Awardees and leaders of the Geriatric Resource Nurse-led Interprofessional Collaborative Practice Program
It’s no secret that caring for ourselves and our well-being becomes more complex as we age, but changes, including a new program at Penn Medicine, are critically needed to care for the nation’s aging population. In fact, in 2014, senior citizens (people aged 65 years or older), made up 14.5 percent of the American population – that’s 46.2 million people. That number is expected to soar to 98 million – more than double the 2014 mark – by the year 2060.
With those aged 80 and older already accounting for 24 percent of the Medicare population and 33 percent of Medicare spending in 2011, the aging population will continue to fuel U.S. healthcare spending that already is much higher per capita than other high-income countries.
As the U.S. population ages, we lack the support to give them the care they need. Though the American Geriatrics Society estimates that as many as 25,000 certified geriatrician practitioners are needed to respond to the expected increase in older patients, just two years ago our country had fewer than 7,500 geriatricians.
Additionally, only eight of the 145 academic medical centers in the U.S. have a full geriatric department, AAMC reports, and even with that, 66 percent of its geriatric fellowship positions go unfilled.
Considering this profound need, in July 2013, Rebecca Trotta, PhD, RN, director of nursing research and science, received a $1.5 million Health Resources and Services Administration (HRSA) grant to develop a nurse-led interprofessional model to deliver evidence-based care for older adult patients.
The geriatric resource nurse (GRN) model took place on three floors of the Hospital of the University of Pennsylvania (HUP) over the past three years. As reported in
HUPdate when the program began, among other tasks, GRNs conducted comprehensive geriatric assessments to find concerns known to contribute to negative outcomes in hospitalized adults age 70 or older, such as delirium risk or presence of delirium, medication management concerns, depression, and malnutrition.
Last month, Trotta and co-program coordinator Aditi Rao, PhD, RN, nurse scientist, joined Regina Cunningham, PhD, RN, FAAN, AOCN, senior vice president and chief nursing executive, and others from HUP nursing for a ceremony to recognize the 27 nurses who completed the HRSA grant-funded fellowship in geriatric nursing.
“The grant allowed us to establish the feasibility, utility, and accessibility of a nurse-led interprofessional practice model to prevent the hazards of hospitalization among older adults in an acute care setting,” Trotta said. “Now we’re taking it a step further by focusing on comprehensive implementation of the model and its impact on outcomes such as length of stay and cost of care.”
Joan E. Brower, BSN, RN-BC, a clinical nurse and geriatric resource nurse on a general medicine unit, served as a GRN approximately once a week while completing the program.
“Our patients and their families were appreciative of the quality time, recommendations and care we were able to provide to them,” Brower said. “Thirty percent of our patients are in this population, so geriatric focused care is very relevant to our day to day responsibilities.”
The nurses in the program dedicated one on one time with patients to understand their needs and support interdepartmental teams in developing individualized care plans. These plans go beyond a patient’s immediate clinical need, also targeting issues like depression, delirium, or other “hazards of hospitalization” that sometimes result from simply being in a hospital for more than a couple days. This commitment is strengthened by 10 nursing students who serve as Student Geriatric Associates and implement protocols to promote function and prevent delirium and other cognitive decline. They work with patients on activities such as eating and walking.
“Making sure patients are mobile and walking around, eating, these are relatively low-tech interventions,” Trotta said. “But they are no less important than other more complex treatments that may be needed, and failure to perform them could lead to consequences.”
Trotta says studies have shown benefits for patients associated with care provided by those with similar training aimed at treating older adults. The next step in this research will build on that body of knowledge by measuring how this GNC support impacts patient length of stay, readmissions, and other measures of health for patients at HUP.
The program improves patient care, but also transforms nursing careers. Colleen Regan, BA, BSN, RN-BC, was relatively new to nursing when she responded to Trotta’s call for program participants. Since then, Regan has completed the program, is halfway through a MSN program at Penn to become a primary care geriatric nurse practitioner, and now serves as a full time geriatric nurse consultant at HUP.
“Because of Rebecca and this program, I've discovered a passion for a career in geriatrics that I never knew I had,” Regan said. “It has advanced my career and body of knowledge, but I have the pleasure of seeing how that also makes a difference in the lives of my patients.”
Regan says the benefits go “beyond the surface.” For example, using a simple eye chart for a quick vision assessment, Regan and colleagues have uncovered severe vision impairments and even blindness in some patients. This trickles down to attacking ways to prevent these patients from falling at home and creating new strategies to help them or help their family members physically see their medication bottles to prevent medical errors at home and thereby help prevent return visits to the hospital.
In addition to Regan, two other nurses received support to serve full time as geriatric nurse consultants at HUP.
Although we may wish to stay forever young, it’s good to know geriatric nurse consultants at Penn Medicine are helping to ensure care teams are ready when we don’t.