Behind the scenes: visionary foundations.

Abstract

V isionaries are those folks who are thought to be impractical with utopian ideas that are fantastic, interesting, and often unrealistic—tilting at windmills with Don Quixote. In nursing, thankfully, we have both Don and Donna Quixotes who see visions and pursue them to realities. How do visions become reality? One must have the capacity to see a need, imagine what could or should be, and the resources and determination to pursue ideas to actuality. In our society, adequate resources, the right connections, and hard work are all essential to success. We seldom give sufficient recognition to the underpinnings that have brought fruition to nursing visions. Three private foundations—W.K. Kellogg Foundation, Robert Wood Johnson Foundation, and John A. Hartford Foundation—stand out, among many, as providers of resources to support visions that have markedly changed the delivery of nursing care to the aged. The following paragraphs emphasize the point. Barbara Lee, the program director during the 1970s and early ’80s for the W.K. Kellogg Foundation, was approached by Dr. Robert Eelkema and Mickey Knuteson, RN, of the University of North Dakota, regarding the need for further preparation for RNs to become practitioners in all fields.Together, with the help of John Gerdes and Doris Schwartz, a plan was conceived for the special education of geriatric nurse practitioners (GNPs) in 13 Western states, with special emphasis on rural and sparsely populated states. The right time, the right place, and the right resources, both material and professional, were necessary to make the program succeed. In addition, James McCall from Ross Laboratories provided grants for the publication of early GNP newsletters and conference receptions to promote visibility, goodwill, and better nutrition for aged individuals. Ross Laboratories in this way helped develop the emerging network of GNPs. From these roots, the National Conference of Geriatric Nurse Practitioners (NCGNP) emerged and has become an energetic organization representing GNPs throughout the nation. In the mid-1970s, Robert Butler, the first director of the National Institute of Aging, made the public aware of the general unavailability of physicians in nursing homes. Linda Aiken, then vice president of the Robert Wood Johnson Foundation, envisioned teaching nursing homes in which geriatric nursing experts filled full-time nursing staff positions. Her goal in creating the Teaching Nursing Home (TNH) Program was to establish links between nursing schools and nursing homes that would be an analogue to our nation’s best teaching hospitals. Over time, the TNH concept has endured and been replicated in different forms. The University of Pennsylvania School of Nursing, which administered the TNH Program for the foundation, owns and operates a PACE program that provides total services for nursing home-eligible patients in community settings. Claire Fagin, who directs the Hartford Centers for Geriatric Nursing Excellence, was chair of the national advisory committee for the Robert Wood Johnson Foundation’s TNH Program.The program’s success in reducing hospital use by nursing home residents influenced the decision to extend Part B Medicare coverage to pay GNPs in nursing homes. The John A. Hartford Foundation Institute for Geriatric Nursing, through the generous endowment of the John A. Hartford Foundation and the able administration of Mathy Mezey and Terry Fulmer, has created numerous avenues of specialized geriatric nursing education, activity, practice, and national visibility. Donna Regenstreif, senior program officer for the Hartford Foundation, has been instrumental in providing the material support and encouragement for this massive effort to bring geriatric nursing to the forefront of U.S. nursing. These examples are just a few of those with the foresight and means to accomplish some of the most important developments in geriatric nursing. These private, nonprofit foundations have allotted significant funds to the betterment of geriatric nursing care. Funds are essential, but the visions of those who guide the decisions are critical.