The Growing Need for Geriatric Nurses


Elderly populations are booming and nurses are needed

By Debra Wood, RN, Contributor

With 44.7 million people 65 years or older in the U.S., the healthcare system is seeing a major impact on their hospital’s emergency departments and nursing staff.  Since many nurses are often the first and last point of contact for patients, some organizations have created specials units with trained interdisciplinary care teams or geriatric emergency departments to devote care and time specifically to that growing population.

Vaunette P. Fay, PhD, RNC, said caring for older adults requires an interdisciplinary team educated in geriatric health.

“While older adults currently make up about 15 percent of the population, they currently account for 35 percent of all hospital stays,” reported Vaunette P. Fay, PhD, RNC, a professor at the UTHealth School of Nursing in Houston. “For older adults, those over 65 years of age, and especially adults over 80, there are physiological changes that occur that make it more difficulty to fight infection and put them more at risk for injury including falls.”

Emergency care of older adults
St. Joseph’s Regional Medical Center in Paterson, N.J., operates one of the first geriatric emergency departments and has dedicated about one-quarter of its 88 ED beds to caring for older adults. “The mindset is different,” explained Richard E. Schultz Jr., BSN, RN, CEN, MICN, geriatric nurse navigator in the emergency department at St. Joseph’s. “You have to slow down and not rush these people.”

Richard E. Schultz Jr., BSN, RN, CEN, MICN, said working in a geriatric ED requires a different mindset.

Many hospitals now operate geriatric emergency departments to care for patients age 65 and older and address their specific needs. Nurses do receive specific geriatric training, and typically the physical environment differs from other emergency departments. Ceiling tiles block noise, railings are everywhere, the floors are non-slip and non-glare, the mattresses are twice as thick, and the electronic medical record system alerts providers if a drug that should not be used in older adults is ordered.

“What makes the Senior ER different is the senior assessment we do,” said Michelle Moccia, DNP, ANP-BC, CCRN, program director of the Senior ER at St. Mary Mercy Livonia Hospital in Michigan. Nurses assess patients’ risk for readmission or admission to a nursing home, mediations, living conditions, caregiver support, recent falls, weight changes, performance of activities of daily living, and atypical disease presentations. They also screen for cognition impairment or depression. “We want patients to go home, but we also look at safety factors,” Moccia said. “We are about resilience and keeping that person empowered.”

Readmission and admission rates fell at St. Joseph’s since opening the geriatric ED. “It’s rewarding to take care of patients when they have been looked at as a person,” Schultz said. “Sometimes in the ER, we get fixated on caring for the patient and not the person. That’s where the difference lies.”

Inpatient geriatric care
On Acute Care for Elders (ACE) units, the bathrooms and bedrooms have handrails, furniture is designed for easy transfers and a congregate room allows for socialization during meals and activities. “Everything we do is geared to that patient population,” Maureen Pisano, RN, BSN, nurse manager of the 10-bed ACE unit at Jefferson Methodist Hospital in Philadelphia.

Michelle Moccia, DNP, ANP-BC, CCRN, said that working in a Senior ER has made her a better clinician.

Patients are 65 or older, from home and planning to go home, and able to participate in their care. The ACE unit does not accept patients with severe dementia or behavioral issues. Two geriatric resource nurses staff the unit at all times. They have time to chat with patients and look beyond the physical complaint to learn about the person as a person. They provide holistic care and educate patients and families. Nurse and patient satisfaction remains high.

“We are about promoting independence,” Pisano said. “It is rewarding to see a patient come in with an illness, and you’re sending them home safer then when they came.”

While some organizations have created special units or emergency departments to care for older adults, the National Gerontological Nursing Association recommends all registered nurses prepare to care for elders through educational offerings. That would include traveler nurses, too.

The American Association of Critical-Care Nurses has developed a course about Optimizing Care for Acutely Ill Older Adults. The Emergency Nurses Association (ENA) has created the Geriatric Emergency Nursing Education Course and Nurses Improving Care for Healthsystem Elders (NICHE) has developed an extensive knowledge center.

© 2015. AMN Healthcare, Inc. All Rights Reserved.

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