A necessity not a luxury: preparing advanced practice nurses to care for older adults.

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population. Relying solely on certified geriatric APNs to care for older adults is not a viable solution. Educating all APNs with grounding in gerontological nursing care may well be the answer to expanding our nation's capacity to competently care for our rapidly aging population. As part of the 4-year Enhancing Geriatric Nursing Education in Baccalaureate and Advanced Practice Nursing Grant, the American Association of Colleges of Nursing developed a set of core gerontological competencies for graduate APN programs. These competencies, entitled Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care, delineate guidelines for APNs who are not specialists in gerontology but provide care to older adults. This article describes the competency development process, provides an overview of broad categories and examples of competency statements, and highlights model case studies for integrating gerontological content throughout APN curricula to ensure that graduates are equipped to provide competent care to older adults.     

Incorporating geriatrics into baccalaureate nursing curricula: laying the groundwork with faculty development.

In June 2001, the John A. Hartford Foundation of New York awarded the American Association of Colleges of Nursing (AACN) a 3.99 million dollar grant to enhance gerontology curriculum development and new clinical experiences in 20 baccalaureate and 10 graduate schools of nursing. Over the 4-year grant implementation period, AACN learned a valuable lesson from the grant's site directors: Faculty development is the single most necessary precursor to the successful implementation and maintenance of geriatric curricular enhancements. Unless faculty members foster positive attitudes toward aging, expand their geriatric nursing knowledge base, and are able to integrate geriatric content into the curricula, progress cannot be made. Enhancing Geriatric Nursing Education project directors recommend that the following steps be taken toward the creation of successful faculty development activities: (1) anoint a champion to mentor and persuade faculty members to embrace gerontology; (2) garner faculty buy-in by engaging the faculty early so that they become active participants in the curricular change process; (3) assess faculty knowledge and comfort level by administering tools developed by the John A. Hartford Foundation Institute for Geriatric Nursing and by conducting surveys based on AACN geriatric core competencies; (4) conduct faculty development workshops that include cutting-edge knowledge and research and provide the faculty with opportunities to discuss feelings and stereotypes about aging; (5) elicit the dean's support to encourage and allow time and opportunities for training; and (6) use the many excellent resources that help the faculty integrate geriatric content into their courses. This article will further elucidate such strategies and will highlight the range of faculty development activities in which grant-funded schools engaged.     

The Young Gerontological Nurse Clinician Program: an innovative geropsychiatric nursing recruitment strategy

Historically, graduate nurses are not attracted to older adults or geriatric care. Innovative strategies, such as the Young Gerontological Nurse Clinician Program (YGNCP) initiated by the John A. Hartford Center for Geriatric Nursing Excellence at the University of Iowa, are needed to promote geriatric nursing as a challenging and rewarding practice focus. The YGNCP, which provides early, positive, self-directed experiences for nursing students under the direction and supervision of faculty and expert clinical mentors, shows excellent potential for recruiting nurses to clinical and leadership positions in geriatric and geropsychiatric care.     

Integrating long-term care concepts into baccalaureate nursing education: the road to quality geriatric health care

Increased numbers of aging Americans requires that today's health care professionals be grounded in education that focuses on patient-centered care of older adults. The growing demand for competent geriatric nurses in West Texas, led the School of Nursing (SON) at Texas Tech University Health Sciences Center (TTUHSC) to conduct an in-depth analysis of its baccalaureate curriculum to determine how, when, and where care of older adults was being addressed. A task force appointed by the SON subsequently chose, as a blueprint for curricular redesign, Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care (American Association of Colleges of Nursing & the John A. Hartford Foundation Institute for Geriatric Nursing, 2000). This article describes how the SON task force planned and implemented a new and strengthened geriatric core in its curricula.     

The national post-baccalaureate graduate nurse residency program: a model for excellence in transition to practice.

The Chief Nursing Officers (CNOs) of the University HealthSystems Consortium (UHC) of Academic Hospitals desired to increase the numbers of baccalaureate graduate nurses hired by their facilities and provide a more consistent, uniform transition into practice for these graduate nurses. A partnership between the UHC CNOs and the American Association of Colleges of Nursing (AACN) led to establishing a National Post-Baccalaureate Graduate Nurse Residency Program. The structure, curriculum, and outcomes measures were developed and the program was implemented, with growth from six original pilot sites to 34 academic hospitals. Outcomes from the first year of program operation at these six sites show a high rate of retention, decreased stress by graduate nurses over time, improved organization and prioritization of care, and increased satisfaction in the first year of practice.     

Infusing gerontological nursing content into advanced practice nursing education

The inclusion of gerontology content in the nursing curriculum is paramount as our population of older adults grows. As one of 10 recipients of the John A. Hartford Foundation/AACN awards for Enhancing Gerontological and Geriatric Nursing Education for Advanced Practice Nursing Programs, we successfully integrated gerontological/ geriatric content throughout core courses for all concentrations taught at the master's level. The Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care were used as a guide to integrate gerontological nursing content across the core courses. We present examples of content, strategies, and evaluation methods that demonstrate infusion of gerontology in a nursing theory course, research course, and healthcare law and policy course. Twenty-two of the competencies are addressed in these core courses and provide a foundation for further development in the support and specialty courses for the nurse practitioner, clinical nurse specialist, nursing administrator, nurse educator, and nurse anesthetist. We also present helpful Web-based resources for older adult care.     

Employment characteristics and role functions of recent PNP graduates

The role of pediatric nurse practitioner (PNP) was initiated in the late 1960's with baccalaureate pediatric nurses trained and educated to provide well care, screening, and common illness management to essentially healthy children in rural areas not adequately served by physicians (Silver & Ford, 1967). Nurse practitioner educational programs have evolved to the graduate level with doctoral preparation proposed for entry into practice by 2015 (American Association of Colleges of Nursing [AACN], 2004). A current survey monitors the change in practice settings and role functions of PNPs to determine trends of professional practice and appropriateness of educational programs in preparing new graduates for the contemporary work place.     

Education/community collaborations for undergraduate nursing gerontological clinical experiences.

In 2000, the American Association of Colleges of Nursing and the John A. Hartford Foundation Institute for Geriatric Nursing developed guidelines to help nurse educators incorporate gerontological nursing content into baccalaureate curricula. In 2001, the Hartford Foundation also provided grant monies to nursing programs to support gerontology curricular innovations and new clinical experiences. The funding allowed faculty to focus time, energy, and resources on gerontological nursing education. We, the authors, representing two funded schools of nursing, collaborated with community agencies to develop undergraduate gerontological clinical learning experiences and are encouraged by the results. This article describes the development of these collaborations and serves as a model for other schools of nursing. The education/community collaborations described here focus on clinical learning strategies, implementation activities, and outcomes/benefits of the experiences. Both educational programs had supportive administration, faculty willing to participate in curriculum change, organized plans to implement geriatric curricular enhancement, and long-standing community partnerships.     

Standards of holistic nursing practice as guidelines for quality undergraduate nursing curricula

The accreditation criteria of the Commission for Collegiate Nursing Education (CCNE) direct faculty to select nationally developed standards for professional practice to guide curricula and to articulate curriculum outcomes. Recently, the CCNE proposed that all undergraduate programs should adopt the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education as one set of national standards for undergraduate and prelicensure programs. Standards of Holistic Nursing Practice, developed by the American Holistic Nurses' Association, is an additional set of standards that assists in defining quality for undergraduate nursing education. Standards of Holistic Nursing shares major concepts with Essentials; however, it accentuates the concepts of nurse self-care, articulated nursing theory as a foundation for practice, managing the care environment to promote healing, and care of the environment as essential to professional practice. These standards do not change the care being provided by professional nurses adhering to nursing theory and current evidence, but they do raise awareness and change emphasis of practice to reflect a holistic perspective. Used together, Standards and Essentials provide complementary guidelines for curricula-preparing professional nurses to care for client and self.     

The Hartford Geriatric Nursing Initiative experience in geriatric nursing education: looking back, looking forward

This article traces the impact of the John A. Hartford Foundation’s (JAHF) Hartford Geriatric Nursing Initiative (HGNI) on the geriatric preparation of nursing students. With over 2.6 million practitioners, nurses play a critical role in assuring the health care of older adults. Older adults make up the majority of patient days in hospitals, home care, and nursing homes. Yet, when the JAHF began its investment in geriatric nursing, specific content on care of older adults was woefully absent in academic programs preparing entry- and graduate-level nurses. Clearly, the JAHF HGNI investment in nursing education has paid huge dividends. Baccalaureate nursing students are now likely to graduate with competencies in care of older adults. In the next 5 years, ongoing JAHF HGNI initiatives should yield similar outcomes in associate degree-prepared graduates and in advanced practice registered nurse graduates. This article traces the impact of the JAHF HGNI on nursing education.     

Gerontology and geriatric issues and trends in U.S. nursing programs: a national survey.

Elderly persons in the United States constitute an increasing proportion of our population impacting nursing education. The purpose of this study was to survey geriatric and gerontology issues and trends in U.S. baccalaureate schools of nursing since the advent of the American Association of Colleges of Nursing's (AACN's) Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care. A national mail survey of all accredited AACN baccalaureate programs was conducted, resulting in 202 responses and a 36% response rate. The results show that half of the respondents reported integrating geriatrics/gerontology, and half reported having stand-alone geriatric/gerontology courses. Results indicate key issues that warrant further investigation. These include: (1) faculty preparation related to geriatrics and gerontology; (2) gaps in implementing the AACN's Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care in both stand-alone courses and integrated curricula; and (3) the extent to which the AACN's Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care is addressed in undergraduate curricula. Trends noted include planning to offer and retaining required stand-alone geriatric/gerontology courses. These results may be useful to nurse educators and researchers who are grappling with nursing education issues concerning geriatric and gerontology preparation. Of importance is that nursing curricula reflect nursing faculty's commitment to addressing the health care needs of the burgeoning number of elderly persons in society.     

The practice doctorate: innovation or disruption?

Advanced practice nurses, particularly nurse practitioners, have been described as a disruptive innovation. The American Association of Colleges of Nursing (AACN) has proposed that by 2015 all advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP). This article uses critical reflection on published literature to examine the potential difficulties that mandating such a change may present to potential students, practicing advanced practice nurses, colleges of nursing, and doctoral education in general. After considering the pressures in the nursing profession to prepare nurse faculty and reviewing the success of current models of education for advanced practice, we explore in depth the unintended consequences of the AACN recommendation. Implications for academic nursing, curriculum, advanced practice nurses, doctoral education, titling and licensure, economic issues, and the lack of evaluation research are addressed. We recommend abandoning the 2015 deadline for implementation of advanced practice nurse preparation with the DNP.     

Indicators of quality in research-focused doctoral programs in nursing

THE AMERICAN Association of Colleges of Nursing (AACN) is the national voice for university and 4-year college education programs in nursing. Representing more than 560 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's degree and graduate degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice.     

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.     

Analysis of end-of-life content in critical care nursing textbooks

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted. Critical care nursing textbooks used for review were published in 1995 or later and identified from the libraries at the University of Wisconsin-Madison and Brigham Young University. The end-of-life content areas identified by the American Association of Colleges of Nursing (AACN), under which the AACN end-of-life competencies for undergraduate nursing students can be taught, were used as a framework for assessing the presence or absence of end-of-life content in the textbooks. When end-of-life content was present, two reviewers judged whether the information was helpful. Four additional end-of-life content areas were identified in some textbooks during the study, and reviewers also judged whether these were helpful. None of the textbooks had end-of-life content in all the content areas used for the analysis. Three textbooks did not contain any end-of-life content.     

Application of Curriculum Mapping Concepts to Integrate Multidisciplinary Competencies in the Care of Older Adults in Graduate Nurse Practitioner Curricula

The number of Americans ages 65 and older is projected to more than double over the next four decades and to equal nearly one-fourth of the entire population by 2060. Recognizing that the health care workforce in the United States is not sufficiently prepared to meet the care needs of this growing population, the National Academy of Medicine has recommended curricular enhancements for health professional educational programs. To meet this challenge, the University of South Florida College of Nursing applied curriculum mapping principles and concepts to examine and align Family Nurse Practitioner and Adult-Gerontology Primary Care Nurse Practitioner program curricula for congruence with Partnership for Health in Aging multidisciplinary geriatric competencies. Through this process, we developed a geriatric-specific curriculum map and threaded geriatric-specific content, learning experiences, and learning assessment strategies to promote attainment of all 23 competencies. Given the growing role that nurse practitioners are projected to play in the delivery of primary care for older adults in the future, it is imperative that colleges and schools of nursing provide students with learning experiences to support attainment of the knowledge and skills graduates will need to care for older adults in practice. The techniques and strategies described here represent our approach.     

Population health as a framework for forensic nursing curriculum

The American Association for the Colleges of Nursing (AACN) has recommended that master's level graduate programs prepare nurses as generalists. There is, however, a gap in the educational ladder at the master's level when current master's clinical nurse specialist (CNP) and nurse practitioner (NP) programs are reconfigured as doctoral programs. To fill this gap, a curriculum model using population health as a framework is proposed.     

Hallmarks of the professional nursing practice environment

THE AMERICAN Association of Colleges of Nursing (AACN) is the national voice for university and 4-year college education programs in nursing. Representing more than 560 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's-degree and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice. Task forces are appointed by the AACN Board of Directors as issues arise that require study and action. This white paper was prepared by the AACN Task Force on Hallmarks of the Professional Practice Setting.     

Using effects-based reasoning to examine the DNP as the single entry degree for advanced practice nursing

In October 2004 the American Association of Colleges of Nursing (AACN) endorsed the Doctor of Nursing Practice (DNP) as the single entry degree for advanced practice nurses (APNs) beginning in 2015. This action initiated significant changes in many graduate nursing programs. Currently 153 DNP programs have enrolled students and an additional 106 programs are in varying stages of development. This article will examine real and potential outcomes of having the DNP degree as the single entry level for APN practice using an effects-based-reasoning framework. The author begins with a discussion of factors that influenced the DNP initiative and an explanation of effects-based reasoning. Within an effects-based framework, the author examines acceptance or rejection of the DNP initiative by APN programs and professional organizations, as well as the effects within the broader healthcare community. Concluding observations will be shared.     

Master's programs preparing nurse educators: what is the current state of affairs?

Master's programs to prepare nurse educators have dramatically increased and are being transformed with the advent of the doctorate in nursing practice. In the absence of standards, questions arise regarding program design and curriculum models. To assess this issue, the authors discuss their review of Web sites for 198 nurse educator programs and describe curricular patterns and trends. The findings are then related to the AACN Essentials of Master's Education for Advanced Practice Nursing and NLN Nurse Educator Certification Criteria.