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A NEW ERA IN GERIATRIC NURSING EDUCATION GINETTE A. PEPPER PHD, RN, FAAN Associate Dean for Research and PhD Program, and Professor, College Of Nursing, University of Utah Salt Lake City, UT Director, Hartford Center Geriatric Nursing Excellence College Of Nursing, University of Utah Salt Lake City, UT E-mail: [email protected]

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TATISTICS DOCUMENTING AGING of the developed world’s populations and the impact on health care are widely recounted. There is hope that age-related disability may be postponed due to progress in disease control and healthy aging, a major focus of gerontological nursing science. Yet longer life spans will undoubtedly intensify demand for competent geriatric nursing care. Since 1996 when the John A. Hartford Foundation (JAHF) began its 20year investment in geriatric nursing, a rich scientific evidence base has been developed as a foundation for geriatric nursing practice and education, comparable to other population specialties such as pediatric and maternity nursing. Recognizing that the greatest barrier to improving geriatric care was the lack of academic capacity, JAHF commenced a geriatric nursing initiative in 2000 focused on nursing education at all levels from associate degree to postdoctoral education (Bednash, Mezey, & Tagliareni, 2011). Over $83 million in support has been awarded to nursing schools and professional organizations by JAHF for elaboration of educational competencies, professional development in teaching geriatrics, and providing accessible educational resources for existing faculty; award of predoctoral and postdoctoral fellowships to support preparation of a cadre of new faculty as future leaders of the field; and designation of one institute and nine centers of geriatric nursing excellence to advance education, practice, and research. As JAHF redirects its funding priorities ‘‘downstream” from building academic capacity in medicine, nursing, and social work to focus on practice change initiatives, the final exit grant in the JAHF nursing initiative ends in 2016. Academic nursing faces challenges not just to maintain the improvements in geriatric nursing education and research of the past 20 years, but also to sustain growth and momentum to ensure that the nursing workforce is prepared to provide competent nursing care as the number of older adults in our healthcare system doubles over the next 20 years. Without deliberate planning by academic leadership on the institutional and national level, the progress of the last two decades could be in jeopardy in both advanced practice and basic nursing education. One of the greatest threats to preserving the profession’s covenant with aging Americans is whether there will be sufficient advanced practice registered nurses 8755-7223

(APRNs) adequately prepared to provide primary care for older adults. The APRN Consensus Model (2008) established adult-gerontology as a population focus to increase the number of APRNs qualified to provide care to older adults. Graduate students in this focus are required to receive a rich and intense exposure to geriatrics based on the Adult-Gerontology Nurse Practitioner and Clinical Nurse Specialist Competencies (2010) in preparation for expanded coverage on certification exams. The consensus model also provided that APRNs prepared for family or gender specific population care must be prepared to meet the needs of the older adult population. Yet, 62% of all primary care nurse practitioners who care for adults are family nurse practitioners (FNPs), and 84.9% of nurse practitioners see patients covered by Medicare, the majority of whom are older adults (AANP, 2013). Not only were the majority of FNPs prepared prior to the consensus model and thus have varying geriatric preparation, but also the infrastructure to ensure that future FNP graduates are

Journal of Professional Nursing, Vol 30, No. 6 (November/December), 2014: pp 443–444 © 2014 Elsevier Inc. All rights reserved.

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adequately prepared is underdeveloped; national competencies, curricular standards, and enhanced certification testing are lacking. While tremendous strides were made in the past 20 years to enhance geriatric content in basic nursing programs, dedicated geriatric nursing courses taught by faculty with graduate preparation in gerontological nursing remain the exception, while coursework by qualified faculty in other population foci (pediatrics, maternity, and mental health) is virtually universal. A growing proportion of prelicensure students, particularly those in second degree programs, recognize the relevance of demographic changes for their future practice, yet many undergraduate learning activities emphasize positive attitudes toward aging, rather than critical competencies such as evidence-based models of gerontological care that promote quality and safety and use of guidelines to prevent and manage geriatric syndromes (Lyons et al., 2014). It is difficult to imagine the state of geriatric nursing education without the impetus of JAHF over the past two decades, but without concerted, continuing effort, it is unlikely that nursing will meet the challenges of 2030. A priority for organized nursing is to provide the academic and professional development structure to ensure that

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APRNs have current geriatric nursing knowledge. Likewise, basic programs need to ensure that quality geriatric nursing education, whether integrated or in a dedicated course, is taught by qualified content experts.

References AANP (2013). NP facts. http://www.aanp.org/images/ documents/about-nps/npfacts.pdf2013 (Retrieved October 3, 2014). Bednash, G., Mezey, M. & Tagliareni, E. (2011). The Hartford Geriatric Nursing Initiative experience in geriatric nursing education: Looking back, looking forward. Nursing Outlook, 59, 229–235. Consensus model for APRN regulation: Licensure, accreditation, certification & education (2008, July 7). http://www. aacn.nche.edu/education-resources/APRNReport.pdf (Retrieved October 4, 2014). Lyons, C. M., Benefield, L., Holtsclaw, B., De Shea, B., Short, D. & Wilson, J. S. (2014). Enhancing gerontology in undergraduate nursing programs. The Oklahoma Nurse, 59, (2), 8–12. Adult-gerontology nurse practitioner and clinical nurse specialist competencies (2010, March). http://www.aacn.nche. edu/geriatric-nursing/adultgerocnscomp.pdf (Retrieved October 4, 2014).

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