Looking Back to Move Forward

1. Looking Back to Move Forward

2. Looking Back to Move Forward • Claire M. Fagin • Mathy Mezey • Neville Strumpf • Cornelia Beck • Susan Reinhard

3. Looking Back to Move Forward • 1987 • 27Centers of Excellence in Geriatric Medicine • Major source of geriatric faculty • Increased prestige, credibility, status and internal funding

4. Looking Back to Move Forward • 1996 • Hartford Institute for Advancing Geriatric Nursing Practice • 1998 • Hartford Social Work Faculty Fellows Program

5. Looking Back to Move Forward • 2000 • Multidisciplinary Expert Panel • Presented white papers on state of the science in geriatric nursing • <.005% of U.S. RNs certified in geriatrics • <25% of SON had required geriatric courses or faculty to teach geriatrics • <5% of APN students were pursuing geriatric specialty • 16% PhD programs surveyed had a primary interest in geriatrics • 16% of NINR funded programs specific to geriatrics

6. Looking Back to Move Forward • 2000 • 5 Centers of Geriatric Nursing Excellence • Predoctoral & Postdoctoral Award Program • 2001 • Nursing School Geriatric Investment Program • 2007 • 4 Additional Centers of Geriatric Nursing Excellence

7. Looking Back to Move Forward • BAGNC; 10 years of investment 2000 2001 2003 2004 2005 2008 2010 Total $31.8 $1.2 $2.2 $7.2 $3.0 $10.4 $7.8

8. Looking Back to Move Forward As of July 1, 2010 • 102 completed 2 year predoctoral scholarship • 4 completed 2 year MBA scholarship • 70 completed 2 year postdoctoral fellowship

9. Looking Back to Move Forward; 2001

10. Looking Back to Move Forward; 2010

12. Looking Back to Move Forward • Panel Members • Mathy Mezey • Neville Strumpf • Cornelia Beck • Susan Reinhard

13. Mathy Mezey, EdD, RN, FAANNYU College of Nursing, Hartford Institute for Geriatric Nursing Looking Back to Move Forward: Focus on Practice

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

15. Focus of Presentation • Achieving geriatric competency of all nurses • Structuring clinical settings to be receptive to best-practice in care of older adults • Creating competencies and resources for the individual nurse • Creating system change

16. Context of geriatric nursing over the past 10 years • We have been supported by an unusually strong commitment to geriatric nursing by foundations (JAHF: Atlantic Philanthropies; the Commonwealth Fund) • Several key reports (IOM; Macy Foundation) have emphasized the need to “re-tool” for an aging America • The aging of the “baby boomer” generation is clearly driving a new look at aging

17. Conceptual changes in geriatric nursing • Movement towards geriatric competency for all practicing nurses rather than primarily specialization in geriatrics • Movement towards language of “care of older adults” and away from “geriatrics” • Movement towards a systems approach in the practice setting in addition to a focus on the individual nurse

18. Achieving geriatric competency of all nurses: The education “pipeline” Entry-level nurses • AACN Baccalaureate Competencies • AACN/HI GNEC program • NLN Advancing Care Excellence for Seniors (ACES) Graduate nurses • AACN Adult/Gerontology NP and CNS Competencies • AACN/HI Resources for Adult/Gerontology NPs and CNS Programs

19. Achieving geriatric competency of all nurses: Reaching the practicing nurse • Nurses in specialty practice: the REASN project • The Adult-Gerontology Nurse Practitioner and Clinical Nurse Specialist (the LACE model) • The STTI Center for Nursing Excellence in Long-term Care

20. Specialty nurses • 60+ associations representing >500,000 nurses • Associations have developed products specific to care of older adults • Critical Care Nurses Association • Emergency Room Nurses • Oncological Nurses Association

21. Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on the individual nurse • Competencies: • The Hartford Institute Geriatric Nursing Hospital Competencies • Geropsychiatric Nursing Collaborative Core Competencies • Nurse Competencies for Nursing Home Culture Change (Pioneer Network) • Evidence-based Resources (web-based and print) • Assessment tools (e.g. Try This ®) • Practice protocols • Age specific and specialty nurse Web sites • Texts

22. Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on achieving system change • NICHE (Nurses Improving Care to Healthsystems Elders) • AONE’s Guiding Principles for the Elder-Friendly Hospital/facility and the Role of the Nurse Leader • Transitional care models • Resident-directed care & culture change movement in nursing homes

23. NICHE • >350+ NICHE hospitals in North America • A systems approach to improving care to older adults • Specific role for the geriatric APRN • Use of evidence-based models, e.g. the Geriatric Resource Nurse (GRN) • Implementation of geriatric protocols and QI indicators

24. Concluding observations • “Pipeline” entry and graduate nursing students are now likely to graduate with competencies in care of older adults • Practicing nurses have access to a wide variety of competencies and resources in care of older adults • Health systems still have a lot to do to be receptive to best-practices in care of older adults • Yet to be fully explored and implemented is the role of inter-disciplinary teams in care delivery to older adults

25. Neville Strumpf, PhD,RN, FAAN Looking Back to Move Forward: Focus on Education

26. Cornelia Beck, PhD, RN, FAAN Looking Back to Move Forward: Focus on Research

27. Susan Reinhard, PhD, RN, FAAN Looking Back to Move Forward: Focus on Policy