Geriatric Nursing Careers: More Care, More Options


By Joan Fox Rose, MA, RN, contributor

“To care for those who once cared for us is one of the highest honors.” - Tia Walker

Maryanne Giulante: RNs with BSNs have more options in geriatric nursing.

The U.S. Census Bureau predicts that by 2030 there will be 974 million people worldwide aged 65 and over. Geriatric nurses will continue to have multiple career opportunities to provide health and supportive care services for older people at hospitals, private homes and in nursing homes.

The entry level requirement for registered nurses to work in metropolitan hospitals is a BSN degree, according to Maryanne M. Giulante, DPN, RN, GNP, ANP-C, program manager and assistant professor of nursing at the NYU Hartford Institute for Geriatric Nursing. “In more rural areas, an RN license is an accepted requirement with the hope nurses will move on to attain BSN degrees,” she said. “There are many options for BSN-prepared nurses in primary care and financial support is available from hospitals and corporations to meet this educational goal.”

Geriatric Nursing Careers: More Care, More Options

“Our American health care system is fragmented, especially when providing medical services for older people who generally present a multitude of comorbid, chronic health conditions and thus become difficult patients to care for,” Giulante pointed out. “Geriatric nurses are expected to practice evidenced-based nursing care through the attainment of higher levels of knowledge and documented practical experience.”

The implementation of the Affordable Care Act has provided more job opportunities for home care nursing services, according to Giulante. Today’s older patients live with serious chronic medical conditions, and after hospitalization often need assistance with activities of daily living (ADLs), medications or dressing changes, among other nursing interventions.

“These are challenging issues for a families to cope with and unheard of just a generation ago,” she said.  “We need to provide good teaching strategies so that family caregivers know what’s expected of them.”

The role of visiting nurses

“Patient and caregiver teaching is a vital part of our care,” said MaryBeth Rutkowski, RN, MSN, director of patient services at the Eddy Visiting Nurse Association of Northeastern New York. Visiting nurses are comprehensive care managers who assess, teach and provide patient care services for older people in their homes, the majority 65 and older.  Nurses assess ADL competencies to determine whether or not patients need assistance with personal tasks; they observe and assess those who may be at risk for falls and other safety hazards while at home, and review medication regimes with patients while consulting with their physicians to ensure patients aren’t taking medications other than what has been prescribed.

Mary Beth Rutkowski said geriatric nurses often teach family caregivers.

“Some examples of our care include advanced wound care,” such as negative pressure, wound therapy, ostomy care and all types of catheter care, Rutkowski explained. “We maintain tracheostomy tubes and ensure care is provided for patients on ventilators and those who are on oxygen therapy and all types of home infusions, except blood transfusions. Among our nurses are those who specialize in palliative care and they assist patients to establish their end-of-life wishes.”

An RN license is required for visiting geriatric nurses; a BSN degree is preferred.  Tuition assistance and flexible work schedules are available for RNs who want to earn BSN degrees, Rutkowski reported. Candidates must have a minimum of two years of hospital acute care experience and there is a preference for nurses with home care experience.

Nursing home care

Nursing home care is available when patients can no longer remain in their homes to receive caring services.  Nursing homes are highly regulated by federal and state governments and their goals concern evidence of quality nursing care  practices, according to Nancy Truland, RN, DON at Eddy Memorial Geriatric Center, an 80-bed skilled nursing home in Troy, N.Y.

“RNs are responsible for resident assessment and care planning designed to meet each individual’s medical and psychosocial needs,” she said. “LPNs work under the direction of RNs and follow each resident’s plan of care to administer medications and perform needed treatments as outlined within their scope of practice.”

Hallmarks of quality care

To ensure quality nursing care is practiced, nurses must be critical thinkers and compassionate and competent practitioners with good communication and time management skills.  It’s important that they have the ability to handle multiple responsibilities as they work collaboratively with others, Rutkowski and Truland agreed.

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