Building APRN Gerontology Workforce Capacity Through New APRN Gerontological Specialist Certification

Abstract

We are reminded every day in our own practices and settings that there is a substantial, growing number of older adults seeking health care services. We are all well aware of the statistics: 10,000 baby boomers will turn 65 every day until 2030 (R. Hemilick, “Baby Boomers Retire,” Pew Research Center, Dec. 29, 2010; https://pewrsr.ch/3rJN5TI). At this pace the older population is projected to exceed the available health care resources. The fastest-growing segment of the United States population is the oldest-old (80 and older). The oldest-old growth rate is twice that of those 65 and older, as well as almost four times that for the total population (J.M. Ortman, V.A. Velkoff, and H. Hogan, “An Aging Nation: The Older Population in the United States,” U.S. Census Bureau, May 2014; www.census.gov/prod/2014pubs/p25-1140.pdf). More older adults are living with multiple chronic conditions for longer periods of time. Older adults comprise a significant portion of the population with chronic disease, with 60% having at least two chronic conditions (“Older Population and Aging,” U.S. Census Bureau, Oct. 7, 2019; www.census.gov/topics/population/older-aging.html). At the same time, the largest portion of older adults are living longer, healthier lives than previous generations. The shortage of geriatrician and gerontological advanced practice nurses has steadily exacerbated over the past two decades. It is projected that there will be a 45% increase in the demand for practitioners specializing in geriatrics by 2025 (National Center for Health Workforce Analysis, “National and Regional Projections of Supply and Demand for Geriatricians: 2013–2025,” May 2017; https://bit.ly/3rIH2yG). Advanced practice registered nurses (APRNs) specializing in gerontology first appeared in 1970, and the first gerontological nurse practitioner (GNP) was certified in 1976. To provide structure and uniformity to the APRN role, the APRN Consensus Model for Regulation, Licensure, Accreditation, Certification and Education (known as the Consensus Model) was adopted in 2008. With the adoption of the Consensus Model, the GNP certification was retired in December 2013, and new Adult-Gerontology Nurse Practitioner and Clinical Nurse Specialist certifications were introduced by American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners Certification (AANPBC). These certifications demonstrated the APRN competencies of caring for older adults and increased the workforce capacity for advanced practice nurses providing care to older adults. Although these changes did result in an increase in APRNs with generalist knowledge in the care of older adults, there was a significant loss of expertise in the care of older adults with complex medical needs, which includes the oldest-old and frail older adults. The Consensus Model left oversight of the competencies and the recognition of the specialty practice to professional nursing organizations. The Gerontological Advanced Practice Nurses Association (GAPNA) is the sole organization specifically for advanced practice nurses with geriatric expertise. GAPNA endorsed the Consensus Model and has led the effort to define and recognize the gerontological advanced practice nurse specialty. A practice analysis was conducted by GAPNA to define the knowledge and skills for the APRN gerontological specialist. GAPNA convened an expert consensus panel of gerontology nursing leaders to develop gerontological advanced practice nursing proficiencies beyond the entry-level competencies for practice. The consensus panel identified 12 proficiency statements that were then developed into the “GAPNA Consensus Statement on Proficiencies for the APRN Gerontological Specialist” published in 2015 (https://bit.ly/3doK85R). Entry level as an APRN requires certification in both a role and a population focus. The four APRN roles include certified nurse practitioner (CNP), certified clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse-midwife (CNM). The six APRN population focuses include family/individual across the life span, adult-gerontology, pediatrics, neonatal, women’s health/gender-related, and psychiatric/mental health. The certifications validate the APRN competencies to practice at the advanced level, and before being recognized as a specialist, an APRN must first hold one of these certifications (CNP, CNS, CNM, or CRNA). The APRN Gerontological Specialist certification (GS-C) provides validation of advanced knowledge and proficiency in the gerontology specialty. GAPNA has explored various APRN specialist recognition frameworks, including portfolios, certificate programs, academic programs, and board certification. After several years of deliberation, in 2018 GAPNA approved and sponsored the creation of the Gerontology Nursing Certification Commission (GNCC) with the mission to improve the quality of care provided to older adults by promoting and acknowledging the highest standards of advanced practice nursing through the certification process (www.gerocert.org). GNCC created and released the first APRN Gerontological Specialist board certification. Specialist certification promotes professional recognition, self-confidence in decision-making, and enhanced credibility. Certification has been associated with patient safety, optimal patient outcomes, decreased errors, improved patient satisfaction, increased staff retention, and job satisfaction (J Nurs Care Qual 2020;35:E1–E5). The GS-C validates advanced knowledge and practice proficiencies beyond the entry level for APRNs who work with older adults with complex care needs. APRN GS-Cs have an up-to-date knowledge base, in part due to their required ongoing professional development. The GS-C offers employers the opportunity to promote positive outcomes and position an organization to provide targeted marketing for ensuring quality and safety. The GC-C requires the applicant to hold an unrestricted RN license. The applicant must be recognized by the state board of nursing to perform as an APRN. The applicant also must hold current national certification as an APRN and have practice experience in the role for a minimum of 2,500 hours within the last five years working with older adults. In addition, the applicant must have completed 50 contact hours of approved continuing education specific to gerontology within the three years before submitting an application. The application process with eligibility requirements, testing content outline, and resources for the GS-C can be found on the GNCC website (www.gerocert.org). Resources to prepare for the GS-C can be found on the GAPNA website (www.gapna.org). Dr. Peraza-Smith is president of Gerontology Nursing Certification Commission (GNCC)