The American healthcare system is taking on new challenges as baby boomers begin identifying themselves as "retired" on their income tax returns and find themselves faced with ailments common for aging adults. While facilities readjust to accommodate the influx of aging patients, their staff - and nurses in particular - realize they too must realign their job responsibilities to care for their aging patient population.
"Over half of the hospital patients are older adults," said Robin Remsburg, PhD, MSN, BSN, director of nursing and associate dean of George Mason University's College of Health and Human Services, Fairfax, VA. "It's simply a grey tsunami and it's a demographic fact that healthcare providers, nurses and others are going to take care of a lot of older adults."
With nurses across the country called upon to care for patients who are more often than not age 65 or older, nurse educators have realized many nursing programs may not offer enough geriatric education necessary to properly prepare nursing students for the onslaught of aging patients.
According to Mathy Mezey, EdD, RN, FAAN, professor emerita, senior research scientist, NYU College of Nursing in New York, and associate director, The Hartford Institute for Geriatric Nursing, a 2004 survey found that only a third of baccalaureate programs offered stand-alone geriatric courses. While she estimates many schools have since added stand-alone courses, there is still a long way to go before all schools fully incorporate gerontological content - and the changing patient population is making gerontological education a must in this day and age.
"If you are going to work as a nurse, by definition you are a geriatric nurse," Mezey said. "You are going to be surrounded by the need to give good care to older patients and if you are doing that, just as if you were in pediatrics, you need to know the content."
But getting that content to nursing students isn't as easy as it sounds; everything from faculty engagement and an already overcrowded curriculum to timing seems to get in the way.
For years, professional nursing organizations such as the American Association of Colleges of Nursing (AACN), the National Gerontological Nursing Association (NGNA) and the Hartford Institute for Geriatric Nursing have made it a mission to educate nurse educators on the importance of including gerontological content in nursing curricula; however, their first hurdle has been getting the faculty themselves up to speed on the content and fostering their passion for geriatric care.
"Many [educators] have not had specialized training in gerontology," Remsburg said. "Most of them probably didn't have much in their basic programs or advanced practice programs."
Initiatives such as the AACN's Geriatric Nursing Education Consortium (GNEC), George Mason University's Partners for Education in Gerontology (PEG) and the Hartford Institute's ConsultGeriRN.org website were designed specifically to build knowledge of and passion for geriatric care in faculty, with the goal of helping them infuse geriatric content into their courses.
"You have to start by engaging the educators," Remsburg continued. "Once they get it, they are committed and they're passionate about it, then we can start to see stand-alone courses, electives, certificates and specialty kinds of courses."
For those bitten by the gerontology bug, Remsburg, Mezey and Laurie Wilson, AACN's gerontology program director and GNEC project director, all agree faculty should consider working toward gerontology certification.
"Every school is going to need at least one faculty member who has pursued a specialization in geriatrics," Mezey continued. "But this content can also be co-taught by accomplished faculty who have attended workshops or pre-conference seminars and have steeped themselves in this content."
Tweaking the Curriculum
Once faculty are on board with gerontological education, there are still obstacles to disseminating that information. Institutions and educators alike are unsure how to add gerontological content to already crammed undergraduate nursing curricula, and while some feel a required stand-alone course is the best option, others aren't sure going through the course approval process will answer the immediate need for geriatric content.
"In some institutions, you have to shepherd a new curriculum through various committees like your undergraduate curriculum committee, and then it may have to be voted on for approval by a larger faculty or school committee, so it could take a very long time," Wilson said. "But if you task faculty with infusing content into their programs, instead of turning their curriculum upside down, then often they can be far more successful and make change happen more quickly."
Added to the time constraint, faculty are not sure what, if anything, can be removed to make room for new content; they also continue to debate when in the curriculum a stand-alone course or, more importantly, clinical experience would fit best. According to Wilson, institutions have to choose carefully when and where students get their clinical experience.
"Some faculty may say long-term care should be introduced later on because the patients are complex and they may intimidate a new student," Wilson explained. "Others will state that long-term care is an excellent site for an early experience because it offers opportunity for continuity of care. It's very difficult to say one way or another what's the ideal."
But even with these challenges, proponents have identified some significant benefits for schools that do manage to add stand-alone gerontological courses to their curriculum.
"When you have the content integrated throughout the curriculum . sometimes students are overwhelmed with all that they have to learn and so it's hard for them to see all the differences," Remsburg said. "But when you put it in a stand-alone course, it's easier for them to organize, learn, comprehend and retain the differences."
The push for more gerontological education in nursing undergraduate curricula comes at a time when associate degree nurses are strongly encouraged to achieve their baccalaureate degree. While attending the recent NGNA convention in Baltimore, both Wilson and Remsburg noticed many associate degree nurses looking to start a baccalaureate program were interested in geriatrics as a specialty.
"The complexity of the patients in the hospitals nowadays, including the age of patients, really begs for a more educated bedside nurse," Remsburg said.
Since the U.S. Census Bureau estimates the population of older adults will rise from 13 percent in 2009 to 20 percent by 2030, instituting more geriatric content - infused throughout the curriculum or with a stand-alone course - will help current students and those planning to return to school for their baccalaureate degree be ready to handle any and all patients they see.
Mezey, Wilson and Remsburg all hope the shift in nursing education toward geriatrics may lead some students to seek further specialization. For Mezey, the best option for nurses looking to continue their geriatric education beyond the baccalaureate level is through new combined adult/gerontological nurse practitioner or clinical specialist programs. Key professional organizations have issued recommendations that geriatric and adult nurse specialties combine into one so more nurses are trained in geriatrics and their training translates better from state to state.
"We were preparing very few geriatric nurse practitioners and clinical specialists, so this will markedly expand the pool of advanced practice nurses who have been prepared in geriatrics," Mezey said. "If a student is interested in geriatrics, that's their next step, to seek a master's program that has this dual preparation."
Rebecca Hepp is an assistant editor at ADVANCE.