Geriatric nursing: a specialty in need

The demand for geriatric nurses might be explained just by taking a look at data highlighting the aging United States. In 2009-2019, adult population people aged 65 and older increased by 36% over 54 million Americans, in accordance with the Administration on Community Living (ACL), a branch of the U.S. Department of Health and Human Services. In comparison, the number of individuals under 65 increased by only 3%. “Thanks to excellent health care and many other factors, people are living longer,” said Janice Whitaker, BSN, MEd, RN, administrator and community liaison for Tressa Nese and Helen Diskevich Center for Geriatric Nursing Excellence (CGNE) at Penn State University. “Geriatric nurses play a critical role in our healthcare workforce.” As the U.S. population continues to grow, in accordance with ACL, multiple in five U.S. adults will likely be over 65 years of age by 2040—signaling a greater need for geriatric nurses and nurse practitioners. “I often tell students that if you work in geriatrics, you will always have a job,” Whitaker said. “In many geriatric professions, we tend to have very consistent hours and very stable employment.”

A note for geriatrics

Kathleen Breda, MSN, BBA, APN, AGACNP-BC, GRN, ONP-C, is a second-career nurse practitioner and NP manager within the department of orthopedics at Cedars-Sinai Medical Center in Los Angeles, California, overseeing the geriatric fracture program. Kathleen Breda, APN Throughout the power, patients are adults aged 65 and over. “We are basically a geriatrics-focused hospital,” Breda said. “Most of our patients are 65 and older. We care for more 80-year-olds than any other Level I academic trauma center in the U.S.” However, the give attention to geriatric care will not be as common across the country, in accordance with Breda. “A lot of people really don’t appreciate that geriatrics is a specialty, just like pediatrics is a specialty,” she said. While working with nursing students, Whitaker also notices an absence of interest in geriatrics. “They often think about things like intensive care, emergency room, pediatrics, [and] in the NICU,” she said. “It’s important for them to understand that in many of the places where they think they want to work – whether it’s the intensive care unit, the ER, medical-surgical units, orthopedics or acute care – over 60% of these patients are older”. Through their work at Penn State, Whitaker and CGNE strive to increase interest and commitment to expanding opportunities for geriatric nurses. “We know we need more nurses recruited into this field,” she said. he said.

Needs for geriatrics

When working with older adults, experts say a geriatric nurse or geriatric NP needs several key qualities.

“They must have strong assessment skills, be able to perform physical, mental, emotional and social assessments of their patients and develop comprehensive health care plans,” Whitaker said. “Older adults have complex health needs. They often don’t have one simple problem.” Breda added that it is important to have a good understanding of physiology and the changes that occur in the body as we age, as well as the ability to look at geriatric patients “way more broadly.” “Sometimes things like a broken hip mean the end of their independence,” she said. “You need to be able to talk about goals of care and what’s important to them, and then incorporate that into your nursing care.” For example, she explained that the nurse may not add a drowsiness medication if the patient’s goal is to walk three times a day. Good clinical judgment, decision-making, problem-solving, leadership and interpersonal skills are also important, according to Whitaker.

“The uniqueness of geriatrics is that it requires a lot of autonomy from the nurse in his or her practice,” she said. “Very often it has to be someone who is very competent and confident, able to work well both independently and in a team.”

Rewards and challenges

Growing up, Breda said her great-grandfather lived with her family. Today, this type of solutions are becoming more and more rare. “The way society cares for older people has changed,” she said. “You used to have big families. “Family members often cared for other family members as they aged.” However, with factors such as family dispersion around the world and greater care needs, the care of older adults is now often left to geriatric care professionals. Often, cognitive conditions such as dementia and delirium can make it difficult for family members to provide needed care at home. Breda cited as a common challenge that clinicians may misinterpret the difference between dementia and delirium in older people. “Nurses would do themselves and their patients a favor by knowing what (delirium) is,” she said. “Outcomes would be much better for patients and their families, as well as the hospital system, because with proper management, length of stay and complications will be reduced.” Whitaker, who previously worked as director of long-term care nursing at a skilled nursing facility, found that coupled with age discrimination, helping students increase their exposure to older adult patients and countering the belief that geriatrics is not “too exciting” or “satisfying” are common challenges. Although the challenges in this specialty can be difficult to overcome, geriatric nurses remain resilient. These nursing professionals find ways to overcome these obstacles while highlighting the most impactful elements of their roles. The most rewarding aspect is the people you care for in geriatric care.

“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 inspiring to learn about this person and what they’ve accomplished throughout their life and the wisdom they can impart.”

Impact on home care

For geriatric nurses or geriatric physicians working in home care, developing specialization is also an ongoing goal. The 2022 National Home Health Care Best Practices and Future Lessons Study, which included more than 3,500 respondents, found that the RN turnover rate increased to 18.7% in 2020, up from 14.6% in 2016. “I would like to see more innovative staffing models that would enable more care the number of patients with complex medical conditions at home,” said one of the respondents. Of all home health agency respondents, 98% said leadership turnover would negatively impact them. The same group found that the three biggest areas for improvement were insufficient development opportunities, pay and lack of work flexibility.

Specialized care and education

Because older adults require clinicians with specialized skills, current and future geriatric nurses and geriatric physicians may seek a variety of educational opportunities. All LPNs, LVNs, RNs and APRNs can have role in geriatric nursing– says the American Geriatrics Society. For students at vocational or technical centers, colleges and universities, Whitaker recommends asking questions about geriatric-specific courses. “Some nursing schools offer specialized courses in geriatrics,” she said. “Not everyone does it, but it’s important that they do. You can continue your education in certificate programs, graduate courses, seminars, workshops, conferences and so on.” Among the vast options available are: Geriatric Nurse Practitioner and Geriatric NP Certifications from the American Nurses Credentialing Center, as well as continuing education courses focused on geriatric nursing. Report in the May 2020 issue A nursing perspective said the NPs and doctors who were there trained in geriatrics and gerontology they usually tend to recommend a profession on this specialty. For current nurses considering a transition to geriatrics, other colleagues can provide beneficial information. “Reach out to people in your community who have experience working in geriatrics,” Whitaker said. (1 contact hour) The increase within the aging population is a large challenge for healthcare staff. Healthcare professionals should have the suitable knowledge to know how age-related changes within the immune system increase the chance and severity of common infections in older adult patients. After completing this course, it’s best to have the ability to discover the foremost physical, psychological, and environmental risk aspects for falls in older adults, and discuss clinical practice guidelines and other measures to forestall falls in hospitalized older adults. Many acutely sick patients are immobile on account of the character of their illness or condition. Immobility is related to a greater risk of many complications, including deep vein thrombosis, compression injuries, contractures, and pneumonia, to call just a few. Interventions to combat the results of immobility are a key aspect of patient care.