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Where Are We And Where Do We Want To Go In Geriatric Nursing?
Where Are We And Where Do We Want To Go In Geriatric Nursing? Taking on the editorship of Geriatric Nursing has helped me to take stock of where we are in geriatric nursing and consider where we want and need to be. The opportunity to take on editorship presented itself to me through the recommendations of many of my colleagues, and I thank them for their support and belief that I could even come close to filling the shoes of Dr. Ebersole. It made me reflect on my long relationship with Geriatric Nursing, first as an undergraduate. At that time, which was in the early 1970s, I was firm in my commitment to focus on care of older adults and was generally talking to myself! Geriatric Nursing was an invaluable resource and helped me know that there were other nurses out there with the same passion. Geriatric Nursing was where I submitted my first manuscript for publication, under the guidance of one of my mentor Dr. Mathy Mezey. The article focused on constipation in older adults and was accepted for publication; I was certain that acceptance was the highlight of my nursing career! Over the years, I have had the opportunity to publish numerous articles in Geriatric Nursing and participate in the education of many nurses who work to provide optimal care to older individuals. The journal has continued to produce wonderful reviews of care management with regard to specific chronic health problems such as urinary incontinence, hearing impairment, diabetes, or Alzheimer’s disease, as well as addressing current policy issues and care management challenges related to medication, various care sites (assisted living versus nursing home), and the cultural and lifestyle differences among the older adults we care for. In addition, cutting-edge care interventions are introduced that focus on chang-
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Barbara Resnick PhD, CRNP, FAAN, FAANP
ing old philosophies of care in areas of fall and injury prevention, restorative care, and management of behavioral problems. So as I take on editorship, I have asked myself, are we there yet? Are we where we need to be in geriatric nursing? If not, how can Geriatric Nursing help us get there? Kovner, Mezey, and Harrington remind us that despite the fact that we have a growing number of older adults with multiple chronic illnesses requiring ongoing medical management, less than 1% of practicing registered nurses are certified in geriatrics (Sprately et al.). Less than a quarter of baccalaureate nursing programs required specific geriatric content, and only 14% had available an elective related to care of the older adult.1,2 Based on a recent survey of nurse practitioners by the American Academy of Nurse Practitioners,3 about 41% of the approximately 106,000 U.S. nurse practitioners (NPs) are family NPs, 19% are adult NPs, and only 4.1% are gerontological NPs. Of the 157,200 registered nurses who have completed a master’s level program to become certified nurse specialists, nurse practitioners, or both, only 3% are certified in geriatric nursing.4 Moreover, there is a critical shortage of geriatric nursing faculty, with one-quarter of nursing programs lacking a faculty member with expertise in this area. There are currently 63 programs in the United States focused on training of geriatric nurse practitioners, and in most of these programs, enrollment is low. Consequently, many of these programs are being blended into adult or family nurse practitioner (ANP or FNP) programs and do not allow for the comprehensive focus on care of older adults across all care settings. Because only 4%, at most, of all NPs iden-
Geriatric Nursing, Volume 27, Number 1
tify gerontology as their main specialty (approximately 4,346 NPs), most NP positions in nursing homes or primary care offices with nursing home affiliations are assumed by FNP and ANPs. It has repeatedly been recognized that specialized knowledge in the care of older adults is needed to ensure that these older adults receive not only safe care but that the level of nursing care will optimize health, function, and quality of life.1,5,6 So, no we are not there yet— but lets keep moving! We are not alone among the disciplines in recognizing that there are not enough nurses available with specialized knowledge in care of older adults. Our physician colleagues and other members of the American Geriatrics Society Task Force on the Future of Geriatric Medicine similarly recognized that there is a paucity of certified geriatricians and insufficient numbers of physicians focused on geriatric care.7 It is hoped that the task force’s comprehensive document, Caring for Older Americans: The Future of Geriatric Medicine, will increase the focus and recognition on the part of policy makers to facilitate removal of barriers to education and training of providers in the care of older adults. In addition, I see Geriatric Nursing as a way to help us get there. Continuing education through peer-reviewed journals in clinically focused care can help us ensure that the best possible care will be provided for our older patients. I challenge each of you not only to continue to subscribe to Geriatric Nursing in the coming years but to read these articles and implement the findings and suggestions into practice. Your
next challenge is to share these articles with a friend or colleague. Bring the journal to your facilities and share it with staff (it is amazing what people will read if it is left in front of them!). Buy a subscription as a gift for a friend, a new graduating nurse, or a nurse who finds that he or she is entering the field of geriatrics by virtue of demographic changes. Share with us your thoughts and comments about these articles and let’s work together to best meet the health care needs of older adults.
References 1. Kovner CT, Mezey M, Harrington C. Who cares for older adults? Workforce implications of an aging society. Health Affairs (Millwood) 2002;S21:78-89. 2. Grocki JH, Fox GE Jr. Gerontology coursework in undergraduate nursing programs in the United States: a regional study. J Gerontol Nurs 2004;30:46-51. 3. American Academy of Nurse Practitioners. Available at www.aanp. Accessed December, 2005. 4. American Nurses Credentialing Center. Available at www.nursingworld.org/ancc. Accessed December, 2005. 5. Ersek M, Ferrell BR. Palliative care nursing education: opportunities for gerontological nurses. J Gerontol Nurs 2005;31:45-51. 6. Futrell M, Melillo KD. Gerontological nurse practitioners: implications for the future. J Gerontol Nurs 2005;31:19-24. 7. Besdine R, Boult C, Brangman S, et al., and the American Geriatrics Society Task Force on the Future of Geriatric Medicine. Caring for older Americans: the future of geriatric medicine. J Am Geriatr Soc 2005;53: S245-56. 0197-4572/06/$ - see front matter © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.11.001
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Barbara Resnick PhD, CRNP, FAAN, FAANP
ing old philosophies of care in areas of fall and injury prevention, restorative care, and management of behavioral problems. So as I take on editorship, I have asked myself, are we there yet? Are we where we need to be in geriatric nursing? If not, how can Geriatric Nursing help us get there? Kovner, Mezey, and Harrington remind us that despite the fact that we have a growing number of older adults with multiple chronic illnesses requiring ongoing medical management, less than 1% of practicing registered nurses are certified in geriatrics (Sprately et al.). Less than a quarter of baccalaureate nursing programs required specific geriatric content, and only 14% had available an elective related to care of the older adult.1,2 Based on a recent survey of nurse practitioners by the American Academy of Nurse Practitioners,3 about 41% of the approximately 106,000 U.S. nurse practitioners (NPs) are family NPs, 19% are adult NPs, and only 4.1% are gerontological NPs. Of the 157,200 registered nurses who have completed a master’s level program to become certified nurse specialists, nurse practitioners, or both, only 3% are certified in geriatric nursing.4 Moreover, there is a critical shortage of geriatric nursing faculty, with one-quarter of nursing programs lacking a faculty member with expertise in this area. There are currently 63 programs in the United States focused on training of geriatric nurse practitioners, and in most of these programs, enrollment is low. Consequently, many of these programs are being blended into adult or family nurse practitioner (ANP or FNP) programs and do not allow for the comprehensive focus on care of older adults across all care settings. Because only 4%, at most, of all NPs iden-
Geriatric Nursing, Volume 27, Number 1
tify gerontology as their main specialty (approximately 4,346 NPs), most NP positions in nursing homes or primary care offices with nursing home affiliations are assumed by FNP and ANPs. It has repeatedly been recognized that specialized knowledge in the care of older adults is needed to ensure that these older adults receive not only safe care but that the level of nursing care will optimize health, function, and quality of life.1,5,6 So, no we are not there yet— but lets keep moving! We are not alone among the disciplines in recognizing that there are not enough nurses available with specialized knowledge in care of older adults. Our physician colleagues and other members of the American Geriatrics Society Task Force on the Future of Geriatric Medicine similarly recognized that there is a paucity of certified geriatricians and insufficient numbers of physicians focused on geriatric care.7 It is hoped that the task force’s comprehensive document, Caring for Older Americans: The Future of Geriatric Medicine, will increase the focus and recognition on the part of policy makers to facilitate removal of barriers to education and training of providers in the care of older adults. In addition, I see Geriatric Nursing as a way to help us get there. Continuing education through peer-reviewed journals in clinically focused care can help us ensure that the best possible care will be provided for our older patients. I challenge each of you not only to continue to subscribe to Geriatric Nursing in the coming years but to read these articles and implement the findings and suggestions into practice. Your
next challenge is to share these articles with a friend or colleague. Bring the journal to your facilities and share it with staff (it is amazing what people will read if it is left in front of them!). Buy a subscription as a gift for a friend, a new graduating nurse, or a nurse who finds that he or she is entering the field of geriatrics by virtue of demographic changes. Share with us your thoughts and comments about these articles and let’s work together to best meet the health care needs of older adults.
References 1. Kovner CT, Mezey M, Harrington C. Who cares for older adults? Workforce implications of an aging society. Health Affairs (Millwood) 2002;S21:78-89. 2. Grocki JH, Fox GE Jr. Gerontology coursework in undergraduate nursing programs in the United States: a regional study. J Gerontol Nurs 2004;30:46-51. 3. American Academy of Nurse Practitioners. Available at www.aanp. Accessed December, 2005. 4. American Nurses Credentialing Center. Available at www.nursingworld.org/ancc. Accessed December, 2005. 5. Ersek M, Ferrell BR. Palliative care nursing education: opportunities for gerontological nurses. J Gerontol Nurs 2005;31:45-51. 6. Futrell M, Melillo KD. Gerontological nurse practitioners: implications for the future. J Gerontol Nurs 2005;31:19-24. 7. Besdine R, Boult C, Brangman S, et al., and the American Geriatrics Society Task Force on the Future of Geriatric Medicine. Caring for older Americans: the future of geriatric medicine. J Am Geriatr Soc 2005;53: S245-56. 0197-4572/06/$ - see front matter © 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2005.11.001
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