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NGNA: Position Paper on Mandatory
Gerontological Nursing Education in all
Registered Nursing Programs and
Gerontological Nursing ContinuingEducation for all RNs in the US
Jane Nunnelee PhD. RN-BC, GNP
Introduction/Problem Statement
The intent of this position statement is to affirm the need to mandate that all registered nursing
education programs offer stand-alone didactic and clinical courses in Gerontological nursing as
part of the undergraduate curriculum. Further, that all registered nurses should be required to
participate in a geriatric continuing education event for continued licensure. All nurses will care
for older adults during their career either professionally or personally regardless of their
specialty. The challenge of the 21st
century for nursing is to educate the profession about the
geriatric population for best practice.
Rationale and Supporting Information
The 21st
century brings a dramatic gain in the aging population globally. Anticipation of the
aging population has spawned numerous concerns for health care. Health care professionals
need to be prepared educationally to care for the older adult population and their unique
needs. The normal process of aging tends to be complicated with the atypical presentation of
diseases which often are under detected with poor outcomes. With a third of baccalaureate
nursing programs offering a stand-alone didactic course in Gerontological nursing, two-thirds of
nurses are missing the knowledge they need to understand and care for this unique population.
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Gerontological nursing must be a required element of training for the next generation of health
care professionals.
In the early part of the 20th
century, pediatrics gained approval to be taught as stand-alone
didactic and clinical courses. The institutions that trained health care workers in the 20th
century responded to the demographics and embraced the need to prepare the health
professional in pediatrics it was a requirement for all nursing and medical programs to have
pediatric rotations and courses. The time has come for a similar commitment to recognize
gerontology/geriatrics and its uniqueness with the appropriate course and clinical for all
nursing students to experience.
To date, there are approximately 1% of registered nurses and 3% advanced practice nurses
certified in Gerontological nursing in the U.S. Since nurses play a critical role in the care of
older adults in various settings of health care, it is vital to promote education in this specialty
area. Nursing schools must raise the profile of Gerontological nursing to attract the new nursesin this field and create collaborative relationships with community healthcare facilities and
institutions. There is an essential need to be proactive in the approach to moving evidence-
based clinical knowledge into practice settings.
The age of 65 has traditionally been considered the beginning of the senior years in the US
because of Social Security and Medicare. The U.S. Census Bureau reported that Americans over
the age of 65 years make up 13% of the population today. By the year 2030, older adults will be
20% of the total population. The growth in the numbers of older adults is unprecedented in the
history of the US and the world. This flourishing of growth is due to the Baby Boomer
generation entering 65 years of age in 2011 and continuing to infiltrate older age through 2030
with a doubling in numbers, becoming one in five Americans.
An aging population means that nursing has an obligation to understand aging and the older
adult. Understanding of normal physiology of aging along with chronic illness and disabilities is
vital in the care of this population. Approximately, 80% of older adults have one chronic health
condition with 50% having at least two. Medicare has begun to hold healthcare facilities
responsible for the errors made with the older population. In 2008, Medicare issued a list of
number of health care mistakes and other preventable situations they will no longer pay for if
the claims are submitted. Medicare will not pay for complications that are preventable. This is astrong financial indicator that health professionals must be educated in the proper care of this
population.
The American Association of Colleges of Nursing noted that approximately 63% of newly
licensed registered nurses work predominately with older adults in their patient load. Further,
older adults care represents 50% of hospital days, 60% of all ambulatory adult primary care
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visits, 70% of home care visits, and 85% of skilled care facilities residents. It is anticipated that
strong job opportunities in clinical practice will be with the older population. We are woefully
unprepared to care for the older population in health care due to the lack of clinical knowledge
and education for the uniqueness of their health-related needs.
In general, graduate nurses need the Gerontological nursing perspective to practice successfully
with the older population to avoid errors in care. Best practices are formed in the
undergraduate nursing programs and must include mandatory didactic and clinical in
Gerontological nursing. Education at the basic level of nursing education and on-going
continuing education must be mandatory for best clinical practice in Gerontological nursing.
Research shows that nurses with preparation and education in geriatrics/gerontology provide
measurably improved care to older adults. When nurses are prepared in both geriatrics and
other specialties such as medical-surgical nursing, this becomes profitable to hospitals and the
community.
All Registered Nurses should and must recognize the physiological, cognitive, psychological,
social changes, and atypical presentations of disease associated with aging and understand that
age alone puts older adults at risk for complications. Since older adults care is complicated due
to usual aging physiological changes coupled with increased incidence of chronic health
conditions, Registered Nurses and Advanced Practice Nurses need to achieve competency in
Gerontological nursing to deliver best practice care. It is strongly advised for Registered Nurses
to seek National Certification to benefit the population of patients served. Raising the standards
of nursing care for older adults through undergraduate education and continuing education for
practicing nurses will ensure that older adults will age with optimal function, comfort, care anddignity.
The Affordable Care Acts goal is to improve the delivery of health care for every American. The
financial incentive and dignified quality care are two motivating constituencies to set this
position in motion. To move forward, American Nurses Association, Board of Nursing in each
state, Medicare and Medicaid (CMS), health care organizations stakeholders (hospitals, clinics,
community agencies), and all professional nursing organizations must strive to adopt this
position and demand Gerontological/geriatric knowledge and skills for the improved care of
older adults by nurses and must provide incentives for adoption for best practices. Together,
we can improve care for this older population and allow dignity and best care practices for all
older adults.
Recommendations
Registered Nursing Programs institute a 3 hour didactic Gerontological stand-alone
nursing course for all undergraduate nursing students by 2013.
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Registered Nursing Programs institute a 3 hour clinical course in geriatrics for all
undergraduate nursing students by 2013.
All practicing nurses in the U.S. participate in a 2 hour minimum continuing education
class on a geriatric topic every year for relicensure in each state.
Registered Nursing Program Faculty teaching adult/geriatric course participate in a
Geriatric continuing education program are encouraged to seek national certification in
Gerontological nursing or annual continuing education in Gerontological nursing.
References:
American Association of Colleges of Nursing /John A. Hartford Foundation (March 2006). Caring
for an Aging America: A Guide for Nursing Faculty. Washington, D.C.
http://www.aacn.nche.edu/geriatric-nursing/monograph.pdf
Census, U.S. (2011). Facts for features: Older Americans Month: May 2011.
http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editio
ns/cb11-ff08.html
Fagin, C., Franklin, P. (2005). Why Choose Geriatric Nursing? Geriatric Nursing,
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http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_SeptOct05_geriatric_fagin.pdf
Hartford Institute for Geriatric Nursing. (2011). Hartford Geriatric Nursing Initiative (HGNI).New
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Committee on the Future Health Care Workforce of Older Americans, Institute of Medicine
(2008). Retooling for an Aging America: Building the Health Care Workforce.
www.iom.edu/agingamerica
Mezey, M., Fulmer, M. (2002). The Future History of Gerontological Nursing. Journal of
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National Center for Chronic Disease Prevention and Health (2009). Healthy Aging Improving and
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