NEW HORIZONS

How an aging population

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is transforming nursing

By Kristen Bryan Wessel, MSN, RN

RZELICH /iSTOCK

ACCORDING TO THE U.S. Census Bureau, 44.7 million Americans are age 65 or older.1 This constitutes a larger group of older adults than at any other time in U.S. history. When the last of the Baby Boomers, those born around 1965, reach retirement age in 2030, more than 20% of the population will be 65 or older. This article outlines how an aging population will challenge the nursing profession and how the nurses of the future can be prepared. Meeting challenges An aging population places additional pressure on the healthcare system in general and on nurses in particular. Many older patients have multiple serious comorbidities requiring highly individualized care from specialists in several healthcare disciplines. Dementia, falls, geriatric syndromes, and elder abuse: All add to the impact on the nursing profession. New models of long-term care are emerging, with requirements for palliative, hospice, and particularly home-based care.

The Bureau of Labor Statistics reports that about 2 million jobs may be added to the homecare field through 2020.2 This is, in part, related to the demand brought on by the aging population. As a result of an increase in demand for care as well as a need for more complex care, home-based care is likely to become more difficult to manage than it has been up until now. The CDC suggests that among older adults living at home, about 25% are in fair or poor health, 29% have diabetes, and more than 50% have hypertension.3 Coordination and teamwork In practice, this means that an older woman admitted to the hospital as the result of a fall may also have a history of diabetes, heart failure, osteoporosis, anemia, and hypertension. Coordinating her treatment is relatively straightforward in the controlled environment of an acute-care setting, but when she returns home, this becomes much more difficult. Attempts to coordinate various specialists, medications, and ap-

pointments can create a chaotic situation in which an overwhelmed patient can become confused, discouraged, or lost in the complex healthcare system. Many studies, including one conducted by the Institute of Medicine (IOM), attribute high-quality, safe patient care to effective teamwork.4 Not surprisingly, the American Geriatrics Society (AGS) promotes greater coordination among the healthcare team members involved in treating and caring for older adults.5 As indicated in the IOM’s 2011 report, The Future of Nursing: Leading Change, Advancing Health, the team can include healthcare providers, geriatric nurses, pharmacists, therapists, and social workers. What does this mean for nurses? The vital, complex, and challenging role of coordination, promoted by the AGS, falls to nurses in most cases.5 Educational boost Many resources have been designed to ensure that nursing students can learn about and provide the geriatric care needed. The Geriatric Nursing

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Education Consortium was initiated to promote geriatric nursing education through the instruction and support of nursing faculty. Its goal is to enhance the geriatric curriculum at the baccalaureate level.6 The consortium continues to provide training and resources intended to aid nursing faculty in the promotion and enhancement of gerontology in undergraduate nursing education. In addition, the American Association of Colleges of Nursing published the Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults. This document is intended to assist nurse educators in incorporating geriatricfocused nursing content and learning opportunities into the baccalaureate nursing curriculum.7 Leadership required Besides commanding more geriatric clinical training and practice, nurses of the future will also need a number of key “soft” skills to foster communication and teamwork. These skills will let them coordinate care more effectively, lead multidisciplinary teams, and advance innovative nursing practice to ensure that older patients get effective multidisciplinary treatment. These skills will be most effective when combined with leadership skills. Some nurses still run into the lingering but mistaken idea that their role is secondary or subservient to that of physicians. This cultural hangover has no place in the changing healthcare environment. The IOM’s report supports nurses as full partners with physicians and other healthcare professionals in redesigning healthcare in the United States: “public, private, and governmental healthcare decision makers at every level should include representation from [the nursing profession] on boards, on executive management teams, and in other key leadership positions.”4 This leadership role may be one of the biggest shifts in the role of

New models of longterm care will require palliative, hospice, and home-based care. nursing. Nurses who wish to step up to leadership roles will also need enhanced critical thinking skills. Nurses must be able to efficiently assess, analyze, and interpret each patient situation. They must also be able to anticipate possible outcomes, formulate a plan, and implement that plan in a timely fashion. That requires nurses of the future to have confidence in their own judgment and to advocate effectively on behalf of patients, staff, or organizations. As more medical care moves into patients’ homes, nurses of the future will also find themselves as the primary provider of direct patient care and support, and a central contact point for coordination of care. Because coordination and collaboration will almost certainly take place outside of the acute care setting, nurses will need to rely heavily on autonomous, evidence-based decisionmaking skills.

Technology leaders Perhaps the most obvious characteristic of nurses of the future is that they’ll become innovators and even technological leaders. Technology can help medical staff provide remote healthcare, but it’s nurses who’ll be encouraging patients, particularly in cases where patients are unfamiliar with technology or reluctant to use it. Part of the role will also be to reassure families about the continued quality of the healthcare being provided by explaining the effectiveness and advantages that technology in healthcare setting can provide. These are essential tasks, given that educating patients has been proven to have a significant impact on readmission rates—which, in turn, affects hospital reimbursement and revenue sources.8 Finally, nurses of the future can become involved in innovative healthcare awareness and communication strategies that target the wider population. As the emphasis shifts to preventive healthcare and resources for care are spread even more widely, this involvement will become even more important. Lifelong learning The changes in healthcare—more patients, more geriatric care, more home care, more focus on wellness and preventive care—demand renewed focus on lifelong learning for nurses. In a 2010 Carnegie publication, Educating Nurses: A Call for Radical Transformation, Benner et al. assert, “The profound changes in nursing practice and healthcare call for equally profound changes in the education of nurses and the preparation of nurse educators.”9 The IOM further recommends increasing the proportion of nurses with a bachelor’s of science in nursing to 80% by 2020.4 Fortunately, opportunities abound for nurses to advance their knowledge and skills in the field of geriatric care. Healthcare has already seen a swing

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toward preventive care and wellness models, and these movements form a solid foundation for geriatric care. As a result, a geriatric care component is often embedded in the final year of undergraduate studies. Formal education, such as an advanced practice degree or certificate in geriatric care, can also help nurses gain the specialized knowledge and skills to care for the aging population. Preparation for leadership, innovation, and coordination will also come from professional development opportunities that stimulate and test critical thinking. Nurse educators are making more courses available that directly address the new skills being demanded of nurses. Formal nursing education programs also prepare nurses for decision-making and leadership roles that combine classroom-based education and realworld experience.

The nursing profession will need to place greater emphasis on lifelong learning for individual practitioners. Already, the opportunities for continual education are flourishing. Not only is this good news for patients, who are much less likely to fall through the gaps, it’s good news for nurses, who can advance professionally while still fulfilling the vocation that drew them to the profession in the first place. ■ REFERENCES 1. United States Census Bureau. As the nation ages, seven states become younger, Census Bureau reports. 2014. http://www.census.gov/newsroom/ press-releases/2014/cb14-118.html. 2. Henderson R. Employment outlook: 2010-2012. Industry employment and output projections to 2020. Monthly Labor Review. 2012;(Jan):65-83. http://www.bls.gov/opub/mlr/2012/01/art4full.pdf. 3. Centers for Disease Control and Prevention (CDC). The State of Aging and Health in America 2013. Atlanta, GA: CDC; 2013. 4. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011.

5. American Geriatrics Society. Care coordination. 2014. http://www.americangeriatrics.org/ advocacy_public_policy/care_coordination. 6. Hartford Institute for Geriatric Nursing. Geriatric Nursing Education Consortium. 2015. http://www. hartfordign.org/education/gnec_%E2%80%93_ geriatric_nursing_education_consortium. 7. American Association of Colleges of Nursing (AACN) and Hartford Institute for Geriatric Nursing. Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults: A Supplement to the Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: AACN; 2010. 8. Roney K. Interactive patient education reduces readmissions, increases satisfaction: Kaiser Permanente Panorama Hospital case study. Becker’s Health IT and CIO Review. 2012. http://www. beckershospitalreview.com/healthcare-informationtechnology/interactive-patient-education-reducesreadmissions-increases-satisfaction-kaiserpermanente-panorama-hospital-case-study.html. 9. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass/Wiley; 2010. Kristen Bryan Wessel is an assistant professor of healthcare programs at Bellevue University in Bellevue, Neb. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000461856.10691.da

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