Last summer the Atlantic Philanthropies awarded the ANA a $5 million, five-year grant through the American Nurses Foundation to support the initiative “Enhancing Geriatric Competence of Specialty Nurses.” Through the grant, the ANA is helping specialty organizations build geriatrics special-interest groups and nursing-education content into their programs. The grant also supports the development of a Web-based comprehensive resource into which specialty organizations can tap. The ANA has teamed up with the New York University–based Hartford Institute of Geriatric Nursing and the American Nurses Credentialing Center (ANCC) in this effort.

The ANCC’s goal is to make its geriatrics-related certification exams more accessible by making them computer based and to encourage RNs to pursue dual certification (in cardiovascular nursing and gerontologic nursing, for example). “Given the demographics of our patient population, most nurses care for older adults nearly every day, regardless of their work setting,” said ANA president Barbara Blakeney, MS, APRN,BC, ANP. “This grant allows nurses to gain expertise in gerontologic nursing, which in turn improves care to this population.”

In a separate initiative, the JAHF announced in December 2000 its $14 million “Building Academic Geriatric Nursing Capacity” program, which funds five university-based centers of geriatric nursing excellence, a scholars’ awards program, and a coordinating center. The foundation subsequently invested an additional $2.2 million in seven other schools of nursing to help build geriatric nursing expertise in their programs.

Grants at Work

In 2003 the ANA will award funds to 12 specialty organizations, with a goal of ultimately reaching approximately 45 more groups.

One recipient, the American Psychiatric Nurses Association, plans to use its two-year grant to develop a Web-based continuing education program that will focus on the psychiatric needs of geriatric patients. The association's executive director, Jane White, DNSc, RN, CS, a District of Columbia Nurses Association member, estimated that nearly 50% of the association's members provide care to this population at some point during their practice. White also said that whereas psychiatric nurses can gain subspecialty expertise in areas such as those that focus on children and adolescents, there are few formal programs available for nurses interested in geropsychiatric nursing. The organization has been trying to fill that geropsychiatric nursing gap in several ways, including through educational programs at its annual meeting. The online course, scheduled to begin this year, likely will review evidence-based practice on disorders that are especially prevalent in older adults, such as depression, dementia, anxiety disorders, and substance abuse.

"Age is the single most important risk factor for cancer in the United States," said Oncology Nursing Society (ONS) director of education Laura Fennimore, MSN, RN. More than 77% of all cancers are diagnosed in men and women who are 55 or older. Fennimore said that oncology nurses working with older adults are constantly grappling with many issues, from ensuring patients are receiving chemotherapy doses that take into account their ages and physiologic changes to helping patients determine end of life care.

The ONS foundation plans on using its grant to sponsor a first-ever “institute of learning,” geared toward nurses who want to know about the specific needs of older adults who have cancer. The institute will take place at the ONS’s annual conference; nurses can also attend through the Internet, and cassettes will be available through the ONS Web site. Participants will earn CE credits. The ONS is currently collaborating on the course content with the multidisciplinary Geriatric Oncology Consortium.

Recent data show that more than half of all patients admitted to intensive care units nationwide are over age 65, and at least 25% are over age 75. Despite this, critical care nurses don't tend to think of themselves as practicing geriatric nursing, said Justine Medina, MS, RN, director of practice and research at the American Association of Critical-Care Nurses (AACN). Rather, they tend to focus on the disease or the special needs of the patient. The AACN will use its grant to broaden the geriatric content in its certification exam for critical care nurses. "We want to infuse our exam with very specific age-related content that can help nurses distinguish more clearly between normal age-related physiologic changes and pathophysiologic changes." With the funding, the group plans to bring together geriatric critical care experts to determine exam content and train them on writing test questions. Medina hopes the questions will be integrated into the 2005 certification exam.

JAHF'S Ongoing Efforts

Rita Jablonski, MSN, RN, is one of 57 pre- and postdoctoral nurses selected as a JAHF scholar over the last three years.

The two-year $100,000 grant allows the flexibility to retain her full-time nursing faculty status while she completes her dissertation. For her research, the Virginia Nurses Association member just completed interviews with 42 people, including cognitively intact and cognitively impaired long-term care residents, as well as physicians, nurses, and the family members of long-term care residents, to see what influenced their decision to proceed with a long-term care resident's emergency transfer to an acute care facility. What she's learned from her research so far is that long-term care nurses must constantly juggle the desires of residents, physicians, and most commonly, residents' family members before someone is transferred. She knows from her own experience as an ED nurse that ED nurses sometimes criticize long-term care nurses for either waiting too long to transfer a resident or questioning the need for the transfer in the first place. Jablonski hopes her research will create better understanding between ED and long-term care nurses. She also hopes it will lead to long-term care nurses receiving the respect “they deserve” and an increase in the number of nurses willing to practice in this setting.

The University of Minnesota School of Nursing is one of the seven nursing programs that received a JAHF “Nursing School Geriatric Investment Program” grant of $75,000 yearly for three years in early 2002. With that money, the university's Center for Nursing Research on Elders (CNRE) collaborated with the Densford International Center for Nursing Leadership and select health care organizations to create “Geriatric Clinical Scholars Partnerships.” In this program, CNRE nursing faculty, advanced practice nurses from clinical agencies, and undergraduate and graduate students work together to improve care of older adults. One of the teams is currently looking at how nurses can better manage pain in cognitively impaired elderly people, an area that CNRE director Jean Wyman, PhD, RN, FAAN, FSGA, a Minnesota Nurses Association member, said has long been neglected. The JAHF grant is also being used to support a gerontologic summit that will bring together national and international nursing researchers to look at strategies to support research in incontinence.

The Hartford Center of Geriatric Nursing Excellence at Oregon Health and Science University School of Nursing in Portland is one of the five original Centers of Geriatric Nursing Excellence created through JAHF funding. With its ongoing funding, the center has strengthened the school of nursing's relationships with community agencies and other nursing programs in the region to enhance care for older adults. “We have numerous well-prepared faculty and researchers here, and having that critical mass has allowed us to move beyond where we were, to increase nurses’ knowledge, and to put gerontologic nursing on the radar screen at other schools of nursing,” said center director Pat Archbold, DNSc, RN, FAAN, an Oregon Nurses Association member.

To address the RN shortage, the center created a BS-to-MS or BS-to-PhD fast-track program that covers nursing students' senior-year tuition and provides them with mentorship and research opportunities. Those students can then apply directly to the graduate program in gerontologic nursing. The center also has a summer postdoctoral fellowship that allows nursing gerontology faculty to jump-start their research careers and allows other faculty to gain expertise in this specialty as well as a best-practices initiative in which center nursing faculty collaborate with four health care organizations on projects that will result in better care to older adults. One initiative is between the center and Kaiser Permanente Northwest, designed to improve wound care in long-term care facilities.

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