Geriatric Nurse Practitioners Research Articles

Supply and Geographic Distribution of Geriatric Physicians and Geriatric Nurse Practitioners.

The rapidly growing population of older adults and their concomitant high prevalence of chronic health conditions require an increased supply in the specialized geriatric workforce to meet increasing health care demands. Understanding trends and geographic disparities in the supply of the geriatric workforce is essential for developing effective policies. To examine temporal and geographic trends in the supply of geriatric physicians (GMDs) and geriatric nurse practitioners (GNPs) from 2010 to 2020 and to assess potential disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study used annual county-level data from 2010 to 2020, encompassing all counties in the 50 US states and Washington, DC. Statistical analysis was performed from June 2023 to March 2024. The primary outcomes were the numbers of GMDs, GNPs, and the combined number of GMDs and GNPs per 100 000 older adults. The secondary outcome included the proportion of counties with or without any GMDs or GNPs. From 2010 to 2020, the national per capita supply of GMDs decreased by 12.7%, from 13.4 per 100 000 older adults in 2010 to 11.7 per 100 000 older adults in 2020, while GNPs increased by 125.0%, from 4.4 per 100 000 older adults in 2010 to 9.9 per 100 000 older adults in 2020. The combined GMD and GNP workforce increased by 21.3%, from 17.8 per 100 000 older adults in 2010 to 21.6 per 100 000 older adults in 2020. The distributions of older adults, GMDs, and GNPs closely resembled the distribution of metropolitan and nonmetropolitan counties, with GMDs and GNPs highly concentrated in metropolitan counties where the number of older adults was greatest. Throughout the study period, 63.9% of counties (2008 of 3142 in 2010-2019; 2009 of 3143 in 2020), predominantly small and nonmetropolitan counties, had no GMDs or GNPs, which was associated with the disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study found that from 2010 to 2020, the overall national supply of GMDs and GNPs kept pace with the growth of the older population, largely due to the rapid growth in the number of GNPs. However, significant geographic disparities persisted, particularly in small and nonmetropolitan counties. Future efforts should focus on increasing the availability of GMDs and GNPs in underserved small and nonmetropolitan counties to ensure equitable access to geriatric care.

Maximization of scope of practice and satisfaction among geriatric nurse practitioners in Israel.

There is an increasing demand for comprehensive geriatric care. Nurse practitioners (NPs), who undergo specialized training, are situated to provide such care. In Israel, the role of a geriatric nurse practitioner was introduced in the health care system 10 years ago. However, little is known about the rate of professional satisfaction and realization of full potential among these nurses. The aims of this study are (1) to describe the geriatric NP workforce in Israel, (2) to measure the current geriatric scope of practice, and (3) to measure the geriatric NP satisfaction from their working environment. For this cross-sectional study, a survey, comprising three sections relating to demographics, professional qualifications and scope of practice, and career satisfaction, was sent to 53 geriatric nurse practitioners in Israel who currently work as geriatric nurse practitioners. Forty-seven nurses participated in the survey. Almost 64% reported that they are satisfied with their position, and 72% reported that they are able to fulfill their full scope of practice. The mean score for scope of practice was 68.31 out of a possible score of 100. A number of qualifications were correlated with satisfaction at work, indicating that nurses tend to be more satisfied at work when they are able to fulfill their potential. Ensuring nurse practitioners' ability to realize their full potential should be a goal of the health care system. Interventions should be in place to encourage nurses to perform tasks related to their work, for which they are trained.

Understanding factors affecting the integration of geriatric nurse practitioners into health systems.

Geriatric nurse practitioners (NPs) are introduced into health systems to alleviate provider shortages and improve care for older adults. To achieve these goals, geriatric NPs must be integrated into the health system such that they can efficaciously practice. Internationally, little is known about factors affecting the integration of NPs. Such evidence would improve policymaking and the impact of geriatric NPs on care. In Israel, geriatric NPs were recently introduced. Their ongoing integration is an exemplar for other countries. To identify factors affecting the integration of geriatric NPs in Israel and discuss application of these factors in international policy and research. The Consolidated Framework for Implementation Research guided this qualitative descriptive study. A semistructured interview guide was used to collect data from four professional groups (geriatric NPs, physicians, administrators, and policymakers), which, together, provide a system-level perspective. Factors were identified using deductive content analysis and designated as facilitators, barriers, neutral, or mixed effects. There were 58 participants across the four professional groups. Twenty-eight factors were identified, including patient needs and leadership engagement (facilitators), available information (barrier), culture (mixed), and evidence strength (neutral). Perspectives on several factors differed by the professional group's role in integrating NPs (e.g., costs ). The barriers highlight lacking interprofessional support from a priori policymaking and communication breakdowns. Policies should reflect priorities of administrators, clinicians, and policymakers. These factors may inform policymaking in other countries but would be most effective if based on country-specific research. This implementation science approach may inform future studies.

Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care.

Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.

\u2018Thinking outside the box\u2019: advanced geriatric nursing in primary health care in Scandinavia

BackgroundOlder people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives.MethodsThe study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis.ResultsThe results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation.ConclusionsThe results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered.

The role of a geriatrician in a cancer center.

39 Background: Older adults are likely to have coexisting health conditions, polypharmacy and functional limitations. The geriatrician may have a pivotal role in risk assessment, prevention and treatment of comorbidities and addressing geriatric syndromes. The purpose of this study is to describe the growth and development of, and the role of a Geriatrics Service (GS) in a cancer center. Methods: A GS was founded in MSKCC in 2009. Since then it has grown to provide inpatient (IP) and outpatient (OP) care for older adults undergoing cancer diagnosis, surveillance or active treatment. It offers preoperative evaluations, geriatric assessment (GA) and follow-up shared- care. Recently, a Transitional Care Management (TCM) program was established for patients at increased risk of rehospitalization. The GS strives to develop an interprofessional educational geriatrics curriculum and to participate in quality and research projects focused on cancer and aging. Results: Between 2009 and 2014 a total of 6679 new patients were evaluated by the GS. 16% of the patients were 65-75, 70% were 76-85 and 14% were older than 85. 46% were male and 84% were white. 15% were IP and 85% were OP consultations. 13% of the OP consults were for GA, the rest were preoperative evaluations. All patients seen preoperatively who are admitted after surgery, are followed postoperatively by the IP geriatrics team. In total, 4 Geriatricians, 2 Geriatric Nurse Practitioners (GNP) and 3 RNs were recruited. The number of follow-up visits increased from 143 in 2009 to 733 in 2014. The new TCM program based on close communication between the IP and OP GNP has been successful in keeping frail patients from frequent rehospitalizations. Noon conferences on geriatrics for the house staff, a biannual course on “Advancing Nursing Expertise in the Care of Older Adults with Cancer” and a monthly interprofessional meeting for the discussion of Geriatric Clinical Complex Cases (GCCC) are ongoing. Research has focused on risk assessment and the use of telemedicine in geriatric patient care. Conclusions: The establishment of a GS in a cancer center was very well received and embraced by the oncologists showing an unmet need in the care of the older cancer patient. The potential reproducibility beyond the cancer center will be discussed.

노인전문간호사의 역할갈등 경험

노인전문간호사의 역할갈등 경험

Risk factors for COPD: What do NPs know?

Chronic obstructive pulmonary disease (COPD) has been identified as the fourth leading cause of death. The primary purpose of this article is to discuss risk factors for COPD and identify at-risk populations. A secondary purpose is to report the findings of a recent survey of nurse practitioners (NPs) in Colorado regarding their knowledge about the risk factors for COPD. Data sources A list of registered NPs in the State of Colorado was obtained from the State Board of Nursing. Surveys were sent to 2916 NPs to assess their knowledge about risk factors for COPD. Although the response rate was less than 10%, this survey highlighted that there were gaps in knowledge especially for pediatric, women's health, and geriatric NPs. NPs are on the front lines in assisting with the prevention, early diagnosis, and management of this complex disease. Formal NP educational programs (regardless of focus) should highlight that through recognition of risk factors, NPs can play a significant role in primary and secondary preventive measures that may decrease the impact of COPD. Public media campaigns to educate the public about risk factors may encourage the individual patients to address these risk factors with the primary care provider.

Prescription Medication Use Among Self Neglecting Elderly

The elderly use approximately one-third of the prescription medication in the United States, often for problems such as chronic pain, insomnia, and anxiety. This study will describe the use of prescription medication, specifically drugs of abuse such as benzodiazepines and opioid analgesics, in a sample of community dwelling elderly referred to Texas Adult Protective Services for self-neglect. We hypothesize that self-neglecting behavior may result in increased use of prescription drugs with known abuse potential. Self-neglecting elders (n = 100) were matched with community controls and interviewed by geriatric nurse-practitioners in their homes. Benzodiazepine use among self neglecting elderly was four-fold that of matched controls, (OR = 4.2, 95% CI = 0.9–20.4), and the use of opioid analgesics slightly higher among self-neglecting elders, (OR = 1.1, 95% CI = 0.5–2.4). Self-neglecters were significantly less likely to be taking non-opioid pain medications such as acetaminophen (p < .011) and gabapentin ...

Ready to Work With a Nurse Practitioner?

Ready to Work With a Nurse Practitioner?

Urinary Incontinence: A Neglected Geriatric Syndrome in Nursing Facilities

Urinary incontinence (UI) is common but inadequately assessed and treated in nursing facility (NF) residents. The purpose of this study is two-fold: (1) to determine perceptions about the importance of UI and its management in the NF setting compared with other geriatric syndromes and (2) to compare barriers to UI care as perceived by physicians, geriatric nurse practitioners (GNPs), directors of nursing and other nurses in administrative positions (DONs), and nursing assistants (NAs). Computer-based surveys of physicians and DONs and a hard copy survey of NAs at their national meetings; an online survey of GNPs. Responses included 395 physicians (31% response rate), 152 DONs (34%), 118 GNPs (23%), and 277 NAs (60%). Physicians, GNPs, and DONs evaluated and managed UI significantly less often than 5 other geriatric syndromes (behavioral symptoms of dementia, falls, unintended weight loss, pain, and delirium). In contrast, NAs were more likely to be involved in UI care than in care provided for residents with any of the other 5 syndromes. All 4 groups agreed that UI has less effect on clinical outcomes than the other 5 syndromes. However, DONs rated UI first with respect to cost of care; NAs third behind falls and pain; and physicians and GNPs rated UI fourth behind falls, behavioral symptoms, and delirium. With respect to quality of life effects, physicians and GNPs rated UI fifth and fourth respectively and DONs fourth. In contrast, NAs rated UI second only to pain with respect to its effect on quality of life. Perceived barriers differ among the 4 groups with physicians relatively more concerned that drug treatment alone is ineffective (P = .002); GNPs relatively more concerned with lack of effective nondrug interventions (P = .001); and DONs relatively more concerned about sufficient time to assess and manage UI (P = .001). NA respondents rated concern about anticholinergic drug effects lower than did respondents in the other 3 groups (P = .001). Physicians, GNPs, and DONs are more likely to be involved in evaluating and managing behavioral symptoms of dementia, pain, falls, delirium, and unintended weight loss than UI in the NF setting. This leaves NAs as first-line managers for a condition that they perceive to have an important impact on quality of life. Perceived barriers to improving UI care differ among the 4 groups suggesting that approaches to overcoming the barriers should be multi-faceted.

CMS Launches Disease Management Models

CMS Launches Disease Management Models

A GRADUATE NURSING CURRICULUM FOR THE EVALUATION AND MANAGEMENT OF URINARY INCONTINENCE

Geriatric nurse practitioners should be educated in the evaluation and treatment of common geriatric syndromes like urinary incontinence. However, many advanced-practice nursing programs do not place an educational emphasis on urinary incontinence management. The purpose of this project is to provide information that supports the need for geriatric-nurse practitioners to evaluate and manage urinary symptoms in clinical practice. One step in addressing this lack of knowledge is to design a curriculum model (not currently available) based on current clinical guidelines, other partial curriculum models, and clinical research. With this education, geriatric-nurse practitioners will be able to provide competent care for the patient with urinary symptoms, while increasing the accessibility and quality of continence care.

Issues of attraction, retention, and affective states for geriatric nurse practitioners in long-term care.

Limited research exists on self-reported geriatric nurse practitioner (GNP) perceptions. Thirty-six GNPs completed a survey for level of importance rather than rank-order. Subjects also completed the Profile of Mood States. Through the use of Pearson correlation techniques, results indicate that the number of years in nursing was related to appreciation from patients, one of the factors keeping GNPs satisfied with long-term care (r =.503). Results indicate that these GNPs had a higher overall affect compared with college norms.

Behind the scenes: visionary foundations.

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.

Creating order out of chaos: models of GNP practice with hospitalized older adults.

It has been well documented that hospitalization of an older adult can trigger a cascade of events that negatively affect quality of life long after hospitalization. Three models of care directed by hospital-based geriatric nurse practitioners (GNPs) are described. The GNPs' roles include primary care provider, consultant, educator, researcher, and/or administrator. In one model, the GNP collaborated with a multi-disciplinary team to create a clinical pathway, the Functional Recovery Pathway. In the second model, the GNP and nurse manager addressed the issue of fall risk with an education program for the staff. As a result, the fall rate decreased 5.8%. In a third model, the GNP coordinated care of hospitalized nursing home residents in a "scatter bed" program. Working synergistically with a case management program, the length of stay for this group of patients decreased from a median of 12 days to 9 days in the first year to 6.8 days in the third year. All three models showed that the GNP facilitate change, improve resource utilization, and create innovative strategies to optimize care for hospitalized elders.

Modeling nursing scientific inquiry. The University of Iowa Hospitals and Clinics Research Utilization Residency Program for Geriatric Nurse Practitioners and Gerontological Clinical Nurse Specialists.

The application of research findings to achieve nursing outcomes sensitive to the effects of nursing care remains a challenge for the nursing profession. The Research Utilization Nursing Residency Program is a project implemented by the University of Iowa Gerontological Nursing Interventions Research Center. For a discharge planning coordinator serving a largely geriatric patient population, the residency experience provided support to apply scientific nursing knowledge to outcomes. Resources from both clinical and academic settings are discussed within the context of the resident's experience.

Geriatric nurse practitioners in long-term care: demonstration of effectiveness in managed care.

This study was undertaken to review the impact of utilizing geriatric nurse practitioner/physician (GNP/ MD) teams on cost and utilization for a cohort of Medicare HMO enrollees residing in long-term care facilities. The results would be used by the organization for further development of the GNP Program. A 1-year retrospective data analysis on revenues and cost for 1077 HMO enrollees residing in 45 long term-care facilities. Proprietary and not-for-profit, licensed long term care facilities in the HMO's service area of central Massachusetts. Facilities in the study had both skilled (Medicare-certified) and custodial beds. Data were collected retrospectively on overall cost, revenues, emergency department (ED) transfers, hospital, and subacute days. Of 1077 residents, 414 were cared for by GNP/MD teams compared with 663 by physicians alone. Acute care and ED costs were significantly lower for the GNP/MD-covered patients. There was a gain of $72 per resident per month (PRPM) with the GNP/MD-covered patients compared with a loss of $197 PRPM for physicians alone. There were no significant differences in ancillary services or prescriptions. The use of GNPs in collaboration with physicians reduced ED and acute care utilization costs as well as overall costs for a cohort of HMO enrollees in long-term care. This encouraged the HMO to support the concept that all long-term care HMO residents should be covered by GNP/MD teams.

Survey of Geriatric Nurse Practitioners in the West: Scope of Practice and Effectiveness

This survey research conducted during a 3-year period was designed to describe the scope of practice and effectiveness of the geriatric nurse practitioner (GNP) in providing health care to older adults in a variety of settings. The University of California, San Francisco, in collaboration with three other GNP programs surveyed graduates (n = 123). Also surveyed were administrators, directors of nursing, and the primary medical consultant where the GNPs were employed. A high degree of agreement among the professional groups was found. Some comparisons are made with the results of previous studies.

Impact of Geriatric Nurse Practitioners on Nursing-Home Residents?? Functional Status, Satisfaction, and Discharge Outcomes

This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.