Advanced practice in gerontological nursing generally falls within two aspects of the APN role: gerontological clinical nurse specialist and geriatric nurse practitioner. Both specialists hold a minimum of a master’s degree in nursing and have passed an examination to obtain cre- dentialing in the specialty, if certified. Although many family nurse practitioners (FNPs) treat older clients or patients and develop an exper- tise in geriatrics, their education and certifica- tion is not as specific to the older adult as gerontological nurse practitioners (GNPs).
The gerontological clinical nurse specialist focuses on education of patients, families, and
staff and often works in collaborative practice with physicians or hospitals. The gerontologi- cal clinical nurse specialist is often an aca- demic educator, consultant, or entrepreneur. In many states, geriatric clinical nurse specialists (CNSs) may obtain prescriptive authority and
broaden the scope of practice. Many CNSs have designed and managed clinics for common conditions in the older population, such as uri- nary incontinence, wounds, and arthritis. The ANCC described the role of the gerontological CNS thus:
Table 1-1 Overview of Test Content Outline
I. Primary Care Consideration A. The aging population B. Theories
C. Communication process D. Death and dying II. Major Health Problems
A. Cardiovascular problems B. Respiratory problems C. Gastrointestinal problems
D. Urinary and reproductive problems E. Hematological problems
F. Musculoskeletal problems G. Metabolic and endocrine problems H. Immunologic problems
I. Neurological problems
J. Psychiatric and psychosocial problems K. Integumentary problems
L. Sensory problems M. Medications N. Pain
III. Organizational and Health Policy Issues A. Health care delivery systems B. Federal regulation
C. Reimbursement mechanisms IV. Professional Issues
A. Scope and standards of practice B. Leadership and management C. Research
D. Ethical and legal issues
E. Gerontological nursing trends and issues
Source: American Association of College of Nursing (2005). Overview of Test Content Outline. Retrieved from the World Wide Web at www.nursecredentialing.org.
The Clinical Nurse Specialist in Geronto- logical Nursing is an expert in providing, directing, and influencing the care of older adults and their families and significant oth- ers in a variety of settings. This nurse special- ist has an in-depth understanding of the dynamics of aging, as well as the intervention skills necessary for health promotion and man- agement of health status alterations. The Clin- ical Nurse Specialist provides comprehensive gerontological nursing services independently or collaboratively with multidisciplinary teams.
The CNS advances the health care of older adults and the specialty of gerontological nurs- ing through theory and research. The CNS is engaged in practice, case management, educa- tion, consultation, research, and administra- tion. (ANCC, 2005a, p. 1)
The GNP is found more often in acute care settings or in collaborative practice with physi- cians who maintain offices that service a large older population.
The Gerontological Nurse Practitioner (GNP) is an expert in providing health care to older adults in a variety of settings, practicing independently and collaboratively with other health care professionals. In this role, the GNP works to maximize patients’ functional abili- ties. Specifically the GNP promotes, maintains, and restores health, prevents or minimizes dis- abilities, and promotes death with dignity. The GNP engages in advanced practice, case man- agement, education, consultation, research, ad- ministration, and advocacy for older adults.
(ANCC, 2005)
Part of the GNP role may be making regular visits to nursing homes where patients in his or her collaborative practice reside. More recently,
Box 1-1 Suggested Web Sites
Educational Web Sites:
www.gerontologicalnursing.info www.geronurseonline.com www.nursingworld.org/ancc/
certification Associations:
Administration on Aging www.aoa.dhhs.gov American Geriatrics Society
www.americangeriatrics.org
American Nurses Credentialing Center www.nursecredentialing.org/
certification
Gerontological Society of America www.geron.org
John A. Hartford Foundation www.hartfordign.org
Hospice and Palliative Care Nurse Association (HPNA)
www.hpna.org
National Adult Day Services Association www.nadsa.org
National Association of Geriatric Nursing Assistants
www.nagna.org
National Association of Professional Geriatric Care Managers
www.caremanager.org National Council on the Aging
www.nic.ncoa.org
National Gerontological Nursing Association
www.ngna.org
National Institute on Aging www.nia.nih.gov
GNPs are carving out a niche in rehabilitation facilities, working in outpatient clinics for reha- bilitation patients after discharge or with spe- cialty physicians, managing caseloads, and diagnosing and treating uncomplicated condi- tions in collaboration with a physician.
Clinician
Advanced Practice Nurses (APNs) who practice in gerontology should be expert clinicians in the field. As GNPs, clinical hours during master’s work or postmaster’s certification are done with
Box 1-2 Additional Resources
American Nurses Credentialing Center (ANCC)
P.O. Box 791333
Baltimore, MD 21279-1333 202-651-7000
800-284-2378
www.nursecredentialing.com John A. Hartford Foundation 55 East 59th Street
16th Floor
New York, NY 10022-1178 212-832-7788
Email: [email protected] www.hartfordign.org www.jhartfound.org
Geriatric Nursing Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing (GNRS) (2003–2005)
Available from the American Geriatrics Society
1-800-334-1429 ext. 2529
older adults. GNPs also collaborate with physi- cians who care for a majority of older patients, whether in clinical settings or nursing homes.
The gerontological CNS is also an expert clini- cian, but with less emphasis on diagnosis and treatment in primary care settings and more on other aspects of care across all levels of preven- tion, usually dealing with older adults with ter- tiary problems.
Educator
Nurses in advanced practice will engage in edu- cation of patients, clients, staff, and other inter- disciplinary team members. The role of educator encompasses a variety of settings, from the com- munity to acute care to tertiary care facilities.
Additionally, many APNs work in academic institutions, teaching students in nursing col- leges, or departments within universities.
Leader
As a leader, the APN actively engages in advo- cating for the health of older adults. This may include mentoring other nurses; acting as an intermediary for patients, family members, and other team members; or being politically active by working to change laws to advance the care of the elderly. Nurse leaders are often seen as pioneers in research, administration, politics, law, and practice. Most nurse leaders are widely published. The role of leader is further discussed in Chapter 21.
Researcher
At the advanced practice level, nurses act as expert consultants and clinicians in research projects. APNs often pose the research questions that arise in practice and collaborate with doc- torally prepared gerontological nurses to explore
areas of interest. Doctorally prepared nurses are educated to design, conduct, and analyze re- search. APNs and doctorally prepared faculty work together to obtain grant funding to carry out important research. This is often done with an interdisciplinary team when exploring topics in gerontology because many researchable prob- lems cross various disciplines. APNs should also keep up to date on the latest research to be able to serve as a resource for other staff members about best practices in gerontology.
Consultant
One of the most unique roles of the APN is that of consultant. Nurses with advanced knowledge, education, and experience are in a special posi- tion to provide consulting services in many areas. This may include legal consulting, work- ing with financial planners, or helping busi- nesses with programming for the elderly. In addition, many APNs act as educational con- sultants for large businesses or for outreach pro- grams in which they are paid to travel to a number of places presenting workshops and seminars for their employers. Other APNs are authors, speakers, and business owners.