Nurses Are Leading the Way to Better Health Care for Older Patients

Jan 21, 2015, 12:00 PM

Barbara Bricoli, MPA, is executive director of Nurses Improving Care for Healthsystem Elders (NICHE), an international program based at New York University’s College of Nursing that is designed to help improve the care of older adults. The program was developed by Terry Fulmer, PhD, RN, FAAN, chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.

The rapid expansion of the aging population is a national concern. Nearly 20 percent of the U.S. population will be over age 65 by 2030, according to the U.S. Administration on Aging. And our aging population will place a heavy burden on our health care system; older adults, in fact, are hospitalized at three times the rate of the general population.

Yet health care providers lack adequate training in geriatrics and gerontology to care for older patients. Nurses Improving Care for Healthsystem Elders (NICHE) is working to change that.

Based at New York University’s College of Nursing, NICHE aims to better enable hospitals and health care facilities to meet the unique needs of older adults and embed evidence-based geriatric knowledge into health care practice. Hospitals and organizations that adopt NICHE report improved outcomes, decreased lengths of stay, better patient and staff satisfaction levels,  and higher success in building systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice.

One key reason for NICHE’s success is its reliance on nurses as the drivers of change. Many programs and models seek to improve quality geriatric care, but NICHE is unique in its emphasis on nursing’s capacity to lead change. Simply put, NICHE would not be as successful as it is without nurses as its leaders.

The program, in fact, has been a shining example of nurse-led innovation and leadership ever since its founding. In 1981, Terry Fulmer created the Geriatric Resource Nurse (GRN) model at Boston’s Beth Israel Hospital to better serve older patients. Under the model, nurses are educated in geriatrics and prepared to serve as geriatrics “point-people” on hospital staffs.

In 1989 and 1999, Fulmer adapted the GRN model within a geriatrician-led care team at Yale-New Haven Hospital with funding from the John A. Hartford Foundation’s Hospital Outcomes Program for the Elderly. And in 1992, the Foundation provided funds to field-test the GRN and other nursing care models at New York University and in the broader hospital community.

Fulmer’s project, now known as NICHE, became an integral program of the Hartford Institute for Geriatric Nursing in 1996. Since then, NICHE has spread slowly but consistently through exposure at national conferences and nursing publications. In 2007, it underwent a rapid expansion thanks to venture capital funding, and it is now in place in more than 580 hospitals and health care organizations with a sustainable business model directed by Elizabeth Capezuti, PhD, RN, FAAN, and myself. Over the years, our team built a sustainable operating infrastructure that allows us to increase dissemination and penetration of health care systems.

As executive director, I continue to work with faculty and colleagues so we can continue to spread NICHE throughout the U.S. health care system and abroad.

To meet that goal, we have created a website that gives hospitals the resources they need to launch, maintain, and sustain their own NICHE programs. Our NICHE knowledge center houses online learning tools and resources, and our leadership training program prepares hospital teams to create custom programs that meet their unique needs. NICHE is also expanding globally; we are working with government and health care organizations in Mexico and Singapore to adapt this model in their countries.

The nurse-led NICHE community of hospitals and health care organizations will continue to lead health care transformation for years to come. Indeed, as America’s population of older adults rapidly increases, we have no plans to slow down.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.