1. Looking Back to Move Forward

2. Claire M. Fagin Mathy Mezey Neville Strumpf Cornelia Beck Susan Reinhard

3. Looking Back to Move Forward 1987 27Centers of Excellence in Geriatric Medicine Major source of geriatric faculty Increased prestige, credibility, status and internal funding

4. Looking Back to Move Forward 1996 Hartford Institute for Advancing Geriatric Nursing Practice 1998 Hartford Social Work Faculty Fellows Program

5. Looking Back to Move Forward 2000 Multidisciplinary Expert Panel Presented white papers on state of the science in geriatric nursing <.005% of U.S. RNs certified in geriatrics <25% of SON had required geriatric courses or faculty to teach geriatrics <5% of APN students were pursuing geriatric specialty 16% PhD programs surveyed had a primary interest in geriatrics 16% of NINR funded programs specific to geriatrics

6. Looking Back to Move Forward 2000 5 Centers of Geriatric Nursing Excellence Predoctoral & Postdoctoral Award Program 2001 Nursing School Geriatric Investment Program 2007 4 Additional Centers of Geriatric Nursing Excellence

7. Looking Back to Move Forward BAGNC; 10 years of investment 20052008200120042000 2010 $7.8 $2.2 $1.2 $10.4 $7.2 Total $31.8 2003 $3.0

8. Looking Back to Move Forward As of July 1, 2010 102 completed 2 year predoctoral scholarship 4 completed 2 year MBA scholarship 70 completed 2 year postdoctoral fellowship

9. Looking Back to Move Forward; 2001

10. Looking Back to Move Forward; 2010

12. Looking Back to Move Forward Panel Members Mathy Mezey Neville Strumpf Cornelia Beck Susan Reinhard

13. Mathy Mezey, EdD, RN, FAAN NYU College of Nursing, Hartford Institute for Geriatric Nursing Looking Back to Move Forward: Focus on Practice

14. Panel 1: Looking Back to Move Forward: Focus on Practice Mathy Mezey, EdD, RN, FAAN, NYU College of Nursing, Hartford Institute for Geriatric Nursing

15. Focus of Presentation Achieving geriatric competency of all nurses Structuring clinical settings to be receptive to best-practice in care of older adults –Creating competencies and resources for the individual nurse –Creating system change

16. Context of geriatric nursing over the past 10 years We have been supported by an unusually strong commitment to geriatric nursing by foundations (JAHF: Atlantic Philanthropies; the Commonwealth Fund) Several key reports (IOM; Macy Foundation) have emphasized the need to re-tool for an aging America The aging of the baby boomer generation is clearly driving a new look at aging

17. Conceptual changes in geriatric nursing Movement towards geriatric competency for all practicing nurses rather than primarily specialization in geriatrics Movement towards language of care of older adults and away from geriatrics Movement towards a systems approach in the practice setting in addition to a focus on the individual nurse

18. Achieving geriatric competency of all nurses: The education pipeline Entry-level nurses –AACN Baccalaureate Competencies –AACN/HI GNEC program –NLN Advancing Care Excellence for Seniors (ACES) Graduate nurses –AACN Adult/Gerontology NP and CNS Competencies –AACN/HI Resources for Adult/Gerontology NPs and CNS Programs

19. Achieving geriatric competency of all nurses: Reaching the practicing nurse Nurses in specialty practice: the REASN project The Adult-Gerontology Nurse Practitioner and Clinical Nurse Specialist ( the LACE model ) The STTI Center for Nursing Excellence in Long-term Care

20. Specialty nurses 60+ associations representing >500,000 nurses Associations have developed products specific to care of older adults –Critical Care Nurses Association –Emergency Room Nurses –Oncological Nurses Association

21. Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on the individual nurse Competencies: –The Hartford Institute Geriatric Nursing Hospital Competencies –Geropsychiatric Nursing Collaborative Core Competencies –Nurse Competencies for Nursing Home Culture Change (Pioneer Network) Evidence-based Resources (web-based and print) –Assessment tools (e.g. Try This ®) –Practice protocols –Age specific and specialty nurse Web sites –Texts

22. Structuring clinical settings to be receptive to best-practice in care of older adults: Focus on achieving system change NICHE (Nurses Improving Care to Healthsystems Elders) AONEs Guiding Principles for the Elder-Friendly Hospital/facility and the Role of the Nurse Leader Transitional care models Resident-directed care & culture change movement in nursing homes

23. NICHE >350+ NICHE hospitals in North America A systems approach to improving care to older adults Specific role for the geriatric APRN Use of evidence-based models, e.g. the Geriatric Resource Nurse (GRN) Implementation of geriatric protocols and QI indicators

24. Concluding observations Pipeline entry and graduate nursing students are now likely to graduate with competencies in care of older adults Practicing nurses have access to a wide variety of competencies and resources in care of older adults Health systems still have a lot to do to be receptive to best-practices in care of older adults Yet to be fully explored and implemented is the role of inter-disciplinary teams in care delivery to older adults

25. Neville Strumpf, PhD,RN, FAAN Looking Back to Move Forward: Focus on Education

26. Cornelia Beck, PhD, RN, FAAN Looking Back to Move Forward: Focus on Research

27. Susan Reinhard, PhD, RN, FAAN Looking Back to Move Forward: Focus on Policy