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OVERVIEW: Nurse Competence in Aging is a five-year initiative created in 2002 through an alliance of the American Nurses Association, the American Nurses Foundation, the American Nurses Credentialing Center, and the John A. Hartford Foundation Institute for Geriatric Nursing. Its goal, at a time when more and more nurses are working with older adults in all settings, is to work with specialty nursing associations in encouraging nurses to gain dual expertise in geriatrics and another specialty.
In almost every setting, the caseload of RNs consists primarily of older adults (those ages 65 and older).1 For example, nurses provide preventive-care and wellness programs, help manage chronic conditions, and facilitate peaceful death. Much evidence shows that nurses with knowledge and skills in geriatrics give better care and produce better outcomes. Yet few nurses have had the opportunity to gain such knowledge, either through education or at work.
Nurse Competence in Aging (NCA) is a five-year initiative created in 2002 through an alliance of the ANA, the American Nurses Credentialing Center (ANCC), and the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute). Funded by the Atlantic Philanthropies, through the American Nurses Foundation, the initiative addresses the need to ensure competence in geriatrics among nursing specialties in which nurses serve older patients. Collectively, the associations that represent these specialties have a membership of over 400,000 practicing nurses,1 who work in settings such as critical care and medical-surgical units, oncology, rehabilitation, and hospice. The main objective of the NCA initiative is to help associations to embrace the concept of, and individual nurses to adopt, "dual professionalism" in geriatrics and another specialty practice.1 (Throughout this article the term nurses refers to RNs; the term geriatrics refers to both geriatric and gerontological practice.)
Research shows that nurses with preparation in geriatrics provide significantly improved care to older adults. For example, studies in nursing homes have shown that when nurses know about the best practices in restraint use, the prevalence of restraint use and the incidence of serious restraint-related injuries decrease.2,3 When nurses are educated to recognize delirium in older adults, delirium is recognized earlier, treatment is more effective, and outcomes improve.4,5 And there is evidence that elderly patients with heart failure who are cared for by nurses prepared in geriatrics have fewer rehospitalizations.6 Yet despite improved outcomes and considerable federal and private funding of nursing education and research in geriatrics, there is a critical shortage of nurses in geriatrics.
Geriatric nurses are certified at two levels: gerontological nurses, and gerontological NPs and clinical nurse specialists (CNSs) (the ANCC uses the term gerontological rather than geriatric in credentialing nurses, but the latter term is also common). Certified gerontological nurses are RNs who have met certain criteria and passed an ANCC examination. According to Bradley R. Brenner, project manager at the ANCC and one of the authors of this article, as of this April, fewer than 1% of nurses in this country were ANCC certified as gerontological nurses. Gerontological NPs and CNSs are master's-prepared advanced practice nurses who have met certain criteria and passed an ANCC examination. And according to Brenner, as of April, roughly 4,300 NPs and CNSs were so certified, representing about 5.6% of all gerontological nurses. These figures fall far short of national needs.
Because it has proven difficult to attract sufficient numbers of nurses to geriatrics, nursing (and medicine in general) has advocated preparing all nurses, especially those in specialty practice, in basic geriatric competencies.
Many RNs with specialized expertise join national nursing associations representing their specialties. These nurses are an appropriate target for encouraging acquisition of geriatric competence along with specialty practice.
About 20% of the nation's practicing nurses are members of specialty nursing associations, which offer the NCA initiative avenues for disseminating information on enhancing competency in geriatrics.
The NCA initiative has three major goals: enhancing geriatric activities of national specialty nursing associations, promoting gerontological nursing certification nationally, and providing an Internet resource center for specialty nurses.
Enhancing geriatric activities of specialty nursing associations. As of April, 55 groups were involved in the NCA initiative: 50 associations representing more than 433,000 RNs have been designated ANA Specialty Nursing Association Partners in Geriatrics (ANA-SNAPGs), and five organizations have been designated NCA Resource Organizations. The ANA-SNAPGs applied for and were awarded funding for planning or implementation grants in order to initiate or expand activities related to geriatric nursing within the association and among individual members. These activities may include promoting dual certification in geriatrics and another specialty, adding geriatrics to specialty certification examinations, and writing and disseminating position papers on geriatrics. Resource organizations provide technical assistance to all ANA-SNAPGs in developing these activities.
Because specialty nursing associations differ in mission and size, the NCA initiative's call for proposals is flexible enough to invite proposals that suit the structure of each association. The NCA initiative's goal is that funding will deepen the commitment of each ANA-SNAPG to the care of older adults during the grant period and afterward.
Several activities serve to do so: forming special interest groups, publishing position papers, incorporating content into specialty practice scopes and standards, publishing articles in specialty nursing association publications, initiating an award for nurses within these associations who provide exemplary care to older adults, and offering sessions at association conferences. From the project's inception, an independent evaluator, the Measurement Group LLC, has evaluated ANA-SNAPG activities on an ongoing basis, through progress reports and conference calls. The first wave of data on ANA-SNAPG activities pertained to the first 26 associations funded. The activities reported most often were disseminating information (96% of ANA-SNAPGs), promoting geriatrics at conferences (96%), promoting the use of the Web site (89%), and creating or amending the ANA-SNAPGs' administrative infrastructure (86%). Early reports from the Measurement Group show that the majority of ANA-SNAPGs have not only accomplished their goals but have surpassed them.
Promoting gerontological certification for nurses in specialty practice. Having nurses prepared in both geriatrics and a specialty such as oncology is advantageous to hospitals. Although not all specialty nurses hold master's degrees, nurses who are members of specialty associations tend to work on specialized units of the hospital (critical and cardiac care, oncology, or the ED, for example). Nurses with dual certification also improve a hospital's ability to respond to community needs (such as by establishing health care promotion programs for older adults), to take advantage of grant-funding opportunities, and to meet requirements of the Joint Commission on Accreditation of Healthcare Organizations.
For the nurse, adding a geriatrics certification to an existing specialty broadens professional opportunities and makes higher earnings more likely. For example, a clinical nurse specialist certified in both geriatrics and wound, ostomy, and continence nursing could work as a consultant in nursing homes and home care, billing Medicare directly.
Through the NCA initiative, gerontological examinations for generalists (diploma nurses and those holding associate's or bachelor's degrees) are now computerized and accessible six days a week at more than 300 testing sites nationwide. The initiative has also launched a public relations campaign to promote the value of gerontological nursing certification, helped nurses find resources for studying for the certification examination, initiated gerontological nursing certification campaigns within facilities, and disseminated information on certification through various media.
Providing an Internet resource center for specialty nurses. From 1999 to 2005, the Hartford Institute sponsored an exhibit booth at specialty nursing association conferences. When the NCA initiative was funded in 2002, the Hartford Institute booth became the Nurse Competence in Aging booth. But the booth was costly to maintain and cumbersome to transport, and with the growth of the Internet making information widely and easily accessible, the NCA initiative's resources could be offered online instead.
In July 2004, the NCA initiative launched GeroNurseOnline (http://www.geronurseonline.org). Users can search the site by signs and symptoms, specific topics in geriatrics, or specialty practice areas. The Web site is organized into three levels of depth. The "Need Help Stat" section provides a drop-down list of patient-care topics that links to concise and targeted material, including assessment instruments for nurses who need information that can be used immediately. The next level is the "Want to Know More" section, which provides further information on those topics. Each topic also links to a "Topic Resource" section, in which users are directed to current journal articles, textbooks, associations, and related practical materials specific to each area.
Nurses can now earn contact hours for reviewing and testing on geriatric topics available on GeroNurseOnline. Free registration allows users to bookmark pages and lets the site suggest additional content, according to their areas of interest.
In 2004 the NCA initiative implemented the Web Fellow Project. The NCA initiative's goal is to have all involved groups designate one or more members as Web Fellows, who are responsible for enhancing access to information on geriatrics on their Web site and for providing content to GeroNurseOnline related to their specialty. So far, 31 associations have designated a Web Fellow.
For a complete list of the ANA-SNAPGs and resource organizations, go to http://www.geronurseonline.org.
1. Scholder J, et al. Nurse competence in aging overview. Nurs Clin North Am 2004;39(3):429-42, vii. [Context Link]
2. Evans LK, et al. A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc 1997;45(6):675-81. [Context Link]
3. Neufeld RR, et al. Restraint reduction reduces serious injuries among nursing home residents. J Am Geriatr Soc 1999;47(10):1202-7. [Context Link]
4. Foreman MD, et al. Delirium in elderly patients: an overview of the state of the science. J Gerontol Nurs 2001;27(4):12-20. [Context Link]
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6. Naylor MD, et al. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc 2004;52(5):675-84. [Context Link]
7. American Association of Critical Care Nurses. AACN certification corporation fact sheet. Aliso Viejo, CA: The Association; 2006. http://www.aacn.org/AACN/mrkt.nsf/Files/CertFactSheet/$file/CertFactSheet.doc.
8. American Association of Critical Care Nurses. Safeguarding the patient and the profession: the value of critical care nurse certification. Aliso Viejo, CA: The Association; 2002 Dec. Prod. #5062. http://www.aacn.org/AACN/mrkt.nsf/Files/CertWhitePaper/$file/CertWhitePaper.pdf.
9. Taskforce on Health Care Workforce Regulation. Reforming health care workforce regulation: policy considerations for the 21st century. San Francisco: Pew Health Professions Commission; 1995 Dec. http://www.futurehealth.ucsf.edu/pdf_files/reforming.pdf.
10. Taskforce on Health Care Workforce Regulation. Strengthening consumer protection: priorities for health care workforce regulation. San Francisco: Pew Health Professions Commission; 1998 Oct. http://www.futurehealth.ucsf.edu/pdf_files/RTF.PDF.
11. Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academies Press; 2000.
12. Mee CL. Salary survey. Nursing 2005;35(10):46-50.
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