APNs who specialize in geriatric care are always out to improve older adult care by steering best practices, performing comprehensive geriatric assessment and managing medication and geriatric syndrome issues.
Michelle Moccia, DNP, ANP-BC, CCRN, GS-C, and Valerie Sabol, PhD, ACNP-BC, GNP-BC, CNE, ANEF, FAANP, talked with us about the expanding roles of APNs in gerontology, its rewards and challenges and how the Gerontological Advanced Practice Nurses Association supports APNs in research, education and practice.
Moccia is president of GAPNA and program director of the senior ER at St. Mary Mercy Livonia in Livonia, Mich. Sabol is the incoming president of GAPNA and chairperson for the Healthcare in Adult Populations Division at Duke University School of Nursing.
How have APNs who specialize in gerontology improved the lives of the elderly and the communities where they live?
These APNs often work with multiple agencies to address disparities, assess social determinants of health, improve care transitions and create awareness of high-risk situations, such as elder abuse, neglect and suicide, said Moccia and Sabol.
APNs lead meaningful conversations about care goals, person-centered care and end-of-life care for the elderly, and they advocate for the well being of older adults through research, policy and service activities.
Service activities can include participation in nonprofit programs that give back to high-risk populations in the community. For example, GAPNA participates in membership fundraisers for goods and services in communities where its members meet for its annual conferences, said Moccia and Sabol.
This year GAPNA’s membership is being asked by a nonprofit organization called Iona Senior Services to donate needed toiletry items and food/drug-store gift cards for older adults in the local community. According to Moccia and Sabol, giving back to the local community allows APN association members from various states to connect, learn from each other and be inspired to create initiatives in their own backyard.
What are some of the rewards for APNs who practice in this specialty?
The APNs realize they have the ability to impact change, shape healthcare policy, narrow the “know-do” gap and practice with the best evidence to improve outcomes in the fastest growing population worldwide, Moccia said.
APNs who care for the elderly are sought out for their expertise and contribute to scholarly discussion, and they show by their active engagement within professional organizations that they can impact change at a national level.
Moccia says GAPNA members have made a difference in the community by:
- Participating in the Advancing Excellence in the Long-Term Care Collaborative 2018 Forum.
- Offering expertise during a Gerontological Society of America’s stakeholder meeting to help improve immunization rates in the long-term care setting.
- Contributing their expertise on advanced care planning and pain management during the Palliative Nursing Summit Steering Committee calls.
GAPNA has many APN members who have been recognized at that the national level for their outstanding accomplishments, Moccia said.
What have been some of the challenges?
Nationwide, less than 1% of nurses are certified as geriatric nursing specialists and only 10% of medical schools require geriatric care training, Sabol said. In addition, since changes were made to integrate adult and geriatric populations into one graduate-level NP curriculum, geriatric specialization was eliminated.
As a result, the numbers of gerontological specialists, including clinical nurse specialists and nurse practitioners, are dwindling, Sabol added.
APN faculty who specialize in geriatrics also are decreasing. This void of specialists in both practice and academe predisposes the older adult to risk of care mismanagement and poor outcomes, Sabol said.
The Institute of Medicine has delivered a call to action to ensure geriatric education and competencies are embedded in curricula to improve recognition of situations that put elders at risk for poor outcomes, such as geriatric syndromes, poly-pharmacy and hospitalizations.
As trusted leaders in the expert care of older adults, it is GAPNA’s mission to promote excellence in advanced practice nursing for the well-being of older adults, Sabol said.
How would you advise RNs who are interested in specializing in gerontology?
Nurses pursuing an advanced degree in gerontology are a highly sought-after group of providers, agree Moccia and Sabol. Currently, preparation for gerontological specialization is optional, and specialization must build upon the current APN role and population-focused competencies.
Those who develop and acquire expertise in geriatric-related care are strong patient and family advocates who are proficient in managing the aging process, which includes normal age-related decline and changes in physical and cognitive function, such as delirium, depression, dementia, frailty and caregiver strain, explain Moccia and Sabol.
Expert APNs who care for older adults also are able to more readily recognize subtle, often insidious, changes in health and the limited physiologic reserve to respond to illness or injury.
APNs who specialize in the care of the elderly can provide leadership among other members of the healthcare team and likely are the strongest advocate for an individual’s or family’s care-related choices, said Moccia and Sabol. The rewards in caring for this unique, sometimes vulnerable, population are endless.
They have the opportunity to distinguish themselves as experts who possess the knowledge, experience and skill sets necessary in managing the complex health needs of older adults by sitting for the association’s APRN Gerontological Specialist Certification (GS-C) examination. This highly anticipated certification exam was first offered this year at GAPNA’s Pharmacology Conference in Boston.
How does GAPNA support their membership in research, practice and educational endeavors?
GAPNA members have many opportunities to engage in the different committees or special interest groups, Sabol said. Currently, there are nine committees and eight special interest groups, and they cater to a broad selection of APN-related interests and offer numerous collaborative opportunities, she continued.
The Research Committee, for example, mentors fellow APNs and student APNs with their research proposal. Committee members support student research and clinical projects through podium or poster presentations during the annual conference with the goal of contributing to nursing’s body of knowledge in the care of older adults, Sabol said.
Educational endeavors include free monthly continuing educational offerings along with numerous sessions in the On-Line Library. GAPNA members receive a free subscription to “Geriatric Nursing,” bimonthly e-alerts noting legislative news, various state chapter events and topics of interest, and discounts to other geriatric-focused professional organizations.
Two toolkits have been released: “Gerontology Resources for APRNs in Acute and Emergent Care Settings” and “Gerontology Resources for APRNs Preceptor and Students.” They were designed with APN students, preceptors and educators in mind, with the goal of improving the quality of healthcare provided to older adults, Sabol said.
Educational endeavors are supported through sponsored scholarships like the Health Affairs Scholarship, which is awarded to a GAPNA member interested in engaging in legislative opportunities that impacts the care of older adults. Five APN student scholarships assist students in earning a master’s or doctoral degree in nursing, with an emphasis on the care of older adults. For those interested in research and scholarship opportunities, the GAPNA Foundation awards three grants to steward clinical advancement, Sabol explained.
How is the issue of emergency care for the elderly being addressed?
The emergency department can be considered the front porch of the community, Moccia said. According to the 2011 Emergency Department National Hospital Ambulatory Medical Care survey, more than 20 million older adults in the U.S. visit an ED annually.
Unfortunately, many EDs often are used inappropriately as a primary care provider, so it is imperative that APNs are skilled in the unique care needs of this often-vulnerable population within this higher acuity setting, Moccia said.
In response to these concerns, a task force published the Geriatric Emergency Department Guidelines to address these public health concerns. In addition, recognizing the need for specialized emergent care of the older adults, geriatric EDs (or senior ERs) are rapidly opening across the U.S.
APN experts who care for older adults in acute and emergent care settings are well-positioned to be thought leaders, change agents and patient advocates in the rapidly changing landscape of healthcare and will play an important role in transitional care, Moccia said. Indeed, many of GAPNA’s current leaders are forging these paths, she added.
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