For young nurses looking at building a career in nursing, the opportunities are vast. One area of nursing is gerontological nursing, which brings care to older adults.
Natalie R. Baker, DNP, ANP-BC, GNP-BC, CNE, GS-C, FAANP, FAAN
President, Gerontological Advanced Practice Nurses Association (GAPNA)
Nurses caring for older adults have many career options and opportunities to directly influence patient care decisions for a population on the rise. In fact, adults aged 65 and older comprise the fastest growing patient population and have varied healthcare needs across multiple healthcare settings.
Gerontological nurses can decide to work in the hospital, clinics, home health, long-term care facilities, or any other location that delivers healthcare to older adults. Depending on the healthcare setting, the nurse may care for a 90-year-old living at home and playing golf daily or a 65-year-old hospitalized after a new diagnosis of heart failure.
Nursing facility care
An often-overlooked career option is caring for older adults residing in skilled nursing facilities, also known as nursing homes.
In the United States, approximately 1.4 million older adults receive care in 15,600 licensed nursing homes. The care requirements for residents admitted to nursing homes may range from short-term skilled nursing care for management of complex diagnoses such as unstable diabetes, or physical, occupational, and speech rehabilitation services after a stroke. Other residents admitted to the nursing home may require long-term custodial care or end-of-life services. The average stay in a nursing home is 485 days (about 16 months), allowing nurses the opportunity to form strong bonds with the older adult and their families.
Facing steep challenges
Already faced with difficulty attracting nurses into this care setting, a workforce crisis has emerged in nursing homes. Most nursing homes have difficulty competing with hospitals that are paying exorbitant salaries, resulting in fewer adequately trained gerontological nurses willing to work with this patient population. Nursing homes are in dire need of compassionate nurses who understand the complexity of this unique population, work well within an interprofessional healthcare team, and advocate on behalf of the resident.
The daily nursing demands in long-term care facilities are challenging. On a typical day, the nurse may discharge a resident home with the assistance of community resources or may provide emotional support to a family faced with making difficult decisions, including those at the end of life. It is uncommon for nurse practitioners or physicians to visit nursing homes daily, creating the need for autonomous nurses who understand subtle changes in older adults that may warrant a rapid change in their treatment plan. The nurses are the “eyes and ears” of the primary care providers; therefore, competence in physical assessment, pathophysiology, pharmacology, and early identification of a change in condition is vital.
Nurse practitioners
With a national shortage of geriatricians, there is a need for nurse practitioners trained in caring for this vulnerable population. Adult-gerontology nurse practitioners (AGNPs) complete graduate-level core and specialty courses designed to assess, manage, and treat acute and chronic illnesses across the continuum of care, including the care of frail older adults. An invaluable member of the healthcare team, AGNPs partner with gerontological nurses to provide patient-centered, evidence-based care.
Throughout my more than 35-year career, I have had the privilege of reading to patients who did not have the opportunity to attend school, listen to veterans tell war stories, hold the hand of a dying patient, and cry with family at funerals. I have also had the privilege of detecting a potentially fatal illness and advocating on behalf of a patient when the family was not accepting of a terminal illness. You may ask: why provide care to older adults? My answer is, why not? What is more honorable, more giving, and more rewarding than celebrating, through a continuity of care and advocacy of wellness, a life lived.
