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Geriatric Nursing: A Specialty in Need


As the U.S. population ages, geriatric nurses and nurse practitioners (NPs) can make an impact. The need for geriatric nurses can be explained simply by looking at data highlighting an aging United States. From 2009 to 2019, the population of adults age 65 and older grew 36% to more than 54 million Americans, according to the Administration for Community Living (ACL) -- a division of the U.S. Department of Health and Human Services. By contrast, the under-65 population grew just 3%. "Because of great healthcare and many other factors, people are living longer," said Janice Whitaker, BSN, MEd, RN, administrator and community liaison for the Tressa Nese and Helen Diskevich Center for Geriatric Nursing Excellence (CGNE) at Penn State University. "Geriatric nurses are critical to our healthcare workforce." As the growth of the U.S. population continues -- more than one in five adults in the U.S. will be over 65 by 2040, says the ACL -- signaling a higher demand for geriatric nurses and NPs. "I often tell students that you're always going to have a job if you work in geriatrics," Whitaker said. "In many geriatric professions, we usually have very steady hours and very steady employment."

Attention for geriatrics

Kathleen Breda, MSN, BBA, APN, AGACNP-BC, GRN, ONP-C, is a second-career nurse and the lead NP in the orthopedics department at Cedars-Sinai Medical Center in Los Angeles, California, overseeing the geriatric fracture program. [caption id="attachment_105673" align="alignleft" width="260"] Kathleen Breda, APN[/caption] Throughout the facility, adults 65 and older dominate the patient population. "We're basically a geriatric-focused hospital," Breda said. "The majority of our patients are 65 years and older. We take care of more 80-year-olds than any other tertiary Level I trauma academic center in the U.S." That focus on geriatric care, however, isn't as prevalent across the country, according to Breda. "A lot of folks really don't appreciate that geriatrics is a specialty, just like pediatrics is a specialty," she said. When working with nursing students, Whitaker also notices a lack of attention on geriatrics. "They often think of things like intensive care, emergency room, pediatrics, [and] neonatal ICU," she said. "What's important for them to understand is that in many of the places that they believe they want to work -- whether it's ICU or ER or medical/surgical units, orthopedics, or acute care -- more than 60% of those patients are older adults." Through her work at Penn State, Whitaker and the CGNE are trying to increase interest and commitment toward expanding geriatric nurse opportunities. "We know that we need more nurses being recruited into this field," she said.

Necessities for geriatrics

When working with older adults, a geriatric nurse or geriatric NP needs several key traits, according to experts. [caption id="attachment_105672" align="alignright" width="260"] Janice Whitaker, RN[/caption] "They need to have strong assessment skills, being able to do physical, mental, emotional, and social assessments of their patients and develop comprehensive healthcare plans," Whitaker said. "Older adults have complex health needs. They don't often have one simple problem." Breda added that a good understanding of physiology and how the body changes with aging is important, along with being able to view "a much bigger picture" with geriatric patients. "Sometimes, things like a hip fracture means the end of their independence," she said. "You have to be able to converse about goals of care and what's important to them, then roll that back into your nursing care." For example, a nursing professional might not add a medication that makes a person sleepy if that patient's goal is to walk three times a day, she explained. Good clinical judgment, decision-making, problem-solving, leadership, and interpersonal skills also are important, according to Whitaker.

"What's unique to geriatrics is that it does require the nurse to have a high level of autonomy in their practice," she said. "Very often, they have to be someone who is very competent and confident and can work well independently as well as on a team."

Rewards and challenges

Growing up, Breda said her great-grandfather lived with her family. Today, that type of arrangement is more uncommon. "The way society cares for older adults has changed," she said. "You used to have big families. Family members often took care of other family members as they aged." But with driving factors like families spread out around the globe and higher-level care needs, the care of older adults is now frequently left to geriatric care professionals. Oftentimes, cognitive conditions such as dementia and delirium can make it difficult for family members to provide necessary care in the home. Breda cited the potential for clinicians to misinterpret the difference between dementia and delirium in an older adult as a common challenge. "Nurses would do themselves and their patients a service by understanding what (delirium) is," she said. "The outcomes would be so much better for patients and their families, and it's better for the hospital system because it decreases length of stay and complications if you manage it properly." Whitaker, who previously worked as a director of nursing in long-term care at a skilled nursing facility, said that along with ageism, helping students to increase their exposure to older adult patients, and countering the perceptions that geriatrics isn't "very exciting or rewarding" are common challenges. While challenges in this specialty can be difficult to overcome, geriatric nurses remain resilient. These nursing professionals find ways to navigate these hurdles, while highlighting the most impactful parts of their roles. The most rewarding aspect is the people you care for in geriatrics.

"You get to meet people who have lived long, interesting lives and have so much to share and so many unique perspectives," Breda said.

Whitaker added, "It's very inspirational getting to know the person and what they've done throughout their life and the wisdom they can impart."

Impact on home care

For geriatric nurses or geriatric NPs working in home care, growing the specialty is also an ongoing goal. The 2022 National Healthcare at Home Best Practices and Future Insights Study, which included more than 3,500 respondents, said the turnover rate for RNs rose to 18.7% in 2020 -- up from 14.6% in 2016. "I'd like to see more innovative staffing models to care for increased volume of medically complex patients in the home," said one respondent. Among all home health agency respondents, 98% said they'll be negatively impacted by leadership turnover. The same group said that not enough growth opportunities, compensation, and lack of flexibility in the job were the three biggest areas that need improvement.

Specialized care and education

Since older adults require clinicians with specialized skills, current and future geriatric nurses and geriatric NPs can seek out a variety of educational opportunities. LPNs, LVNs, RNs, and APRNs can all have a role in geriatric nursing, according to the American Geriatrics Society. For students at career or technical centers, colleges, and universities, Whitaker recommended asking questions about geriatric-specific courses. "Some schools of nursing have specialized courses in geriatrics," she said. "Not all do, but it's important that they do. You can go on to take certificate programs, graduate-level courses, seminars, workshops, conferences, and so forth." Among the vast options available are geriatric nurse and geriatric NP certifications from the American Nurses Credentialing Center as well as continuing education courses geared toward geriatric nursing. A report in the May 2020 issue of Nursing Outlook said NPs and physicians who have been trained in geriatrics and gerontology are more likely to recommend careers in the specialty. For current nurses considering a switch to geriatrics, other colleagues can provide valuable information. "Reach out to people in your community who have had experience working in geriatrics," Whitaker said. Learn more about geriatric nursing with these courses: Aging Immune Systems (1 contact hour) The increase in the aging population is an enormous challenge for healthcare professionals. Healthcare professionals must be equipped with the appropriate knowledge to understand how age-related changes in the immune system increase the risk for and severity of common infections in older adult patients. Older Adults: Fall Prevention (0.50 contact hour) After taking this course, you should be able to identify the major physical, psychological, and environmental risk factors for falls in older adults, as well as discuss clinical practice guidelines and other measures for preventing falls in hospitalized older adults. Combatting the Effects of Immobility (1 contact hour) Many patients in the acute setting are immobile due to the nature of their disease or condition. Immobility is associated with a higher risk for many complications including deep vein thrombosis, pressure injuries, contractures, and pneumonia, to name a few. Interventions to combat the effects of immobility are a critical aspect of caring for a patient.