The Gerontologist, 2015, Vol. 55, No. S1, S1–S12 doi:10.1093/geront/gnv056 Introduction
The National Hartford Center of Gerontological Nursing Excellence: An Evolution of a Nursing Initiative to Improve Care of Older Adults J Taylor Harden, PhD, RN, FGSA, FAAN,*,1 and Rachael A. Watman, MSW2 National Hartford Center of Gerontological Nursing Excellence, Washington, District of Columbia. 2The John A. Hartford Foundation, New York, New York. 1
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*Address correspondence to J Taylor Harden, PhD, RN, FGSA, FAAN, National Hartford Center of Gerontological Nursing Excellence, 1220 L Street NW, Suite 901, Washington, DC 20005. E-mail: [email protected] Received October 1 2014; Accepted March 16 2015.
The mission of the John A. Hartford Foundation is to improve the health of older Americans. This mission has been realized throughout the evolution of the National Hartford Center of Gerontological Nursing Excellence—an international collaboration between Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing—whose goal is to support research, education, and practice to provide better nursing care for our aging society. The National Hartford Center is the focus of this supplement and an example of the Foundation’s grant-making to prepare the nursing workforce to be competent to care for our aging society. This article traces the innovative origin and inception of the National Hartford Center, first as the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative in 2000 under the leadership of two groundbreaking scholars in nursing and aging sciences: Claire M. Fagin, PhD, RN, and Patricia G. Archbold, DNSc. We continue through to today’s leadership and culminate by describing the Center’s influence on the gerontological nursing workforce and clinical practice; the paper also includes a brief introduction to the articles, highlighting advances in gerontological nursing science. With funding from the John A. Hartford Foundation, The Atlantic Philanthropies, The Mayday Fund, and a number of creative public and nonprofit partnerships, the National Hartford Center celebrates two decades and its greatest asset—the nearly 300 gerontological nursing leaders, including Archbold nursing pre-docs, Fagin nursing post-docs, and expert faculty, along with its Hartford Centers of Gerontological Nursing Excellence across the country. We trace the transition of BAGNC to the membershipbased National Hartford Center and its move to T he Gerontological Society of America to become a self-sustaining, autonomous unit. Current needs, challenges, lessons learned, and strategies of the National Hartford Center are examined within the context of sustainability, which has become paramount as Hartford Foundation funding ends in 2016. Despite the auspicious beginnings of the National Hartford Center, system change has been slow. There remains a strong need to continue to grow the field of gerontological nursing and aging sciences. We are working diligently to drive health system reform, and develop and support gerontological nursing leaders and members of the National Hartford Center as exemplars for innovation in care of older adults. The contributing
© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].
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authors of this supplement are from member schools of the National Hartford Center or are current or past program Scholars or Fellows. Herein these authors showcase innovation for older adults through their research that addresses an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs. Key words: John A. Hartford Foundation, Centers of Excellence, Schools of Nursing, Nursing research, Clinical practice, Nursing education, Pre-doctorates and post doctorates
formative and summative evaluations (Fagin, Franklin, Regenstreif, & Huba, 2006). One of the great strengths of the National Hartford Center is the assembly of an outstanding cohort of scientists and experts in gerontology, nursing, and management of research and training programs, who are poised to deliver on our societal responsibility and promise of improved health and nursing care for older adults.
Conceptual Framework Systems science is the unifying concept for the National Hartford Center and this supplement, and reflects a synthesis of living systems (from cells to societies, and inclusive of subsystems), communications, person–environment interactions, information, technology, space, time, and energy (Miller, 1978). Health systems for the care of older adults are living, highly complex, and interrelated. Systems science brings levels of coherence and methods for examining gerontological nursing as a multifaceted and interdisciplinary field—from simple to complex—in science and in society (Hieronymi, 2013). Themes commonly stressed in system science and nested in this supplement are: (a) holistic view, (b) interaction between a system and its embedding environment, and (c) complex (often subtle) trajectories of dynamic behavior that sometimes are stable (health), but at various “boundary conditions” can become unstable (disease and disability). Systems science and theory have been used by many nurses to examine inputs, throughputs, and outcome variables and to improve nursing practice (Chaffee & McNeill, 2007; Johnston, Guadron, Verchot, & Gueldner, 2011; Neuman & Reed, 2007; Riehl & Roy, 1974). Systems thinking (Bertalanffy, 1968) and the conceptual model designed to guide and link all components of the National Hartford Center are depicted in Figure 1. Basic concepts in the model presented in this supplement issue are open systems, subsystems, structure, processes, outcomes, boundary, stability (balance and steady state) and instability, and adaptation. The definitions and descriptions of these concepts are varied among theorists (Bertalanffy,
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Roughly 10,000 Baby Boomers will turn 65 every day for the next decade (Pew Research Center, 2010; Cohn & Taylor, 2010; U.S. Census Bureau, 2014). Moreover, the population age 85 and older is expected to quadruple in size to 19 million by mid-century (Vincent & Velkoff, 2010). The shift in the age distribution of America’s population attributed largely to aging Baby Boomers continues to place mounting demands on the U.S. health care system. The Institute of Medicine (IOM) report, Retooling for an Aging America: Building the Health Care Workforce, stated that “the nation is not prepared to meet the social and health care needs of this population” (IOM (Institute of Medicine), 2008). Nurses represent the largest segment of the U.S. health care workforce, but only a small percentage are formally prepared and poised to provide care to older adults. Without sufficient nurses competent in gerontological nursing sciences, the odds of improving our health care system for older adults are dismal. To meet health care’s dynamic challenges, nurses must be competent in gerontology, care of older adults, leadership, health system improvement, research, teamwork, collaboration, and public health (IOM (Institute of Medicine), 2011). The National Hartford Center of Gerontological Nursing Excellence (National Hartford Center or Center, NHCGNE) is an international collaboration of Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing supporting transformative research, education, leadership, and clinical practice to provide better nursing care for our aging nation. Collectively, the National Hartford Center and its member schools have over 500 years of experience in the nursing care of older adults. The purpose of the National Hartford Center is to develop capacity to ensure a nursing workforce that will improve the health, quality of life, and health care of the aging U.S. population. The purpose and goals of the National Hartford Center are synergistic and complementary to those of our parent organization, the Gerontological Society of America, and continue a legacy of workforce development through scholarship, mentoring and leadership, inter-Center partnerships and collaborations, and
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1968; Clancy, Effken, & Pesut, 2008; Jarrin, 2007; Meyer & O’Brien-Pallas, 2010; Whitfield, Edwards, & Nelson, 2010). The NHCGNE conceptual framework is holistic, and the concentric and overlapping circles at the center of the model represent one level of interaction among its parts. At the center of the model is a core subsystem of management that is open and inclusive of the co-ordinating center, the Hartford Gerontological Nursing Leaders alumni network, and the executive committee that are embedded within the greater Gerontological Society of America (GSA) interprofessional environment. In sum, systems theory is broad and encompassing of many disciplines and across components and levels of inquiry representing how we communicate and process a variety of outcomes, and exchange ideas and energy with embedded environments The science presented within this supplement provides guidance for navigating, understanding, and communicating the innovative and changing structures of gerontological nursing science, aging, and health care (Börner, 2010). Examples may include promoting systems of person-centered care in nursing home settings, multifunctional technology systems, sensor detection systems, understanding disease and disability etiology across complex health systems, home-based and hospital systems of care, member educational systems, and a myriad of bio-psycho-social living systems. To understand the current configuration and needs of the National Hartford Center, it is important to reflect on its long evolution—including its goals and outcomes, its challenges, and lessons learned. The history of the National
Hartford Center begins in June 2000, when the Trustees of the Hartford Foundation made a $7.8 million grant to create the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative. BAGNC was built on two successful home grown model systems: (a) the Centers of Excellence in Geriatric Medicine, first funded by the Hartford Foundation in 1987, based on the IOM’s recommendation to produce geriatrics faculty and capacity in the United States; and (b) the John A. Hartford Foundation’s Institute for Geriatric Nursing at New York University (NYU), created in 1996. These two programs, together with a national survey of doctoral nursing programs; consultation from the founding director Dr. Claire M. Fagin, Dean Emeritus of the University of Pennsylvania; and four commissioned white papers on a variety of gerontological and nursing topics ultimately led to the BAGNC Initiative and its co-ordinating center being established. The Initiative was managed at the American Academy of Nursing through 2012. The BAGNC Initiative had two main components: (a) the administration of the Hartford geriatric nursing Archbold predoctoral scholars and Fagin postdoctoral fellowship programs, with annual leadership conferences; and (b) 10 national centers of geriatric nursing excellence (CGNEs). The cohorts of scholars and fellows were competitively selected annually; scholars received a total of $50,000 per year for 2 years to cover tuition, academic fees, and stipend; postdoctoral Claire M. Fagin Fellows were awarded $60,000 per year for each of the 2 years of advanced, mentored research and leadership training. The
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Figure 1. NHCGNE conceptual framework. NHCGNE, National Hartford Center of Gerontological Nursing Excellence.
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they had published 2,521 peer-reviewed articles, made over 4,900 presentations, received prestigious honors, and obtained over $200 million in grants. As faculty, this group has mentored and taught geriatrics and gerontological nursing to more than 184,000 nursing students. A major contributor to the success of the scholars and fellows throughout the course of the Initiative has been their level of support, including academic release time, leadership development, engaged mentoring, and generous financial resources. These assets have been possible because of the numerous funding partners who have maximized the reach and work of the Initiative. Strategic partnerships continue to aid our efforts toward sustainability and fulfilling the mission. Exemplary partners include the Mayday Fund, Atlantic Philanthropies (AP), AP Health and Aging Policy Fellowship Program, Evercare of United Health Care, and the Donald W. Reynolds Foundation. The Mayday Fund is dedicated to alleviating the incidence, degree, and consequence of human physical pain; it has supported the National Hartford Center through supplementing existing awards for a total of $125,000 dollars to 25 Scholars and Fellows investigating a range of research topics, including projects that result in clinical interventions to reduce physical pain, better understand pain experiences in nonverbal and older populations and refine methods to measure pain in older adults. This partnership permitted the Center to extend its influence in pain research. Since 2004, The AP has invested $5.4 million and supported 39 Claire M. Fagin postdoctoral fellows. In 2013, the National Hartford Center again partnered with AP to co-fund a Fagin/Health and Aging Policy Fellow (HAPF). The first fellow was selected in July 2014. Our cost-sharing model is a 50/50 split; the Fagin-HAPF awardee attends the Center’s Academic Leadership Conference and the HAPF’s month-long American Political Science Association Congressional Fellowship Program Orientation. Evercare of United Health Care, the largest employer of geriatric nurse practitioners in the country, has supported Evercare Scholars at each of the original five CGNEs to conduct projects in a practice setting to improve nursing care for older adults. As noted, the Donald W. Reynolds Foundation has committed $5.2 million to create a new CGNE in Oklahoma, modeled after the Hartford centers, including $1.8 million for predoctoral Reynolds Scholar awards (modeled after Hartford Scholar awards) for doctoral students in geriatric nursing at the University of Oklahoma. Lastly, the Jonas Center for Nursing Excellence has supported a nursing scholar at each of the Hartford centers to: (a) facilitate doctoral education to increase the number of nursing faculty; and (b) prepare nurse leaders for a future in community health, geriatrics, policy and workforce, education
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Foundation funded the first five Hartford Centers in 2000 at $1 million each, at Oregon Health & Science University; the University of Arkansas for Medical Sciences; the University of California, San Francisco; the University of Iowa; and the University of Pennsylvania. The centers advanced Hartford’s strategic vision to improve nursing care for older adults by creating more nursing faculty and students with gerontological competence that translated into higher quality nursing care to older adults. Consistent with system science and based on the successful outcomes of these individual Hartford Centers, multiple renewals were awarded. In September 2007, the Trustees endorsed the establishment of four new centers—Arizona State University, Pennsylvania State University, and the Universities of Minnesota and Utah. A $2.6 million Donald W. Reynolds Center of Geriatric Nursing Excellence, modeled specifically after the Hartford Centers, was created in May 2008. This Reynolds Center, located at the University of Oklahoma and directed by Lazelle Benefield, PhD, RN, a BAGNC postdoctoral alumna, is a National Hartford Center founding member and participates in Hartford center activities. The initial goal of the BAGNC Initiative and the Centers was to support people and programs to promote the critical need for increased research capacity on the health issues of older Americans. As the Initiative evolved under the guidance of its second director, Patricia Archold, DNSc, RN, former director of Oregon’s CGNE, its focus was on producing high-quality nursing care for our rapidly expanding older population by: (a) increasing the number of geriatric nursing faculty, (b) building leadership capacity in geriatric nurses through annual Leadership Conferences, (c) facilitating collaboration among the CGNEs, and (d) strategically disseminating BAGNC outcomes with the expectation of soliciting new investments in geriatric nursing. A guiding principle of BAGNC has been that if the Foundation produced gero-expert faculty, these faculty would be in the classroom, educating all nurses—regardless of specialty—in the skills, knowledge, and tools needed to provide quality care for our aging society. Success of the BAGNC/National Hartford Center Initiative has been evident across systems and in its performance domains and outcomes (Figure 2). Foremost are the support, funding, and training of 249 nursing faculty members with expertise in gerontological nursing and aging. Since its inception in 2000, a total of 280 awards encompassing most of the United States have been made─172 predoctoral Hartford Scholar awards, 108 postdoctoral Claire M. Fagin Fellowships, including four master’s of business administration scholar awards. Scholars, fellows, and alumni have been academically productive and influential, and have made important contributions to geriatric nursing and aging sciences. As of 2013,
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(technology), mental health, and nursing administration. Between 2010 and 2012, the Jonas Center provided over $230,000 to the National Hartford Center. All told, more than $5.8 million in new funding has been leveraged through partnerships to advance the work of gerontological nursing. Yet, despite the success of the Initiative and the productive partnerships, a number of challenges emerged that forced leadership to strategically reexamine the mission and long-term sustainability of the program. When Dr. Archbold retired in December 2011, leadership transitioned to J Taylor Harden, PhD, RN, a 17-year veteran of the National Institutes of Health. Dr. Harden and staff of the Foundation capitalized on this opportunity to commence critical conversations with key stakeholders regarding the future of the Archbold and Fagin awards and the national co-ordinating center initiative, knowing the Hartford Foundation—having recently changed strategic direction to focus on more practice-driven efforts—would be funding its final grant to the National Center in 2012. It became imperative to ask essential questions: Should the Initiative broaden its organizational home beyond nursing? If so, where would the Initiative reside? How could the work of the Initiative, both the scholarship awards and the individual centers, continue post-Hartford funding? What efforts should be put in place during the final grant award
to position the National Hartford Center to become sustainable? How could we draw on the expertise and energy of the individual centers and the co-ordinating center to create a greater whole? What had we learned from systems science that could prepare us as a dynamic, collective, interdependent enterprise for the future? After months of planning, in July 2012 the co-ordinating center was relocated from its 12-year home at the Academy to the GSA because of synergies among mission, membership, and an array of internal business processes to support and sustain complementary, autonomous units such as the Center. With the support of both a new executive director and parent organization, the co-ordinating center actively established the NHCGNE program (foregoing the BAGNC name to recognize this new collaborative entity branded as a Hartford program). To this end, the co-ordinating center convened the center directors and GSA leadership on multiple occasions to submit a final renewal proposal in 2012 combining the collective strengths of the co-ordinating center and eight centers of geriatric nursing excellence. This final grant aimed to grow new gero-focused nursing faculty, retool existing faculty, and sustain the work of the National Hartford Center post-Hartford funding. Moreover, a constellation of 2012 science-driven final transition grants to the individual Hartford centers was awarded to help the
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Figure 2. Primary/core Hartford Center of Geriatric Nursing Excellence performance domains and secondary/peripheral performance domains.
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co-ordinating center and the centers to consolidate their successes, wind down the scholarship programs, further develop connections to alumni, and, most important, begin new activities with the potential to sustain the initiative and its impact after Foundation support ends. The future charge of the centers―individually and as part of the collective National Hartford Center―is to focus on three core activities: faculty development, sustainability, and advancement of the collaborative enterprise.
Components of the National Hartford Centers
Archbold Scholar and Fagin Fellow Award Program The National Hartford Center’s Scholar and Fellow Award Program was created to enhance academic gerontological
nursing capacity in the United States by increasing the number of well-prepared gerontological nursing faculty. National Hartford Center Scholars and Fellows, in collaboration with their mentors, implement a tailored professional development plan that supports development of new skills and competencies and enhances effectiveness as an academic leader. The National Hartford Center, like the BAGNC Initiative, supports competitive pre- and postdoctoral training through 2-year awards of $100,000– $120,000, respectively. For the first time, matching funds in the amount of 10% were required from the home institution of scholars and fellows to provide evidence of financial buy-in and support to sustain award funds, permitting some expansion of the initiative and a slight increase in the number of scholars. The Award Program supports our core mission—to enhance and sustain the capacity and competence of nurses to provide high-quality care to older adults through faculty development, advancing new knowledge and gerontological nursing science, facilitating adoption of best practices, fostering leadership internationally, and designing and shaping policy (e.g., long-term care supports and services). The continued engagement of award program recipients and new member schools in the activities of the National Hartford Center is essential to our future viability.
Annual Academic Leadership Conference Supporting leadership development and achievement in gerontological nursing and aging sciences is paramount to ensuring nursing’s continued scientific advancement. The Academic Leadership Conference occurs prior to the annual meeting of the GSA and encourages networking, sharing of career opportunities, and showcasing of scientific innovation. Past conferences have emphasized mentoring, coaching, and advising in biomedical sciences, the role of nursing leaders in the board room, the need to master the art of negotiation, and the importance of using your uniqueness to maximum effect. The conference is an important system component for communicating nursing science and exchanging ideas and energy. As of 2013, each member school of the National Hartford Center has received two free registrations to the Academic Leadership Conference, supporting both our mission and margin.
Content Development Parallel to the rapid demographic shift in population age is the rapidly expanding body of knowledge needed by nurses and other health professionals to safely and competently care for older adults. Content development is a core function and essential to the mission of each National Hartford Center member School of Nursing and other
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The NHCGNE is a collaboration among the co-ordinating center, independently funded centers housed at Schools of Nursing across the nation, and a growing network of member schools and institutions that have demonstrated the highest level of commitment to the field of gerontological nursing. Our institutional membership brings together committed U.S. leaders from top nursing schools, professional societies, health care, and philanthropy through an entrepreneurial approach that advances gerontological nursing science, fosters development of policy for system change, facilitates adoption of best practices in clinical sciences, promotes leadership in executive academic gerontological nursing, and supports development of gerontological programs as well as the requisite faculty leaders. The year 2016 is visible on the horizon, and the National Hartford Center’s challenge to sustain a system of operations previously supported by Foundation funds is constrained by a lack of prior experience in transitioning a complex and integrated system from grant funding to diversified business revenue streams, a paucity of funders focused on aging, and at times paired and competing infrastructures. To our knowledge, few have attempted such an effort. Building on decades of Hartford Initiatives, on formal and informal linkages among Schools of Nursing, on leveraged partnerships and funding, and on primary and secondary (Figure 2) performance domains (Huba et al., 2006), five new or continuing domains were identified as being pivotal to the future of gerontological nursing and to the sustainability of the National Hartford Center: (a) Archbold Scholar and Fagin Fellow Award Program, (b) Annual Academic Leadership Conference, (c) Content Development including Nursing Education Exchange– NEXus and Facilitated Learning to Advance Geriatrics (FLAG) Institute, (d) a Pilot Research Grant Program, and (e) a Membership Model for the National Hartford Center.
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health professions schools. With hundreds of years of important development and delivery of gerontological nursing content, our cache of proven educational products is diverse. The Nursing Education Exchange (NEXus) and FLAG Institute are two examples of creative educational programs to enhance the number and capacity of faculty in nursing to teach and deliver better care for older adults.
Facilitated Learning to Advance Geriatrics The FLAG program is a nationally recognized faculty development experiential workshop designed for nurse educators in pre-licensure programs. FLAG, an affiliate of the University of Minnesota’s CGNE, was established in 2008. Initially offered to faculty, doctoral students, and advanced practice nurses who resided in a four-state region in the Upper Midwest, the program has grown to over 160 participants, and now has national reach to include 15 states. Within the current 2-day structure, this program, offered for 18 continuing education credits, has several add-on components: (a) a 2-day summer institute; (b) year-long
Small Pilot Grant Process The Hartford Foundation has a rich history of creating mechanisms for grantees to interact in meaningful ways that encourage information, ideas, and lessons learned to be shared across projects and settings. Borrowing this philosophy and marrying with our mission and margin, the Small Pilot Grant Program was conceived to supplement retooling efforts, test new business models, grow our membership, and broaden the expertise of the National Hartford Center. Based on their strength and commitment to gerontological nursing, three schools/colleges of nursing were selected to participate in the pilot program: the Hartford Institute for Geriatric Nursing (HIGN) at NYU, the University of Maryland School of Nursing, and the Johns Hopkins University School of Nursing. The pilot program builds on their institutional strengths and provides educational and programmatic content toward the collective goal of developing gero-expert faculty and retooling existing faculty. To demonstrate institutional buy-in and contribute to the sustainability of the pilot work, matching funds in the amount of 80% were secured from each of the three participating schools.
New York University Modest pilot funding was provided to the HIGN at NYU to support a series of research-related preconference workshops held prior to the four regional nursing research society meetings. The HIGN Research Scholars Program began 14 years ago and has helped to provide more than 200 doctorally prepared nurses with a 1-week summer educational and mentoring “boot camp” experience. Using accomplished leaders in the field, selected scholars shape their clinical research interests into a research grant proposal for external funding.
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Nursing Education Exchange—NEXus A goal of NEXus is to address the national nursing shortage by educating well-prepared nurse educators through application of distance-accessible delivery methods. Since its inception, and continuing through its recent partnership with the National Hartford Center, NEXus membership has expanded to 20 academic collaborating institutions (which both offer courses and access to them at collaborating universities) and one academic affiliate (which accesses courses from collaborating universities). The NEXus catalog includes over 150 PhD and DNP courses in 10 topical “Clusters,” including Nursing Education and Gerontology and Geriatrics. Advantages to participating institutions are the ability to fill “seats” in classes and increase tuition revenues. The plan is to expand the market for NEXus offerings by jump-starting growth in institutional NEXus and Center memberships and greatly increase the volume of gerontology offerings and course sales. Because there is still limited availability of gerontology courses at schools around the country, and because we expect that one of the long-term effects of the National Hartford Center will be to increase demand for such courses, we will be able to grow NEXus’ business without reducing the existing revenue streams of member schools. NEXus is a mission-driven component of the National Hartford Center and a tested business model for Schools of Nursing. Advantages to students include expanded gerontology course offerings, opportunities to study with experts in gerontological research, increased flexibility, and greater access by enrolling directly as a nonmatriculated student, as NEXus students have preference for class seats (www.winnexus.org).
mentorship to assist FLAG Fellows in conducting a geriatric nursing education project to develop their expertise in geriatric nursing; and (c) networking opportunities and access to geriatric teaching resources. The FLAG Institute provides education, group mentoring, and support in selected core content areas. FLAG is phasing in registration charges to make its model self-supporting. An important lesson learned in the course of establishing the FLAG Institute is that converting a free, local, 4-day professional development program into a national revenue-generating 2-day program requires substantial changes to structure, location, and timing. The current cost model for FLAG varies by educational level of the participant and can range from $295 for postdoctoral students to $595 for regular registration (flagprograms.org).
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Through this National Hartford Center pilot award, NYU distilled their Research Scholars Program into a day-long preconference format at the four nursing regional research society meetings and the American Society on Aging’s annual conference. To ensure the sustainability of the program, a franchise model called the Hartford Institute/National Hartford Center Geriatric Research Scholars Program that generates income via tuition is being marketed. Moreover, to further contribute to its sustainability, faculty for the preconferences is provided by NYU and the National Hartford Center. The pre-conferences are proving successful in generating revenues and advancing our mission.
The University of Maryland
Johns Hopkins University Through a third pilot award, the Johns Hopkins University School of Nursing, in partnership with the National Hartford Center, hosted two Summer Research Institutes (SRI) which greatly aided our research mission; it focused on interventions to improve practice. The goal of the SRI is to help participants develop testable interventions that have the potential for implementation in practice environments and to advance appropriate clinical trial designs.
Membership Model for the National Hartford Center At a 2010 retreat, the National Hartford Center Directors made the decision to submit a collaborative renewal project,
Lessons Learned Throughout the 14-year evolution of the National Hartford Center, from its organizational home, to transitions in leadership, and ultimately to the joining of the individual centers into one collective enterprise, a number of lessons have been learned. The lessons fall into four main categories: Serve Yourself and Then Others, Charity begins at Home, the Value of Partnerships, and Mission Versus Margin.
Serve Yourself and Then Others Academic institutions do not generally volunteer to come together to serve a population in need. It is counter to the culture of universities to spontaneously join forces and pool resources to advance a common agenda. Historically, the individually funded Hartford Centers of Gerontological Nursing Excellence were given stand-alone grants to autonomously
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Congruent with the mission of the National Hartford Center, the University of Maryland was awarded a small pilot grant to support content development in dissemination sciences and to increase the aging expertise of nursing faculty. The aim of this project was to establish the Maryland Online Dissemination and Implementation Program (UM-ODIP). Specifically, the UM-ODIP provided online workshops with a total of 25 faculty participants in four webinars and homework assignments, with ongoing mentoring through online office hours. An Online Publication Workshop was held in the first year, resulting in submission of a manuscript for publication by each participant, and the publishing of a supplemental issue of Geriatric Nursing. Year Two included a second cohort for the Online Publication Workshop and also culminated in the development of a supplemental issue of Geriatric Nursing. As was the case with the NYU pilot grant, the University of Maryland award advanced the mission of the National Hartford Center by disseminating the work of gerontological nurses and is now exploring its revenue-generating potential to advance the National Hartford Center margin in a fee-for-service model.
leveraging its collective knowledge and vision to provide all nurses with expertise to be competent to care for an aging society. From the initial decision, additional ideas and strategies were examined to sustain our mission and margin over time. In a year-long facilitated discussion on strategic planning and sustainability, the Directors, now the Board of Directors, supported the idea of establishing an institutional-based National Hartford Center membership model, born from a few truths: there are many Schools of Nursing and institutions that want to be affiliated with the Hartford centers because of their strong reputation as a leader in aging; many Schools of Nursing have sought counsel or resources from the Hartford centers; and there is a demand for the Hartford name, its products, and its opportunities. Membership in the National Hartford Center affords an array of benefits, including reduced NEXus fees and access to opportunities described above, with a potential and conservative savings of more than $3,000.00 per year, after initial start-up. Further, participation in the only Academic Leadership Conference designed by and for nurses in gerontology provides access to esteemed thought leaders, individualized experiential learning, and unparalleled networking and partnership opportunities. Based on market research and information from a range of consultants, the National Hartford Center priced institutional membership at $3,000.00 per year. The fee is comparable with corporate membership fees in professional groups (e.g., American Society for Engineering Education). The membership fee structure, as well as all business processes are reviewed frequently and are subject to revision. There are over 1,600 schools and colleges of nursing across the nation; they are the target market for membership in the National Hartford Center. Currently, there are 43 member schools (see Table 1).
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Table 1. Member Institutions
Note: NHCGNE = National Hartford Center of Gerontological Nursing Excellence.
advance the mission of their specific centers. In 2010, when the Centers decided to create one entity—The National Hartford Center of Gerontological Nursing Excellence, which would be larger than the collective sum of its individual parts—the intent was good. The understanding of the challenges behind this altruistic goal to collaboratively improve the nursing care of older adults, however, was limited. First, the centers were each watching their own funding clocks. The Hartford Foundation, in rolling out their new practice-driven strategic vision, made final grants to
each of the eight academic Hartford centers in 2012; funding was to end in December 2015. This meant that while each center is a founding member of the Board of Directors of the National Hartford Center (whose Hartford funding ends in December 2016), the centers have to balance the needs and tensions of their individual home offices with those of the overall enterprise. In short, the individual centers have to tend to personal matters, sustainability issues, and secure institutional buy-in among a host of other final grant-related matters while focusing (or sacrificing) their
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NHCGNE members are Schools of Nursing and related organizations: 1. Arizona State University College of Nursing and Health Innovation – Founding Member 2. Boston College William F. Connell School of Nursing 3. Case Western Reserve University Frances Payne Bolton School of Nursing 4. Duke University School of Nursing 5. East Carolina University College of Nursing 6. Hartford Institute for Geriatric Nursing at the NYU College of Nursing 7. Hong Kong Polytechnic University School of Nursing 8. Hunter-Bellevue School of Nursing, Hunter College, CUNY 9. Iberia Rehabilitation Hospital 10. Illinois State University, Mennonite College of Nursing 11. Johns Hopkins University School of Nursing 12. Northeastern University Bouve College of Health Sciences School of Nursing 13. Ohio State University College of Nursing 14. Oregon Health & Science University School of Nursing – Founding Member 15. Our Lady of the Lake College School of Nursing 16. Penn State University College of Nursing – Founding Member 17. Sigma Theta Tau International 18. Texas Tech University Health Sciences Center School of Nursing 19. University of Alabama at Birmingham School of Nursing 20. University of Alabama Capstone College of Nursing 21. University of Alberta Faculty of Nursing 22. University of Arkansas for Medical Sciences College of Nursing – Founding Member 23. University of California Los Angeles School of Nursing 24. University of California San Francisco School of Nursing – Founding Member 25. University of Connecticut School of Nursing 26. University of Delaware, School of Nursing 27. University of Illinois at Chicago College of Nursing 28. University of Iowa College of Nursing – Founding Member 29. University of Maryland School of Nursing 30. University of Massachusetts, Amherst College of Nursing 31. University of Massachusetts Lowell, College of Health Sciences, School of Nursing 32. University of Minnesota School of Nursing – Founding Member 33. University of Missouri Sinclair School of Nursing 34. University of Oklahoma Health Sciences Center College of Nursing – Founding Member 35. University of Pennsylvania School of Nursing 36. University of Pittsburgh School of Nursing 37. University of San Francisco School of Nursing and Health Professions 38. University of Utah College of Nursing – Founding Member 39. University of Virginia School of Nursing 40. University of Washington School of Nursing 41. University of Wisconsin-Madison, School of Nursing 42. University of Wisconsin-Milwaukee College of Nursing 43. Vanderbilt University School of Nursing
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Charity Begins at Home Similar to the lesson above, the co-ordinating center and Foundation staff learned the value of taking an organizational pulse to determine if our original home was meeting our evolving needs. As noted earlier, after a series of thorough assessments of our future needs and candid conversations with leadership at the American Academy of Nursing, it was determined a move was needed. The BAGNC Initiative would benefit from an organization that could offer an interdisciplinary membership committed to our long-term sustainability and improving the health of older adults. After some searching, The GSA emerged as the best fit. Not only did the Society meet the criteria above, but also CEO James Appleby pledged to work with our initiative to obtain status as an autonomous unit within the GSA. This remains a goal of the National Hartford Center to help sustain our work post-Hartford funding. Today we remain pleased to be housed within the well-respected and mission-congruent parent organization.
The Value of Partnerships As noted in this article, through a series of partnerships, the National Hartford Center has been able to align its work and that of other funders to advance specific components of the Initiative (e.g., scholarship awards, pre-conferences). From its inception, the leaders of the Initiative have understood the importance of not having all of their funding eggs in one basket, and that cultivating co-funded activities requires time, energy, and, most important, an invitation. An interesting finding is that aging does not have to be the primary focus for both parties. For example, the MayDay Fund was open to wedding their strategic focus on pain
with that of the National Hartford Center’s focus on older adults. Together, we have been able to support nurses who are interested in pain management in older Americans.
Mission Versus Margin Mission and margin discussions are a bit of a chicken and egg causality dilemma. At this stage, the circular cause and consequence is somewhat irrelevant, as the National Hartford Center is committed to both and fully acknowledges our societal responsibility and associated concern for ethics, justice, and beneficence (Voges, 2012). “No margin, no mission” is a familiar refrain, and portends a number of challenges and lessons learned. For example, transitioning from grant funding to self-sustaining has had a number of challenges. A lesson learned over and over again is, “if it is easy, then it would already have been done.” Collectively, the Center and its members are goal-driven, and believe in beneficence and the utility of the National Hartford Center. Another important challenge and lesson learned is recognition of our collective brand. Our mission is to serve the health care and nursing community. Are we national or global? We are global, but our name reflects our commitment to the United States. The “National Hartford Center of Gerontological Nursing Excellence” is long and does not easily roll off the tongue, but it does accurately tie us to our mission and, importantly, to our roots as part of the legacy of the John A. Hartford Foundation. The lesson: Think carefully before you brand a product with a wellknown name, such as “Hartford.” Does this brand limit us in future funding? We do not know the answer, and are uncertain at this juncture; however, we seek to do no harm to ourselves or the Hartford Foundation, as we proudly bear its name. Research is a core value of the Center, and drives what we teach in the classroom and what we do in clinical practice. A repetitive and albeit rhetorical question leveled at the National Hartford Center is: If we had to build this project again, would it look the way it does today? The lesson here was what we do now is based on lessons learned. The Center members are diverse in their research programs; hence, like systems science, we seek to find utility and common purpose in our diversity. We admit that greater coherence among member schools, content domains, and research missions might enhance marketing to a particular niche industry, but that is not who we are today. We respect our diverse scientific interests and are working in tandem to advance each member school’s research and teaching mission. Change tends to create a period of instability in systems operation. As such, we need to accommodate the change and build supports across the Center. With successions
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work at a larger center level; this additional focus has been more challenging at some centers than others. For example, for centers that have secured funding (e.g., promises from funders post-Hartford), it has been easier to be “present” at the National table. It was important for us as a collection of centers (including the co-ordinating center, as well as the staff of the Hartford Foundation and the GSA) to acknowledge this conflict and to routinely revisit it during retreats and on monthly phone calls. This issue often was the elephant in the room. While it was only natural that an individual center needed to be on solid footing before firmly committing to the collaborative, it was helpful for the group to publically recognize this tension within specific centers and to validate that this, indeed, is part of the process and makes programmatic and strategic sense.
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gerontology. Our continuing successes and collective accomplishments in gerontological nursing allow optimism for our profession and for the health care of older adults globally.
Funding This work was supported by a grant from the John A. Hartford Foundation, grant number 2012-0052, to the first author.
Acknowledgments The authors wish to thank the National Hartford Center Founding member schools and express our appreciation to Dr. Ginny Pepper, NHCGNE President, for her contributions to the conceptual framework and to Drs. Terri Harvath, Betty Irene Moore School of Nursing and Jean Wyman, University of Minnesota for their contributions to the NEXus and FLAG programs.
References Bertalanffy, L. V. (1968). General system theory: Foundations, development, applications. New York: George Braziller. Börner, K. (2010). Atlas of Science – Visualizing What We Know. MIT Press: Cambridge, MA. Chaffee, M. W., & McNeill, M. M. (2007). A model of nursing as a complex adaptive system. Nursing Outlook, 55, 232–241. doi:10.1016/j.outlook.2007.04.003 Clancy, T. R., Effken, J. A., & Pesut, D. (2008). Applications of complex systems theory in nursing education, research, and practice. Nursing Outlook, 56, 248–256.e3. doi:10.1016/j. outlook.2008.06.010 Cohn, D., & Taylor, P. (2010). Baby Boomers Approach 65 – Glumly, PEW Research Center Social and Demographic Trends, Washington, DC. Retrieved from http://www.pewsocialtrends. org/topics/baby-boomers/2010/ Fagin, C. M., Franklin, P. D., Regenstreif, D. I., & Huba, G. J. (2006). Overview of the John A. Hartford Foundation building academic geriatric nursing capacity initiative. Nursing Outlook, 54, 173–182. doi:10.1016/j.outlook.2006.05.008 Hieronymi, A. (2013). Understanding systems science: A visual and integrative approach. Systems Research and Behavioral Science, 30, 580–595. doi:10.1002/sres.2215 Huba, G. J., Fagin, C. M., Franklin, P. D., & Regenstreif, D. I. (2006). Outcomes and lessons learned from the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Initiative Centers of Geriatric Nursing Excellence. Nursing Outlook, 54, 243–253. doi:10.1016/j.outlook.2006.05.011 IOM (Institute of Medicine). (2008). Committee on the Future Health Care Workforce for Older Americans. Retooling for an aging America: Building the health care workforce. Washington, DC: The National Academies Press. IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press. Jarrin, O. F. (2007). An Integral Philosophy and Definition of Nursing, School of Nursing Scholarly Works, Paper 47. Retrieved from http://digitalcommons.uconn.edu/son_articles/47
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and retirements, the John A. Hartford Foundation has aided our processes by supporting site visits to member schools, at which we share energy, ideas, and best practices. Successions and retirements may have made us sad, but consistently opened new opportunities, memberships, partnerships, and potential for growth. Growth has been perhaps most evident in the 249 individual recipients of the National Hartford Center’s Patricia G. Archbold and Claire M. Fagin Fellow Awards Program. These individuals are engaged in the operations of the Center and are members of the GSA. They are our greatest asset and work to support our mission and margin. What we have learned and value is that respect, collaboration, persistence, and stability pay outstanding dividends. Today, we celebrate innovations and advances in gerontological nursing science. A representative selection of 16 articles from the field are shared in this volume addressing an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs. Professionals—researchers, clinicians and educators— should find the collection of articles to be thought provoking as well as informative. Drs. Galik, Jao, Tak, Kolanowski and Gilmore-Bykovskyi and colleagues address system complexities for persons with dementia in variety of longterm care environments in the first five articles in this supplement. The section on geriatric syndromes and other chronic conditions cover a range of disorders including behavior, pain, and genetics with depressive symptoms (Klinedinst et al.), resident-to-resident violence (Snellgrove et al.), fall risk assessment (Miller et al.), vision impairment in subsidized housing (Elliott et al.), and Parkinson’s disease (Pretzer-Aboff et al.). The supplement closes with two special articles on educating gerontological nurses. The FLAG is a well-tested educational model for those who wish to increase their capacity to teach students about caring for older adults (Kirchbaum et al.) and an equally compelling young scholars program to entice early entry into the academic faculty role (Mentes et al.). As we look forward to the next several years of the National Hartford Center, we envision an international collaboration of schools and institutions that capitalizes on the enormously talented and dedicated assets of our members, colleagues, scholars, fellows, and partners. It is anticipated that the membership will advance the way in which nurses care for older adults by leading change in our science, knowledge, clinical practice, and educational pursuits. The National Hartford Center is a unique entity for nursing and
S12 Johnston, N., Guadron, M, Verchot, C. & Gueldner, S. (2011). Validation of the Well-being Picture Scale (WPS) as a measure of mood, Visions. The Journal of Rogerian Science, 18, 8–21. Miller, J. G. (1978). Living systems. New York: McGraw-Hill. Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66, 2828–2838. doi:10.1111/j.1365-2648.2010.05449.x Neuman, B., & Reed, K. S. (2007). A Neuman systems model perspective on nursing in 2050. Nursing Science Quarterly, 20, 111–113. doi:10.1177/0894318407299847 Pew Research Center. (2010). Baby Boomers Retire: Numbers, Facts and Trends Shaping Your World. Washington, DC: Pew Research Center. Retrieved from http://www.pewresearch.org/ daily-number/baby-boomers-retire/
The Gerontologist, 2015, Vol. 55, No. S1 Riehl, J. P., & Roy, C. (1974). Conceptual models for nursing practice. New York: Appleton-Century-Crofts. U.S. Census Bureau. (2014). 65+ in the United States: 2010. Washington, DC: U.S. Government Printing Office. Vincent, G. K., & Velkoff, V. A. (2010). The Next Four decades – The Older Population in the United States: 2010–2050. Washington, DC: U.S. Census, Author Retrieved from http://www.census.gov/ prod/2010pubs/p25-1138.pdf Voges, N. D. (2012). The ethics of mission and margin, The Fund for Innovation in Healthcare Leadership. Retrieved from http:// www.ache.org/abt_ache/SO12_F3_reprint.pdf Whitfield, K. E., Edwards, C. L., & Nelson, T. L. (2010). Methodological considerations for the examination of complex systems in aging. In K. E. Whitefield & T. C. Antonucci (Eds.), Annual Review of Gerontology and Geriatrics. New York: Springer Publishing Company. Downloaded from http://gerontologist.oxfordjournals.org/ by guest on November 14, 2015
The National Hartford Center of Gerontological Nursing Excellence: An Evolution of a Nursing Initiative to Improve Care of Older Adults J Taylor Harden, PhD, RN, FGSA, FAAN,*,1 and Rachael A. Watman, MSW2 National Hartford Center of Gerontological Nursing Excellence, Washington, District of Columbia. 2The John A. Hartford Foundation, New York, New York. 1
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*Address correspondence to J Taylor Harden, PhD, RN, FGSA, FAAN, National Hartford Center of Gerontological Nursing Excellence, 1220 L Street NW, Suite 901, Washington, DC 20005. E-mail: [email protected] Received October 1 2014; Accepted March 16 2015.
The mission of the John A. Hartford Foundation is to improve the health of older Americans. This mission has been realized throughout the evolution of the National Hartford Center of Gerontological Nursing Excellence—an international collaboration between Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing—whose goal is to support research, education, and practice to provide better nursing care for our aging society. The National Hartford Center is the focus of this supplement and an example of the Foundation’s grant-making to prepare the nursing workforce to be competent to care for our aging society. This article traces the innovative origin and inception of the National Hartford Center, first as the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative in 2000 under the leadership of two groundbreaking scholars in nursing and aging sciences: Claire M. Fagin, PhD, RN, and Patricia G. Archbold, DNSc. We continue through to today’s leadership and culminate by describing the Center’s influence on the gerontological nursing workforce and clinical practice; the paper also includes a brief introduction to the articles, highlighting advances in gerontological nursing science. With funding from the John A. Hartford Foundation, The Atlantic Philanthropies, The Mayday Fund, and a number of creative public and nonprofit partnerships, the National Hartford Center celebrates two decades and its greatest asset—the nearly 300 gerontological nursing leaders, including Archbold nursing pre-docs, Fagin nursing post-docs, and expert faculty, along with its Hartford Centers of Gerontological Nursing Excellence across the country. We trace the transition of BAGNC to the membershipbased National Hartford Center and its move to T he Gerontological Society of America to become a self-sustaining, autonomous unit. Current needs, challenges, lessons learned, and strategies of the National Hartford Center are examined within the context of sustainability, which has become paramount as Hartford Foundation funding ends in 2016. Despite the auspicious beginnings of the National Hartford Center, system change has been slow. There remains a strong need to continue to grow the field of gerontological nursing and aging sciences. We are working diligently to drive health system reform, and develop and support gerontological nursing leaders and members of the National Hartford Center as exemplars for innovation in care of older adults. The contributing
© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].
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authors of this supplement are from member schools of the National Hartford Center or are current or past program Scholars or Fellows. Herein these authors showcase innovation for older adults through their research that addresses an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs. Key words: John A. Hartford Foundation, Centers of Excellence, Schools of Nursing, Nursing research, Clinical practice, Nursing education, Pre-doctorates and post doctorates
formative and summative evaluations (Fagin, Franklin, Regenstreif, & Huba, 2006). One of the great strengths of the National Hartford Center is the assembly of an outstanding cohort of scientists and experts in gerontology, nursing, and management of research and training programs, who are poised to deliver on our societal responsibility and promise of improved health and nursing care for older adults.
Conceptual Framework Systems science is the unifying concept for the National Hartford Center and this supplement, and reflects a synthesis of living systems (from cells to societies, and inclusive of subsystems), communications, person–environment interactions, information, technology, space, time, and energy (Miller, 1978). Health systems for the care of older adults are living, highly complex, and interrelated. Systems science brings levels of coherence and methods for examining gerontological nursing as a multifaceted and interdisciplinary field—from simple to complex—in science and in society (Hieronymi, 2013). Themes commonly stressed in system science and nested in this supplement are: (a) holistic view, (b) interaction between a system and its embedding environment, and (c) complex (often subtle) trajectories of dynamic behavior that sometimes are stable (health), but at various “boundary conditions” can become unstable (disease and disability). Systems science and theory have been used by many nurses to examine inputs, throughputs, and outcome variables and to improve nursing practice (Chaffee & McNeill, 2007; Johnston, Guadron, Verchot, & Gueldner, 2011; Neuman & Reed, 2007; Riehl & Roy, 1974). Systems thinking (Bertalanffy, 1968) and the conceptual model designed to guide and link all components of the National Hartford Center are depicted in Figure 1. Basic concepts in the model presented in this supplement issue are open systems, subsystems, structure, processes, outcomes, boundary, stability (balance and steady state) and instability, and adaptation. The definitions and descriptions of these concepts are varied among theorists (Bertalanffy,
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Roughly 10,000 Baby Boomers will turn 65 every day for the next decade (Pew Research Center, 2010; Cohn & Taylor, 2010; U.S. Census Bureau, 2014). Moreover, the population age 85 and older is expected to quadruple in size to 19 million by mid-century (Vincent & Velkoff, 2010). The shift in the age distribution of America’s population attributed largely to aging Baby Boomers continues to place mounting demands on the U.S. health care system. The Institute of Medicine (IOM) report, Retooling for an Aging America: Building the Health Care Workforce, stated that “the nation is not prepared to meet the social and health care needs of this population” (IOM (Institute of Medicine), 2008). Nurses represent the largest segment of the U.S. health care workforce, but only a small percentage are formally prepared and poised to provide care to older adults. Without sufficient nurses competent in gerontological nursing sciences, the odds of improving our health care system for older adults are dismal. To meet health care’s dynamic challenges, nurses must be competent in gerontology, care of older adults, leadership, health system improvement, research, teamwork, collaboration, and public health (IOM (Institute of Medicine), 2011). The National Hartford Center of Gerontological Nursing Excellence (National Hartford Center or Center, NHCGNE) is an international collaboration of Schools of Nursing and Sigma Theta Tau International Honor Society of Nursing supporting transformative research, education, leadership, and clinical practice to provide better nursing care for our aging nation. Collectively, the National Hartford Center and its member schools have over 500 years of experience in the nursing care of older adults. The purpose of the National Hartford Center is to develop capacity to ensure a nursing workforce that will improve the health, quality of life, and health care of the aging U.S. population. The purpose and goals of the National Hartford Center are synergistic and complementary to those of our parent organization, the Gerontological Society of America, and continue a legacy of workforce development through scholarship, mentoring and leadership, inter-Center partnerships and collaborations, and
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1968; Clancy, Effken, & Pesut, 2008; Jarrin, 2007; Meyer & O’Brien-Pallas, 2010; Whitfield, Edwards, & Nelson, 2010). The NHCGNE conceptual framework is holistic, and the concentric and overlapping circles at the center of the model represent one level of interaction among its parts. At the center of the model is a core subsystem of management that is open and inclusive of the co-ordinating center, the Hartford Gerontological Nursing Leaders alumni network, and the executive committee that are embedded within the greater Gerontological Society of America (GSA) interprofessional environment. In sum, systems theory is broad and encompassing of many disciplines and across components and levels of inquiry representing how we communicate and process a variety of outcomes, and exchange ideas and energy with embedded environments The science presented within this supplement provides guidance for navigating, understanding, and communicating the innovative and changing structures of gerontological nursing science, aging, and health care (Börner, 2010). Examples may include promoting systems of person-centered care in nursing home settings, multifunctional technology systems, sensor detection systems, understanding disease and disability etiology across complex health systems, home-based and hospital systems of care, member educational systems, and a myriad of bio-psycho-social living systems. To understand the current configuration and needs of the National Hartford Center, it is important to reflect on its long evolution—including its goals and outcomes, its challenges, and lessons learned. The history of the National
Hartford Center begins in June 2000, when the Trustees of the Hartford Foundation made a $7.8 million grant to create the Building Academic Geriatric Nursing Capacity (BAGNC) Initiative. BAGNC was built on two successful home grown model systems: (a) the Centers of Excellence in Geriatric Medicine, first funded by the Hartford Foundation in 1987, based on the IOM’s recommendation to produce geriatrics faculty and capacity in the United States; and (b) the John A. Hartford Foundation’s Institute for Geriatric Nursing at New York University (NYU), created in 1996. These two programs, together with a national survey of doctoral nursing programs; consultation from the founding director Dr. Claire M. Fagin, Dean Emeritus of the University of Pennsylvania; and four commissioned white papers on a variety of gerontological and nursing topics ultimately led to the BAGNC Initiative and its co-ordinating center being established. The Initiative was managed at the American Academy of Nursing through 2012. The BAGNC Initiative had two main components: (a) the administration of the Hartford geriatric nursing Archbold predoctoral scholars and Fagin postdoctoral fellowship programs, with annual leadership conferences; and (b) 10 national centers of geriatric nursing excellence (CGNEs). The cohorts of scholars and fellows were competitively selected annually; scholars received a total of $50,000 per year for 2 years to cover tuition, academic fees, and stipend; postdoctoral Claire M. Fagin Fellows were awarded $60,000 per year for each of the 2 years of advanced, mentored research and leadership training. The
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Figure 1. NHCGNE conceptual framework. NHCGNE, National Hartford Center of Gerontological Nursing Excellence.
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they had published 2,521 peer-reviewed articles, made over 4,900 presentations, received prestigious honors, and obtained over $200 million in grants. As faculty, this group has mentored and taught geriatrics and gerontological nursing to more than 184,000 nursing students. A major contributor to the success of the scholars and fellows throughout the course of the Initiative has been their level of support, including academic release time, leadership development, engaged mentoring, and generous financial resources. These assets have been possible because of the numerous funding partners who have maximized the reach and work of the Initiative. Strategic partnerships continue to aid our efforts toward sustainability and fulfilling the mission. Exemplary partners include the Mayday Fund, Atlantic Philanthropies (AP), AP Health and Aging Policy Fellowship Program, Evercare of United Health Care, and the Donald W. Reynolds Foundation. The Mayday Fund is dedicated to alleviating the incidence, degree, and consequence of human physical pain; it has supported the National Hartford Center through supplementing existing awards for a total of $125,000 dollars to 25 Scholars and Fellows investigating a range of research topics, including projects that result in clinical interventions to reduce physical pain, better understand pain experiences in nonverbal and older populations and refine methods to measure pain in older adults. This partnership permitted the Center to extend its influence in pain research. Since 2004, The AP has invested $5.4 million and supported 39 Claire M. Fagin postdoctoral fellows. In 2013, the National Hartford Center again partnered with AP to co-fund a Fagin/Health and Aging Policy Fellow (HAPF). The first fellow was selected in July 2014. Our cost-sharing model is a 50/50 split; the Fagin-HAPF awardee attends the Center’s Academic Leadership Conference and the HAPF’s month-long American Political Science Association Congressional Fellowship Program Orientation. Evercare of United Health Care, the largest employer of geriatric nurse practitioners in the country, has supported Evercare Scholars at each of the original five CGNEs to conduct projects in a practice setting to improve nursing care for older adults. As noted, the Donald W. Reynolds Foundation has committed $5.2 million to create a new CGNE in Oklahoma, modeled after the Hartford centers, including $1.8 million for predoctoral Reynolds Scholar awards (modeled after Hartford Scholar awards) for doctoral students in geriatric nursing at the University of Oklahoma. Lastly, the Jonas Center for Nursing Excellence has supported a nursing scholar at each of the Hartford centers to: (a) facilitate doctoral education to increase the number of nursing faculty; and (b) prepare nurse leaders for a future in community health, geriatrics, policy and workforce, education
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Foundation funded the first five Hartford Centers in 2000 at $1 million each, at Oregon Health & Science University; the University of Arkansas for Medical Sciences; the University of California, San Francisco; the University of Iowa; and the University of Pennsylvania. The centers advanced Hartford’s strategic vision to improve nursing care for older adults by creating more nursing faculty and students with gerontological competence that translated into higher quality nursing care to older adults. Consistent with system science and based on the successful outcomes of these individual Hartford Centers, multiple renewals were awarded. In September 2007, the Trustees endorsed the establishment of four new centers—Arizona State University, Pennsylvania State University, and the Universities of Minnesota and Utah. A $2.6 million Donald W. Reynolds Center of Geriatric Nursing Excellence, modeled specifically after the Hartford Centers, was created in May 2008. This Reynolds Center, located at the University of Oklahoma and directed by Lazelle Benefield, PhD, RN, a BAGNC postdoctoral alumna, is a National Hartford Center founding member and participates in Hartford center activities. The initial goal of the BAGNC Initiative and the Centers was to support people and programs to promote the critical need for increased research capacity on the health issues of older Americans. As the Initiative evolved under the guidance of its second director, Patricia Archold, DNSc, RN, former director of Oregon’s CGNE, its focus was on producing high-quality nursing care for our rapidly expanding older population by: (a) increasing the number of geriatric nursing faculty, (b) building leadership capacity in geriatric nurses through annual Leadership Conferences, (c) facilitating collaboration among the CGNEs, and (d) strategically disseminating BAGNC outcomes with the expectation of soliciting new investments in geriatric nursing. A guiding principle of BAGNC has been that if the Foundation produced gero-expert faculty, these faculty would be in the classroom, educating all nurses—regardless of specialty—in the skills, knowledge, and tools needed to provide quality care for our aging society. Success of the BAGNC/National Hartford Center Initiative has been evident across systems and in its performance domains and outcomes (Figure 2). Foremost are the support, funding, and training of 249 nursing faculty members with expertise in gerontological nursing and aging. Since its inception in 2000, a total of 280 awards encompassing most of the United States have been made─172 predoctoral Hartford Scholar awards, 108 postdoctoral Claire M. Fagin Fellowships, including four master’s of business administration scholar awards. Scholars, fellows, and alumni have been academically productive and influential, and have made important contributions to geriatric nursing and aging sciences. As of 2013,
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(technology), mental health, and nursing administration. Between 2010 and 2012, the Jonas Center provided over $230,000 to the National Hartford Center. All told, more than $5.8 million in new funding has been leveraged through partnerships to advance the work of gerontological nursing. Yet, despite the success of the Initiative and the productive partnerships, a number of challenges emerged that forced leadership to strategically reexamine the mission and long-term sustainability of the program. When Dr. Archbold retired in December 2011, leadership transitioned to J Taylor Harden, PhD, RN, a 17-year veteran of the National Institutes of Health. Dr. Harden and staff of the Foundation capitalized on this opportunity to commence critical conversations with key stakeholders regarding the future of the Archbold and Fagin awards and the national co-ordinating center initiative, knowing the Hartford Foundation—having recently changed strategic direction to focus on more practice-driven efforts—would be funding its final grant to the National Center in 2012. It became imperative to ask essential questions: Should the Initiative broaden its organizational home beyond nursing? If so, where would the Initiative reside? How could the work of the Initiative, both the scholarship awards and the individual centers, continue post-Hartford funding? What efforts should be put in place during the final grant award
to position the National Hartford Center to become sustainable? How could we draw on the expertise and energy of the individual centers and the co-ordinating center to create a greater whole? What had we learned from systems science that could prepare us as a dynamic, collective, interdependent enterprise for the future? After months of planning, in July 2012 the co-ordinating center was relocated from its 12-year home at the Academy to the GSA because of synergies among mission, membership, and an array of internal business processes to support and sustain complementary, autonomous units such as the Center. With the support of both a new executive director and parent organization, the co-ordinating center actively established the NHCGNE program (foregoing the BAGNC name to recognize this new collaborative entity branded as a Hartford program). To this end, the co-ordinating center convened the center directors and GSA leadership on multiple occasions to submit a final renewal proposal in 2012 combining the collective strengths of the co-ordinating center and eight centers of geriatric nursing excellence. This final grant aimed to grow new gero-focused nursing faculty, retool existing faculty, and sustain the work of the National Hartford Center post-Hartford funding. Moreover, a constellation of 2012 science-driven final transition grants to the individual Hartford centers was awarded to help the
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Figure 2. Primary/core Hartford Center of Geriatric Nursing Excellence performance domains and secondary/peripheral performance domains.
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co-ordinating center and the centers to consolidate their successes, wind down the scholarship programs, further develop connections to alumni, and, most important, begin new activities with the potential to sustain the initiative and its impact after Foundation support ends. The future charge of the centers―individually and as part of the collective National Hartford Center―is to focus on three core activities: faculty development, sustainability, and advancement of the collaborative enterprise.
Components of the National Hartford Centers
Archbold Scholar and Fagin Fellow Award Program The National Hartford Center’s Scholar and Fellow Award Program was created to enhance academic gerontological
nursing capacity in the United States by increasing the number of well-prepared gerontological nursing faculty. National Hartford Center Scholars and Fellows, in collaboration with their mentors, implement a tailored professional development plan that supports development of new skills and competencies and enhances effectiveness as an academic leader. The National Hartford Center, like the BAGNC Initiative, supports competitive pre- and postdoctoral training through 2-year awards of $100,000– $120,000, respectively. For the first time, matching funds in the amount of 10% were required from the home institution of scholars and fellows to provide evidence of financial buy-in and support to sustain award funds, permitting some expansion of the initiative and a slight increase in the number of scholars. The Award Program supports our core mission—to enhance and sustain the capacity and competence of nurses to provide high-quality care to older adults through faculty development, advancing new knowledge and gerontological nursing science, facilitating adoption of best practices, fostering leadership internationally, and designing and shaping policy (e.g., long-term care supports and services). The continued engagement of award program recipients and new member schools in the activities of the National Hartford Center is essential to our future viability.
Annual Academic Leadership Conference Supporting leadership development and achievement in gerontological nursing and aging sciences is paramount to ensuring nursing’s continued scientific advancement. The Academic Leadership Conference occurs prior to the annual meeting of the GSA and encourages networking, sharing of career opportunities, and showcasing of scientific innovation. Past conferences have emphasized mentoring, coaching, and advising in biomedical sciences, the role of nursing leaders in the board room, the need to master the art of negotiation, and the importance of using your uniqueness to maximum effect. The conference is an important system component for communicating nursing science and exchanging ideas and energy. As of 2013, each member school of the National Hartford Center has received two free registrations to the Academic Leadership Conference, supporting both our mission and margin.
Content Development Parallel to the rapid demographic shift in population age is the rapidly expanding body of knowledge needed by nurses and other health professionals to safely and competently care for older adults. Content development is a core function and essential to the mission of each National Hartford Center member School of Nursing and other
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The NHCGNE is a collaboration among the co-ordinating center, independently funded centers housed at Schools of Nursing across the nation, and a growing network of member schools and institutions that have demonstrated the highest level of commitment to the field of gerontological nursing. Our institutional membership brings together committed U.S. leaders from top nursing schools, professional societies, health care, and philanthropy through an entrepreneurial approach that advances gerontological nursing science, fosters development of policy for system change, facilitates adoption of best practices in clinical sciences, promotes leadership in executive academic gerontological nursing, and supports development of gerontological programs as well as the requisite faculty leaders. The year 2016 is visible on the horizon, and the National Hartford Center’s challenge to sustain a system of operations previously supported by Foundation funds is constrained by a lack of prior experience in transitioning a complex and integrated system from grant funding to diversified business revenue streams, a paucity of funders focused on aging, and at times paired and competing infrastructures. To our knowledge, few have attempted such an effort. Building on decades of Hartford Initiatives, on formal and informal linkages among Schools of Nursing, on leveraged partnerships and funding, and on primary and secondary (Figure 2) performance domains (Huba et al., 2006), five new or continuing domains were identified as being pivotal to the future of gerontological nursing and to the sustainability of the National Hartford Center: (a) Archbold Scholar and Fagin Fellow Award Program, (b) Annual Academic Leadership Conference, (c) Content Development including Nursing Education Exchange– NEXus and Facilitated Learning to Advance Geriatrics (FLAG) Institute, (d) a Pilot Research Grant Program, and (e) a Membership Model for the National Hartford Center.
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health professions schools. With hundreds of years of important development and delivery of gerontological nursing content, our cache of proven educational products is diverse. The Nursing Education Exchange (NEXus) and FLAG Institute are two examples of creative educational programs to enhance the number and capacity of faculty in nursing to teach and deliver better care for older adults.
Facilitated Learning to Advance Geriatrics The FLAG program is a nationally recognized faculty development experiential workshop designed for nurse educators in pre-licensure programs. FLAG, an affiliate of the University of Minnesota’s CGNE, was established in 2008. Initially offered to faculty, doctoral students, and advanced practice nurses who resided in a four-state region in the Upper Midwest, the program has grown to over 160 participants, and now has national reach to include 15 states. Within the current 2-day structure, this program, offered for 18 continuing education credits, has several add-on components: (a) a 2-day summer institute; (b) year-long
Small Pilot Grant Process The Hartford Foundation has a rich history of creating mechanisms for grantees to interact in meaningful ways that encourage information, ideas, and lessons learned to be shared across projects and settings. Borrowing this philosophy and marrying with our mission and margin, the Small Pilot Grant Program was conceived to supplement retooling efforts, test new business models, grow our membership, and broaden the expertise of the National Hartford Center. Based on their strength and commitment to gerontological nursing, three schools/colleges of nursing were selected to participate in the pilot program: the Hartford Institute for Geriatric Nursing (HIGN) at NYU, the University of Maryland School of Nursing, and the Johns Hopkins University School of Nursing. The pilot program builds on their institutional strengths and provides educational and programmatic content toward the collective goal of developing gero-expert faculty and retooling existing faculty. To demonstrate institutional buy-in and contribute to the sustainability of the pilot work, matching funds in the amount of 80% were secured from each of the three participating schools.
New York University Modest pilot funding was provided to the HIGN at NYU to support a series of research-related preconference workshops held prior to the four regional nursing research society meetings. The HIGN Research Scholars Program began 14 years ago and has helped to provide more than 200 doctorally prepared nurses with a 1-week summer educational and mentoring “boot camp” experience. Using accomplished leaders in the field, selected scholars shape their clinical research interests into a research grant proposal for external funding.
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Nursing Education Exchange—NEXus A goal of NEXus is to address the national nursing shortage by educating well-prepared nurse educators through application of distance-accessible delivery methods. Since its inception, and continuing through its recent partnership with the National Hartford Center, NEXus membership has expanded to 20 academic collaborating institutions (which both offer courses and access to them at collaborating universities) and one academic affiliate (which accesses courses from collaborating universities). The NEXus catalog includes over 150 PhD and DNP courses in 10 topical “Clusters,” including Nursing Education and Gerontology and Geriatrics. Advantages to participating institutions are the ability to fill “seats” in classes and increase tuition revenues. The plan is to expand the market for NEXus offerings by jump-starting growth in institutional NEXus and Center memberships and greatly increase the volume of gerontology offerings and course sales. Because there is still limited availability of gerontology courses at schools around the country, and because we expect that one of the long-term effects of the National Hartford Center will be to increase demand for such courses, we will be able to grow NEXus’ business without reducing the existing revenue streams of member schools. NEXus is a mission-driven component of the National Hartford Center and a tested business model for Schools of Nursing. Advantages to students include expanded gerontology course offerings, opportunities to study with experts in gerontological research, increased flexibility, and greater access by enrolling directly as a nonmatriculated student, as NEXus students have preference for class seats (www.winnexus.org).
mentorship to assist FLAG Fellows in conducting a geriatric nursing education project to develop their expertise in geriatric nursing; and (c) networking opportunities and access to geriatric teaching resources. The FLAG Institute provides education, group mentoring, and support in selected core content areas. FLAG is phasing in registration charges to make its model self-supporting. An important lesson learned in the course of establishing the FLAG Institute is that converting a free, local, 4-day professional development program into a national revenue-generating 2-day program requires substantial changes to structure, location, and timing. The current cost model for FLAG varies by educational level of the participant and can range from $295 for postdoctoral students to $595 for regular registration (flagprograms.org).
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Through this National Hartford Center pilot award, NYU distilled their Research Scholars Program into a day-long preconference format at the four nursing regional research society meetings and the American Society on Aging’s annual conference. To ensure the sustainability of the program, a franchise model called the Hartford Institute/National Hartford Center Geriatric Research Scholars Program that generates income via tuition is being marketed. Moreover, to further contribute to its sustainability, faculty for the preconferences is provided by NYU and the National Hartford Center. The pre-conferences are proving successful in generating revenues and advancing our mission.
The University of Maryland
Johns Hopkins University Through a third pilot award, the Johns Hopkins University School of Nursing, in partnership with the National Hartford Center, hosted two Summer Research Institutes (SRI) which greatly aided our research mission; it focused on interventions to improve practice. The goal of the SRI is to help participants develop testable interventions that have the potential for implementation in practice environments and to advance appropriate clinical trial designs.
Membership Model for the National Hartford Center At a 2010 retreat, the National Hartford Center Directors made the decision to submit a collaborative renewal project,
Lessons Learned Throughout the 14-year evolution of the National Hartford Center, from its organizational home, to transitions in leadership, and ultimately to the joining of the individual centers into one collective enterprise, a number of lessons have been learned. The lessons fall into four main categories: Serve Yourself and Then Others, Charity begins at Home, the Value of Partnerships, and Mission Versus Margin.
Serve Yourself and Then Others Academic institutions do not generally volunteer to come together to serve a population in need. It is counter to the culture of universities to spontaneously join forces and pool resources to advance a common agenda. Historically, the individually funded Hartford Centers of Gerontological Nursing Excellence were given stand-alone grants to autonomously
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Congruent with the mission of the National Hartford Center, the University of Maryland was awarded a small pilot grant to support content development in dissemination sciences and to increase the aging expertise of nursing faculty. The aim of this project was to establish the Maryland Online Dissemination and Implementation Program (UM-ODIP). Specifically, the UM-ODIP provided online workshops with a total of 25 faculty participants in four webinars and homework assignments, with ongoing mentoring through online office hours. An Online Publication Workshop was held in the first year, resulting in submission of a manuscript for publication by each participant, and the publishing of a supplemental issue of Geriatric Nursing. Year Two included a second cohort for the Online Publication Workshop and also culminated in the development of a supplemental issue of Geriatric Nursing. As was the case with the NYU pilot grant, the University of Maryland award advanced the mission of the National Hartford Center by disseminating the work of gerontological nurses and is now exploring its revenue-generating potential to advance the National Hartford Center margin in a fee-for-service model.
leveraging its collective knowledge and vision to provide all nurses with expertise to be competent to care for an aging society. From the initial decision, additional ideas and strategies were examined to sustain our mission and margin over time. In a year-long facilitated discussion on strategic planning and sustainability, the Directors, now the Board of Directors, supported the idea of establishing an institutional-based National Hartford Center membership model, born from a few truths: there are many Schools of Nursing and institutions that want to be affiliated with the Hartford centers because of their strong reputation as a leader in aging; many Schools of Nursing have sought counsel or resources from the Hartford centers; and there is a demand for the Hartford name, its products, and its opportunities. Membership in the National Hartford Center affords an array of benefits, including reduced NEXus fees and access to opportunities described above, with a potential and conservative savings of more than $3,000.00 per year, after initial start-up. Further, participation in the only Academic Leadership Conference designed by and for nurses in gerontology provides access to esteemed thought leaders, individualized experiential learning, and unparalleled networking and partnership opportunities. Based on market research and information from a range of consultants, the National Hartford Center priced institutional membership at $3,000.00 per year. The fee is comparable with corporate membership fees in professional groups (e.g., American Society for Engineering Education). The membership fee structure, as well as all business processes are reviewed frequently and are subject to revision. There are over 1,600 schools and colleges of nursing across the nation; they are the target market for membership in the National Hartford Center. Currently, there are 43 member schools (see Table 1).
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Table 1. Member Institutions
Note: NHCGNE = National Hartford Center of Gerontological Nursing Excellence.
advance the mission of their specific centers. In 2010, when the Centers decided to create one entity—The National Hartford Center of Gerontological Nursing Excellence, which would be larger than the collective sum of its individual parts—the intent was good. The understanding of the challenges behind this altruistic goal to collaboratively improve the nursing care of older adults, however, was limited. First, the centers were each watching their own funding clocks. The Hartford Foundation, in rolling out their new practice-driven strategic vision, made final grants to
each of the eight academic Hartford centers in 2012; funding was to end in December 2015. This meant that while each center is a founding member of the Board of Directors of the National Hartford Center (whose Hartford funding ends in December 2016), the centers have to balance the needs and tensions of their individual home offices with those of the overall enterprise. In short, the individual centers have to tend to personal matters, sustainability issues, and secure institutional buy-in among a host of other final grant-related matters while focusing (or sacrificing) their
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NHCGNE members are Schools of Nursing and related organizations: 1. Arizona State University College of Nursing and Health Innovation – Founding Member 2. Boston College William F. Connell School of Nursing 3. Case Western Reserve University Frances Payne Bolton School of Nursing 4. Duke University School of Nursing 5. East Carolina University College of Nursing 6. Hartford Institute for Geriatric Nursing at the NYU College of Nursing 7. Hong Kong Polytechnic University School of Nursing 8. Hunter-Bellevue School of Nursing, Hunter College, CUNY 9. Iberia Rehabilitation Hospital 10. Illinois State University, Mennonite College of Nursing 11. Johns Hopkins University School of Nursing 12. Northeastern University Bouve College of Health Sciences School of Nursing 13. Ohio State University College of Nursing 14. Oregon Health & Science University School of Nursing – Founding Member 15. Our Lady of the Lake College School of Nursing 16. Penn State University College of Nursing – Founding Member 17. Sigma Theta Tau International 18. Texas Tech University Health Sciences Center School of Nursing 19. University of Alabama at Birmingham School of Nursing 20. University of Alabama Capstone College of Nursing 21. University of Alberta Faculty of Nursing 22. University of Arkansas for Medical Sciences College of Nursing – Founding Member 23. University of California Los Angeles School of Nursing 24. University of California San Francisco School of Nursing – Founding Member 25. University of Connecticut School of Nursing 26. University of Delaware, School of Nursing 27. University of Illinois at Chicago College of Nursing 28. University of Iowa College of Nursing – Founding Member 29. University of Maryland School of Nursing 30. University of Massachusetts, Amherst College of Nursing 31. University of Massachusetts Lowell, College of Health Sciences, School of Nursing 32. University of Minnesota School of Nursing – Founding Member 33. University of Missouri Sinclair School of Nursing 34. University of Oklahoma Health Sciences Center College of Nursing – Founding Member 35. University of Pennsylvania School of Nursing 36. University of Pittsburgh School of Nursing 37. University of San Francisco School of Nursing and Health Professions 38. University of Utah College of Nursing – Founding Member 39. University of Virginia School of Nursing 40. University of Washington School of Nursing 41. University of Wisconsin-Madison, School of Nursing 42. University of Wisconsin-Milwaukee College of Nursing 43. Vanderbilt University School of Nursing
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Charity Begins at Home Similar to the lesson above, the co-ordinating center and Foundation staff learned the value of taking an organizational pulse to determine if our original home was meeting our evolving needs. As noted earlier, after a series of thorough assessments of our future needs and candid conversations with leadership at the American Academy of Nursing, it was determined a move was needed. The BAGNC Initiative would benefit from an organization that could offer an interdisciplinary membership committed to our long-term sustainability and improving the health of older adults. After some searching, The GSA emerged as the best fit. Not only did the Society meet the criteria above, but also CEO James Appleby pledged to work with our initiative to obtain status as an autonomous unit within the GSA. This remains a goal of the National Hartford Center to help sustain our work post-Hartford funding. Today we remain pleased to be housed within the well-respected and mission-congruent parent organization.
The Value of Partnerships As noted in this article, through a series of partnerships, the National Hartford Center has been able to align its work and that of other funders to advance specific components of the Initiative (e.g., scholarship awards, pre-conferences). From its inception, the leaders of the Initiative have understood the importance of not having all of their funding eggs in one basket, and that cultivating co-funded activities requires time, energy, and, most important, an invitation. An interesting finding is that aging does not have to be the primary focus for both parties. For example, the MayDay Fund was open to wedding their strategic focus on pain
with that of the National Hartford Center’s focus on older adults. Together, we have been able to support nurses who are interested in pain management in older Americans.
Mission Versus Margin Mission and margin discussions are a bit of a chicken and egg causality dilemma. At this stage, the circular cause and consequence is somewhat irrelevant, as the National Hartford Center is committed to both and fully acknowledges our societal responsibility and associated concern for ethics, justice, and beneficence (Voges, 2012). “No margin, no mission” is a familiar refrain, and portends a number of challenges and lessons learned. For example, transitioning from grant funding to self-sustaining has had a number of challenges. A lesson learned over and over again is, “if it is easy, then it would already have been done.” Collectively, the Center and its members are goal-driven, and believe in beneficence and the utility of the National Hartford Center. Another important challenge and lesson learned is recognition of our collective brand. Our mission is to serve the health care and nursing community. Are we national or global? We are global, but our name reflects our commitment to the United States. The “National Hartford Center of Gerontological Nursing Excellence” is long and does not easily roll off the tongue, but it does accurately tie us to our mission and, importantly, to our roots as part of the legacy of the John A. Hartford Foundation. The lesson: Think carefully before you brand a product with a wellknown name, such as “Hartford.” Does this brand limit us in future funding? We do not know the answer, and are uncertain at this juncture; however, we seek to do no harm to ourselves or the Hartford Foundation, as we proudly bear its name. Research is a core value of the Center, and drives what we teach in the classroom and what we do in clinical practice. A repetitive and albeit rhetorical question leveled at the National Hartford Center is: If we had to build this project again, would it look the way it does today? The lesson here was what we do now is based on lessons learned. The Center members are diverse in their research programs; hence, like systems science, we seek to find utility and common purpose in our diversity. We admit that greater coherence among member schools, content domains, and research missions might enhance marketing to a particular niche industry, but that is not who we are today. We respect our diverse scientific interests and are working in tandem to advance each member school’s research and teaching mission. Change tends to create a period of instability in systems operation. As such, we need to accommodate the change and build supports across the Center. With successions
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work at a larger center level; this additional focus has been more challenging at some centers than others. For example, for centers that have secured funding (e.g., promises from funders post-Hartford), it has been easier to be “present” at the National table. It was important for us as a collection of centers (including the co-ordinating center, as well as the staff of the Hartford Foundation and the GSA) to acknowledge this conflict and to routinely revisit it during retreats and on monthly phone calls. This issue often was the elephant in the room. While it was only natural that an individual center needed to be on solid footing before firmly committing to the collaborative, it was helpful for the group to publically recognize this tension within specific centers and to validate that this, indeed, is part of the process and makes programmatic and strategic sense.
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gerontology. Our continuing successes and collective accomplishments in gerontological nursing allow optimism for our profession and for the health care of older adults globally.
Funding This work was supported by a grant from the John A. Hartford Foundation, grant number 2012-0052, to the first author.
Acknowledgments The authors wish to thank the National Hartford Center Founding member schools and express our appreciation to Dr. Ginny Pepper, NHCGNE President, for her contributions to the conceptual framework and to Drs. Terri Harvath, Betty Irene Moore School of Nursing and Jean Wyman, University of Minnesota for their contributions to the NEXus and FLAG programs.
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and retirements, the John A. Hartford Foundation has aided our processes by supporting site visits to member schools, at which we share energy, ideas, and best practices. Successions and retirements may have made us sad, but consistently opened new opportunities, memberships, partnerships, and potential for growth. Growth has been perhaps most evident in the 249 individual recipients of the National Hartford Center’s Patricia G. Archbold and Claire M. Fagin Fellow Awards Program. These individuals are engaged in the operations of the Center and are members of the GSA. They are our greatest asset and work to support our mission and margin. What we have learned and value is that respect, collaboration, persistence, and stability pay outstanding dividends. Today, we celebrate innovations and advances in gerontological nursing science. A representative selection of 16 articles from the field are shared in this volume addressing an array of diseases and conditions affecting human systems, embedded in a variety of environments, including in-home care, subsidized housing communities, nursing homes, assisted living facilities, memory care units, and rural community environs. Professionals—researchers, clinicians and educators— should find the collection of articles to be thought provoking as well as informative. Drs. Galik, Jao, Tak, Kolanowski and Gilmore-Bykovskyi and colleagues address system complexities for persons with dementia in variety of longterm care environments in the first five articles in this supplement. The section on geriatric syndromes and other chronic conditions cover a range of disorders including behavior, pain, and genetics with depressive symptoms (Klinedinst et al.), resident-to-resident violence (Snellgrove et al.), fall risk assessment (Miller et al.), vision impairment in subsidized housing (Elliott et al.), and Parkinson’s disease (Pretzer-Aboff et al.). The supplement closes with two special articles on educating gerontological nurses. The FLAG is a well-tested educational model for those who wish to increase their capacity to teach students about caring for older adults (Kirchbaum et al.) and an equally compelling young scholars program to entice early entry into the academic faculty role (Mentes et al.). As we look forward to the next several years of the National Hartford Center, we envision an international collaboration of schools and institutions that capitalizes on the enormously talented and dedicated assets of our members, colleagues, scholars, fellows, and partners. It is anticipated that the membership will advance the way in which nurses care for older adults by leading change in our science, knowledge, clinical practice, and educational pursuits. The National Hartford Center is a unique entity for nursing and
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