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The Next Generation of Geriatric Nurse Specialists

2010; Slack Incorporated (United States); Volume: 36; Issue: 1 Linguagem: Inglês

10.3928/00989134-20091207-98

1938-243X

Stephanie Postma, Mary E. Flikkema,

Aging and Gerontology Research

Endnotes freeThe Next Generation of Geriatric Nurse Specialists Stephanie Postma, BSN, RN, ; and , BSN, RN Mary E. Flikkema, MSN, RN, , MSN, RN Stephanie Postma, BSN, RN and Mary E. Flikkema, MSN, RN Address correspondence to Mary E. Flikkema, MSN, RN, Professor of Adult Health, Calvin College Department of Nursing, 1734 Knollcrest Circle SE, Grand Rapids, MI 49546-4403; e-mail: E-mail Address: [email protected]. Published OnlineDecember 07, 2009https://doi.org/10.3928/00989134-20091207-98Cited by:1PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreIntroductionHow will we educate the next generation of geriatric nurses? New nursing graduates are usually interested in critical care, the emergency department, or other fast-paced, exciting settings. Among the clients in these settings are older adults with not only acute illness or injury, but other underlying comorbidities. Many graduate nurses are unaware of the special knowledge and skills needed to provide care for clients across the life span in emergency and critical care settings. Nurses see geriatric clients everywhere and will need the skills, abilities, and attitudes to effectively care for them. Experience with older adults during undergraduate nursing education provides opportunities to see the possibilities in geriatric care.Co-author Stephanie Postma smiles with Clark Retirement Community resident Dorothy, whom she befriended during her nursing student internship.Photo courtesy of Calvin College Department of NursingNursing students often have experience working in nursing homes, yet they may see little more than the role of the certified nursing assistant. Graduates are unaware of the leadership roles in facilities that provide different levels of care for older adults, and thus innovative ways to mentor undergraduate students must be developed. Faculty members can make connections with local multicare level facilities to provide collaborative experiences for students who have expressed an interest in caring for older adults.Students who indicate an interest in geriatric care can and should be nurtured and supported during their undergraduate years. It is important, especially for baccalaureate graduates, to find a place in geriatric care. Skills in leadership and management, research, and evidence-based practice are critical when working with older adults. Expert clinical skills are needed to identify atypical presentations that may be missed during assessments. Innovative and individualized care planning is required.Current demographics indicate that the number of older adults with chronic illness is increasing rapidly and will require high-quality, cost-effective nursing care. Judicious use of resources for our aging population is essential. Now more than ever, the expertise of nurses to identify best practices for older adults is crucial. This population will need nursing care in primary, secondary, and tertiary care settings, as well as hospice and dementia care.Our college department of nursing was awarded a scholarship to promote an experience in a local retirement community offering all levels of care. Clark Retirement Community offers multiple levels of care and was receptive to having a nursing student intern. The scholarship, called the Whitney Young Gerontological Nursing Scholarship, came from the Whitney Young Outreach Organization and was gratefully accepted by the college and the department of nursing. The donors outlined the structure of the scholarship and thus brought a new approach to scholarships that we had not considered prior to this time.Because the scholarship was new and provided funds for an internship at the retirement community, as well as tuition money, the student's nursing faculty mentor and the Director of Nursing (DON) at Clark worked closely in the establishment of the internship program. What would the student do? What learning experiences would be valuable to an undergraduate student? How would the student be paid, and how many hours would the student work? How much should the student receive for the work he or she performed? What would be helpful to staff of the retirement community? It was clear that we were moving into a new and valuable process, and so we began making plans for how the student role would develop.Co-author Stephanie Postma and Clark Retirement Community resident Dorothy share a happy moment outside the facility.Photo courtesy of Calvin College Department of NursingThe scholarship identified an amount of payment for the student internship. The Nursing Department Scholarship Committee, along with the college development and financial departments, worked together to outline a plan for supervision and reimbursement. It was determined that the student would work during one semester of the academic year and would be paid through the college at a rate consistent with what other students working on campus would receive. Because the college paid the student, the retirement community did not have to hire the student directly. The student's faculty mentor supervised the student's activities and projects. This required cooperative work with the college nursing department and the DON at Clark.This student (S.P.) was oriented to care and observed some of the most up-to-date examples of truly award-winning dementia care. The scholarship was continued for a second year and thus allowed more time to develop the objectives and roles for student experiences. During her two semesters at Clark, the nursing student developed a research paper and a type 2 diabetes teaching module for licensed personnel. The student adapted a Microsoft® PowerPoint® presentation from the John A. Hartford Foundation, Hartford Institute for Geriatric Nursing, and the Geriatric Nursing Education Consortium (GNEC) in the fall of 2008. The materials were used with the expressed permission of the GNEC.The following is a first-person perspective of the student's experience during her 2-year internship at Clark Retirement Community.Internship ExperienceHow do young nursing students become passionate about caring for older adults? My exposure to this age group began in fourth grade through my mother persuading me to play my violin in area retirement homes. I do not know if she noticed a niche for me in this area, but in eighth grade, she decided I had too much free time and encouraged me to read to an elderly blind woman in a nursing home. Looking back, the early experiences gave me the interest and motivation to become a certified nursing assistant in high school. For 2 years, I worked in an 80-bed nursing home on both the regular unit and the locked dementia unit. At a time when I lacked confidence and had a difficult time fitting in with my peers, the residents offered me friendship and genuine acceptance. It also introduced me to nursing as a profession. After transitioning to college in another state, I missed these friendships and volunteered at an assisted living facility through my residence hall. The other volunteers and I played games, ate ice cream, and chatted about life with the residents.Through these experiences, I discovered a connection with older adults. I felt relaxed and confident interacting with them. When seeing them experience a hurt, I had a desire to fix it. I found myself becoming defensive when someone questioned my desire to work with older adults, as if every nurse should want to work in pediatrics. Older adults have so much to give and receive, yet they are erased from memories once becoming a shut-in or living in a nursing home.When I entered the baccalaureate nursing program, I began to wonder where I would proceed with this passion. I knew little about nursing opportunities and older adults. Advertisements for nursing promote “exciting” careers in emergency, critical, and pediatric care. I did not see how I would fit, because my knowledge was limited to the general hospital role and direct client care in extended nursing. I wanted an independent role with control and decision making in my client care. I wanted to enhance older adults' enjoyment of life.Authors Mary E. Flikkema and Stephanie Postma join Clark Retirement Community's Director of Nursing, Jane Johnson, on the facility campus.Photo courtesy of Calvin College Department of NursingIn the fall semester of my junior year, a new scholarship became available for a nursing student interested in working with older adults. It included a paid internship at a nearby retirement community. I was excited to be recognized for my desire to work with older adults and for the opportunity to explore this area of nursing. The internship had few requirements, which allowed freedom to tailor it to my interests. However, because the scholarship was new, there was a period of time before anyone knew what I would do with the internship, and it took some initiative on my part to let those involved know I was serious about making it happen and not just trying to benefit from the scholarship money. I was also concerned that I would be a burden to those working with me. After a few weeks of uncertainty, my professor (M.E.F.), Clark's DON, and I collaborated and decided that the goal of the internship would be for me to learn about their continuum of care.I worked closely with the DON, and each week she assigned me to various areas of Clark Retirement Community. I shadowed a geriatric nurse practitioner and was impressed with her diverse role: comforting a dying patient, prescribing medications, and later discussing a resident's care with a physician. While following a clinical coordinator, I saw the mounds of paperwork in this field and the challenges these coordinators face to receive state and federal funding and reimbursement.I witnessed a nurse counseling a resident transitioning from independent living to assisted living. Physical decline frightened the resident, and the nurse was available to counsel and comfort. I participated in several staff meetings, including Residents in Transition, Marketing, and the Dementia Education Taskforce. I was surprised at how closely the facility monitors their residents and the degree of collaboration between different departments. I helped the dementia educator write competencies for staff; until then, I hadn't realized that all staff members need information and training to care for complicated residents, some with dementia, depression, physical disabilities, or difficult personalities. Family situations present additional challenges, from those who are not involved to those who are overly involved.I experienced each level of care, from independent living to assisted living to nursing and how the community provides care in each area. Weekly, the DON and I discussed each experience and she answered any of my questions. This one-on-one time showed me they valued my role and that this area was the place for me.During my internship, the community underwent the Commission on Accreditation of Rehabilitation Facilities-Continuing Care Accreditation Commission (CARF-CCAC) accreditation process. The CARF-CCAC is the “only accrediting organization for continuing care retirement communities and other types of aging services networks…. Surveyors make site visits lasting several days and examine 1,200 standards, including resident care and services and administrative structure and fiscal practices. In addition, interviews are conducted with residents, families, and staff members” (Holst, 2008, para. 5–6). I was impressed with how little preparation was needed for direct caregivers and the nursing staff. It was business as usual.For the past 4 years, the community's educators have used a small group process to teach employees about best practice, person-centered care, and dementia care. Staff share about resident needs, give input, and problem solve. All the pieces were in place for high-quality care and were routinely practiced, not just when the surveyor site visit occurred. I was present during one day of the surveyor's site visit and participated in several staff group interviews and sat with the surveyors as they examined policies and reports. I did not know about this process, and it was great to see the community rewarded for its excellent quality of care. Clark Retirement Community is the first organization in the United States to receive accreditation for dementia services and is also accredited as a continuum care retirement community and for person-centered care in nursing (Holst, 2008).I spoke with employees about their feelings on the accreditation process, and their responses were positive: “We work like this all the time,” “This is my livelihood. I want to do my best,” “It backs us up with what we're doing,” and “I did what I normally do.” The nursing leaders and other administrators enabled the primary caregivers to provide the best care possible and to make it an everyday expectation.The internship affected me in many ways. At school, my professor mentored me throughout the semester, and her support pushed me to succeed. A close relationship with a professor or mentor is important in nurturing geriatric nurses. At the facility, the DON provided my link into the community and offered individual time, advice, and experience.During the semester, I became personally acquainted with employees, feeling valued by them and included in discussions. I saw how challenging and rewarding it is when different levels of care work together, from nursing to dining to marketing. My heart was touched seeing how the community knew each resident and provided individualized care. I saw how leaders can challenge their staff and improve the facility through accreditation.As a future leader in geriatric nursing, it will be my responsibility and honor to foster growth in the employees around me and improve the level of care provided. The variety of shadowing experiences broadened my understanding of geriatric nursing, and I caught a glimpse of how I may fit into the continuum of care. I am now interested in becoming a geriatric nurse practitioner.Holst J. (2008, May 6). Local retirement community receives national recognition. Cadence. Retrieved from http://www.mlive.com/cadenceadvance/index.ssf/2008/05/local_retirement_community_rec.html Google Scholar Previous article FiguresReferencesRelatedDetailsCited by Caldeira S, Merighi M, Muñoz L, Jesus M, Domingos S and Oliveira D (2012) Nurses and care delivery to elderly women: a social phenomenological approach, Revista Latino-Americana de Enfermagem, 10.1590/S0104-11692012000500010, 20:5, (888-895), Online publication date: 1-Oct-2012. Request Permissions InformationCopyright 2010, SLACK IncorporatedThe authors acknowledge Clark Retirement Community and Kathy Miles, Floyd Miles, and Christopher Wilks, donors of the Whitney Young Scholarship to Calvin College.PDF downloadAddress correspondence to Mary E. Flikkema, MSN, RN, Professor of Adult Health, Calvin College Department of Nursing, 1734 Knollcrest Circle SE, Grand Rapids, MI 49546-4403; e-mail: [email protected]edu.Ms. Postma is a staff nurse, Acute Care for the Elderly Unit, Spectrum Health, Blodgett Campus, and Ms. Flikkema is Professor of Adult Health, Calvin College Department of Nursing, Grand Rapids, Michigan. Received4/09/09Accepted4/29/09