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Gerontological Nursing

Written by: Ryan Miller, RN, MN, GNC(c) on behalf of the Gerontological Nursing Association of Ontario

A day in the life

Ana works on a 34 bed geriatric rehab unit. Most of her patients are over the age of 65. Ana is the unit team leader and works eight-hour day shifts, Monday through Friday. She works with a multi-disciplinary team to coordinate all care activities, therapy sessions and the discharge planning for all patients, many of whom have multiple comorbidities.

A typical Monday begins with the weekly unit rounds. In this meeting, Ana leads a problem-focused discussion about each patient on the unit. The team uses this time to update each other on a patient’s progress towards meeting his/her goals. Ana listens intently, making notes on things she will follow up on after the meeting. One concern Ana wants to investigate after the meeting involves Mr. S., a 75 year old recovering from pneumonia and functional decline. Mr. S. had a fall last night and the evening staff wondered if it could be related to a recent medication change. Following the meeting, Ana calls the team pharmacist and together they determine the medication could have contributed to the patient's fall and may need to be changed.

There is a new graduate nurse on the unit and she asks Ana to help her with her wound care. Ana guides the new nurse through the steps of applying a VAC (Vacuum-assisted closure) dressing. While she is in the room Ana has an opportunity to talk with the patient about his weekend pass home. She makes a note to follow up with the patient’s occupational therapist regarding concerns he expressed about some of his home equipment needs.

The daily education session is Ana’s responsibility on Mondays, so she makes her way to the patient dining room and assembles the props she will need for a discussion on orthostatic hypotension. With 14 patients in attendance, Ana reviews the causes, symptoms and interventions for orthostatic hypotension. She talks about slowly rising from lying or sitting positions and how dizziness can be a risk for falls.

Afterwards, Ana returns to the nursing station only to be called down the hall to another patient’s room. The patient is experiencing a great deal of respiratory distress. Ana helps reposition the patient and then leaves the patient with the primary nurse in order to call the physician. The respiratory therapist (RT) arrives and it is quickly determined that the patient needs increased monitoring. Ana relays her concerns to the physician who agrees to see the patient immediately. It is determined the patient will be transferred to the ICU. Ana calls the hospital supervisor and requests that the patient be transferred. Ana, the patient’s primary nurse, and the RT move the patient to the ICU.

Ana must now determine, from the waitlist, who can be admitted to a bed that will become vacant that afternoon. There is a patient on the waitlist currently occupying a surgical bed. The patient suffered a fractured hip and it had previously been determined by the rehab team that admission to the geriatric rehab unit would be helpful for the patient once a bed becomes available.

Ana calls the surgical unit and speaks with the potential admissions nurse. She needs to ensure that the patient is still stable and there have been no major status changes since his application came to the unit last week. Ana then calls the patient’s physician and receives an order to admit the patient to the rehab unit. Ana knows the nurse who will look after the new admission is busy, so she admits the patient to the unit herself. She provides information about the unit, visiting hours and rehab times to the patient and his spouse. She completes a head-to-toe assessment of the patient, documents her findings and puts his chart together. She reviews his medication list and ensures the night staff has access to what the patient will require.

Ana, almost at the end of her day, returns to the nursing station to complete a chart review. The next morning there is a case conference for a patient who is struggling to meet her goals and will likely not be able to return home. Ana must prepare herself for the conference by ensuring that she is familiar with the patient’s history, rehabilitation goals, and medications.

Background

Too often, gerontological nursing is associated with end-of-life activities when, in fact, it is much broader. Gerontological nursing involves caring for older adults in various stages of life. The goals are to maximize functional health and psychosocial well being. Geriatrics involves caring for people over the age of 65, and gerontological nurses work in acute care, mental health and community settings as well as LTC. Gerontological nursing ties in with many other speciality areas including: medical-surgical nursing, palliative care, rehabilitation and community health.

In 1999 the first Canadian Nurses Association exam in gerontology was written. Currently there are more then 1,800 nurses certified in gerontology across Canada. In many areas of Ontario, the senior population is the fastest growing (CNA, 2010).

Specialty Education

The Canadian Nurses Association recognizes gerontology as a specialty. This certified credential is an important indicator to patients, employers, the public and professional licensing bodies that the certified nurse is qualified, competent and current in a nursing specialty/area of nursing practice (CNA, 2010).

Other opportunities for education exist in a variety of formats. Certificates in gerontological nursing are available through a variety of community college programs. As well, a bachelor of arts in geriatrics is available through many Ontario Universities.

Many nurses complete graduate degrees focusing on geriatrics, thus enabling them to practice as clinical nurse specialists or advance practice nurses.

Scope of Practice Application

In 2010, the Canadian Gerontological Nursing Association published nursing competencies and standards of practice. Practice standards are organized into six categories:

  • Physiological Health
  • Optimizing Functional Health
  • Responsive Care
  • Relationship Care
  • Health System
  • Safety and Security
  • Practice Environment

There is a great deal of diversity in workplace settings for gerontological nurses. Nurses may choose to work in long-term care, acute care, community or primary care.

 

Clinical Laddering

Opportunities in gerontological nursing continue to grow. There is potential for growth in all areas a gerontological nurse may choose to work. Gerontological nurses may choose to complete graduate degrees and practice as clinical nurse specialists or in health-care leadership roles. Others may choose to become nurse practitioners and work with older adults in primary care, long term care, the community or acute care.

There are also opportunities to sub-specialize within the field of gerontological nursing, for example, in mental health gerontological nursing.

Clinical fellowships through the RNAO may be available for nurses working in gerontology.

Current Status

Gerontological RNs provide care across the province in a variety of settings. Nurses can find positions providing front line care in LTC, acute care, as well as in the community. Mental health gerontological nursing is a sub-speciality that focuses on the mental health of older adults. Hospital and community-based programming give RNs interested in geriatrics and mental health an opportunity to focus on both, while treating one client population.

Gerontological nurses with advanced (master's) degrees may practice as clinical nurse specialists, providing advanced care to clients, education and leadership.

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