Matt Dane Baker, PA-C, DHSc, Executive Dean of the College of Science, Health, and the Liberal Arts at Philadelphia University, gives all of his students, whether they be aspiring PAs, NPs, audiologists, or occupational therapists, a dose of reality:
“You know, you guys will be taking care of me someday. You won’t be able to avoid me. Even if you say you’re going into orthopedics because you want to take care of David Beckham—you won’t be! You’ll be taking care of me when I break my hip.”
Baker isn’t there yet, but his point rings true: America as a nation is getting older. The fastest-growing segment of the population is those older than 85, with a rapidly increasing group older than 100. We’re living longer, and we’re doing so with comorbid conditions and chronic illnesses that killed off previous generations at younger ages.
The recurring question has been: Who will care for us as we age? Geriatrics as a specialty remains a hard sell, so advocates say the time has come for its concepts to be better incorporated into primary care. And as the advanced practice nursing (APN) community transforms its educational process in response, clinicians who care for older adults continue to debate the wisdom of the changes.
NURSING’S RESPONSE TO THE PROBLEM
The changes to APN education—the elimination of the gerontology and adult NP and CNS tracks and the introduction of a combined adult/gerontology track—originated with the 2008 release of the National Council of State Boards of Nursing Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. While there was initial controversy over the decision to eliminate the GNP track at a time when America is bracing for a “silver tsunami,” that fervor had quieted down.
That is, until this spring, when the American Nurses Credentialing Center and the American Academy of Nurse Practitioners Certification Program sent out letters indicating that after 2015, the gerontology and adult NP certification exams would no longer be offered. (The letters were sent at the request of the American Association of Colleges of Nursing [AACN], to provide a timeframe for schools to ensure their graduates are prepared to sit for the new adult/gero exam.) That communication seemed to reignite the passion of GNPs and others who care for older adults.
“I know that individuals who have chosen gerontology as their major in the past, and our colleagues who are very committed to care of the older adult, have had a real sense of loss around the ending of programs focused solely on gerontology,” says Geraldine “Polly” Bednash, PhD, RN, FAAN, Chief Executive Officer/Executive Director of AACN. “But it was very clear in the minds of educators and clinicians working to develop the consensus model that the patients many of us are seeing today are older adults.”
Echoing that point is Elizabeth Galik, PhD, CRNP, President of the Gerontological Advanced Practice Nurses Association (GAPNA) and an Assistant Professor in the School of Nursing at the University of Maryland, Baltimore: “No matter where you practice as an NP—perhaps excepting neonatal, unless you’re dealing with a grandparent—you’re going to encounter older adults.”
The issue is twofold: While GNPs are passionate about what they do, there aren’t many of them. Data indicate that as few as 2% of NPs are GNPs; in 2010, AACN says, there were 3,967 certified GNPs. Enrollment in GNP programs has not been increasing, either.
Coupled with that is the reality that many, if not most, older adults are being seen by ANPs, whose training did not specifically prepare them to address the problems of aging. Furthermore, some states, such as Maryland, make distinctions about the age range of patients that traditionally prepared ANPs and GNPs can manage and treat.
“Our view was that we needed to dramatically revamp the educational programs” to address all these issues, according to Bednash. “It was a response to the reality of the population they’re providing care to and the need to be sure that they have all the knowledge and all the skills available to give the best evidence-based care to older adults.”
“When you stop to think about ‘How do we create capacity?’ one of the ways we do that is to make people who want to take care of adults have to take care of all adults,” says Debra Bakerjian, PhD, RN, FNP, Vice Chair for FNP/PA Studies, Department of Family and Community Medicine, and Assistant Adjunct Professor, Betty Irene Moore School of Nursing, University of California–Davis. “That’s the impetus of this program; if we just focus on the GNP, we’re going to continue—despite everybody’s best efforts—to have a very small percentage of folks who are trained in geriatrics.”