Preparing the Nursing Workforce for the Demographics of Aging and Chronicity

Jul 14, 2011, 12:00 PM, Posted by

Jennie Chin Hansen, R.N., M.S., F.A.A.N. is the chief executive officer of the American Geriatrics Society (AGS) and past president of the AARP. Prior to joining the AGS, she was CEO for OnLok, Inc., a nonprofit family of organizations providing integrated and comprehensive care community-based services in San Francisco. Read more about her work.

Since the release of the October 2010 Institute of Medicine (IOM) report on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, there has been significant interest in the key report recommendations: having nurses practice to the full extent of their education and training, ensuring a strong anchor in baccalaureate nursing education, positioning nurses as strong and full partners in the redesign and leadership of an effective health care system, and creating a sound approach to projecting nursing workforce needs.

My particular interest in each of these areas is to see that our profession, as well as other providers and caregivers, will implement these recommendations with full consideration of our rapidly expanding aging population. It is this growth of age, diversity, and chronicity, separately and together, that will shape and define the type of workforce and the competencies needed for nurses to be effective stakeholders in and contributors to our health care system.

The 2010 IOM Nursing Initiative report goes hand-in-hand with the 2008 IOM report, Retooling for an Aging America: Building the Health Care Workforce, which addresses the critical need to ensure that our entire health care workforce, including the caregiver public, are prepared to care for the Baby Boomer generation.

As we engage in our work and hear about the concerns of health care quality, safety and cost, I don’t believe it is top of mind for most to consider that our population is experiencing a growth in chronic care needs, especially since most nurses still work in acute care settings. Fortunately, thanks to the leadership of foundations like the John A. Hartford Foundation, the Donald W. Reynolds Foundation, and the Atlantic Philanthropies, a significant amount of past and current funding has been dedicated to educating our health care workforce about geriatrics. The nursing community has also had the foresight and commitment to prepare for the needs of older adults.

On the educational preparation level, the American Association of Colleges of Nursing (AACN) 2008 Essentials of Baccalaureate Education for Professional Nursing Practice identified BSN competencies that address the older adult and complexity of care. This document includes "practice areas across the life span," with a specific discussion of the over-65 population. This ensures that graduates are able to recognize the impact of attitudes, values and expectations on the care of the frail older adults, and are prepared to manage common geriatric syndromes.

In 2010, an additional AACN/Hartford Institute (at NYU) publication, Recommended Baccalaureate Competencies and Curricular Guidelines for the Nursing Care of Older Adults, a supplement to the 2008 Essentials document, lists geriatrics competencies and activities for each BSN Essential.

A key companion development occurred in July 2008 for advance practice nurses, through the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. This document evolved from work by the Advance Practice Registered Nurse (APRN) Consensus Work Group and the National Council of State Boards of Nursing APN Advisory Committee. This seminal effort will produce an across-the-board inclusion of aging and geriatric content for all adult advance practice nurses, ensuring that all graduates will have the knowledge and competency to address the needs of older adults. Taken together, the preparation at the undergraduate level and advanced practice level bodes well for a nursing workforce better equipped to care for our aging population.

As we strengthen our policy and quality focus on safety and performance, we must remember that there are nearly 12 million older adults who are discharged from acute care every year, as nearly 1 in 5 older adults have an acute admission. There is a tremendous need for applying geriatrics and gerontological science and knowledge in all the settings in which older adults receive care—home, outpatient, acute/inpatient care and post-acute care, as well as nursing home and hospice settings.

For our profession to advance, we must provide the best care possible for older adults, with knowledge and compassion. For who among us doesn’t know an older person, from our own family or network of friends, who could have received more knowledgeable, better coordinated and more effective care; care that was provided to them as an individual rather than as a “multiplicity of diagnoses”? Your friend or family member may just happen to be 85 years of age or older—a member of one of the fastest growing segments of the U.S. population and in populations in other parts of the developed world.

Let’s prepare to do some of our finest work simplifying health and care where possible, adding the discernment of how best to manage complex situations when needed. Let’s continue to advance our best training and caring for this incredible generation of older adults, hopefully many of whom will be not only our friends and families, but also ourselves.


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