNL has worked with the NHCGNE to develop a model to merge the two organizations. This new model will ensure inclusion of all current and former Patricia G. Archbold Scholars and Claire M. Fagin Fellows who may not work at NHCGNE member institutions. The merger will be completed within the 2015–2016 academic year. Upon completion, the HGNL and the National Hartford Center of Gerontological Nursing Excellence will represent one focused effort to enhance and sustain the growth of gerontological nursing capacity.
Conclusion: The Future of Advancing Gerontological Nursing Science Nursing science is key to continued growth of the capacity of gerontological nurses. Several interacting factors make this a critical time in history to advance gerontological nursing science. The population of older adults is growing, becoming more diverse, and surviving longer with chronic conditions and disabilities. As a result, older adults are at risk for substantially more physician visits and hospitalizations than younger adults (Anderson, 2010). Furthermore, older adults' health care cost three times more per person than the average working age adult (Lassman, Hartman, Washington, Andrews, & Catlin, 2014). Older adults' increased disability and health care expenditures warrant creating, testing, and disseminating evidence-based, innovative programs to achieve the triple aim of improving health care, improving lives, and decreasing costs (Berwick, Nolan, & Whittington, 2008). In addition to HGNL's merger with the NHCGNE, building partnerships will be critical to continue advancing gerontological nursing science. National and international partnerships among groups with shared interests will serve as a vehicle for advancing gerontological nursing research. Potential collaborators include AARP, Robert Wood Johnson Foundation, World Health Organization, American Geriatrics Society, American Society on Aging, International Association of Gerontology and Geriatrics, Expert Panel on Aging within the American Academy of Nursing, American Association of Colleges of Nursing, and various local and state-level health coalitions. Nontraditional partners and those that focus on the needs of traditionally underrepresented groups, such as the National Hispanic Council on Aging and the Diverse Elders Coalition, will also be critical. Building these much needed alliances will cultivate new collaborations to facilitate research and advance the science of gerontological nursing. HGNL will also continue working with the John A. Hartford Foundation by participating in the new opportunities arising from the Foundation's new vision and funding structure. HGNL, in partnership with the NHCGNE, envisions its future as growing a force of highly educated nurses that will lead
ARTICLE IN PRESS
HARTFORD GERONTOLOGICAL NURSING LEADERS
and improve the future of gerontological health and health care throughout all 50 United States.
Acknowledgments The Authors would like to thank J Taylor Harden, PhD, RN, FGSA, FAAN, Executive Director, Coordinating Center, NHCGNE, for her careful review of this article.
References Academic Center for Evidence-Based Practice (ACE). (2012). Retrieved from, http://www.acestar.uthscsa.edu. Anderson, G. (2010). Chronic care: Making the case for ongoing care. Retrieved from, http://www.rwjf.org/content/ dam/farm/reports/reports/2010/rwjf54583. Bellot, J., Carthron, D. L., O'Connor, M., Rose, K., Shillam, C., Van Cleave, J. H., et al (2013). Advancing the future of nursing: A report by the Building Academic Geriatric Nursing Capacity (BAGNC) Alumni Policy and Leadership Committee. Nursing Outlook, 61, 55–57, http://dx.doi.org/10.1016/j.outlook.2012.11.005. Berwick, D. M., Nolan, T. W. & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27, 759–769, http://dx.doi.org/10.1377/hlthaff.27.3.759. Boltz, M., Capezuti, E., Bowar-Ferres, S., Norman, R., Secic, M., Kim, H., et al (2008). Hospital nurses' perception of the geriatric nurse practice environment. Journal of Nursing Scholarship, 40, 282–289. Boltz, M., Capezuti, E., Shuluk, J., Brouwer, J., Carolan, D., Conway, S., et al (2013). Implementation of geriatric acute care best practices: Initial results of the NICHE SITE self-evaluation. Nursing & Health Sciences, 15, 518–524, http://dx.doi.org/10.1111/nhs.12067. Capezuti, E., Boltz, M. P., Shuluk, J., Denysyk, L., Brouwer, J. P. Roberts, M.-C., et al (2013). Utilization of a benchmarking database to inform NICHE implementation. Research in Gerontological Nursing, 6, 198–208, http://dx.doi.org/10.3928/1940492120130607-01. Chesla, C. A. (2008). Translational research: Essential contributions from interpretive nursing science. Research in Nursing & Health, 31, 381–390, http://dx.doi.org/10.1002/nur.20267. D'Avolio, D. A., Strumpf, N. E., Feldman, J., Mitchell, P. & Rebholz, C. M. (2013). Barriers to primary care: Perceptions of older adults utilizing the ED for nonurgent visits. Clinical Nursing Research, 22, 416–431, http://dx.doi.org/10.1177/1054773813485597. Franklin, P. D., Archbold, P. G., Fagin, C. M., Galik, E., Siegel, E., Sofaer, S., et al (2011). Building Academic Geriatric Nursing Capacity: Results after the first 10 years and implications for the future. Nursing Outlook, 59, 198–205, http://dx.doi.org/10.1016/j.outlook.2011.05.011. Galik, E., Resnick, B., Hammersla, M. & Brightwater, J. (2013). Optimizing function and physical activity among nursing home residents with dementia: Testing the impact of function-focused care. The Gerontologist, 54, 930–943, http:// dx.doi.org/10.1093/geront/gnt108. Grady, P. A. (2010). Creating a healthier tomorrow through research, practice, and policy. Nursing Outlook, 58, 268–271, http://dx.doi.org/10.1016/j.outlook.2010.07.007.
7
Hansen, L., Cartwright, J. C. & Craig, C. E. (2011). End-oflife care for rural-dwelling older adults and their primary family caregivers. Research in Gerontological Nursing, 5, 6–15, http:// dx.doi.org/10.3928/19404921-20111213-01. Institute of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: The National Academies Press. Lassman, D., Hartman, M., Washington, B., Andrews, K. & Catlin, A. (2014). US health spending trends by age and gender: Selected years 2002–10. Health Affairs, 33, 815–822, http:// dx.doi.org/10.1377/hlthaff.2013.1224. Levin, R. F. & Feldman, H. R. (2006). Teaching evidencebased practice in nursing: A guide for academic and clinical settings. New York: Springer Publishing. National Hartford Center of Gerontological Nursing Excellence (NHCGNE) (2015). HGNL. retrieved at, http://www. nhcgne.org/hgnl-alumni. Petticrew, M. & Roberts, H. (2006). Systematic reviews in the social sciences. Maiden, MA: Wiley Blackwell. Resnick, B., Galik, E. & Vigne, E. (2014). Translation of function-focused care to assisted living facilities. Family & Community Health, 37, 155–165, http://dx.doi.org/10.1097/ FCH.0000000000000021. Rosswurm, M. A. & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image Journal of Nursing Scholarship, 31, 317–322. Straus, S. E., Richardson, W. S., Glasziou, P. & Haynes, R. B. (2005). Evidence-based medicine: How to practice and teach EBM. (3rd ed.). Edinburgh, United Kingdom: Churchhill Livingstone. Talley, K. M. C., Wyman, J. F. & Shamliyan, T. A. (2011). State of the science: Conservative interventions for urinary incontinence in frail community-dwelling older adults. Nursing Outlook, 59, 215–220, http://dx.doi.org/10.1016/j.outlook.2011.05.010. The John A. Hartford Foundation (2015). The Hartford Change AGEnts Initative: An overview. Retrieved May 5, 2015, from, http://www.changeagents365.org/images/agents/ Overview_Updated.2014.pdf. Titler, M. G. (2010). Translation science and context. Research and Theory for Nursing Practice, 24, 35–55, http:// dx.doi.org/10.1891/1541-6577.24.1.35. Toles, M., Barroso, J., Colón-Emeric, C., Corazzini, K., McConnell, E. & Anderson, R. A. (2012). Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility: A multiple case study. Family & Community Health, 35, 334–344, http://dx.doi.org/10.1097/FCH.0b013e31826666eb. United States Census Bureau (2012). Population Projections. Retrieved from, https://www.census.gov/population/ projections/data/national/2012/summarytables.html. Wagner, L. M., McDonald, S. M. & Castle, N. G. (2012). Relationship between nursing home safety culture and Joint Commission accreditation. The Joint Commission Journal on Quality and Patient Safety, 38, 207–215 (Retrieved from, http:// www.ncbi.nlm.nih.gov/pubmed/22649860). Werner, R. M. & Konetzka, R. T. (2010). Advancing nursing home quality through quality improvement itself. Health Affairs, 29, 81–86, http://dx.doi.org/10.1377/hlthaff.2009.0555.