Excellence in Geriatric Nursing

Behind the smile is an eager nurse with a heightened purpose.

“Good morning, I’m Colleen and I will be your geriatric resource nurse for the day.”

Whether it’s Colleen M. Regan, RN, Joan Browner, BSN-BC, RN, or 32 other Geriatric Resource Nurses (GRNs) now certified on three medical units at the Hospital of the University of Pennsylvania (HUP), the friendly introduction is simply a prelude to an array of changes in senior healthcare at the renowned facility in Philadelphia.

Rebecca L. Trotta, PhD, RN, director of nursing research and science at HUP, knew early in her 16-year career that she wanted to try to improve care for the underserved but growing population of senior citizens. By the year 2030, the number of U.S. adults over age 65 will grow from 37 million to more than 70 million – accounting for an increase from 12% to 20% of the U.S. population, according to the U.S. Census Bureau.

Now, four months after being awarded a three-year $1.5 million grant from the Health Resources and Services Administration (HRSA) to develop a nurse-led interprofessional collaborative practice model for the geriatric population on the medical units at HUP, Trotta is making it happen.

HUP’s “Developing Geriatric Resource Nurse-led Interprofessional Collaborative Practice (IPCP) Project” officially kicked off on Feb. 17.

“I’m so thrilled that the implementation went so smoothly. Everyone is so engaged,” Trotta told ADVANCE.

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ACHIEVING EXCELLENCE: HUP’s first class of newly minted Geriatric Resource Nurses show off their silly side while celebrating their achievement. photo courtesy Penn Medicine

Inspired Outcomes

“The clinical care model incorporates representatives from medicine, pharmacy, social work, therapy and other disciplines to provide an answer to the gap in geriatric care,” said Trotta, who is also coordinator of HUP’s Nurses Improving Care for Health Systems Elders (NICHE)-designated program. “This grant grows nurses’ capacity to lead that team in providing comprehensive, individualized, geriatric-focused care.”

Trotta was inspired to seek the grant just three months after undertaking the director’s position in September 2011. She immediately proposed the idea to Victoria Rich, PhD, RN, FAAN, who was HUP’s chief nurse executive at the time.

“It was a massive undertaking,” said Trotta, who with much support from hospital leadership devoted two months to writing the grant application.

The grant was awarded in July 2013 and runs through June 2016.

The IPCP project addresses a critical need, both locally and nationally, Trotta asserted in her grant application. She noted that Philadelphia’s population ranks the fifth oldest among U.S. major cities, and Pennsylvania is home to the second oldest population among the 50 states. Additionally, she noted that 30% of the patients hospitalized on medical units at HUP are over the age of 65.

She underscored the facts: Not only are older adults typically at high risk for cognitive, functional and nutritional decline over the course of hospitalization, they have higher rates of readmission and longer lengths of stay.

And she asserted: “Early individualized intervention can mitigate risks and improve outcomes.”

Multi-Faceted Role

As part of the ongoing IPCP project, 34 nurses on three units have completed the NICHE geriatric resource nurse (GRN) curriculum, which includes 20 hours of online evidence-based training, as well as an additional two-day class on geriatric assessment, taught by Trotta. The units include Silverstein 11, Founders 12 and Founders 14, representing a total of 92 beds.

While the online training gave them a geriatric perspective, Trotta said her class “prepared them to implement the role.” The role of the geriatric resource nurse under the new care model is multi-faceted:

  • Conduct comprehensive geriatric assessments (CGAs) on select geriatric patients;
  • Present CGA findings and recommendations during interprofessional rounds for team input and consensus, and facilitate actualization of recommendations; and
  • Work collaboratively with patients, families, nursing colleagues, and interprofessional team members around specific geriatric issues.

Since February, one GRN has been assigned on each of the three units, Monday through Friday, 7 a.m. to 3 p.m. On each shift, the GRN sees one or two new patients and following up on patients who were seen on previous days. In addition to addressing the patient and family’s individual needs, follow-up care includes special attention to delirium prevention, maintenance of functional status, and paint management.

“That’s what makes this so unique. It’s an extra layer of attention with a geriatric focus,” Trotta emphasized.

As nurse manager on Founders 14, Betty Ann Boczar, MS, BSN, RN, provides support for GRNs, particularly around scheduling to ensure they are able to attend the training sessions and then have dedicated time as a GRN on the unit.

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HOSPITALWIDE SUPPORT: The entire HUP team, including (l to r) Rebecca Trotta PhD, RN, director of Nursing Research; Karen Hutchinson, BSN, RN, Clinical Nurse II; Diane Lawson, MSN, RN, Clinical Nurse IV; Aditi Rao, PhD, RN, nurse scientist; and AnnMarie Papa, DNP, RN, FAEN, FAAN, clinical director, Emergency and Medical Nursing, worked together to ensure geriatric patients received the best possible care. photo courtesy Penn Medicine

 

“It has been amazing to observe the clinical nurses apply the specific geriatric knowledge and skills to the individual patients,” said Boczar, a 32-year HUP nurse who has been in a leadership position for 22 years. “Their ability to perform cognitive assessments and further explore their functional and nutritional capacity has led to recommendations with the interdisciplinary team.”

Like Trotta, Boczar said it’s exciting to watch the team embrace their still unfolding roles.

Among the corps of GRN’s is Joan Brower, BSN-BC, RN, who was also one of the first nurses to take part in the NICHE program at HUP in 2010. She said the IPCP project allows “for elements above and beyond what the primary nurse would do.”

Brower explained that the GRNs receive a list of patients 65 years of age or older every day. From that list, they choose one or two patients to focus on during their assigned day.

As the project unfolds, nurses will work with the HUP Patient and Family Advisory Council to strengthen patient and family partnerships and engagement in geriatric care, both in the hospital and during care transitions, Trotta said. The GRN-led interprofessional model will incorporate specific patient and family-centered activities, such as ensuring participation in care planning, targeted assessment of caregiver preparedness and individualized support during transitions in care.

“This grant grows nurses’ capacity to lead that team in providing comprehensive, individualized, geriatric-focused care,” Trotta said.

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